Unbiased Analysis of Today's Healthcare Issues

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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Medicare Payments Cut for Low-Quality Hospitals

In the past, Medicare basically paid hospitals the same amount for every type of admission regardless of quality.  Of course, Medicare did adjust payments to hospitals based on the their cost of labor (hospital wage index adjustment), share of low-income patients (disproportionate share hospital payment), and number of medical school residents (indirect medical education payment), […]

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Medicare Spending per Beneficiary

Medicare’s Hospital Compare website evaluates hospital quality.  One of the most recent measures to be added to Hospital Compare is a measure of efficiency.  The measure calculates a price-standardized, case-mix adjusted measure of spending during period before, during and after a hospital admission. The Healthcare Economist (Jason Shafrin) and a team at Acumen (including Tom […]

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Measuring Patient Case Mix in Medicare

How does Medicare measure patient case mix?  For the most part, Medicare uses the Hierarchical Condition Category (HCC) model.  A recent CMS presentation describes the HCC model in more detail.  Today I review where CMS applies the HCC model, provide an overview of the HCC methodology, briefly describe its performance, and give some background on […]

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Medicare Reforms Linking Reimbursement Rates with Hospital Performance

Health reform not only changes the health care market for the demand side (e.g., patients, insurers), but also for the supply side (e.g., hospitals, physicians).  In the Medicare setting, a number of initiatives have aimed to pay providers who provide high-quality or low-cost care more money, and pay providers who provide low-quality or high-cost care […]

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Medicare to Hospitals: The Patient is Always Right

Starting in fiscal year 2014, Medicare will start rewarding hospitals with high quality care and penalizing hospitals with low quality care.  The rewards and penalties will be financial in nature. High-quality hospitals will receive a bonus and low-quality hospitals will receive a financial penalty.  There is a lot of existing documentation on this hospital value-based […]

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