HACKENSACK, N.J. - For the second year in a row, Hackensack University Medical Center has emerged as the top hospital in a nationwide Medicare program meant to demonstrate whether financial incentives can improve patient care.

Hackensack will get a $744,000 bonus from Medicare because it was found to be providing high-quality care in five areas: heart attack, heart failure, pneumonia, heart bypass surgery, and knee and hip replacement.

Last year, the 781-bed academic medical hospital received $848,000. It is the only New Jersey hospital in the voluntary program, which involves more than 260 hospitals in 38 states.

"They do have a real culture of quality at that institution. That's what it takes. The money is just a small part of the total picture," Mark Wynn, who manages the demonstration unit at the Centers for Medicare and Medicaid Services, told the Star-Ledger of Newark.

The program, managed for Medicare by San Diego-based health-care alliance Premier Inc., is giving $8.6 million to 115 hospitals this year.

The pilot effort, which ended in December, has resulted in fewer complications and deaths at hospitals, according to government officials.

Hackensack improved its score on pneumonia from 89.8 to 93.75. Its heart-attack score was up from 96.5 to 98.23. The highest score, 99.07, involved cardiac bypass surgery.

"It's a process as patients move across the hospital, not a one-shot deal. You really have to view it as how you manage a patient with a specific disease," said Regina Berman, Hackensack's administrative performance improvement director.

Ron Czajkowski, a spokesman for the New Jersey Hospital Association, described pay-for-performance as a "relatively new venture" that "hasn't been fully tested." But the association's 81 acute-care hospitals are looking for ways to get more involved, he said.

Congress has required Medicare, the federal health-care insurance program for people 65 and older, to find a program that can be rolled out to all hospitals in fiscal 2009.