Unbiased Analysis of Today's Healthcare Issues
Do Medicare beneficiaries in fee-for-service plans access better physicians than those in Medicare Managed Care (MMC) plans? Huesch (2010) attempts to answer this question for beneficiary access to quality cardiologists. Using data on heart patients without AMI in Florida, the authors observes the following results: “No evidence was found that Medicare payor type significantly influenced…
“Pay-for-performance (P4P) is one of the primary tools used to support healthcare delivery reform. Substantial heterogeneity exists in the development and implementation of P4P in health care and its effects.” Today, I review a paper which summarizes evidence, obtained from studies published between 1990-2009, concerning P4P effects. Measure Effectiveness Which types of measures produce the…
A paper by Holmboe et al. (2010) evaluates physician performance on quality measure. The authors use a sampled the medical records of an average of 95 patients per general internist. They found that “performance on the individual and composite measures varied substantially within and between physicians…Higher certification exam scores were associated with better performance on…
Bundled payment has been gaining popularity in the minds of policymakers. In essence, a bundled payment structure gives providers a single lump sum payment to cover all related services for an episode of care. In the private sector, the Texas Heart Institute and Geisinger Health System both charge a single lump sum for certain procedures.…
Asymptotic theory has played a large role in the development of many recent econometric methods. For instance, the central limit theorem states that distribution of the mean drawn from any large samples is approximately normally distributed. Asymptotic theory, however, generally assumes that sampling occurs infinitely and with replacement. In the real world, populations are not…
All patients with end stage renal disease (ESRD) are eligible for Medicare regardless of their age. In 1972, the Social Security Act extended all Medicare Part A and Part B benefits to individuals with ESRD (of any age) who are entitled to receive Social Security benefits. ESRD beneficiaries now account for 1% of Medicare enrollment.…
From a paper by Weinstein and Skinner (NEJM 2010): “Moreover, there is considerable variation in health care expenditures and a weak or even negative association between spending and outcomes, such as mortality at the regional level and quality measures at the state level. This evidence has been interpreted to mean that cutting back on these…
A paper by Sutton, Elder Guthrie and Watt (2010) describes the UK’s National Health Service’s (NHS) adoption of the Quality and Outcomes Framework (QOF) in April 2004. In general, P4P programs can have positive or negative spillovers. An example of a positive spillover would be the adoption of EMR to comply with certain P4P initiatives,…
“The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires the Department of Health and Human Services (DHHS) to develop a plan that will transition Medicare payments into a VBP [value based purchasing] program for physician and other professional services that is based on efficiency and the quality of services provided. The Act…
Avedis Donabedian has a revealing article regarding how to assess quality in the medical profession. His 1988 JAMA and 2005 Milbank Quarterly articles include the following important points: Physician quality is not only technical. Interpersonal skills are also important. The patient must communicate information to the physician and the physician must provide information to the…