Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Quality' Category

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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The cost of quality measurement

An interesting editorial in JAMA by Schuster, Onorato and Meltzer (2017) makes the following point: So how should quality measures be prioritized? Many factors are currently considered, including a measure’s expected effect on patients and health care, potential for promoting improvement, scientific underpinnings, usability, and feasibility. But there is a major omission from this list: […]

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Identifying high quality providers in the presence of heterogeneous preferences

Why is it so difficult for health care payers to identify a “best” provider?  A paper by Gutacker and Street (2017) explains: There are two key elements that complicate assessment of how well public sector organisations are doing their job (Besley & Ghatak, 2003; Dixit, 2002). First, they lack a single overarching objective against which […]

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The news you didn’t notice when reading about the $475,000 treamtent

David Augus and and Dana Goldman weigh in on Novartis’ decision to price their new chimeric antigen receptor T-cell (CAR-T) therapy known as Kymriah (tisagenlecleucel).  The treatment represents ground-breaking technology, but is priced at $475,000 per treatment.  But the authors note that there is something else novel about this technology: There was another announcement from […]

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What outcomes matter to patients with Rheumatoid Arthritis?

That is the question that the Outcome Measures in Rheumatology (OMERACT) Working Group attempted to answer. Specifically, the working group aimed to determine the core set of outcome domains for measuring the effectiveness of shared decision-making (SDM) interventions within clinical trials used to treat rheumatic diseases.  These diseases included osteoarthritis (OA), rheumatoid arthritis (RA), and psoriatic […]

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Appropriate Use Criteria, or how I learned to love CMS telling doctors what to do

As part of Section 218(b) of the Protecting Access to Medicare Act, CMS instituted the appropriate use criteria (AUC) for the use of advanced diagnostic imaging.  In order to be reimbursed for these diagnostic imaging services, physicians must consult with and document that they used AUC software before recommending advanced diagnostic imaging.  Failing to document use […]

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