Report: State program to boost care across races is a good effort but comes up short

By Chelsea Conaboy, Globe Staff

Massachusetts lawmakers made a bold move in 2006 when they created a program to reward hospitals that can show they are working to close the gaps in quality of care between races and ethnic groups.

No other state had tried a pay-for-performance program to address disparities in care. But authors of a report published last week in Health Affairs said that, while the state has made a good effort, the program is not effective.

For starters, the state’s metrics reward hospitals that have fewer minority patients - a result that is at odds with the goals of the program, the authors said.

The report “shows the complexity of translating a very worthy policy into a program,” said Jan Blustein, lead author and a professor of health policy at New York University Wagner School of Public Service.

The state’s program scores hospitals according to the quality of care they provide to minority patients in five clinical areas: prevention of surgical infection, pneumonia, pediatric asthma, and the health of mothers and of newborns. But many hospitals had too few non-white patients within each group to statistically compare their care to that of white patients.

Even when the researchers combined the statistics for each hospital to compare care statewide, they did not find significant differences between racial groups. The authors said that does not mean that the disparities don’t exist. Nationally, they are well-documented.

But the state, which distributed $32 million in incentive payments last year, may be looking in the wrong place, the authors said.

“As with any incentive program, before you start to distribute financial reward or make it high stakes in any other way, you should look at the data,” said Joel Weissman, professor of health policy at the Mongan Institute for Health Policy at Massachusetts General Hospital.

Weissman said the quality of care in Massachusetts if very high across the board. That makes differences between patient groups harder to detect. He said the state might have better luck looking at more outpatient measures, such as care for people with diabetes, or by concentrating on hospitals with some threshold level of minority patients.

“This experience should be seen as a first try with lots of lessons, but it doesn’t mean that it’s a bad idea,” Weissman said.

Anuj Goel, vice president for legal or regulatory affairs at the Massachusetts Hospital Association, said his members were particularly unhappy with a portion of the program that the state scrapped last year. It judged hospitals in part based on their mission statements and other written policies, but the state had provided no guidelines about what hospitals needed to do to achieve the highest scores, Goel said. As for how effective the program is overall, “the jury’s still out,” he said.

Dr. JudyAnn Bigby, Health and Human Services secretary, said her office is considering revising the program. Among the questions yet to be answered is whether all hospitals should be required to participate in the program or whether it should be limited to those that serve a measurable minority population.

Now that the state has expanded health insurance coverage to nearly all Massachusetts residents, improving the quality of care for everyone is critical, she said.

“Even when people have equal insurance, the quality of care they receive is not the same,” she said.

For that reason, she said, the state should keep trying.