Impact of Financial Incentives on Early and Late Adopters among US Hospitals: observational study.

Objective: To examine how hospitals that volunteered to be under financial incentives for more than a decade as part of the Premier Hospital Quality Incentive Demonstration (early adopters) compared with similar hospitals where these incentives were implemented later under the Hospital Value-Based Purchasing program (late adopters).

Design: Observational study.

Setting: 1189 hospitals in the USA (214 early adopters and 975 matched late adopters), using Hospital Compare data from 2003 through 2013.

Participants: 1 371 364 patients aged 65 years and older, using 100% Medicare claims.

Main Outcome Measures: Clinical process scores and 30 day mortality.

Results: Early adopters started from a slightly higher baseline of clinical process scores (92) than late adopters (90). Both groups reached a ceiling (98) a decade later. Starting from a similar baseline, just below 13%, early and late adopters did not have significantly (P=0.25) different mortality trends for conditions targeted by the program (0.05% point difference quarterly) or for conditions not targeted by the program (-0.02% point difference quarterly).

Conclusions: No evidence that hospitals that have been operating under pay for performance programs for more than a decade had better process scores or lower mortality than other hospitals was found. These findings suggest that even among hospitals that volunteered to participate in pay for performance programs, having additional time is not likely to turn pay for performance programs into a success in the future.