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Archive for the 'Quality' Category

Nurse practitioners reduce cost, but can they provide high-quality care?

Not all medical problems can or should be treated by a nurse practitioner (NP).  However, may can be.  Increasing access to care through NPs can reduce wait times through expanding access and decrease cost.  The access and cost issues are not in doubt; the question is, can NPs improve or at least maintain patient care?  […]

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Outcomes-based pricing for Cardiovascular Disease

An interest Health Affairs blog post on outcomes-based pricing from Daniel M. Blumenthal Samuel Nussbaum Neil J. Weissman and Mark Linthicum. Insurers are increasingly tying health service payments to clinical outcomes to improve care value and quality. Outcomes-based pricing—setting treatment reimbursements to reflect their prospectively determined value to patients and the health care system—is a promising alternative payment […]

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The costs of quality reporting

Provider pay-for-performance initiatives aim to increase reimbursement to physicians and others who provide high-quality, low-cost care to patients. Medicare has two main programs for physicians to ahcieve these goals: (i) the Merit-Based Incentive Payment System (MIPS) and (ii) the Alternative Payment Models (APM).  MIPS measures cost and quality for smaller physicians groups whereas APM requires […]

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Which Medicare initiatives use quality measures?

In December, CMS listed its quality measures that it is considering for incorporation into some of their value-based payment programs and quality reporting programs. However, which Medicare quality reporting and payment initiatives use quality measures?  A full list is below. Ambulatory Surgical Center Quality Reporting Program (ASCQR) End-Stage Renal Disease Quality Incentive Program (ESRD QIP) […]

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Does the value-modifier improve quality and reduce health disparities?

In short, no.  That is the answer Roberts, Zaslavsky and McWilliams reach in their 2017 paper in Annals. Some background on the value modifier program.  In 2013, practices with 100 or more eligible clinicians were rewarded just from reporting quality measures. By 2014, however: Practices with 100 or more clinicians were subject to upward, downward, […]

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Physician use of “Choosing Wisely”

Choosing Wisely aims to identify low value services and advise physicians to avoid or at least be more conservative in the use of these services.  The ability to implement these changes, however, depends on physician awareness of these initiatives.  A paper by Colla and Mainor (2017) examines trends in awareness of the Choosing Wisely initiative: […]

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Measuring hospital quality requires understanding what a hospital is

Many programs–such as Medicare’s Hospital Value-Based Purchasing (HVBP) program–aim to reward hospitals with high quality through higher reimbursement and penalize hospitals with low quality through lower reimbursement.  Will this approach be successful? A commentary by McMahon and Howell (2017) says that hospitals are not really unified entities but rather a collection of workshops. Thus, the […]

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Outcomes-based contracts: Where are we now?

“Value” is the latest trend in health care.  However, how does value get integrated into reimbursement?  One approach to tying value to prices is through and outcomes based contract (OBC) where the reimbursement for a drug will depend on the real world outcomes experienced by the relevant patient population. A study by Nazareth et al. […]

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Why do physician practices join value-based payment initiatives?

Are physicians ready for value-based payment? That is the question a recent paper by Markovitz et al. (2017) attempts to answer. This question is not hypothetical as the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA) requires physicians to choose between the current fee-for-service structure under the Merit-Based Incentive Payment System (MIPS) or […]

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Does patient demand respond to physician quality?

The answer to this question must be ‘yes’.  Everyone wants to see a good doctor compared to a bad doctor.  However, what defines a “good” doctor?  Patients perception of what makes a doctor good (e.g., bedside manner, clinic amenities) may not correspond to what technocrats or policmakers think (e.g., process of care measures).  Even if […]

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