Unbiased Analysis of Today's Healthcare Issues

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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Core Quality Measures

One challenge providers have faced in the past is that quality measure reporting has been complex.  Medicare may ask for quality measures with one definition, commercial payers may define quality a second way, and Medicaid may ask for a third definition of quality.  Keeping track of these definitions and recording quality measures distracts providers from actually providing quality […]

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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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