Hospital Size, Uncertainty and Pay-for-Performance. Working Paper Series No. 3

摘要

The Premier Hospital Quality Incentive Demonstration (HQID) is a project sponsored by the Centers for Medicare and Medicaid Services (CMS) that is being conducted with participating hospitals that are members of Premier Inc., a national alliance of non-profit hospitals. The demonstration was designed to examine whether a system that explicitly pays-for-performance can lead to system-wide improvement in the quality of care that hospitals provide in selected medical conditions. For this pay-for-performance demonstration project, high performance and some aspects of low performance are defined in a relative sense through the ranking of hospitals performance in providing specific services. Because hospitals vary greatly in the annual number of patients seen with these medical conditions, statistical theory suggests that smaller hospitals can expect to experience much greater sampling variability in their performance scores. In this study we construct statistical models to assess whether hospital size will impact our ability to identify true hospital ranks using data generated by pay-for-performance programs patterned after HQID.