Unbiased Analysis of Today's Healthcare Issues

“Adjustments” drive variation in Medicare hospital reimbursement rates

In my previous work, I have examined regional variation in Medicare and Medicaid costs through reports to the Institute of Medicine and publications in peer-reviewed journals.  We found significant variation in health care costs across regions, that high-cost regions tended to remain high cost over time, but that a region that is high-cost for treating one medical condition […]

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Does more spending improve patient outcomes?

The answer to this question is not so clear cut.  Comparing outcome for patients living in Beverly Hills and those in South Los Angeles may be different not only due to health care spending but also due to the patient socioeconomic factors that affect health outcomes.  To get around this econometric challenge, an interesting paper […]

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Are home births as safe as hospital births?

The popularity of home births has been rising in recent years. One question is whether they are as safe as in-hospital births. A new study in NEJM found that most home births are safe, but hospital births are safer. As the N.Y. Times reports: The study analyzed nearly 80,000 pregnancies in Oregon, and found that […]

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ASSA 2016: Regional variation in hospital spending among U.S. privately insured patients

How do health care costs vary across the country. Although the team at the Dartmouth Atlas has done this exercise with patients in Medicare, there has been less study of region variation in health care spending among the privately insured with the notable exception of a 2013 Institute of Medicine report. In a study by […]

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30-day readmission rates

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

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Does Increased Hospital Spending Reduce Mortality?

According to Romley, Jena and Goldman (2011), the answer is yes. For each of 6 diagnoses at admission—acute myocardial infarction, congestive heart failure, acute stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia—patient admission to higher-spending hospitals was associated with lower risk-adjusted inpatient mortality. During 1999 to 2003, for example, patients admitted with acute myocardial infarction to […]

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How Medicare Measures Hospital Quality

There are many ways that Medicare evaluates hospital quality. Medicare conducts patient surveys (i.e,. HCAHPS). Medicare has hospitals report a variety of process of care measures through the Inpatient Quality Report (IQR) Program. Medicare uses data that Centers for Disease Control and Prevention (CDC) collects via the National Healthcare Safety Network (NHSN) tool to measure […]

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Will Medicare Reduce Your Hospial’s Reimbursement Rates?

Do you work at New York-Presbyterian in Manhattan? Massachusetts General Hospital in Boston? Both these hospitals, with large market shares in their cities, will see their Medicare payments reduced through the Hospital Value-Based Purchasing (HVBP) program. If you work at Cleveland Clinic or Intermountain Medical Center in Utah, on the other hand, Medicare will be […]

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Appropriate IME and DSH payments

Although Medicare has a set rate schedule, not all hospitals receive the same payment for providing the same service. Among the number of adjustments Medicare makes to its inpatient prospective payments rates are the indirect medical education (IME) and disproportionate share hospital (DSH). The goal of IME is to compensate hospitals for patient care costs […]

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How much does a hospital stay cost?

A paper by Geue et al. (2012) attempts to answer this question by examining five different methods of estimating the cost of a continuous hospital stay (CIS). Each method is discussed below in more detail. Costing Methods

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