Unbiased Analysis of Today's Healthcare Issues
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…
Comparative Effectiveness Research (CER) aims to determine whether a drug or medical procedure’s are more cost-effective than alternative treatments and/or none at all. Although the U.S. is not known as a leader in CER research (in part because public health insurance bodies such as Medicare do not take CER evidence into account when making coverage…
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…
A number of studies have already examined this question. Baker et al. (2003) examined the effectiveness of a public reporting effort in hospitals in Ohio, finding little relationship between a hospital’s report card ranking and changes in its market share. Cutler et al. (2004) examined the effects of reporting quality information about cardiac surgery on…
Medicare’s Hospital Compare website evaluates hospital quality. One of the most recent measures to be added to Hospital Compare is a measure of efficiency. The measure calculates a price-standardized, case-mix adjusted measure of spending during period before, during and after a hospital admission. The Healthcare Economist (Jason Shafrin) and a team at Acumen (including Tom…
Many of Medicare’s value-based purchasing (VBP) initiatives offer a continuum of rewards based on provider performance. Whereas all-or-nothing VBP initiatives only grant bonuses to providers who exceed a single threshold, the Medicare VBP programs–such as its hospital VBP program–reward hospitals based a value-based modifier that is proportional to its quality score. One of the reasons…
The N.Y. Times has an interesting article citing a number of reasons why there are no good websites with doctors reviews on the web. There are some ratings websites (HealthGrades, RateMDs, Angie’s List, Yelp), but the listings are often sparse, with few contributors and little of substance.) For one, physicians don’t like them. “Several years ago,…
Medicare payments for End Stage Renal Disease rely on a value-based purchasing (VBP) system known as the Quality Incentive Program (QIP). Today I review proposed changes to the QIP that will effect the payments for dialysis centers in 2013 and 2014. Payment Year 2013 Two measures have been adopted for the payment year (PY) 2013…
Health reform not only changes the health care market for the demand side (e.g., patients, insurers), but also for the supply side (e.g., hospitals, physicians). In the Medicare setting, a number of initiatives have aimed to pay providers who provide high-quality or low-cost care more money, and pay providers who provide low-quality or high-cost care…