Unbiased Analysis of Today's Healthcare Issues
How does one measure hospital quality? Quality occurs along multiple dimensions. Thus, to summarize overall quality, one must create a weighting scheme to compete the distinct quality measures in a single measure. In most cases, quality measures should also account for differences in patient case mix. Hospitals should not be punished with lower quality scores…
The UnitedHealth Premium Physician Designation Program assesses the quality and efficiency of physicians’ practice patterns. UnitedHealth uses Quality of care is measured using measures from the NQF and NCQA. Cost efficiency (i.e., being low cost) is measured using the Symmetry ETG and PEG episodes. The information generated by this program is used to i) give…
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),…
Many payers are moving towards value-based purchasing programs that reward efficient physicians with additional payments and punish inefficient physicians with decreased payments. Medicare’s Quality and Resource Use Reports (QRUR) are a step in this direction. However, summarizing overall physician quality is a difficult prospect. First, the types of cases each physician treats is not homogeneous,…
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…
Many of Medicare’s value-based purchasing (VBP) initiatives offer a continuum of rewards based on provider performance. Whereas all-or-nothing VBP initiatives only grant bonuses to providers who exceed a single threshold, the Medicare VBP programs–such as its hospital VBP program–reward hospitals based a value-based modifier that is proportional to its quality score. One of the reasons…
Medicare payments for End Stage Renal Disease rely on a value-based purchasing (VBP) system known as the Quality Incentive Program (QIP). Today I review proposed changes to the QIP that will effect the payments for dialysis centers in 2013 and 2014. Payment Year 2013 Two measures have been adopted for the payment year (PY) 2013…
In short, the answer is no. The CBO released an issue brief examining two types of demonstrations. Disease management and care coordination demonstrations have sought to improve the quality of care of beneficiaries with chronic illnesses and those whose health care is expected to be particularly costly. Value-based payment demonstrations have given health care providers…
The Medicare billing system is complex. There an alphabet soup of acronyms, (e.g., RVUs, CPT, HCPCS, GPCI) and each of these affects payments in different ways. In addition to the standard payment terms, Medicare is also creating additional payment incentives. These payment incentives fall into three broad categories: Quality reporting e-Prescribing (eRx) Electronic Health Records…
Massachusetts’ Medicaid program instituted a pay-for-performance program in 2008. Did it work? According to this paper, the answer is no. MassHealth P4P Background The MassHealth pay-for-perfrmance P4P program was implemented in 2008. At first the program was implmented using a P4P structure for pneumonia and pay-for-reporting for surgical infection prevention (SIP) and transitioning to P4P…