Unbiased Analysis of Today's Healthcare Issues
Medicare Advantage has grown over time. In 2020, nearly four in ten (39%) of all Medicare beneficiaries – 24.1 million people out of 62.0 million Medicare beneficiaries overall – were enrolled in Medicare Advantage (MA) plans. With MA enrollment growing, a key question is who provides higher quality care: Medicare fee-for-service (FFS) or MA? Who…
Many Medicare payment initiatives aim to link reimbursement to value. Value includes both cost and quality of care. However, measuring quality of care during a pandemic is problematic. Further, most of CMS’ value-based purchasing programs–such as Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program (HRRP) and the Hospital-Acquired Condition (HAC) Reduction Program all…
Is your hospital high quality? Well, this depends on what quality means. Does it have low readmission rates? Low rates of mortality? Do they follow clinical guidelines? Are patients satisfied? Are they good at cardiology care? What about cancer treatment? Combining all these different dimensions of quality is a complex task. The Centers for Medicare…
If you want to implement value-based care, you need to define what a ‘good’ outcome is. A good outcome may be different for different individuals. For instance, if you look at mortality rates for a given disease, it makes sense that individuals age 80 and above will have higher mortality rates than those 20-29 year…
Quality of care is difficult to measure. Even if you had a perfect measure of quality in terms of health outcomes, risk adjustment is imperfect. For instance, academic medical centers are often assumed to have high quality, but actual outcomes observed in the data may not be that good if they also receive the sickest,…
There are a few sub-questions we need to break down to answer before answering this one larger question. These sub-questions include: Is nursing staff turnover at nursing homes a big problem? Is nursing staff turnover correlated with quality of care? Does using nursing staff turnover as a quality metric provide the right incentives? A paper…
This weekend, my fire alarms kept going off. I called the local fire department who came out and they checked everything out. They arrived quickly, were extremely friendly and explained everything clearly. The did some tests and said all was well. If I were asked to rate their quality, I would rate them very high.…
The Oncology Care Model is slated to end soon. Specifically, the last set of six-month episodes would initiate no later than December 31, 2020 and thus all episodes will be completed in June 30, 2021. Nevertheless, CMS is proposing a successor to the Oncology Care Model called the Oncology Care First (OCF) Model. CMS describes…
Pharmacists are typically paid for dispensing drugs. They receive a fee to cover the price for acquiring a given drug and a dispensing fee. In general, however, pharmacists are not paid based on patient outcomes. Will that change? Troy Trygstad (2020) argues that value-based reimbursement for pharmacists through accountable pharmacy organizations (APOs) may be the…
Academic health centers often have a glowing reputation among clinicians and the general public of being the best of the best. In many cases, simple analysis of the numbers does not seem to back this assertion up. Part of the reason is selection bias. Academic and community health centers do not treat the same types…