Unbiased Analysis of Today's Healthcare Issues
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…
Goitein (2020) argues that Clinician-Directed Performance Improvement is the best way to improve quality. I agree. This approach empowers physicians and other health care professionals to identify areas for improvement and work on those. Clinician Directed Performance Improvement (CDPI)…had its origins in 2013, when a group of physicians requested support for a physician-led quality program…
This is the title of my recent commentary in the Journal of Clinical Pathways. The article discusses a number of challenges of measuring quality of care in oncology: The challenges mentioned included: the long time-lag to develop new guidelines and then incorporate these into validated quality measures, the potential narrow populations to which guidelines would…
Let’s say I ask you–on a scale from 0 to 1–what your utility would be if you had cancer. This is a difficult question for most people to answer not only because many people will not have cancer and will not know what it is actually like, but also the concept of “utility” is not…
This question is difficult to answer. In many countries with government provided health care, wait times are long. For the Veterans Affairs (VA) beneficiaries, this does not seem to be much of an issue according to a Penn et al. (2019) study covering wait times between 2014 and 2019: Although wait times in the VA…
Physician quality is often regarded by researhers as an immutable trait. There are high-quality physicians and low-quality physicians. In most areas where technical skill is required, however, practice makes perfect. A key question is, does ‘practice-makes-perfect’ (aka learning-by-doing) occur for physicians as well? A key challenge when doing this research is knowing the direction of…
A number of studies (e.g., Wasfy et al. 2017, Desai et al. 2016) have found that the Centers for Medicare and Medicaid Services (CMS) Hospital Readmissions Reduction Program (HRRP) reduce hospital readmissions. However, are these findings valid? A recent paper by Ody et al. (2019) argues maybe not. Because readmission rates are risk-adjusted, changing coding…
The answer is ‘perhaps’ according to a new paper by Wadhera et al. (2018). They use data from 2005 to 2015, and apply an inverse probability–weighted 30-day and 45-day post-discharge mortality measure stratified by whether there was an associated readmission. They examine admissions for acute myocardial infarction, heart failure, and pneumonia. Among Medicare beneficiaries, the HRRP…
In the past few weeks, I discussed how well Hospital Compare does on measuring the quality of hospital care (see here and here). Now, I turn to how well Nursing Home Compare does on truly measuring quality of care. A study by Brauner et al. (2018) attempts to answer this question. They compare the quality…
CMS is increasingly moving to alternative payment models whereby providers are paid based on their ability to improve/maintain quality and hold the line on cost. A key question then, is how does CMS evaluate quality of care? Today, the Healthcare Economist will answer this question for the case of Medicare’s Shared Savings Program (MSSP), which…