Market Forces

Market competition has only marginal effect on hospital performance for heart failure

Wide variations exist in the care and treatment of patients hospitalized for heart failure. As a way to improve care quality outcomes, The Joint Commission requires hospitals to submit data on their performance for the treatment of these patients. This information is reported publicly, making market competition a potential driver for better care. However, a new study found only a marginal effect of market competition on hospital performance for treating heart failure.

The researchers obtained heart failure performance data from The Joint Commission's Web site called Quality Check. Quality indicators used for the study were published from 2003 to 2006 and consisted of heart failure drugs used, left ventricular function assessment, smoking-cessation counseling, and hospital discharge instructions.

Average hospital-level performance over time improved significantly on all of the heart failure quality indicators. Overall, hospitals in the least competitive markets performed slightly better (2.9 percent) than those in the most competitive markets for left ventricular function assessment. Among hospital referral regions, the least competitive markets performed about 5.1 percent worse for smoking-cessation counseling compared to the most competitive markets. The researchers suggest several reasons why market competition did not have a stronger influence on the heart failure quality indicators. First, hospitals may be engaging more in competitive pricing and other nonprice avenues. Second, patients may not be using The Joint Commission public data enough to guide their health care decisionmaking. Finally, hospitals across all markets increased their compliance with the heart failure indicators over time. The study was supported in part by the Agency for Healthcare Research and Quality (HS17944).

See "Effect of market competition on hospital performance for heart failure," by Jared Lane K. Maeda, Ph.D., M.P.H., and Anthony T. Lo Sasso, Ph.D., in the December 2011 American Journal of Managed Care 17(12), pp. 816-822.

— KB

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