The Journal of Bone and Joint Surgery (American). 2008;90:1240-1243.
doi:10.2106/JBJS.G.01172
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Hospital Characteristics Associated with Success in a Pay-for-Performance Program in Orthopaedic Surgery

Timothy Bhattacharyya, MD1, Priyesh Mehta, BA1 and Andrew A. Freiberg, MD2

1 Partners Orthopaedic Trauma Service, Massachusetts General Hospital, 55 Fruit Street, Yawkey 3600, Boston, MA 02114
2 Arthroplasty Service, Massachusetts General Hospital, 55 Fruit Street, Yawkey 3918, Boston, MA 02114

Investigation performed at Massachusetts General Hospital and Brigham and Women's Hospital, Boston, Massachusetts

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (Zimmer and Biomet). Also, commercial entities (Zimmer and Biomet) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

Background: Pay-for-performance programs are designed to link payments to clinical outcomes. We investigated the characteristics of hospitals in the United States, such as size and volume, that were associated with the receipt of a clinical performance bonus in a nationwide pay-for-performance program involving hip and knee replacement.

Methods: We obtained hospital-level outcomes data from a nationwide pay-for-performance demonstration project on hip and knee replacement. We obtained data on the hospital's size, procedure volume, and case-mix index as well as whether it was a teaching hospital and then performed a multivariate analysis to determine which factors were associated with the receipt of a performance bonus.

Results: Hospital size and revenue were not associated with the receipt of a performance bonus. Top-performance hospitals tended to be those specialized in orthopaedics (p < 0.002). Multivariate analysis revealed that high-performance hospitals tended to perform a high volume of hip and knee replacements (p < 0.008), to be teaching hospitals (p < 0.037), and to be located in the Midwestern United States (p < 0.001).

Conclusions: Teaching hospitals that perform a high volume of hip and knee replacements will tend to succeed should pay-for-performance programs be enacted nationwide.


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