Unbiased Analysis of Today's Healthcare Issues

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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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 […]

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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 […]

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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. […]

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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 […]

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