Unbiased Analysis of Today's Healthcare Issues
How does one measure hospital quality? Quality occurs along multiple dimensions. Thus, to summarize overall quality, one must create a weighting scheme to compete the distinct quality measures in a single measure. In most cases, quality measures should also account for differences in patient case mix. Hospitals should not be punished with lower quality scores…
Some background: Created in March 2007, the PQRI established a financial incentive for eligible healthcare professionals to participate in a voluntary quality reporting program. By reporting on a minimum of 3 measures on a specified group of patients, a physician can earn a bonus payment of 0.5% on all of their Medicare billing for 2012.…
The UnitedHealth Premium Physician Designation Program assesses the quality and efficiency of physicians’ practice patterns. UnitedHealth uses Quality of care is measured using measures from the NQF and NCQA. Cost efficiency (i.e., being low cost) is measured using the Symmetry ETG and PEG episodes. The information generated by this program is used to i) give…
In the past, Medicare basically paid hospitals the same amount for every type of admission regardless of quality. Of course, Medicare did adjust payments to hospitals based on the their cost of labor (hospital wage index adjustment), share of low-income patients (disproportionate share hospital payment), and number of medical school residents (indirect medical education payment),…
I can’t answer that. But I can tell you that young physicians are more likely to favor more costly medical intervetions. At least this is the conclusion of a recent study by Ateev Mehrotra and colleagues. They find: We found that physicians with fewer than ten years of experience had 13.2 percent higher overall costs…
How do you measure whether a quality measure is reliable? What does the term “reliable” even mean? In the world of quality measurement, reliability is the ability to confidently tell the difference between a high-performing individual (or physician or hospital) and a low-performing individual. One can think of reliability as a signal-to-noise measure; if the…
Do report cards improve quality or simply incentivize hospitals and physicians to stratetically choose which patients to treat? To answer this question, a paper by Chen and Meinecke (2012) examine coronary artery bypass graft (CABG) report cards introduced in Pennsylvania. Report cards can improve quality but they can also induce selection behavior not only by…
Shrinkage estimators (such as the James-Stein estimator) are well-known in the economics literature and have a number of applications. A recent paper by Shwartz et al. 2012 demonstrates how one could apply shrinkage estimators to measure nursing home quality. “A challenge when examining individual QIs across a range of facilities is that sample sizes are…
Many payers are moving towards value-based purchasing programs that reward efficient physicians with additional payments and punish inefficient physicians with decreased payments. Medicare’s Quality and Resource Use Reports (QRUR) are a step in this direction. However, summarizing overall physician quality is a difficult prospect. First, the types of cases each physician treats is not homogeneous,…
Medicare recently released the Medicare Spending per Beneficiary (MSPB) measure on Hospital Compare. This measure includes all payments to doctors, hospitals or other facilities for services provided to a patient during the three days before the hospital stay, during the stay, and during the 30 days after discharge from the hospital. Kaiser Health news provides…