Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Supply of Medical Services' Category

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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Health insurance expansion and physician supply

When new bills pass in Congress or state legislatures that expand health insurance coverage, most researcher look at the demand side effect.  How does the insurance expansion affect the number uninsured?  How does it affect access to care?  How does it affect out of pocket cost? What is less frequently studied is the supply side […]

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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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Why are hospital prices crazy?

Sarah Kliff of Vox has an interesting article looking at hospital pricing.  She provides examples of $629 for a Band-Aid in an emergency department to over $3,000 to look at a bruised finger. Part of these high costs are not just physician time and treatment materials but a facility fee.  The facility fee is basically the […]

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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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Health care market concentration

One question is whether more physician concentration is a good thing.  On the one hand, larger practices could lead to more efficient care. On the other hand, larger practices could give providers more market power and could drive up prices. A separate question is whether federal authorities could do anything about increased physician market concentration. […]

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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 market works!

In 2011, CMS created a demonstration to have competitive bidding for durable medical equipment (DME).   Prior to the implementation of this program, CMS used an administrative fee schedule, similar to how physicians are currently reimbursed.  How did this market-based solution fare?  A paper by Newman, Barrette, and McGraves-Lloyd (2017) answers this question. We compared […]

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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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Does more spending improve outcomes?

A number of studies have claimed that increased health expenditures may result in no better, or even worse outcomes.  For instance, a paper by Fisher et al. (2003) looking at patients with acute myocardial infarction, colorectal cancer, or hip fracture finds that “Quality of care in higher-spending regions was no better on most measures and […]

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