CEOs were paid more at hospitals that had high patient satisfaction scores; used more high-tech equipment including advanced imaging machines; had more beds and were located in large urban areas. But pay wasn't reflected in 30-day outcomes for patients with heart attacks, heart failure or pneumonia in 2008, including deaths and readmissions. Those are among publicly reported outcome measures used by the federal Centers for Medicare & Medicaid Services and others.
While these hospitals get big tax exemptions for providing charity care and other community benefits, the researchers said the top executives' annual pay wasn't tied to those measures, either.
CEO compensation varied widely, from less than $100,000 to more than $3 million but averaged almost $600,000 in 2009, the study found.
The results were "a little disappointing," said study author Dr. Ashish Jha, a health policy professor at Harvard's School of Public Health. To not hold CEOs accountable for whether patients live or die within 30 days of treatment "doesn't quite make sense," he said.
Jha said the study results are a message for hospital boards that decide CEO compensation: '"If you really care about patient outcomes here's a place to look."
The study was published Monday in JAMA Internal Medicine.
The study is based on an analysis of public records including federal tax returns for 1,877 CEOs overseeing 2,681 private nonprofit hospitals. Most U.S. hospitals are nonprofit and those studied comprise 98 percent of private nonprofit hospitals, the study authors said.
In an editorial in the same journal, a hospital CEO in San Francisco disputes the conclusion and said CEOs may be compensated based on many other quality measures the authors didn't consider. Dr. Warren Browner, CEO at California Pacific Medical Center, said using death rates and readmissions as a comparison can be misleading because both may be higher at hospitals that treat a higher proportion of very sick patients.
The American Hospital Association also took issue with the study.
Compensation for nonprofit hospital leaders "is set by an impartial board of community representatives," said association spokeswoman Elizabeth Lietz. "It appears that the study fails to fully capture the full range of responsibilities of today's health care leaders."
Browner, the editorial author, said hospital CEOs' compensation typically includes a base salary plus incentive pay if the hospital meets certain targets, which may include financial performance, patient satisfaction and several other quality measures. Browner noted that patient satisfaction is subjective but easier to measure than some other measures.
JAMA Internal Medicine: http://jamainternalmedicine.com
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