Unbiased Analysis of Today's Healthcare Issues

Does more spending improve quality?

In most goods and services you buy, the answer is yes.  A Tesla is more expensive than a KIA; a large house is more expensive than a big house; a night at the Ritz Carlton is more expensive than a night at the Motel 6. Nevertheless, in healthcare, many policy wonks believe that cost and quality may […]

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Trends in Value-based reimbursement

A McKesson study cites 7 trends in value-based reimbursement: Rapid adoption of VBR. About 90% of payers and 81% of providers are already using some mix of value-based reimbursement (VBR) combined with fee-for-service (FFS). Collaborative regions are more aligned with VBR. Collaborative regions, where one or two payers and providers stand out, are more aligned […]

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Reimbursement Rates and Quality

How do reimbursement rates affect quality?  One school of thought holds that decreased reimbursement decreases quality in the short-run and decreases innovation in the long-run.  Another school of thought believes that there is so  much inefficiency in the health care system, that reducing reimbursement rates will have no affect  on quality.  Which answer is correct? A study […]

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Disparities in Schizophrenia Care

Do African Americans and Latinos receive the same quality care as Caucasians?  This is the question asked by Horvitz-Lennon et al. (2014). Quality of Care Before one can answer this question, one first has to define what “quality care” means.  The authors use the following definition for pharmacological indicators: Any use of antipsychotic drugs, Conditional on […]

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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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7 Key P4P Research Questions

Why do physician practice patterns differ so much?  One cause of the regional variation the utilization of medical care is due to regional variation in patient health status.  Maynard, however, states that variation in patient health is not a primary cause of regional variation in the utilization of medical services.  He cites an article by […]

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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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The Unintended Consequences of P4P

Pay-for-performance (P4P) may be better at improving documentation of outcomes rather than actually improving outcomes.  Farmer, Black and Bonow give the following example: Beginning in the fourth quarter of 2008, [CMS] ceased to reimburse for costs due to selected preventable adverse events, including patient safety indicator 5 (PSI-5) (leaving a foreign object in the body […]

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How Missing Data affects Physicians’ P4P Bonuses

Pay-for-performance programs often offer bonuses (or penalties) for physicians, hospitals and other providers based on the quality of care patients receive.  Measuring quality of care, however, is often difficult.  For chronic conditions, for instance, many patients eligible for outcome measures may be lost to follow-up.  This issue can potentially affect provider evaluations and bonus payments. […]

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The Effect of Medicaid P4P on Nursing Home Quality

Over 10 million Americans need long-term services and supports to assist them in life’s daily activities.  Of these, 1.6 million reside in a nursing home. Nursing home care, however, is expensive ($74,800 per year) and and quality is highly variable. To improve the quality of care, many states have begun adopting pay-for-performance (P4P) programs for nursing homes. Between […]

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