Pay for Performance, Quality of Care, and Outcomes in Acute Myocardial Infarction

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Abstract
The concept of providing financial incentives to health care givers to improve quality of care, known as pay for performance, has received national attention as a potential means of narrowing well-documented gaps between health care guidelines and clinical practice.1-5 In collaboration with Premier Inc, a nationwide organization of nonprofit hospitals, the Centers for Medicare & Medicaid Services (CMS) launched the Hospital Quality Incentive Demonstration in 2003. As part of this pay-for-performance pilot project, 260 Premier Inc hospitals agreed to provide CMS with performance measurement information for 5 clinical conditions, including acute myocardial infarction. Hospitals in the 2 highest deciles of performance for a condition received a reimbursement bonus while those with the poorest performance risked future financial penalty.6 Bonuses for the first 2 years of the incentive program totaled $17.55 million across the 5 clinical conditions, payable to a total of 123 hospitals in the first year and 115 hospitals in the second year.

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