New analysis shows that safety net hospitals have improved patient care through a nationwide pay-for-performance demonstration project, even without the help of information technology.

The Premier healthcare alliance released the results of its research on Thursday. Premier Senior Vice President of Public Affairs Blair Childs said the study included 250 hospitals of all types. The intent was to gauge whether certain types of hospitals performed differently.

Officials at two of the hospitals say the work of gathering the required information will be made much easier and faster once they role out an electronic health record.

"We do not have a fully integrated health information system," said Cathy Robinson, the corporate compliance officer and vice president of medical staff and support services at Rush Health Systems in Meridian, Miss.

Although hospitals like those in the Rush system and the Sinai Health System in Chicago, which serve a disproportionate share of indigent patients, performed below others at the outset, the research revealed that differences in quality lessened after three years in the clinical areas of heart attack, heart failure and hip/knee replacement.

Also after three years the under-representation of safety net hospitals dissipated for hospitals receiving awards that recognize facilities for performance in the top 20 percent of all participants.

The HQID project, or Hospital Quality Incentive Demonstration, is the basis for CMS' proposal to Congress for a national value-based purchasing (VBP) or pay-for-performance (P4P) program.

"The program creates a dynamic where the work is never done – quality goals keep getting more aggressive because as a group, HQID hospitals are improving rapidly over time," said Jack Garon, MD, chief medical officer at the Sinai Health System. "We focus on current performance, and our goal remains staying in the top 10 percent, which means we must continually improve.

The program has encouraged everyone at the hospital "to chase the top levels of performance," Garon said. "It has also helped us develop quality improvement tools we use to address other quality issues. This program gives everyone the clear goals and the focus they need to eliminate care variations so that all patients – no matter where they live or what hospital they visit – receive the same evidence-based, high-quality care."

Robinson agreed. "It has been suggested that rural or safety net hospitals will struggle as part of value-based purchasing or pay-for-performance programs," she said. "While we certainly face unique challenges as a rural safety net facility and have needed time to effectively implement the evidence-based protocols required in HQID, our successes and those of the other safety net participants clearly show that any hospital can deliver high-quality care."

The HQID project is the first national project of its kind, designed to determine if economic incentives to hospitals are effective at improving the quality of inpatient care.

"Through our work in HQID, we have learned the critical components of an effective VBP program," said Premier president and CEO Susan DeVore. "We believe that, properly structured, VBP is a powerful engine for performance improvement that will enhance quality, reduce variation and avoid unnecessary costs."

"Current VBP proposals are structured appropriately to allow all hospitals to succeed, regardless of size, location or patient/payer mix," continued DeVore. "We are confident that if our recommendations are followed, VBP will be an effective national reform that will improve quality, reduce variation and avoid unnecessary costs."