In examining the association between a hospital's local economic and workforce resources and its ability to improve patient care, the researchers examined complete reporting data provided by 2,705 hospitals from 2004 to 2007 to U.S. Centers for Medicare and Medicaid Service (CMS), the federal agency that leading the initiative. The researchers analyzed these hospitals' performance over the four-year period in treating myocardial infarction and heart failure, using a methodology previously suggested by the CMS to score hospital performance. They then calculated scores for each hospital.

"U.S. hospitals operating in locations with richer economic and human resources attained significantly higher clinical process scores than those located in less advantaged areas during the period 2004-2007," according to the study. A lag in the clinical indicators translated into substantially lower net scores under the CMS's Performance Assessment Model, which would presumably lead to reduced funding under Medicare's "Value Based Purchasing." However, the details of hospital VBP remain to be determined by the Centers for Medicare and Medicaid Service. As the authors emphasize, there are still opportunities "to modify and improve upon the current version" of hospital pay-for-performance.

"Holding providers accountable is not an unreasonable approach to quality improvement" the study concludes, but "it must be done in a way that attends to the profound inequalities in local circumstances that shape life in the twenty-first century."

Source: New York University