Unbiased Analysis of Today's Healthcare Issues
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…
This is basically the question that Perez and Freedman (2018) ask. They find the following: Among crowdsourcing sites’ best‐ranked hospitals, 50–60% were also the best ranked on [Hospital Compare’s] HC’s overall and patient experience ratings; 20% ranked as the worst. Best‐ranked hospitals had significantly better clinical quality scores than worst ranked hospitals, but were not…
The 340B program requires pharmaceutical firms to give large discounts to hospitals and clinics that serve high volumes of low-income patients. This sounds like a good idea at first: give money to people who can’t afford their medicines. However, when one reads the sentence above closely, it becomes clear that patients don’t receive these discounts:…
Yesterday, I discussed the idea of managed competition in California. One of the original tenets of managed competition was insurers having integrated, mutually exclusive provider networks. This would mean much more consolidation on the provider side. While this could improve quality, there is also a risk that prices could rise. In fact, this is what…
Yesterday I noted that competition is key to driving down prices in health insurance markets. Competition is about expanding the number of suppliers available for a given product. Now let’s think about the demand side. Does reducing the number of purchasers increase or decrease price? One could think that price would fall because buyers would…
Conventional wisdom holds that in recent years the answer is ‘yes’, however what does the data show? A paper by Nipay, Richards and Penso (2018) uses an SK&A survey of physician office practices between 2007 and 2017 to find the answer. In short, conventional wisdom is largely true with the caveat that there is significant…
The effect of health care industry consolidation on prices is a question argued about by many including researchers, economists, anti-trust, lawyers, regulators and more. There is evidence that health plan consolidation increases premiums, and hospital consolidation increases price. For instance, Dafny et al. 2015 writes: The harsh reality is that it’s difficult to find well-documented…
Many of Medicare’s alternative payment models are based on the premise that there is a lot of waste in health care. If that is the case, we could reduce cost with little to no effect on quality. While that would be nice, is that really the case? Consider two articles from the most recent edition…
This is the question put forth in a paper by Chen et al. (2017). The authors examine Medicare’s Acute Care Episode (ACE) Demonstration Program, which was a small, voluntary episode-based bundled payment program. According to the CMS website, There were 28 cardiac and 9 orthopedic inpatient surgical services and procedures included in the bundled payment demonstration. These…
That is the question that Carroll and co-authors try to answer in their latest NBER working paper (WP #23926). They examine the Arkansas Health Care Payment Improvement Initiative (APII), which is a state-wide, multi-payer episode-based program. Unlike most episode-based payment (EBP) models, provider participation in the program was mandatory (as of 2013). NBER summarizes the program…