Ten of 13 Hawaiian hospitals studied earned $354,883 for implementing
specific parts of a cardiovascular guidelines program established by the
American Heart Association and the American College of Cardiology, according
to the research published in the American Journal of Managed Care.
The incentives money was paid as part of a more comprehensive
hospital “pay-for-performance” program
called the Hospital Quality and Service Recognition Program, implemented
by the commercial insurer Hawaii Medical Service Association, Blue Cross
Blue Shield of Hawaii.
“This finding suggests that the presence of financial incentives
tied to the steps of participation may play an important role in speeding
the adoption of innovative programs,” say John T.Berthiaume, M.D.,
of the Hawaii Medical Service Association and colleagues.
The hospitals earned the money by accumulating “points” for
building a hospital team trained in the guidelines, attending regular workshops
on the recommended treatments, submitting patient data to a special database
and using preprinted doctors’ orders and protocols.
Hospitals could also earn points by making sure that at least 85 percent
of eligible cardiovascular patients received recommended follow-up care,
including the prescription of aspirin, beta-blockers, ACE inhibitors, cholesterol-lowering
drugs and counseling to quit smoking. Four of the 13 hospitals reached
the 85 percent goal.
Participating hospitals also received reimbursement for half the cost
of the data collection and management tool used by the guidelines program.
Most of the hospital administrators said the extra money was used to boost
staff salaries and cover the costs of attending meetings and workshops
on the guidelines.
The researchers have not confirmed whether the changes
have reduced cardiovascular problems among hospitalized patients, but “a significant and measurable
improvement in secondary prevention of coronary artery disease in Hawaii
is anticipated” based on results from similar studies, Berthiaume
says.
The study was supported by the Hawaii Medical Service Association and
the Centers for Medicare and Medicaid Services.
