Unbiased Analysis of Today's Healthcare Issues
How well does Medicare measure quality? Not very well, especially across different treatment settings. According to a RAND report: “Only 10 clinical conditions are addressed by reporting programs for more than one setting. Three clinical conditions are included in programs for three settings: (1) acute myocardial infarction, (2) perioperative/surgical care, and (3) urinary incontinence. Seven…
Episodes of care are defined as the bundle of medical treatments used to treat an illness over a specified time period. Because all treatments are bundled together, these episodes have been thought to provide a superior unit of analysis in pay-for-performance (P4P) systems. In fact, Oxford Health Plan pioneered episode payment in the 1990s. [Later,…
One laudable goal is to improve medical quality while reducing cost. One way members of Congress have proposed to accomplish this is to use episode groupers in order to provide feedback to doctors regarding their resource use. None other than Max Baucus has advocated this (see p. 45 of this white paper). However, matching patient…