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Archive for the 'P4P' Category

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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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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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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Did P4P work among VA Minorities with Hypertension?

Background Do pay-for-performance (P4P) programs work?  P4P programs pay paying providers (or health plans) more if they have better outcomes or follow specific best practices. Whether or not they lead to better outcomes has been much debated.  However, many P4P programs implemented in the real world have been evaluated using a pre-post design which could […]

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Value-Based Payments and Incentives to Improve Care

Please check out my latest publication in Value in Health titled “Value-Based Payments and Incentives to Improve Care: A Case Study of Patients with Type 2 Diabetes in Medicare Advantage“. This work is based on research conducted with my co-authors Jesse Sussell, Kata Bognar, Taylor T. Schwartz, John J. Sheehan, Wade Aubry, and Dennis Scanlon, […]

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Medicare’s value-based purchasing fail?

Value-based payment is the latest hot topic.  One question remains, however, does it work?  Does paying for quality improve quality.  A study by Zuckerman et al. (2016) finds that the hospital readmissions reduction program (HRRP) did appear to reduce re-hospitalization rates among the targeted conditions. What about the hospital value-based purchasing program (HVBP).  Beginning in […]

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Can physician quality be captured by a single composite measure?

Value-based payment for providers is often predicated on being able to measure physician quality with a single composite measures.  For instance, Medicare’ s Value-Based Payment Modifier (Value Modifier) combines a variety of individual quality metrics across domains to create a single quality score.  Payment to physicians is adjusted based on a combination of physician quality […]

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Measuring the quality of cancer care

How do you measure the quality of care patients with cancer receive?  How long they live?  Avoiding side effects?  Patient satisfaction? Process measures? Further, there are multiple types of cancer and different cancer have different recommended treatments and methods of providing care.  To further complicate the issue, new cancer treatments are being introduced in rapid succession; […]

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