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Comment & Response
October 2, 2013

Mortality Reporting and Pay-for-Performance Programs

Author Affiliations
  • 1Department of Medicine, University of Virginia Health System, Charlottesville
  • 2Center for Biomedical Ethics and Humanities, University of Virginia Health System, Charlottesville
  • 3Department of Public Health Sciences, University of Virginia Health System, Charlottesville
JAMA. 2013;310(13):1404-1405. doi:10.1001/jama.2013.277981

To the Editor In his Viewpoint, Dr Kupfer1 challenged the utility of 30-day mortality reporting and its use in pay-for-performance programs. He cautioned that the 24-hour rule, which excludes patients who elect hospice during the first 24 hours of an index admission from 30-day mortality statistics, may encourage overuse of hospice services. We believe that logistics and sound communication with patients or surrogates will limit this consequence. We caution against the opposite effect: the underuse of hospice and palliative care services. Once the first 24 hours have passed, there may be an incentive for physicians to pursue life-prolonging interventions (irrespective of their clinical effectiveness) past the 30-day mark to avoid the consequences of a qualifying mortality event.