Unbiased Analysis of Today's Healthcare Issues

Measuring the quality of cancer care

How do you measure the quality of care patients with cancer receive?  How long they live?  Avoiding side effects?  Patient satisfaction? Process measures? Further, there are multiple types of cancer and different cancer have different recommended treatments and methods of providing care.  To further complicate the issue, new cancer treatments are being introduced in rapid succession; […]

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Quality of care and prices

There have been a number of studies that have examined how publicly reporting quality ratings (for health plans, physicians, hospitals or other health care providers) affects market share.  Less attention has been paid to the effect of measured quality on health care prices.  A paper by Huang and Hirth (2016) aim to answer just this […]

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Can we accurately classify physicians as high vs. low quality?

Medicare aims to tie 90% of reimbursement to quality measures.  The potential for quality-linked reimbursement to incentivized improved quality of care, however, depends critically on whether physician quality can be measured reliably. Profiling individual physicians is difficult. Sample sizes are small and attributing patients to a single physician can be difficult (as Mehtrotra et al. 2010 […]

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Are quality bonus payments based on hospital readmissions reliable?

Maybe not.  That is the answer from a study by Thompson et al. (2016).  Using data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) for six states (AR, FL, IA, MA, NY,WA)  from 2011 to 2013, the authors measure hospital performance reliability for the Hospital Readmission Reduction Program (HRRP).  The define reliability as follows: […]

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Will technology replace nurses?

Many people have feared that robots, computers, and other forms of technology will take people’s jobs. Conventional wisdom holds that healthcare workers have been largely immune from these technological changes to date. However, a new paper from Lu, Rui and Seidmann examines whether technological advances–specifically computerized provider order entry (CPOE)–affects employment at nursing homes. Using […]

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Is value-based purchasing working for hospitals?

The Incidental Economist is one of my favorite blogs to read.  This week’s post on a recent BMJ article on the failure of P4P did not disappoint.  The article (Figueroa et al. 2016) looks at 4267 acute care hospitals in the United States that participated in Medicare’s Hospital Value Based Purchasing (HVBP) system.  During my time […]

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How do consumers perceive low priced health care?

Is it a bargain?  Or do low prices represent low quality?  Or is cost independent of quality?  To try to answer this question Phillips, Schleifer, and Hagelskamp (2016) conducted a nationally representative survey to investigate whether consumers believe that price and quality are associated.  They found that: Most Americans (58–71 percent, depending on question framing) did not think that […]

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Effect of publicly reported surgical quality measures and outcomes

There has been a shift towards making quality data publicly available for patients to examine when choosing physicians.  A commentary by Burns et al. (2016) finds that there is mixed evidence regarding whether making surgery-related mortality data publicly available improves patient outcomes (see table below). Article Time Period Country Participants Key Findings Hannan 1994 1989-1992 US NY State cardiac […]

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How do pregnant women measure quality?

What do women care about when giving birth? A study Maurer et al. (2016) conducted a focus group study of 41 pregnant women in North Carolina. They found that women valued the following aspects of quality. Providing individualized care that focuses on, and has respect for, each woman’ s health, needs, and personal preferences for labor, […]

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Cost of Quality Reporting: $15.4 billion

Medicare aims to move away from fee-for-service reimbursement and towards value-based payment mechanisms based on quality of care.  Although the goal is laudable, there are a number of practical challenges.  First, most care is still provided via fee for service.  In 2013, 95% of all physician office visits were reimbursed using fee-for-service.  Second, collecting quality of […]

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