The edicare and remier nc. ospital uality ncentive emonstration (), a hospital‐based pay‐for‐performance program, changed its incentive design from one rewarding only high performance (hase 1) to another rewarding high performance, moderate performance, and improvement (hase 2). We tested whether this design change reduced the gap in incentive payments among hospitals treating patients across the gradient of socioeconomic disadvantage.
To estimate incentive payments in both phases, we used data from the remier nc. website and from edicare rovider nalysis and eview files. We used data from the merican ospital ssociation nnual urvey and enters for edicare and edicaid ervices mpact ile to identify hospital characteristics.
Hospitals were divided into quartiles based on their isproportionate hare ndex (), from lowest disadvantage (uartile 1) to highest disadvantage (uartile 4). In both phases of the , we tested for differences across the quartiles for three outcomes: (1) receipt of any incentive payments; (2) total incentive payments; and (3) incentive payments per discharge. For each of the study outcomes, we performed a hospital‐level difference‐in‐differences analysis to test whether the gap between uartile 1 and the other quartiles decreased from hase 1 to hase 2.
In hase 1, there were significant gaps across the quartiles for the receipt of any payment and for payment per discharge. In hase 2, the gap was not significant for the receipt of any payment, but it remained significant for payment per discharge. For the receipt of any incentive payment, difference‐in‐difference estimates showed significant reductions in the gap between uartile 1 and the other quartiles (uartile 2, 17.5 percentage points [ < .05]; uartile 3, 18.1 percentage points [ < .01]; uartile 4, 28.3 percentage points [ < .01]). For payments per discharge, the gap was also significantly reduced between uartile 1 and the other quartiles (uartile 2, $14.92 per discharge [ < .10]; uartile 3, $17.34 per discharge [ < .05]; uartile 4, $21.31 per discharge [ < .01]). There were no significant reductions in the gap for total payments.
The design change in the reduced the disparity in the receipt of any incentive payment and for incentive payments per discharge between hospitals caring for the most and least socioeconomically disadvantaged patient populations.