Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Supply of Medical Services' Category

Is current hospice care inadequate?

In recent years, demand for palliative rather than interventionist end-of-life in hospices has grown dramatically. More than a million patients each year use hospice facilities. In fact, in some cases terminally patients live longer in hospice than in more intensive care settings. However, hospice are generally most attractive when they provide treatment if patients face […]

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The uselessness of volume-based hospital analysis

Do hospitals with higher volumes have better outcomes? If hospitals specialize or providers learn-by-doing, hospitals with more admissions or more procedures may have higher quality. A paper by Hentschker and Mennicke (2014) examine just this question and find: We define hypothetical minimum volume standards in both conditions and assess consequences for access to hospital services […]

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Do you live in an area with hospital competition?

Likely not.  At least according to some research by William Vogt.  In an NIHCM Issue Brief, Dr. Vogt states: The inpatient hospital market in the United States was transformed by a wave of hospital consolidation during the 1990s, which witnessed more than 900 mergers and acquisitions. Many cities came to be dominated by two or three large hospital systems, and […]

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30-day readmission rates

AHRQ has put together a nice infographic, which I show below.

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AMA wants more money for docs

File under “least shocking development of the day”: The American Medical Association opposes cuts to physician salaries. In a letter on Monday, the AMA stated that it expreses: …strong support for the “SGR Repeal and Medicare Provider Payment Modernization Act of 2014” (H.R. 4015/S. 2000)…Previous Congresses have spent more than $150 billion over the past […]

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Health Care Workers and Informal Payments

In many developing countries, making informal payments to health care workers is common.  Lewis (2000) estimates the frequency of informal payments in selected Asian and Central/Eastern European countries as: Armenia: 91%; Azerbaijan: 78%; Kyrgyz Republic: 75% Poland: 78%; Russia: 74% Vietnam: 81%; Do these payments work?  Would people be better off if these bribes were made […]

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History of Medicare Home Health Payments

Medicare pays home health agencies (HHAs) to care for patients who cannot care for themselves in their own homes.  HHAs, however, have experienced significant changes in the way Medicare pays them over the past 30 years.  A recent paper by Huckfeldt et al. (2014) summarizes these changes: 1983: Medicare switches to an inpatient prospective payment […]

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Scope of Practice for NPs and PAs

This blog has been a proponent of increased use of nurse practitioners and physician assistants to reduce the cost of health care.  However, do they really reduce the cost of care?  On the one hand, NPs and PAs cost less than physicians.  On the other hand, if patients must visit an NP/PA and then a […]

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The End of Hospital Cost Shifting?

Medicare is cutting reimbursement to hospitals.  Austin Frakt (HSR 2013) gives some highlights findings from a CMS report: [The ACA] will permanently reduce the Medicare payments hospitals would otherwise receive. Its ‘productivity adjustment’ will scale payments downward by the average rate at which private nonfarm businesses’ productivity increases. That rate has been estimated to be […]

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Doc Fix: 2014 Edition

It’s that time of year.  The time of year where Medicare threatens to cut physician salaries by double digits (in this case 24.4%).  This is no idle threat.  Under current law, CMS is mandated to cut physician salaries under the sustainable growth rate formula.   Its the time of year that physician lobbyists (rightly) complain that […]

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