Data and Outcomes - National


U.S. National Data and Outcomes Literature


(338) Layton TJ, Ryan AM. Higher Incentive Payments in Medicare Advantage’s Pay-for-Performance Program Did Not Improve Quality But Did Increase Plan Offerings. Health Services Research. 2015 Dec;50(6):1810-28. doi: 10.1111/1475-6773.12409. Epub 2015 Nov 9.

PMID: 26549194


  • Evaluation of effect of financial bonuses on quality of care and number of offered plans in Medicare Advantage Quality Bonus Payment Demonstration (MAQBPD)
  • Utilized public CMS data from 2009-2014 on Medicare Advantage quality ratings, service area of each plan, and measures used to determine plan payments
  • Since the start of MAQBPD in 2012, all Medicare Advantage plans were eligible to receive bonus payments connected to their plan-level quality scores. Some counties offered bonus payments that were twice as large as others
  • Difference-in-difference analysis was used to evaluate the effects of bonus size on quality scores and number of plan offerings

Significance to Literature:

Double bonuses were not associated with increased quality despite the estimated $3.43 billion increase in payments over the first three years of MAQBPD. Increase in bonuses was associated with an increase in number of plans offered.


Key Article

(353) Kahn CN 3rd et al. Assessing Medicare's hospital pay-for-performance programs and whether they are achieving their goals. Health Affairs. 2015 Aug;34(8):1281-8. doi: 10.1377/hlthaff.2015.0158.

PMID: 26240240


  • An increasing amount of Medicare hospital payments are tied to one of Medicare’s three pay-for-performance programs (Hospital Readmission Reduction Program, Value-Based Purchasing Program, and the Hospital-Acquired Condition Reduction Program)
  • In 2015, four out of five eligible hospitals will be penalized by one of the three programs and one out of three teaching hospitals will be penalized by all three programs

Significance to Literature:

Reevaluation of program components may be necessary. Authors propose ensuring risk-adjustment appropriateness, minimizing program overlap and differences in scoring, increasing incentive to improve even if below target levels, and considering alternatives to the current three programs.


(382) Ryan et al. The Early Effects of Medicare’s Mandatory Hospital Pay-for-Performance Program. Health Serv Res. 2015 Feb;50(1):81-97. doi: 10.1111/1475-6773.12206. Epub 2014 Jul 15.

PMID: 25040485


  • Analysis of the impact of hospital value-based purchasing (HVBP) on quality performance and patient satisfaction during its original implementation period (July 2011-March 2012)
  • HVBP was established by the Affordable Care Act and ties Medicare payments to quality performance for all acute care hospitals in the U.S.
  • Critical access hospitals and hospitals in Maryland were exempt from HVBP
  • Data was pulled from Hospital Compare from 5 years before implementation of HVBP to three quarters after
  • Performance was compared on 12 clinical process and 8 patient experience measures between those hospitals exposed to HVBP and those that were exempt
  • Results actually showed a slight decrease in both quality of care and patient experience associated with HVBP introduction in acute care hospitals
  • Notably, there was evidence for clinical process measure improvement prior to the implementation of HVBP, possibly driven by the expectation of HVBP penalties

Significance to Literature:

Early stages of HVBP implementation has not been associated with an improvement in clinical process or patient experience


(442) Petersen et al. Impact of a Pay-for-Performance Program on Care for Black Patients with Hypertension: Important Answers in the Era of the Affordable Care Act. Health Serv Res. 2016 Jun 22. doi: 10.1111/1475-6773.12517. [Epub ahead of print]

PMID: 27329344


  • Data was collected between 2007 and 2009 from Veterans Affairs (VA) physicians to evaluate the effect of P4P on the quality of hypertension care for black patients and risk selection
    • The study was nested within a randomized control trial for assessing the impact of P4P on hypertension care in the VA primary care setting
    • Physician-level incentives, practice-level incentives, and a combination of both were used for the incentive arm of the larger study but were combined in this particular evaluation
    • Participants received feedback and potential monetary rewards every four months for 20 months, with an average compensation of $2,744 over the course of the study
    • Risk selection was determined by the evaluating the proportion of patients who switched providers, patient visit frequency, and primary care panel turnover
  • The proportion of black patients meeting blood pressure goals or receiving an appropriate clinical response to uncontrolled blood pressure (both based on JNC 7 hypertension guidelines) increased by 6.3% from baseline with physicians receiving financial incentives compared to control physicians
  • There was no difference between patient groups in terms of provider switching, visit frequency, or panel turnover

Significance to Literature:

Evidence that P4P can improve blood pressure control for black patients without producing risk selection