And for heart failure, hospitals in areas suffering from longstanding poverty had a mean HQA composite score of 73, compared with the hospitals not in poor regions, that got an 84, according to the paper.

Although low-performing hospitals, disproportionately from poor areas, improved the most in absolute terms over the four years covered by the study, they "still lagged behind their locationally advantaged counterparts," the researchers wrote.

Plus, the way scores are assigned in the Medicare model used by the study favored higher-performing hospitals, Blustein said.

"If you start low, it's like a ruler that's stretched out," she said, meaning the low-performing hospitals had to do more to gain points. "The attainment scores for better-off hospitals swamped improvement scores, so they ended up doing better."

REASON FOR PERFORMANCE SPLIT

It's up in the air what's causing the difference in performance outcomes, according to the researchers. Hospitals in richer, better educated areas not only reported higher scores, but were more likely to report, suggesting their ability to perform could have to do with being more wired with high-tech IT equipment, and having better trained personnel able to use it.

"To some extent that has to do with having good IT and good coders, and it may be entirely due to that," Blustein said. "We don't know."

More worryingly, the problems could be structural. In the paper, Blustein mentions that hospitals in poor areas can have a hard time attracting top talent, because of lack of good nearby schools or limited opportunities for the staff's spouses to work. Also, they could simply be poorer.

"They might not have the money to hire consultants to help them meet these requirements," Blustein said. "[Richer] hospitals can just buy [staff] essentially to helicopter in to show them how to do what they need to do."

Medicare will likely start rolling out the program in 2012. Similar plans have already been implemented in the UK, Australia and Taiwan, the researchers said.

Read the study: http://www.plos.org/press/plme-07-06-blustein.pdf

Check out this earlier DOTmed News story on pay-for-performance schemes hurting doctors who serve the poor and ethnic minorities.


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