VA vs. private hospitals

How do efficiently is care provided for patients at Veteran Affairs’ hospitals as compared to private hospitals? This is not an easy question to answer as the composition of patients differs between these hospitals. Even among dually-eligible individuals–those with both VA and commercial insurance–individuals treated at VA hospitals are generally more severely ill. To better…

Impact of star ratings on provider demand

For years, Medicare and other payers have used quality measures to evaluate the quality of care patients receive at various types of providers settings (e.g., hospital, home health agencies, skilled nursing homes). For some payers, higher quality scores/higher star ratings lead to direct increases in reimbursement through a value-based purchasing arrangement. Typically, value-based payment systems…

Measuring Hospital Quality

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,…

Clinician-Directed Performance Improvement is the best way to improve quality…why won’t payers use it?

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…

Improving Care for Older Adults with Cancer

Cancer is a horrible disease. Providing high quality care often means providing safe, effective and cost-effective treatments that meets a patient’s priority. Reaching these goals, however, is particularly challenging when treating older adults with cancer. A paper on this exact topic by Ramsdale et al. (2017) notes that: Cancer care delivery for older adults with…

Does the VA provide high-quality care?

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…