Unbiased Analysis of Today's Healthcare Issues
Today I will discuss the evolution of home health care measures over the past 15 years. The majority of the content comes from an article by Robert Rosati (2009). Timeline Here is a link to a TIMELINE that briefly summarizes the key developments in home health care quality measurements. Risk Adjustment From the early development…
More than 3 million frail and disabled individuals rely on nursing home services in any given year. About half of these individuals consider the nursing home to be their primary place of residence. Nursing home quality, however, has often been called into question. Some experts believe pay-for-performance schemes will improve nursing home quality. Today, I…
The call for the adoption of value based purchasing programs has gained in popularity in recent years. These programs give physicians, hospitals, or other providers bonuses (or penalties) depending on the quality of care their patients receive. The Affordable Care Act (ACA a.k.a Health Reform) includes provisions to establish a VBP program for hospital payments…
The Health Reform (ACA) legislation mandated Medicare establish a hospital value-based purchasing (VBP) program by 2012. In fact, the Deficit Reduction Act of 2005 already authorized Medicare to develop a plan to implement VBP for 2009. How will they do this? A CMS report from 2007 sheds some light on the topic. Since 2005,…
“Reinforcement theory from psychology literature suggests that changing behavior by incentives is easiest when the linkage between behavior and incentive (or positive reinforcer) is clearest, and the reinforcers are placed in routine. ” Does that mean that more frequent P4P evaluations and payments are optimal? More frequent physician performance payments increase administrative cost, but may…
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…
How well does Medicare measure quality? Not very well, especially across different treatment settings. According to a RAND report: “Only 10 clinical conditions are addressed by reporting programs for more than one setting. Three clinical conditions are included in programs for three settings: (1) acute myocardial infarction, (2) perioperative/surgical care, and (3) urinary incontinence. Seven…
“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.…