Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Quality' Category

Quality Adjusted Cost of Care Analysis

The health care industry should take into account outcomes when weighing the cost of new treatments and technologies and make quality-adjusted life years (QALYs) part of the equation, say the authors of a study in the April issue of Health Affairs. This is the begining of an article in Managed Care Magazine that reviews a […]

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What is MIPS?

Yesterday I posted about MIPS, the new Medicare physician reimbursement program set to begin in 2019.  The Health Affairs blog provides a nice summary of some of the changes. First and probably most importantly, the formulaic approach to setting base payment rates is gone, replaced with automatic increases for all doctors from 2015 through 2019. For […]

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Narrow Networks

One of the ways health plans in the health insurance exchanges have been able to keep premiums down is through offering beneficiaries very narrow networks. By steering patients towards “efficient” doctors, premiums stay low. However, patients may worry that these “low cost” doctors are lower quality than those outside of the network. The tradeoff between […]

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Medicare to Pay for Value

I have spilled much ink on this blog discussing the pros and cons of pay-for-performance approaches to medicine.  Incentivizing high quality care is good in theory, but in practice changes in quality have been modest and providers may be able to readily game the system.  Despite these challenges, Medicare announced this week that it would being  tying 30 […]

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Do quality rankings matter?

There have many policy initiatives to measure and improve quality of care.  For instances, NCQA’s HEDIS measure are the most widely used quality measures among commercial insurers.  Since employers generally choose insurance plans for employees (or at least select the menu of insurance options for employees), one would expect that employers would look for high […]

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Does more spending improve quality?

In most goods and services you buy, the answer is yes.  A Tesla is more expensive than a KIA; a large house is more expensive than a big house; a night at the Ritz Carlton is more expensive than a night at the Motel 6. Nevertheless, in healthcare, many policy wonks believe that cost and quality may […]

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Trends in Value-based reimbursement

A McKesson study cites 7 trends in value-based reimbursement: Rapid adoption of VBR. About 90% of payers and 81% of providers are already using some mix of value-based reimbursement (VBR) combined with fee-for-service (FFS). Collaborative regions are more aligned with VBR. Collaborative regions, where one or two payers and providers stand out, are more aligned […]

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How important is having a good nurse?

Perhaps unfairly, doctors get all the credit. When patients have better health outcomes, physicians are rewarded; when they have worse health outcomes, the physician is blamed. However, the quality of nurses also likely affects the quality of care that patients receive. A recent paper by Yakusheva, Lindrooth and Weiss (2014) finds that nurse quality does […]

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Reimbursement Rates and Quality

How do reimbursement rates affect quality?  One school of thought holds that decreased reimbursement decreases quality in the short-run and decreases innovation in the long-run.  Another school of thought believes that there is so  much inefficiency in the health care system, that reducing reimbursement rates will have no affect  on quality.  Which answer is correct? A study […]

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Will P4P work?

In pay-for-performance (P4P) or value-based purchasing (VBP) schemes, health care provider reimbursement rates depend on performance. Physicians can receive bonuses for following best practices, and hospitals can increase reimbursement rates from Medicare if they improve clinical processes and patient satisfaction. As an economist, rewarding good performance with financial payments makes perfect sense. Or does it? […]

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