0
Viewpoint |

The Morality of Using Mortality as a Financial Incentive:  Unintended Consequences and Implications for Acute Hospital Care

Joel M. Kupfer, MD
JAMA. 2013;309(21):2213-2214. doi:10.1001/jama.2013.5009.
Text Size: A A A
Published online

Extract

The strategy of using financial incentives to improve quality and lower costs is firmly embedded in the Affordable Care Act and the hospital value-based purchasing program launched nationwide in October 2012. The Affordable Care Act not only stiffens penalties for hospitals with high readmission rates but also uses risk-standardized 30-day mortality rates (RSMRs) for patients diagnosed with pneumonia, congestive heart failure, and acute myocardial infarction as a criterion for rewarding or penalizing hospitals. As currently designed, these incentives set a new benchmark for hospital quality and functionally establish a 30-day “warranty period” during which hospitals and physicians are held accountable for patient outcome.1 However, 2 questions are worth asking: (1) are RSMRs an appropriate measure of hospital quality; and (2) does linkage of incentives to RSMRs for the 3 highest-volume hospital conditions increase the potential for early misuse or overuse of hospice or palliative care measures for patients whose risk of death is higher than expected but by no means certain?

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles
Jobs
JAMAevidence.com


Mortality

brightcove.createExperiences();