Unbiased Analysis of Today's Healthcare Issues
How well does Medicare measure quality? Not very well, especially across different treatment settings. According to a RAND report: “Only 10 clinical conditions are addressed by reporting programs for more than one setting. Three clinical conditions are included in programs for three settings: (1) acute myocardial infarction, (2) perioperative/surgical care, and (3) urinary incontinence. Seven…
“Pay-for-performance (P4P) is one of the primary tools used to support healthcare delivery reform. Substantial heterogeneity exists in the development and implementation of P4P in health care and its effects.” Today, I review a paper which summarizes evidence, obtained from studies published between 1990-2009, concerning P4P effects. Measure Effectiveness Which types of measures produce the…
The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a standardized survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience. HCAPHS is the first national standard for collecting and reporting hospitals quality data. The survey asks discharged patients 27 questions about their recent hospital stay. The survey is…
Until their most recent quality stumbles, Toyota’s production techniques were the darlings of the management consulting world. The Toyota process is embodied by the concept of kaizen, a Japanese notion of continuous improvement. The latest gurus have even applied the production techniques to the health care arena (see Designed to Adapt). A Health Affairs article…
A paper by Sutton, Elder Guthrie and Watt (2010) describes the UK’s National Health Service’s (NHS) adoption of the Quality and Outcomes Framework (QOF) in April 2004. In general, P4P programs can have positive or negative spillovers. An example of a positive spillover would be the adoption of EMR to comply with certain P4P initiatives,…
The US News and World Report has popular rankings for colleges, graduate schools and now hospitals. Do patients actually decide to seek care at different hospitals based on these ratings? Devin Pope attempts to answer this question in a recent Journal of Health Economics article (free draft). To determine whether or not this is the…
Accountable Care Organizations (ACOs) are the latest rage in the health policy world. The question is, what are ACOs. The Urban Institute’s Kelly Devers and Robert Berenson try to answer the following question: “Can Accountable Care Organizations Improve the Value of Health Care by Solving the Cost and Quality Quandaries?” The goal of ACOs is…
Avedis Donabedian has a revealing article regarding how to assess quality in the medical profession. His 1988 JAMA and 2005 Milbank Quarterly articles include the following important points: Physician quality is not only technical. Interpersonal skills are also important. The patient must communicate information to the physician and the physician must provide information to the…
People today want high quality health care at lower cost (to be honest, people throughout history have always wanted better quality and lower cost). However, defining the ‘value’ of medical services is not easy. In fact, it is often difficult for companies to demonstrate to customers that they provide superior value. Joe Paduda has a…
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,…