Unbiased Analysis of Today's Healthcare Issues

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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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 […]

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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 […]

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