January 2011

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Global Health Corps

January 31, 2011 in Miscellaneous | 1 comment

How can you help improve the quality of health care services for the poor around the world?  Are you interested in improving access to health care for those who currently do not have it?  Are you interested in working abroad?  If your answer to all these questions is yes, then the Global Health Corps could be an attractive option for you.  The program aims to connect outstanding young leaders with organizations working on the front lines in the fight for global health.

The program was of particular interest to me since all fellows complete a rigorous Summer Training Institute sponsored by Stanford University’s Center for Health Policy (CHP).  In my work at Acumen, I have worked with CHP faculty members like Jay Bhattacharya.

GHC give young professionals the opportunity to participate in a year-long fellowships. GHC fellows will have a measurable impact on the health of the communities in which they work, and they will draw upon that experience and the GHC alumni network to deepen their impact throughout their careers contributing to future innovations to address complex and growing challenges.

GHC fellows receive full funding, in addition to mentorship, training, and support from the GHC community of alumni and advisors. We aim to place 70 fellows in the 2011-2012 fellowship year in Burundi, Malawi, Rwanda, Uganda, Newark, Washington D.C, and Boston. Fellows will be placed with outstanding partner organizations including Partners in Health, Clinton Health Access Initiative, FACE AIDS, Elizabeth Glaser Pediatric AIDS Foundation, Infectious Disease Institute of Uganda, and others. Fellowship roles and placements change year to year based on the needs of our partner organizations and the communities they serve.

Applications open February 1st. You can find more information about fellowship placements and the application at http://ghcorps.org.

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State Adoption of Nursing Home Pay-for-Performance

January 31, 2011 in Nursing Homes, P4P | No comments

On the importance of Nursing homes:

“More than 1.5 million people reside in U.S. nursing homes at a cost of more than $120 billion per year (Kaiser Family Foundation, 2007). Medicaid is the majority payer of nursing home services, giving indigent people access to nursing home care by directly reimbursing facilities for the care of Medicaid-eligible residents…State Medicaid programs are responsible for approximately half of all nursing home spending, and Medicaid residents constitute 65% of all bed-days.”

As nursing home expenditures have taken up a larger and larger share of expenditures, a number of State Medicaid Agencies have instituted pay-for-performance requirements (P4P).  A paper by Werner, Konetzka and Liang (2007) evaluate some of these P4P efforts.  A total of 15 states had planned or existing nursing home P4P programs when this article was published.

Here is a map of all the states who have initiated P4P programs for Nursing Homes.

“Financial rewards in nursing home P4P are based on a variety of different quality measures , including traditional measures such as staffing, regulatory deficiencies, resident satisfaction, and clinical quality and less traditional measures such as occupancy, efficiency, Medicaid use, and culture change. Most use at least 4 different categories of measures, and none uses less than 3.”

The following table summarizes the types of quality measures used in state nursing home P4P programs.  This table lists specific clinical measures used for P4P.

High performing nursing homes generally receive a financial reward for their status.  Most states use a per-diem add on as a reward for high performance.  One state, Vermont, gave flat-rate bonuses to up to 5 facilities that met predetermined quality thresholds.  This table summarizes the level of payment in selected state nursing home P4P programs.

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What is Egypt like?

January 29, 2011 in Current Events | 4 comments

Egypt has taken over the news as protests have spread throughout the country.  One of Cairo main squares (Midan Tahrir) is the focal point where protesters have been expressing their discontent with current president (and dictator) Hosni Mubarak.

What is Egypt like?  Ironically, I just returned from a trip to Egypt less than a month ago. Today, I’ll give you my perspective.

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Prison

January 28, 2011 in Economics - General | No comments

Below are two excerpts from a series of articles in Wilson Quarterly on Prison reform:

“With effective programs, we could reduce the number of repeat offenders by nearly 100,000.  We could do even better if these efforts were linked to improved services in teh community upon release.  Such efforts would pay for themselves by reducing future criminal justice and corrections cost.  Economist Mark A. Cohen and criminologist Alex Piquero found in a recent study that a high-risk youth who become a chronic offender costs society between $4.2 and $7.2 million, principally in police and court outlays, property losses, and medical care.  We either pay now or pay later–and we pay a lot more later.”

“Unserved warrants tend not to pile up in jurisdictions with commercial bondsmen.  In those places, the bail bond agent is on the hook for the bond and thus has a strong incentive to bring those who jump bail to justice.”

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History of the Medicare Economic Index (MEI)

January 27, 2011 in Medicare, Physician Compensation | 3 comments

The Medicare Economic Index (MEI) is a measure of practice cost inflation that was developed in 1975 as a way to estimate annual changes in physicians’ operating costs and earnings levels. Today, I review a timeline of how Medicare has paid physicians over time and also describe some adjustments CMS makes to the MEI to either improve its accuracy or reduce its growth (depending on who you talk to).

Timeline

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CoR #123

January 26, 2011 in Carnivals | No comments

The 123rd edition of the Cavalcade of Risk is up at the Notwithstanding Blog.  This ‘high-yield’ edition contains posts on ACOs, FSAs, HSAs, PPACA, and other non-acronym related topics.  You can even find out what insurance not to buy and how  truck operators avoid crashing the top of their vehicle against a rapidly-approaching underpass.

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Physician Perspectives on Pay-for-Performance

January 26, 2011 in P4P, Quality | No comments

Survey Results

A 2004 poll of a sample of 400 randomly selected physicians found the following:

  • 71% of physicians supported payments based on the quality of care they provide,
  • over 60% of physicians thought that hospitals should also be paid based on the quality of care they provide,
  • Almost 90% of physicians thought that the current reimbursement system did not reward them for providing high-quality care, and
  • 62% supported public access to information about the quality of care they provide.

Quotation #1: Changing Perspective on P4P

“When I started my career in the late 1970s as an academic internist and geriatrician, I was skeptical of pay-for-performance, feeling that standards of care could not accurately assess the real benefits of my care of my frail elderly patients with multiple impairments. I still feel that way today because despite the rapid growth of the evidence base, we continue to measure relatively simple aspects of the process of care rather than measuring outcomes. I also felt then that pay-for-performance was a thinly veiled effort to increase efficiency rather than quality. Subsequent experience as the leader of a large academic health science center and as chief executive officer of a major health insurer has led me to believe that pay-for-performance holds substantial potential for enhancing quality of care.”

  • John W. Rowe, MD

    Quotation #2: The Problem of Complex Patients

    “Should metrics be simple or complex? Most current standards are simple. They state a basic clinical service that all patients with a certain condition should receive, such as prescription of β-blockers after myocardial infarction. Approximately 5% of patients are responsible for 50% of health care costs. They are typically complex. Therefore, we need standards to evaluate management of patients with chronic disease and multiple comorbid conditions. To achieve this goal, we will need a much richer evidence base than is currently available.”

    • John W. Rowe, MD

    Source: John W. Rowe, MD. Pay-for-Performance and Accountability: Related Themes in Improving Health Care. Ann Intern Med. 2006;145:695-699.

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    Tuesday Links

    January 25, 2011 in Current Events | No comments

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    MedPAC’s 2011 Home Health Reform Recommendations

    January 24, 2011 in Home Health, Medicare | 6 comments

    In 2009, 3.3 million Medicare beneficiaries used home health.  In the past few years, the home health expenditure growth rate has outpaced Medicare spending in all other areas.  This finding is likely correlated with the 9.7% increase in the number of home health agencies between 2008 and 2009.  How should Medicare reform home health to improve outcomes and reduce spending.  A post by William Dombi of the National Association for Home Care & Hospice (NAHC) summarizes MedPAC’s recommendations.

    Recommendations

    1. Eliminate any inflatinon update in 2012. In 2009, freestanding home health agency margins were 17.7% (although hospital-based home health agency margins were negative). Margins have average 17.1% since 2011.  With such large margins, MedPAC believes an inflation payment update is unnecessary.
    2. Eliminate the therapy utilization threshold. MedPAC staff belive that “the current case-mix system overpays for higher case-mix weighted services such as episodes with therapy care and underpays for many non-therapy related episodes.” Instead, the case-mix adjustment should rely on patient characteristics to set payment for both therapy and non-therapy services. The NAHC has long criticized using therapy thresholds for the purpose of case mix adjustment.
    3. Establish risk corridors. This recommendation would modify the payment system to included more of a mix of prospective and cost-based reimbursement. “The ‘corridors’ are effectively limits on profit and losses that come from an imprecise system or abusive clinical practices that define care needs based on a provider’s desired margin.” The GAO proposed this alternative a number of years ago.
    4. Beneficiary cost sharing. To reduce the rise in the number of home health episodes per beneficiary–many of which may be unnecessary–MedPAC recommends some form of cost sharing. In particular, since the growth in home health spending is primarily driven from community-admitted patients, the copayment would apply only to community-admitted patients rather than hospital-admitted patients. One suggestion for the copayment amount was $300 per episode. “..Medigap insurances would be prohibited from covering the cost of any home health copayment.”

    The MedPAC commissioners will meet in January 2011 to vote on the recommendations and will issue a report to Congress in March 2011.
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    Quotation of the Day: Defining Complexity

    January 21, 2011 in Miscellaneous | No comments

    “The complexity of a particular system is the degree of difficulty in predicting the properties of the system if the properties of the system’s parts are given.”

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