Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Quality' Category

The uselessness of volume-based hospital analysis

Do hospitals with higher volumes have better outcomes? If hospitals specialize or providers learn-by-doing, hospitals with more admissions or more procedures may have higher quality. A paper by Hentschker and Mennicke (2014) examine just this question and find: We define hypothetical minimum volume standards in both conditions and assess consequences for access to hospital services […]

Read the rest of this entry »

P4P in the UK

General Practitioners (GPs) in the UK NHS are paid a mixture of capitation, lump sum allowances, and a pay-for-performance bonus. The P4P element, the Quality and Outcomes Framework (QOF), rewards GPs according to their performance on a large number of indicators. QOF payments represented up to 20% of GPs ’ income in the first year […]

Read the rest of this entry »

P4P in Ontario

Ontario implemented a physician pay-for-performance (P4P) scheme in 2002.  This P4P framework was a jointly agreed upon by the  Ontario government and the Ontario Medical Association.  The Ontario P4P program is described in Hurley, DeCicca and Buckley (2013) in more detail below: [Ontario's P4P program] targets performance bonuses on effective preventive services whose rates of provision were […]

Read the rest of this entry »

What is value-based pricing?

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 […]

Read the rest of this entry »

7 Key P4P Research Questions

Why do physician practice patterns differ so much?  One cause of the regional variation the utilization of medical care is due to regional variation in patient health status.  Maynard, however, states that variation in patient health is not a primary cause of regional variation in the utilization of medical services.  He cites an article by […]

Read the rest of this entry »

Is Quality of Care within a Hosptial Homogeneous?

According to a paper by Zhang, Hauck and Zhao (2013), the answer is ‘no‘.   Using a Bayesian approach (i.e., three-level random intercept probit mode) the authors find that different specialties within the same hospital can provide very different quality of care to the patients.  The authors summarize their findings as follows: Of the variation in […]

Read the rest of this entry »

The Unintended Consequences of P4P

Pay-for-performance (P4P) may be better at improving documentation of outcomes rather than actually improving outcomes.  Farmer, Black and Bonow give the following example: Beginning in the fourth quarter of 2008, [CMS] ceased to reimburse for costs due to selected preventable adverse events, including patient safety indicator 5 (PSI-5) (leaving a foreign object in the body […]

Read the rest of this entry »

Does Competition Improve Quality?

For the most part, the answer is “Yes” according to a recent study by Jung and Polsky.  The authors use a Herfindahl index to measure competition and examine how outcomes for home health patients vary based on the level of competition.  The (unadjusted) figures–based on data from OASIS– show that quality increases as competitions increases […]

Read the rest of this entry »

Will missing data affect physician P4P scores?

The answer is yes, but maybe not as much as you may thought. A paper by Ryan and Bao use data from a randomized controlled trial (RCT) called IMPACT (Improving Mood-Promoting Access to Collaborative Treatment) to determine if errors in physician quality  profiling are due mostly to random variation or missing data.  For this report, […]

Read the rest of this entry »

How Missing Data affects Physicians’ P4P Bonuses

Pay-for-performance programs often offer bonuses (or penalties) for physicians, hospitals and other providers based on the quality of care patients receive.  Measuring quality of care, however, is often difficult.  For chronic conditions, for instance, many patients eligible for outcome measures may be lost to follow-up.  This issue can potentially affect provider evaluations and bonus payments. […]

Read the rest of this entry »