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Archive for the 'Quality' Category

Effect of publicly reported surgical quality measures and outcomes

There has been a shift towards making quality data publicly available for patients to examine when choosing physicians.  A commentary by Burns et al. (2016) finds that there is mixed evidence regarding whether making surgery-related mortality data publicly available improves patient outcomes (see table below). Article Time Period Country Participants Key Findings Hannan 1994 1989-1992 US NY State cardiac […]

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How do pregnant women measure quality?

What do women care about when giving birth? A study Maurer et al. (2016) conducted a focus group study of 41 pregnant women in North Carolina. They found that women valued the following aspects of quality. Providing individualized care that focuses on, and has respect for, each woman’ s health, needs, and personal preferences for labor, […]

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Cost of Quality Reporting: $15.4 billion

Medicare aims to move away from fee-for-service reimbursement and towards value-based payment mechanisms based on quality of care.  Although the goal is laudable, there are a number of practical challenges.  First, most care is still provided via fee for service.  In 2013, 95% of all physician office visits were reimbursed using fee-for-service.  Second, collecting quality of […]

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Core Quality Measures

One challenge providers have faced in the past is that quality measure reporting has been complex.  Medicare may ask for quality measures with one definition, commercial payers may define quality a second way, and Medicaid may ask for a third definition of quality.  Keeping track of these definitions and recording quality measures distracts providers from actually providing quality […]

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P4P in Medicaid

Does Medicaid use pay-for-performance (P4P) for providers?  If so, how does it work?  And does it affect quality and cost? These are the questions of interest to Rosenthal et al. (2015) in their study of P4P programs in Alabama, Minnesota, and Pennsylvania.  Although all three focus on physicians, the Alabama program is a “medical home ” […]

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Which value-based payment system is best?

Clearly, there is no single answer to this question and the answer depends on a number of factors including the market structure, provider responsiveness to intrinsic vs. extrinsic motivation, provider sample size, and the ability to accurately measure quality of care.  Douglas Conrad (2015) uses agency theory to provide an overview of existing value-based payment systems.  The […]

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Does tying payment to quality improve quality?

Although the typical economist answer would be yes, in the case of one Medicare Advantage program, the answer is ‘no’. A paper by Layton and Ryan (2015) [earlier draft] examine the Medicare Advantage Quality Bonus Payment Demonstration (MA QBP) which began in 2012.  In this program: …plans receive bonus payments based on an overall plan quality […]

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Synthetic Control Method

A common method for measuring the effect of policy interventions is the difference in difference (DiD) approach.  In essence, one examines the change in outcomes among observations subject to the policy intervention and compare them agains observations that were not eligible for the policy intervention. A key assumption for this approach to be valid is […]

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What is MACRA?

MACRA is the Medicare Access & CHIP Reauthorization Act, also know colloquially as the ‘permanent doc fix’.  Although MACRA is know for repealing the Sustainable Growth Rate (SGR) provisions that would have significantly cut physicians salaries (but was reversed every December), there are other provisions. Although physicians may take comfort in avoiding the year end doc […]

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NCCN Evidence Blocks

NCCN recently released a new approach to measure the value of cancer medicines. The approach–known as Evidence Blocks–evaluates medications on 5 dimensions: Efficacy of regimens, Safety of regimens, Quality and quantity of evidence for regimens, Consistency of evidence for regimens, and Affordability of regimens. Each criteria is ranked on a 1 to 5 block scale. […]

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