Unbiased Analysis of Today's Healthcare Issues
A paper by Holmboe et al. (2010) evaluates physician performance on quality measure. The authors use a sampled the medical records of an average of 95 patients per general internist. They found that “performance on the individual and composite measures varied substantially within and between physicians…Higher certification exam scores were associated with better performance on…
Bundled payment has been gaining popularity in the minds of policymakers. In essence, a bundled payment structure gives providers a single lump sum payment to cover all related services for an episode of care. In the private sector, the Texas Heart Institute and Geisinger Health System both charge a single lump sum for certain procedures.…
All patients with end stage renal disease (ESRD) are eligible for Medicare regardless of their age. In 1972, the Social Security Act extended all Medicare Part A and Part B benefits to individuals with ESRD (of any age) who are entitled to receive Social Security benefits. ESRD beneficiaries now account for 1% of Medicare enrollment.…
“The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires the Department of Health and Human Services (DHHS) to develop a plan that will transition Medicare payments into a VBP [value based purchasing] program for physician and other professional services that is based on efficiency and the quality of services provided. The Act…
How does one evaluate a physician’s efficiency level? This process has five main dimensions. Which resource use measurement methodology to use. There are two main profiling methodologies: per capita and episode-based. How to account for differences in patient health status. This is done through risk adjustment. However, choosing the proper risk adjustment method is crucial…
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…