Unbiased Analysis of Today's Healthcare Issues

Medicare Hospital Value-Based Purchasing

The Health Reform (ACA) legislation mandated Medicare establish a hospital value-based purchasing (VBP) program by 2012.  In fact, the Deficit Reduction Act of 2005 already authorized Medicare to develop a plan to implement VBP for 2009.   How will they do this?  A CMS report from 2007 sheds some light on the topic. Since 2005, […]

Read the rest of this entry »

Defining a Hospital Catchment Area

From what areas does a hospital draw on to fill its beds?  There have been many attempts to define a hospital’s catchment area.  The Dartmouth Atlas Group uses hospital referral regions (HRRs) and hospital service areas (HSAs). One method is to determine a minimum admission rate for a given geographic unit (e.g., county, census tract, […]

Read the rest of this entry »

Are All Readmissions Bad Readmissions?

Currently, Medicare and private insurers are attempting to put in place incentives to reduce the number of readmissions. Visits to the hospital are costly and reducing the frequency of hospital visits is the best means to reduce medical costs. In particular, if readmissions are the fault of the care the patients receive during the initial […]

Read the rest of this entry »

Wage Index Reclassifications

Should Medicare pay hospitals located in New York City more for the same care as hospitals in Montana?  Prima facie, one might believe that New York hospitals should receive higher wages since the costs of operating a hospital are much higher in New York.  Labor (i.e., nurses, doctors, etc.) may prefer to live in an […]

Read the rest of this entry »

Hospital Quality

The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a standardized survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience.  HCAPHS is the first national standard for collecting and reporting hospitals quality data. The survey asks discharged patients 27 questions about their recent hospital stay.  The survey is […]

Read the rest of this entry »

Effect of Massachusetts Health Reform on Hospital and Preventive Care

Kolstad and Kowalski (2010) examine how the Massachusetts individual mandate affected uninsurance rates, hospital and outpatient utilization, and preventive care: “Among the population discharged from the hospital in Massachusetts, the reform decreased uninsurance by 28% relative to its initial level. Increased coverage affected utilization patterns by decreasing length of stay and the number of inpatient […]

Read the rest of this entry »

An evaluation of MedPAC’s hospital wage index revisions

Some press on a report I worked on at Acumen, LLC. “The hospital wage index used to adjust Medicare inpatient prospective payment system (IPPS) payments to reflect the geographic differences in labor costs has created payment problems through its use of metropolitan statistical areas (MSAs) and “rest of state” areas to define hospital labor markets. […]

Read the rest of this entry »

Do Hospitals “Cost Shift” to the Privately Insured when Medicare Reduces Prices?

Many health policy experts believe that when Medicare or Medicaid decrease prices, hospitals will increase the prices they charge to the privately insured. Does this make sense?  Ginsburg (2003) summarizes the debate: Most executives in hospitals, physician organizations, health plans, and businesses have long been convinced that reductions in rates paid to Medicare and Medicaid […]

Read the rest of this entry »

Does hospital ambience affect patient health?

Does a fancy hospital interior and soothing music help promote faster healing?  Sharp Hospital system certainly things so. NPR’s Marketplace even covers the story: Dan Gross is executive vice president of Sharp Healthcare. I meet up with him in the lobby for my tour of the swanky Sharp Memorial. Its a $200-million hospital in San […]

Read the rest of this entry »

When is closing a hospital a good idea?

Typically when a business closes, it is a sad event, but one business’s demise often makes way for more efficient competitors to gain market share. This is rarely, how hospital closures are seen, however. In the press, a hospital closure is met with fears of decreased health care access and quality for the local community. […]

Read the rest of this entry »