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Comment & Response |

Mortality Reporting and Pay-for-Performance Programs—Reply

Joel M. Kupfer, MD1
[+] Author Affiliations
1Department of Cardiology, Methodist Medical Center, Peoria, Illinois
JAMA. 2013;310(13):1405. doi:10.1001/jama.2013.277987.
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In Reply I agree with Dr Bourque and colleagues that current methods of risk adjustment are imperfect and that prolonging life-sustaining measures in patients with little or no likelihood of recovery can be harmful. In contrast, I disagree that the inclusion of 30-day mortality data in hospital value–based purchasing will result in underuse of hospice services. A recent survey of Medicare beneficiaries indicates an increase in hospice use at the time of death.1 Regardless of the specific effect, I am in agreement with Bourque et al that incentivizing specific outcomes has the potential to influence physician behavior and health care delivery.

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October 2, 2013
Jamieson M. Bourque, MD, MHS; Ashley R. Hurst, JD, MDiv; Mary Faith Marshall, PhD
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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