Unbiased Analysis of Today's Healthcare Issues
Pharmacists are typically paid for dispensing drugs. They receive a fee to cover the price for acquiring a given drug and a dispensing fee. In general, however, pharmacists are not paid based on patient outcomes. Will that change? Troy Trygstad (2020) argues that value-based reimbursement for pharmacists through accountable pharmacy organizations (APOs) may be the…
Academic health centers often have a glowing reputation among clinicians and the general public of being the best of the best. In many cases, simple analysis of the numbers does not seem to back this assertion up. Part of the reason is selection bias. Academic and community health centers do not treat the same types…
Goitein (2020) argues that Clinician-Directed Performance Improvement is the best way to improve quality. I agree. This approach empowers physicians and other health care professionals to identify areas for improvement and work on those. Clinician Directed Performance Improvement (CDPI)…had its origins in 2013, when a group of physicians requested support for a physician-led quality program…
A number of studies (e.g., Wasfy et al. 2017, Desai et al. 2016) have found that the Centers for Medicare and Medicaid Services (CMS) Hospital Readmissions Reduction Program (HRRP) reduce hospital readmissions. However, are these findings valid? A recent paper by Ody et al. (2019) argues maybe not. Because readmission rates are risk-adjusted, changing coding…
The answer is ‘perhaps’ according to a new paper by Wadhera et al. (2018). They use data from 2005 to 2015, and apply an inverse probability–weighted 30-day and 45-day post-discharge mortality measure stratified by whether there was an associated readmission. They examine admissions for acute myocardial infarction, heart failure, and pneumonia. Among Medicare beneficiaries, the HRRP…
CMS is increasingly moving to alternative payment models whereby providers are paid based on their ability to improve/maintain quality and hold the line on cost. A key question then, is how does CMS evaluate quality of care? Today, the Healthcare Economist will answer this question for the case of Medicare’s Shared Savings Program (MSSP), which…
A recent report from the Health Care Payment Learning and Action Network (HCP LAN) examines how providers are getting paid in the U.S. today. Traditionally, health care providers (e.g., physicians, hospitals) were paid via fee-for-service (FFS). Fee-for-service means that every time a provider does a service, they get paid. This is truly largely regardless of…
Pharmaceuticals on the one hand can greatly improve patients health and quality of life. At the same time, some of these treatments are expensive and–despite clinical trial results–evidence from the real-world is lacking at the time of a drug launch. To address these issues, Oklahoma’s Medicaid program is taking the lead by adopting two different…
Medicare’s Merit-based Incentive Payment System (MIPS) aims to link physician quality of care to their reimbursement. At first glance, paying more to high quality physicians seems like a great idea. However, a paper by Liao et al. (2018) surveys physicians from a large national sample maintained by the American College of Physicians (ACP). They find…
CMS has focused in recent years on payment reform–especially alternative payment models–in Medicare’s fee-for-service (FFS) reimbursement system, but much less has been paid to beneficiaries enrolled in Medicare’s managed care program (i.e., Medicare Advantage). Currently, however, more than 1 in 3 beneficiaries are enrolled in an Medicare Advantage plan, and by 2028 that number could…