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. 2009 Mar-Apr;28(2):526-32.
doi: 10.1377/hlthaff.28.2.526.

Measuring the report card: the validity of pay-for-performance metrics in orthopedic surgery

Timothy Bhattacharyya  1 , Andrew A Freiberg, Priyesh Mehta, Jeffrey Neil Katz, Timothy Ferris
Affiliations

Measuring the report card: the validity of pay-for-performance metrics in orthopedic surgery

Timothy Bhattacharyya et al. Health Aff (Millwood). 2009 Mar-Apr.

Abstract

To assess the validity of performance measures used in a nationwide pay-for-performance (P4P) project on hip and knee replacement, we analyzed hospital performance data from a Medicare P4P initiative and compared them to publicly available outcomes data. Overall, the ability to measure hospital quality was poor. A hospital's ranking on the composite score was primarily determined by process measures. A higher composite quality score was not associated with lower rates of complications or mortality. The current Medicare P4P quality measure has limited validity because of poor discrimination, lack of measure balance, and lack of correlation with important clinical outcomes.

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Comment in

  • Measuring the report card: the validity of P4P.
    Bankowitz R. Bankowitz R. Health Aff (Millwood). 2009 Jul-Aug;28(4):1230-1; author reply 1231. doi: 10.1377/hlthaff.28.4.1230-a. Health Aff (Millwood). 2009. PMID: 19597232 No abstract available.
  • Quality and value in orthopedic surgery.
    Chambers L. Chambers L. Health Aff (Millwood). 2010 Mar-Apr;29(3):566; author reply 566. doi: 10.1377/hlthaff.2010.0162. Health Aff (Millwood). 2010. PMID: 20195002 No abstract available.

References

    1. See, for example, Epstein AM. Pay for Performance at the Tipping Point. New England Journal of Medicine. 2007;356(no. 5):515–517.

    1. Landon BE, et al. Physician Clinical Performance Assessment: Prospects and Barriers. Journal Of the American Medical Association. 2003;290(no. 9):1183–1189. - PubMed
    1. Naylor CD. Public Profiling of Clinical Performance. Journal of the American Medical Association. 2002;287(no. 10):1323–1325. - PubMed

    1. See, for example, Colwell CW. Evidence-Based Guidelines for Venous Thromboembolism Prophylaxis in Orthopedic Surgery. Orthopedics. 2007;30(no. 2):129–135.

    1. Kim S. Changes in Surgical Loads and Economic Burden of Hip and Knee Replacements in the U.S.: 1997–2004. Arthritis and Rheumatism. 2008;59(no. 4):481–488. - PubMed