Unbiased Analysis of Today's Healthcare Issues
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…
A recent report from the Health Care Payment Learning and Action Network (HCP LAN) examines how providers are getting paid in the U.S. today. Traditionally, health care providers (e.g., physicians, hospitals) were paid via fee-for-service (FFS). Fee-for-service means that every time a provider does a service, they get paid. This is truly largely regardless of…
Provider pay-for-performance initiatives aim to increase reimbursement to physicians and others who provide high-quality, low-cost care to patients. Medicare has two main programs for physicians to ahcieve these goals: (i) the Merit-Based Incentive Payment System (MIPS) and (ii) the Alternative Payment Models (APM). MIPS measures cost and quality for smaller physicians groups whereas APM requires…
“Value” is the latest trend in health care. However, how does value get integrated into reimbursement? One approach to tying value to prices is through and outcomes based contract (OBC) where the reimbursement for a drug will depend on the real world outcomes experienced by the relevant patient population. A study by Nazareth et al.…
Background Do pay-for-performance (P4P) programs work? P4P programs pay paying providers (or health plans) more if they have better outcomes or follow specific best practices. Whether or not they lead to better outcomes has been much debated. However, many P4P programs implemented in the real world have been evaluated using a pre-post design which could…
Value-based payment for providers is often predicated on being able to measure physician quality with a single composite measures. For instance, Medicare’ s Value-Based Payment Modifier (Value Modifier) combines a variety of individual quality metrics across domains to create a single quality score. Payment to physicians is adjusted based on a combination of physician quality…
How do you measure the quality of care patients with cancer receive? How long they live? Avoiding side effects? Patient satisfaction? Process measures? Further, there are multiple types of cancer and different cancer have different recommended treatments and methods of providing care. To further complicate the issue, new cancer treatments are being introduced in rapid succession;…
Medicare aims to tie 90% of reimbursement to quality measures. The potential for quality-linked reimbursement to incentivized improved quality of care, however, depends critically on whether physician quality can be measured reliably. Profiling individual physicians is difficult. Sample sizes are small and attributing patients to a single physician can be difficult (as Mehtrotra et al. 2010…
I wrote last week about whether pay-for-performance (P4P) are doomed to fail. One group of providers–physicians–certainly does not appreciate the current P4P programs instituted by the Centers for Medicare and Medicaid Services. In a press release, the American Medical Association stated: …it appears that CMS has made significant improvements by recasting the EHR Meaningful Use program and by…
The Incidental Economist is one of my favorite blogs to read. This week’s post on a recent BMJ article on the failure of P4P did not disappoint. The article (Figueroa et al. 2016) looks at 4267 acute care hospitals in the United States that participated in Medicare’s Hospital Value Based Purchasing (HVBP) system. During my time…