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. [...]
Read the rest of this entry »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 [...]
Read the rest of this entry »Effect of Nursing Home Ownership on Quality
Do non-profit nursing home provide better quality than for-profit nursing homes? Generally, for-profit nursing homes appear to have better quality measures, but this could be due to the fact that non-profit nursing homes act as a safety net, whereas non-profit nursing homes treat sicker patients. Today, I look at Grabowski et al. (2012)‘s attempt to [...]
Read the rest of this entry »Nursing Home Quality
Typically, Nursing Home quality is measured using metrics from Nursing Home Compare. These metrics are calculated based on survey and certification processes and resident assessments from from the Minimum Data Set (MDS). These, however, are not the only quality metrics one can use. For instance, one can use consumer complaints as a measure of quality [...]
Read the rest of this entry »Measuring Hospital Quality
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 [...]
Read the rest of this entry »How do commercial insurers evaluate physician quality?
Often, this is done with claims-based measures and beneficiary surveys. Today, I take a more detailed look at the UnitedHealth Premium physician designation program. The program evalutates physicians based on established quality measures and–for those who meet the minimum quality requirement–a measure of efficiency (i.e., low cost). A more detailed description is available here. Without [...]
Read the rest of this entry »PQRS in 2013
Some background: Created in March 2007, the PQRI established a financial incentive for eligible healthcare professionals to participate in a voluntary quality reporting program. By reporting on a minimum of 3 measures on a specified group of patients, a physician can earn a bonus payment of 0.5% on all of their Medicare billing for 2012. [...]
Read the rest of this entry »How does UnitedHealth Evaluate Physician Performance?
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 [...]
Read the rest of this entry »Hospital Quality Reporting in Italy
In the U.S. patients can use Hospital Compare to evaluate the quality of care individuals receive at each hospital in the U.S. In Italy, there is P.Re.Val.E. A paper by Renzi et al. explains: A Regional Outcome Evaluation Program (P.Re.Val.E.) was launched in the Lazio region of central Italy starting in 2005 (Fusco et al. [...]
Read the rest of this entry »Shrinkage Estimators and Composite Quality Scores
Shrinkage estimators (such as the James-Stein estimator) are well-known in the economics literature and have a number of applications. A recent paper by Shwartz et al. 2012 demonstrates how one could apply shrinkage estimators to measure nursing home quality. “A challenge when examining individual QIs across a range of facilities is that sample sizes are [...]
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