Unbiased Analysis of Today's Healthcare Issues

Does tying payment to quality improve quality?

Although the typical economist answer would be yes, in the case of one Medicare Advantage program, the answer is ‘no’. A paper by Layton and Ryan (2015) [earlier draft] examine the Medicare Advantage Quality Bonus Payment Demonstration (MA QBP) which began in 2012.  In this program: …plans receive bonus payments based on an overall plan quality […]

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What is MACRA?

MACRA is the Medicare Access & CHIP Reauthorization Act, also know colloquially as the ‘permanent doc fix’.  Although MACRA is know for repealing the Sustainable Growth Rate (SGR) provisions that would have significantly cut physicians salaries (but was reversed every December), there are other provisions. Although physicians may take comfort in avoiding the year end doc […]

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Patient Reported Quality

Should doctors financial incentives be tied to patient perceptions of quality?  Some physicians are reluctant for this to happen.  Paula Chatterjee and co-authors, however, argue that patient satisfaction should play a role in how incentives tied to value-based care are measured. Although I do not disagree with Chatterjee, it is not clear how patient perceptions of […]

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How useful are health rankings?

According to an HSR editorial by Stephan Arndt, the answer is not very.  Generally, county level health rankings are too variable to be of much use.  Further, while some metropolitan regions may have large sample sizes, the sample sizes in less densely populated rural counties will be far lower leading to less precise estimates of any […]

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Quality Adjusted Cost of Care Analysis

The health care industry should take into account outcomes when weighing the cost of new treatments and technologies and make quality-adjusted life years (QALYs) part of the equation, say the authors of a study in the April issue of Health Affairs. This is the begining of an article in Managed Care Magazine that reviews a […]

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Narrow Networks

One of the ways health plans in the health insurance exchanges have been able to keep premiums down is through offering beneficiaries very narrow networks. By steering patients towards “efficient” doctors, premiums stay low. However, patients may worry that these “low cost” doctors are lower quality than those outside of the network. The tradeoff between […]

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Quality and Quality of Life

There have been numerous efforts to measure quality of health care, especially among the elderly.  For instance, Nursing Home Compare measures of quality of care for nursing homes.  However, these quality measures focus on health and safety.  They do not measure quality of life.  Atul Gawande’s book Being Mortal describes why nursing homes focus more on […]

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Do quality rankings matter?

There have many policy initiatives to measure and improve quality of care.  For instances, NCQA’s HEDIS measure are the most widely used quality measures among commercial insurers.  Since employers generally choose insurance plans for employees (or at least select the menu of insurance options for employees), one would expect that employers would look for high […]

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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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