Unbiased Analysis of Today's Healthcare Issues
Where has public policy gone in the last few years? Popular policies include move towards more bundled payments, the creation of accountable care organizations, additional funding for comparative effectiveness research (CER), evidence-based medicine (EBM) and value-based purchasing programs that link payments to various quality metrics. With health care costs rising, payers are looking to decrease…
Pay for performance (P4P) is the latest rage in healthcare quality monitoring. Paying physicians more who provide high quality care makes sense intituitvely. The U.S. isn’t the only country to hop on the P4P bandwagon. In 2001, the Australian government initiated a financial incentive program for “improved management of diseases such as asthma and diabetes…
Over 10 million Americans need long-term services and supports to assist them in life’s daily activities. Of these, 1.6 million reside in a nursing home. Nursing home care, however, is expensive ($74,800 per year) and and quality is highly variable. To improve the quality of care, many states have begun adopting pay-for-performance (P4P) programs for nursing homes. Between…
Maryland is a unique state for Hospitals. Since 1977, Maryland’s Health Services Cost Review Commission sets payment rates for all hospitals regardless of the payer. This approach is only feasible because Maryland receives a federal waiver that exempts its hospitals from national Medicare and state Medicaid fee schedules. Just as Medicare has begun implementing its…
Do you work at New York-Presbyterian in Manhattan? Massachusetts General Hospital in Boston? Both these hospitals, with large market shares in their cities, will see their Medicare payments reduced through the Hospital Value-Based Purchasing (HVBP) program. If you work at Cleveland Clinic or Intermountain Medical Center in Utah, on the other hand, Medicare will be…
How does one measure hospital quality? Quality occurs along multiple dimensions. Thus, to summarize overall quality, one must create a weighting scheme to compete the distinct quality measures in a single measure. In most cases, quality measures should also account for differences in patient case mix. Hospitals should not be punished with lower quality scores…
The UnitedHealth Premium Physician Designation Program assesses the quality and efficiency of physicians’ practice patterns. UnitedHealth uses Quality of care is measured using measures from the NQF and NCQA. Cost efficiency (i.e., being low cost) is measured using the Symmetry ETG and PEG episodes. The information generated by this program is used to i) give…
In the past, Medicare basically paid hospitals the same amount for every type of admission regardless of quality. Of course, Medicare did adjust payments to hospitals based on the their cost of labor (hospital wage index adjustment), share of low-income patients (disproportionate share hospital payment), and number of medical school residents (indirect medical education payment),…
The Wall Street Journal reports: “…research showing that the majority of U.S. spending also highly concentrated on a small group of high-cost patients. These typically include people with one or more chronic conditions, such as diabetes, high cholesterol, arthritis and cancer, said Steven B. Cohen, a director at the federal Agency for Healthcare Research and…
Medicare’s Hospital Compare website evaluates hospital quality. One of the most recent measures to be added to Hospital Compare is a measure of efficiency. The measure calculates a price-standardized, case-mix adjusted measure of spending during period before, during and after a hospital admission. The Healthcare Economist (Jason Shafrin) and a team at Acumen (including Tom…