Unbiased Analysis of Today's Healthcare Issues

Hospitals moving to the ‘burbs

The ACA offers States the option to expand Medicaid eligibility to millions of Americans.  The goal of the expansion was to increase poor and middle class Americans’s access to affordable health care.  However, access to acute care may be getting more difficult for poor individuals. A recent article looking at Milwaukee’s hospital market describes how hospitals are […]

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Will a VA scandal happen in England?

The VA scandal of long wait times is now well-known. Part of the reason why patients were left off official wait lists–ironically–was because VA senior staffers wanted to reduce wait times. Senior VA staff monitored wait times closely to check for any upticks. Some of the VA management at the Phoenix hospital believed the only […]

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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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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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California Hospitals Charge Fair Prices to the Uninsured

Why is that?  Because in 2006 California passed the Hospital Fair Pricing Act.  Melnick and Fonkych (2013) describe the bill as follows. The Hospital Fair Pricing Act…mandated that hospitals develop formal, written financial assistance policies and limit the  prices they charge uninsured patients with low to moderate incomes…Under the law, hospitals must limit the amounts they collect from […]

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Is Quality of Care within a Hosptial Homogeneous?

According to a paper by Zhang, Hauck and Zhao (2013), the answer is ‘no‘.   Using a Bayesian approach (i.e., three-level random intercept probit mode) the authors find that different specialties within the same hospital can provide very different quality of care to the patients.  The authors summarize their findings as follows: Of the variation in […]

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Effect of P4P on Hospital Profits

How do value-based purchasing programs affect hospitals’ bottom lines? This is a particularly important question as the Affordable Care Act (ACA) mandates that CMS reward high-quality, low-cost hospitals with bonuses and give financial penalties to low-quality, high-cost hospitals. In 2003, CMS began a pay-for-performance (P4P) demonstration. Using this demonstration as a natural experiment, Kruse et […]

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Healthcare for Hospitals

Benefits are taking up a continually greater share of employee compensation. This trend is as true for hospitals as any other industry. Keenan Health Care summarizes some recent trends for California hospitals. According to a survey of 83 California health care organizations (representing 219 hospitals): Benefits represent 28% of the employee compensation for the average […]

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P4P for Maryland Hospitals

Maryland is a unique state for Hospitals. Since 1977, Maryland’s Health Services Cost Review Commission sets payment rates for all hospitals regardless of the payer. This approach is only feasible because Maryland receives a federal waiver that exempts its hospitals from national Medicare and state Medicaid fee schedules. Just as Medicare has begun implementing its […]

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