DALLAS, Oct. 21, 2008 -- A Journal of the American Medical Association (JAMA) article published today suggests that hospitals' ability to qualify for financial incentives is influenced by their patients' age, race/ethnicity and the severity of their illnesses.

This study used data reported by the American Heart Association's Get With the Guidelines-Coronary Artery Disease (CAD) program between Jan. 2000 and March 2008. Researchers evaluated the treatment of 148,472 heart attack patients from 449 hospitals, using the composite adherence score based on eight process performance measures --- aspirin on admission and at discharge, beta-blocker use on admission and at discharge, ACE inhibitor use for left ventricular systolic dysfunction at discharge, tobacco cessation counseling at discharge and administration of thrombolytic (clot-busting) agents within 30 minutes and PCI within 90 minutes.

The study authors ranked hospitals into three performance categories, using a process similar to that used by the Centers for Medicare and Medicaid Services (CMS) for public reporting and pay-for-performance programs. Based on composite scores, hospitals ranked in the top 20 percent are likely to receive incentive payments, the middle 60 percent are likely to receive no incentives and the lowest 20 percent are likely to receive reductions in payments.

When adjustments were made to quality reporting and evaluations based on the patient mix, the rankings shifted, which could equate to changes in financial incentives. Researchers found that compared to high ranking hospitals, most low-performing hospitals were smaller and non academic, with larger numbers of patients from racial or ethnic minority groups who also had diabetes, heart failure, chronic atrial fibrillation and other conditions.

"High quality health care is essential for all patients, no matter who they are, where they are or how sick they are," said Rajendra H. Mehta, M.D., M.S, lead author, associate professor and cardiologist at Duke University Medical Center. "That said, there are no easy answers for hospitals treating the sickest, least insured and most at-risk patients. Under the current model, hospitals may be doing everything right and still be penalized."

In addition to CMS incentives and reimbursement, hospital performance is increasingly being linked to incentive payments in pay-for-performance programs. But as the study reports, "such systems are only as fair as the metrics used to assess hospital performance."

"Our study reveals the need to level the playing field, so hospitals serving more minority, elderly, sick or uninsured patients can compete fairly with others," said Eric Peterson, MD, MPH, FAHA, senior author and director of cardiovascular research at Duke Clinical Research Institute. "Adjusting for these patient factors could allow such hospitals to be more competitive and not be at risk to lose money under pay for performance."

Study authors noted the need for all hospitals to show quality performance among high risk patient groups. They also suggest the need for hospitals to collect and report comprehensive clinical data that will allow them to identify and close treatment gaps that arise based on their patient mix.

"This study further illustrates the important role that the American Heart Association's Get With The Guidelines program is playing in advancing the science of measuring and improving the quality of cardiovascular care" said Gregg C. Fonarow, M.D., FACC, FAHA, chairman of the American Heart Association's Get With the Guidelines Steering Committee.

Launched in 2000 to support and facilitate the improvement of the quality of care of patients with cardiovascular disease, Get With The Guidelines uses a web based patient management tool (powered by Outcome Sciences, Inc., Cambridge, Mass.) to collect clinical data, provide decision support, and provide real-time online reporting features. For more information, visit americanheart.org/getwiththeguidelines.

CONTACT: Tagni McRae of the American Heart Association, (214) 706-1383