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Comment & Response |

Mortality Reporting and Pay-for-Performance Programs

Jamieson M. Bourque, MD, MHS1; Ashley R. Hurst, JD, MDiv2; Mary Faith Marshall, PhD3
[+] Author Affiliations
1Department of Medicine, University of Virginia Health System, Charlottesville
2Center for Biomedical Ethics and Humanities, University of Virginia Health System, Charlottesville
3Department of Public Health Sciences, University of Virginia Health System, Charlottesville
JAMA. 2013;310(13):1404-1405. doi:10.1001/jama.2013.277981.
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To the Editor In his Viewpoint, Dr Kupfer1 challenged the utility of 30-day mortality reporting and its use in pay-for-performance programs. He cautioned that the 24-hour rule, which excludes patients who elect hospice during the first 24 hours of an index admission from 30-day mortality statistics, may encourage overuse of hospice services. We believe that logistics and sound communication with patients or surrogates will limit this consequence. We caution against the opposite effect: the underuse of hospice and palliative care services. Once the first 24 hours have passed, there may be an incentive for physicians to pursue life-prolonging interventions (irrespective of their clinical effectiveness) past the 30-day mark to avoid the consequences of a qualifying mortality event.

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October 2, 2013
Joel M. Kupfer, MD
1Department of Cardiology, Methodist Medical Center, Peoria, Illinois
JAMA. 2013;310(13):1405. doi:10.1001/jama.2013.277987.
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