Unbiased Analysis of Today's Healthcare Issues
Pay-for-performance is a hot topic in the health policy world. However, one of the largest pay-for-performance programs has already been implemented in the UK’s National Health Service. A paper by Doran et al. (2006) reviews the overall implementation of the NHS’s P4P program as well as how some physicians used exceptions to greatly increase their…
Pay-for-performance has become very fashionable of late. One way to measure physician performance is with episode groupers. This software groups together some or all of the services related to the care of a patient’s chronic or acute medical conditions. Policymakers can then use the episode as the unit of observation for: feedback on physician performance,…
A paper by Hofer et al. (JAMA 1999) looked at the reliability of physician report cards having to do with diabetes treatment. The authors looked at variability across physicians in the number of physician visits and hospitalizations among diabetic patients. They found: Other factors affect hospitalization more than physician care. “For profiles based on hospitalization…
Episodes of care are defined as the bundle of medical treatments used to treat an illness over a specified time period. Because all treatments are bundled together, these episodes have been thought to provide a superior unit of analysis in pay-for-performance (P4P) systems. In fact, Oxford Health Plan pioneered episode payment in the 1990s. [Later,…
One laudable goal is to improve medical quality while reducing cost. One way members of Congress have proposed to accomplish this is to use episode groupers in order to provide feedback to doctors regarding their resource use. None other than Max Baucus has advocated this (see p. 45 of this white paper). However, matching patient…
According to Eisenberg (Medical Care 2002): “Although physicians’ professional fees represent only one fifth of health care expenditures, they are responsible far decisions that govern the way that as much as 90% of each health care dollar is used.” One way to change behavior is to give physician feedback. Here’s how to do it right:…
A paper by Thomas, Grazier, and Ward (2004) analyzes a variety of risk adjustment software products. Using these six risk adjustment products to calculate physician efficiency scores, they found “moderate to high levels of agreement were observed among the six risk-adjusted measures of practice efficiency.” However: “And even though our analyses suggest that 50 percent…
In an article called “That Loving Feeling,” Judy Capko gives some tips for providers on how to treat patients. Some gems include: “A sign in sheet is an excuse to ignore patients.” Nurses and receptionists need to introduce themselves. Otherwise, patients just feel if they are another name in the schedule. Ambience makes a difference.…
Measuring efficiency is a difficult business. As AHRQ, “In most cases, individuals and firms will define efficiency as a relationship between what it costs them and what service or outcome they receive, rather than as a trait inherent in the provider.” Further, efficiency can be measured as either production efficiency or allocative efficiency. “For example,…
Efficiency in the field of economics increases when either 1) outputs are increased for a given level of inputs, or 2) inputs are decreased for a given level of output. Estimating efficiency in the medical field is more difficult, however, since the output (marginal health improvement) is difficult to measure. In the area of hospitals,…