Unbiased Analysis of Today's Healthcare Issues
Massachusetts’ Medicaid program instituted a pay-for-performance program in 2008. Did it work? According to this paper, the answer is no. MassHealth P4P Background The MassHealth pay-for-perfrmance P4P program was implemented in 2008. At first the program was implmented using a P4P structure for pneumonia and pay-for-reporting for surgical infection prevention (SIP) and transitioning to P4P…
How do you know if a patient is receiving the correct dose? Better yet, how can you check if your entire patient panel is on the right dosage? Although identifying the ‘right’ dosage is difficult, it is much easier to see if your patients are on the wrong dosage. Medi-Span’s Dose-Chek data provides information on…
At a recent AcademyHealth presentation, Cheryl Damberg discussed her research to design a P4P program for implementation for Integrated Healthcare Association (IHA). One thing I noticed about the presentation was that smaller provider groups had patients with lower risk scores (i.e., healthier patients). Is it really the case that small providers treat much healthier patients?…
According to the CMS website, Quality Improvement Organizations (QIOs) are private, mostly not-for-profit organizations, which are staffed by professionals, mostly doctors and other health care professionals, who are trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum…
“In January 2009 Blue Cross Blue Shield of Massachusetts launched a new provider payment system called the Alternative Quality Contract that exemplifies the type of experimentation with novel payment models that the Affordable Care Act encourages. The Alternative Quality Contract is a modified global payment model in which annual payments to medical groups are linked to a per member per month budget.” Today I…
As part of health reform, Medicare is looking to institute value-based purchasing or pay-for-performance programs in a number of settings. In fact, in my work for Acumen, I have worked on a number of these initiatives (e.g., P4P for physician efficiency profiling, implementing a VBP system in home health). Medicare, however, isn’t the only…
The Affordable Care Act of 2010 includes a number of provisions to study and/or implement value-based purchasing (VBP) programs in the United States’ health care system. These provisions target Medicare payment policies in particular. Today I review a Robert Wood Johnson (RWJ) article which provides an overview of the ACA provisions related to VBP. There…
More quality at lower cost has been the mantra of payers for many years. But how do we make this goal a reality? Value-based insurance alters cost sharing structure so that beneficiaries have low levels of cost sharing for cost-effective services and high compayments for low value items. I report by Joan Kapowich (2010) looks…
On the importance of Nursing homes: “More than 1.5 million people reside in U.S. nursing homes at a cost of more than $120 billion per year (Kaiser Family Foundation, 2007). Medicaid is the majority payer of nursing home services, giving indigent people access to nursing home care by directly reimbursing facilities for the care of…
Survey Results A 2004 poll of a sample of 400 randomly selected physicians found the following: 71% of physicians supported payments based on the quality of care they provide, over 60% of physicians thought that hospitals should also be paid based on the quality of care they provide, Almost 90% of physicians thought that the…