Study: Medicare pay-for-performance penalizes hospitals that treat more elderly patients

Hospitals that serve large groups of the elderly, poor, African-American or female patients tend to be ranked lower than hospitals with healthier, younger clientele under the Medicare pay-for-performance program, according to new research from the Duke Clinical Research Institute.

Investigators examined the records of nearly 150,000 Medicare beneficiaries at 449 hospitals around the country who had suffered a heart attack between 2000 and 2006. They evaluated each hospital’s performance based on guidelines established by the Centers for Medicare & Medicaid Services and then adjusted the findings to account for patient demographics, such as age, race, income and gender. CMS does not currently factor in these variables when considering performance.

While their initial findings meshed with CMS’ ranking, researchers say 16.5% of hospitals treating more elderly and poor patients-when adjusted to account for less-healthy patient demographics-would fall under a different category in Medicare’s pay-for-performance program. To reduce the disparity, report authors suggest rewarding hospitals for improvements based on evidence-based treatment, as opposed to rewarding a single score or ranking.