Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Hospitals' Category

Do does episode bundling improve quality and reduce cost?

This is the question put forth in a paper by Chen et al. (2017).  The authors examine Medicare’s Acute Care Episode (ACE) Demonstration Program, which was a small, voluntary episode-based bundled payment program. According to the CMS website, There were 28 cardiac and 9 orthopedic inpatient surgical services and procedures included in the bundled payment demonstration. These […]

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Does episode-based payment reduce cost?

That is the question that Carroll and co-authors try to answer in their latest NBER working paper (WP #23926).  They examine the Arkansas Health Care Payment Improvement Initiative (APII), which is a state-wide, multi-payer episode-based program.  Unlike most episode-based payment (EBP) models, provider participation  in the program was mandatory (as of 2013).  NBER summarizes the program […]

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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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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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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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Hospital of the future

The Economist‘s recent article “Prescription for the future” describes some new trends in health care treatment and predicts what the hospital of the future will look like.  Some excerpts are below: When I think of the hospital of the future, I think of a bunch of people sitting in a room full of screens and phones,” […]

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Are quality bonus payments based on hospital readmissions reliable?

Maybe not.  That is the answer from a study by Thompson et al. (2016).  Using data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) for six states (AR, FL, IA, MA, NY,WA)  from 2011 to 2013, the authors measure hospital performance reliability for the Hospital Readmission Reduction Program (HRRP).  The define reliability as follows: […]

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ACOs and VBP

Accountable Care Organizations aim to link providers through the supply chain (i.e., hospitals, physicians, post-acute care facilities) to incentivize providers to improve quality and reduce costs.  In addition to its ACO program (the Medicare Shared Savings Program), the Centers for Medicare and Medicaid Services (CMS) have implemented a number of value-based payment programs, including the […]

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