National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
101 to 125 of 201 Research Studies DisplayedModi PK, Kaufman SR, Qi J
National trends in active surveillance for prostate cancer: validation of medicare claims-based algorithms.
This study analyzed the use of active surveillance of low-risk prostate cancer among a wide variety of health care practices. Researchers identified men with prostate cancer from 2012-2014 using a 100% sample of Michigan Medicare data and linked them with the Michigan Urologic Surgery Improvement Collaborative (MUSIC) registry. They analyzed the performance of 8 claims-based algorithms that were used and selected 3 of them to apply to a 20% national Medicare sample. The 3 algorithms were determined to be either the most sensitive, the most specific, and a balanced algorithm incorporating age and comorbidity. They found that use of surveillance for men increased from 2007 to 2014 but there was a large decrease in the rate of prostate cancer diagnosis. The rate of active surveillance either increased or remained stable depending on the algorithm used.
AHRQ-funded; HS025707.
Citation: Modi PK, Kaufman SR, Qi J .
National trends in active surveillance for prostate cancer: validation of medicare claims-based algorithms.
Urology 2018 Oct;120:96-102. doi: 10.1016/j.urology.2018.06.037..
Keywords: Cancer, Cancer: Prostate Cancer, Medicare, Men's Health, Payment
Yokoe DS, Avery TR, Platt R
Ranking hospitals based on colon surgery and abdominal hysterectomy surgical site infection outcomes: impact of limiting surveillance to the operative hospital.
This study examined how hospitals are ranked based on colon surgery and abdominal surgical site infection (SSI) outcomes. This ranking can impact how financial penalties are determined. Currently SSI surveillance focuses mainly on the operative hospital, but patients sometimes go to a different hospital after an SSI as opposed to readmission in the operative hospital. The authors used data from a California statewide hospital registry to assess for evidence of SSI for surgeries performed from March 2011 through November 2013. This analysis showed show that operational hospital surveillance alone would have missed 7.2% of colon surgery and 13.4% of abdominal hysterectomy SSIs. This leads to an inaccurate assignment or avoidance of financial penalties for approximately 1 in 11-16 hospitals.
AHRQ-funded; HS021424.
Citation: Yokoe DS, Avery TR, Platt R .
Ranking hospitals based on colon surgery and abdominal hysterectomy surgical site infection outcomes: impact of limiting surveillance to the operative hospital.
Clin Infect Dis 2018 Sep 14;67(7):1096-102. doi: 10.1093/cid/ciy223..
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Infectious Diseases, Injuries and Wounds, Adverse Events, Hospitals, Payment, Patient Safety, Provider Performance
Thompson MP, Cabrera L, Strobel RJ
Association between postoperative pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery.
Postoperative pneumonia is the most common healthcare-associated infection in cardiac surgical patients, yet their impact across a 90-day episode of care remains unknown. The objective of this study was to examine the relationship between pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery. The investigators concluded that postoperative pneumonia was associated with significantly higher 90-day episode payments and inferior outcomes at the patient and hospital level.
AHRQ-funded; HS022535.
Citation: Thompson MP, Cabrera L, Strobel RJ .
Association between postoperative pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery.
Circ Cardiovasc Qual Outcomes 2018 Sep;11(9):e004818. doi: 10.1161/circoutcomes.118.004818..
Keywords: Elderly, Surgery, Medicare, Cardiovascular Conditions, Heart Disease and Health, Pneumonia, Payment, Healthcare Costs, Outcomes, Healthcare-Associated Infections (HAIs), Health Insurance
Whaley CM, Brown TT
Firm responses to targeted consumer incentives: evidence from reference pricing for surgical services.
This study examined how health care providers respond to a reference pricing insurance program that increases consumer cost sharing when they chose high-priced surgical providers. Geographic variation was used to estimate supply-side responses. Limited evidence of market segmentation and price reductions for providers with baseline prices above the reference price was found. However, 75% of the reduction in provider prices benefited a population that was not subject to the program.
AHRQ-funded; HS022098.
Citation: Whaley CM, Brown TT .
Firm responses to targeted consumer incentives: evidence from reference pricing for surgical services.
J Health Econ 2018 Sep;61:111-33. doi: 10.1016/j.jhealeco.2018.06.012..
Keywords: Health Insurance, Surgery, Payment, Healthcare Costs
Rhee C, Wang R, Jentzsch MS
Impact of the 2012 Medicaid health care-acquired conditions policy on catheter-associated urinary tract infection and vascular catheter-associated infection billing rates.
This study examines the impact of the 2012 Medicaid health care-acquired conditions policy on catheter-associated urinary tract infection and vascular catheter-associated infection billing rates. The investigators found no impact of the policy on rates of the two conditions among Medicaid or non-Medicaid patients.
AHRQ-funded; HS025008; HS018414; HS000063.
Citation: Rhee C, Wang R, Jentzsch MS .
Impact of the 2012 Medicaid health care-acquired conditions policy on catheter-associated urinary tract infection and vascular catheter-associated infection billing rates.
Open Forum Infect Dis 2018 Sep;5(9):ofy204. doi: 10.1093/ofid/ofy204..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Medicaid, Payment, Policy
Sen AP, Chen LM, Wong Samson L
Performance in the Medicare Shared Savings Program by accountable care organizations disproportionately serving dual and disabled populations.
The purpose of this study was to examine performance by accountable care organizations (ACOs) in the top quintile of their proportion of beneficiaries who were dually enrolled in Medicare and Medicaid (high-dual), and the top quintile of disabled beneficiaries (high-disabled). Measures used were quality scores, savings per beneficiary, whether or not the ACO shared savings and the amount of shared savings. The researchers found that high-dual and high-disabled ACOs had similar or higher spending than other ACOs at baseline, but achieved greater savings and were equally or more likely to earn shared savings; alternative payment models can have positive financial outcomes for providers serving vulnerable populations.
AHRQ-funded; HS024698.
Citation: Sen AP, Chen LM, Wong Samson L .
Performance in the Medicare Shared Savings Program by accountable care organizations disproportionately serving dual and disabled populations.
Med Care 2018 Sep;56(9):805-11. doi: 10.1097/mlr.0000000000000968..
Keywords: Disabilities, Medicare, Healthcare Costs, Provider Performance, Payment, Low-Income, Vulnerable Populations
Hollingsworth JM, Oerline MK, Ellimoottil C
Effects of the Medicare Modernization Act on spending for outpatient surgery.
The objective of the study was to examine the effects of Medicare's revised ambulatory surgery center (ASC) payment schedule on overall payments for outpatient surgery. The study concluded that despite lessening demand, reduced ASC facility payments did not curb spending for outpatient surgery. In fact, overall payments actually increased following the policy change, driven by higher average episode payments.
AHRQ-funded; HS024525; HS024728.
Citation: Hollingsworth JM, Oerline MK, Ellimoottil C .
Effects of the Medicare Modernization Act on spending for outpatient surgery.
Health Serv Res 2018 Aug;53 Suppl 1:2858-69. doi: 10.1111/1475-6773.12807..
Keywords: Payment, Policy, Ambulatory Care and Surgery, Surgery
Markovitz AA, Ramsay PP, Shortell SM
Financial incentives and physician practice participation in Medicare's value-based reforms.
The purpose of this study was to evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary value-based payment reforms. The authors concluded that Medicare must complement financial incentives with additional efforts to address the needs of practices with less experience with such incentives to promote value-based payment on a broader scale.
AHRQ-funded; HS018546.
Citation: Markovitz AA, Ramsay PP, Shortell SM .
Financial incentives and physician practice participation in Medicare's value-based reforms.
Health Serv Res 2018 Aug;53 Suppl 1:3052-69. doi: 10.1111/1475-6773.12743..
Keywords: Payment, Medicare, Provider Performance
Sinha SS, Moloci NM, Ryan AM
The effect of Medicare accountable care organizations on early and late payments for cardiovascular disease episodes.
In this study, the investigators examined the association between Medicare accountable care organization (ACO) implementation and episode spending for 2 different cardiovascular conditions. The investigators found that for beneficiaries with acute myocardial infarction or congestive heart failure, admission to ACO participating hospitals was not associated with changes in early episode spending, but it was associated with significant savings during the late episode. ACO effects on late episode spending may complement other value-based payment reforms that target the early episode.
AHRQ-funded; HS024728; HS024525.
Citation: Sinha SS, Moloci NM, Ryan AM .
The effect of Medicare accountable care organizations on early and late payments for cardiovascular disease episodes.
Circ Cardiovasc Qual Outcomes 2018 Aug;11(8):e004495. doi: 10.1161/circoutcomes.117.004495..
Keywords: Cardiovascular Conditions, Payment, Medicare
Holmgren AJ, Adler-Milstein J, Chen LM
Participation in a voluntary bundled payment program by organizations providing care after an acute hospitalization
This research letter addresses spending on post–acute care (PAC), or care provided after a stay in an acute care hospital. PAC is the largest driver of variation in total per capita Medicare spending. To address this, Medicare has targeted PAC spending in payment reforms including voluntary bundled payment programs. This letter discusses participation in these voluntary payment programs.
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AHRQ-funded; HS024698
Citation: Holmgren AJ, Adler-Milstein J, Chen LM .
Participation in a voluntary bundled payment program by organizations providing care after an acute hospitalization
JAMA 2018 Jul 24;320(4):402-04. doi: 10.1001/jama.2018.8666..
Keywords: Payment, Health Services Research (HSR), Health Services Research (HSR), Hospitalization, Medicare
Ouayogode MH, Meara E, Chang CH
Forgotten patients: ACO attribution omits those with low service use and the dying.
Alternative payment models, such as accountable care organizations, hold provider groups accountable for an assigned patient population, but little is known about unassigned patients. This study compared clinical and utilization profiles of patients attributable to a provider group with those of patients not attributable to any provider group. The study concluded that attribution approaches that more fully capture unattributable patients with low service use and patients near the end of life should be considered to reward population health efforts and improve end-of-life care.
AHRQ-funded; HS024075.
Citation: Ouayogode MH, Meara E, Chang CH .
Forgotten patients: ACO attribution omits those with low service use and the dying.
Am J Manag Care 2018 Jul;24(7):e207-e15..
Keywords: Access to Care, Patient-Centered Outcomes Research, Payment, Vulnerable Populations
Decker SL
AHRQ Author: Decker SL
No association found between the Medicaid primary care fee bump and physician-reported participation in Medicaid.
The Affordable Care Act required states in 2013 and 2014 to raise Medicaid payment rates to primary care physicians for certain services to the level of Medicare rates. The result was an average 73 percent increase in primary care Medicaid payments for qualifying physicians. This study used nationally representative data to examine the association between this Medicaid "fee bump" and physician-reported measures of participation in Medicaid. No such association was found. The lack of a sizable change in measures of physician participation in Medicaid may have been due to the temporary nature of the fee bump.
AHRQ-authored.
Citation: Decker SL .
No association found between the Medicaid primary care fee bump and physician-reported participation in Medicaid.
Health Aff 2018 Jul;37(7):1092-98. doi: 10.1377/hlthaff.2018.0078..
Keywords: Healthcare Costs, Payment, Medicaid, Policy, Primary Care
McCurdy RK, Encinosa WE
AHRQ Author: Encinosa, WE
Are medical offices ready for value-based reimbursement? Staff perceptions of a workplace climate for value and efficiency.
The goal of the study was to assess medical office staff member perceptions of a workplace climate for value. The study’s findings highlight the need for management strategies that emphasize staff training and engagement and the use of performance data and that stress value principles across all organizational activities, including workforce development, performance management, and recruitment.
AHRQ-authored; AHRQ-funded
Citation: McCurdy RK, Encinosa WE .
Are medical offices ready for value-based reimbursement? Staff perceptions of a workplace climate for value and efficiency.
Am J Accountable Care 2018 Jun;6(2):11-19..
Keywords: Payment, Provider: Health Personnel
Perez V
Does capitated managed care affect budget predictability? Evidence from Medicaid programs.
This study is the first to test whether managed care enrollment reduces the variance of Medicaid spending, in contrast to the focus of the existing literature on spending levels. Although the majority of Medicaid enrollees are in managed care, the study shows that managed care use has been concentrated among the enrollees with the most stable spending, resulting in only small gains to budget predictability. Perez concludes that this finding is robust to the exclusion of the claims expenditures that exhibit the most variance.
AHRQ-funded; HS022797.
Citation: Perez V .
Does capitated managed care affect budget predictability? Evidence from Medicaid programs.
Int J Health Econ Manag 2018 Jun;18(2):123-52. doi: 10.1007/s10754-017-9227-7.
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Keywords: Healthcare Costs, Payment, Medicaid, Health Insurance
Hsu HE, Kawai AT, Wang R
The impact of the Medicaid healthcare-associated condition program on mediastinitis following coronary artery bypass graft.
This study aimed to evaluate the impact of a program that eliminated additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) to include Medicaid on mediastinitis rates reported by the National Healthcare Safety Network (NHSN). It found that the 2012 Medicaid program to eliminate additional payments for mediastinitis following CABG had no impact on reported mediastinitis rates.
AHRQ-funded; HS025008; HS018414; HS000063.
Citation: Hsu HE, Kawai AT, Wang R .
The impact of the Medicaid healthcare-associated condition program on mediastinitis following coronary artery bypass graft.
Infect Control Hosp Epidemiol 2018 Jun;39(6):694-700. doi: 10.1017/ice.2018.69.
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Keywords: Cardiovascular Conditions, Payment, Healthcare-Associated Infections (HAIs), Patient Safety, Surgery
Martin BI, Lurie JD, Farrokhi FR
Early effects of Medicare's Bundled Payment For Care Improvement program for lumbar fusion.
The purpose of this study was to describe the early effects of Bundled Payment for Care Improvement (BPCI) program participation for lumbar fusion on 90-day reimbursement, procedure volume, reoperation, and readmission. The investigators included 89,605 beneficiaries undergoing lumbar fusion, finding that the mean age was 73.4 years, with 59% women, 92% White, and 22% with a Charlson Comorbidity Index of 2 or more. Participant hospitals had greater procedure volume, bed size, and total discharges. Relative to nonparticipants, risk-bearing hospitals had a slightly increased fusion procedure volume from 2012 to 2013, did not reduce 90-day episode of care costs, increased 90-day readmission rate, and increased repeat surgery rates.
AHRQ-funded; HS024714; HS024075; HS021695.
Citation: Martin BI, Lurie JD, Farrokhi FR .
Early effects of Medicare's Bundled Payment For Care Improvement program for lumbar fusion.
Spine 2018 May 15;43(10):705-11. doi: 10.1097/brs.0000000000002404.
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Keywords: Payment, Medicare, Quality Improvement, Patient-Centered Outcomes Research, Surgery
Funk RJ, Owen-Smith J, Kaufman SA
Association of informal clinical integration of physicians with cardiac surgery payments.
This study examined how physician interaction patterns vary between health systems and to assess whether variation in informal integration is associated with care delivery payments. It found that when beneficiaries were treated in health systems with higher informal integration, the greatest savings of lower estimated payments were from hospital readmissions (13.0 percent) and postacute care services (5.8 percent).
AHRQ-funded; HS024728.
Citation: Funk RJ, Owen-Smith J, Kaufman SA .
Association of informal clinical integration of physicians with cardiac surgery payments.
JAMA Surg 2018 May;153(5):446-53. doi: 10.1001/jamasurg.2017.5150.
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Keywords: Healthcare Costs, Payment, Health Systems, Surgery
Eze-Ajoku E, Lavoie M, DeCamp M
Exploring the evidence base behind quality measures.
This study examined the strength of evidence behind quality measures used in Medicare’s 2016 Shared Savings Program. These measures apply to more than 430 accountable care organizations (ACOs). Differences existed in the grading systems used and the evidentiary strength. Based on average ACO performance, performance appeared to be lower in the moderate evidence category (overall average, 61 percent) compared to the high evidence category (overall average, 77 percent).
AHRQ-funded; HS023684.
Citation: Eze-Ajoku E, Lavoie M, DeCamp M .
Exploring the evidence base behind quality measures.
Am J Med Qual 2018 May/Jun;33(3):321-22. doi: 10.1177/1062860617721645.
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Keywords: Evidence-Based Practice, Medicare, Payment, Provider Performance, Quality Measures
Briggs ADM, Alderwick H, Fisher ES
Overcoming challenges to US payment reform: could a place-based approach help?
Place-based approaches are defined as giving health care organizations or systems some degree of responsibility for the health or care of all individuals living in a specific place, a geographically defined area such as a county, hospital referral region, or state. As the United States moves away from mandatory participation in payment reform, the current place-based reforms in England offer some useful insights for US policy makers.
AHRQ-funded; HS024075.
Citation: Briggs ADM, Alderwick H, Fisher ES .
Overcoming challenges to US payment reform: could a place-based approach help?
JAMA 2018 Apr 17;319(15):1545-46. doi: 10.1001/jama.2018.1542.
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Keywords: Payment, Policy, Quality Indicators (QIs)
Chen LM, Ryan AM, Shih T
Medicare's acute care episode demonstration: effects of bundled payments on costs and quality of surgical care.
This study evaluated whether participation in Medicare's Acute Care Episode (ACE) Demonstration Program-an early, small, voluntary episode-based payment program-was associated with a change in expenditures or quality of care. Participation in Medicare's ACE Demonstration Program was not associated with a change in 30-day episode-based Medicare payments or 30-day mortality for cardiac or orthopedic surgery, but it was associated with lower total 30-day post-acute care payments.
AHRQ-funded; HS018546; HS024698; HS020671.
Citation: Chen LM, Ryan AM, Shih T .
Medicare's acute care episode demonstration: effects of bundled payments on costs and quality of surgical care.
Health Serv Res 2018 Apr;53(2):632-48. doi: 10.1111/1475-6773.12681.
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Keywords: Healthcare Costs, Payment, Quality of Care, Surgery
da Graca B, Ogola GO, Fullerton C
Offsetting patient-centered medical homes investment costs through per-member-per-month or Medicare merit-based incentive payment system incentive payments.
The purpose of this study was to examine potential offsets through commercial payer per-member-per-month (PMPM) payments and the Medicare Merit-based Incentive Payment System (MIPS). The researchers found that with PMPM, breaking even required that 2.4% to 6.4% of commercially insured patients per physician to be covered; with MIPS incentive payments, they would exceed PCMH costs by 2022.
AHRQ-funded; HS022621.
Citation: da Graca B, Ogola GO, Fullerton C .
Offsetting patient-centered medical homes investment costs through per-member-per-month or Medicare merit-based incentive payment system incentive payments.
J Ambul Care Manage 2018 Apr/Jun;41(2):105-13. doi: 10.1097/jac.0000000000000224..
Keywords: Healthcare Costs, Medicare, Patient-Centered Healthcare, Payment, Primary Care
Colla CH, Morden NE, Sequist TD
Payer type and low-value care: comparing Choosing Wisely services across commercial and Medicare populations.
This study compared low-value health service use among commercially insured and Medicare populations and explored the influence of payer type on the provision of low-value care. In measuring use of seven Choosing Wisely-identified low-value services, it concluded that low-value care appears driven by factors unrelated to payer type or anticipated reimbursement.
AHRQ-funded; HS023812.
Citation: Colla CH, Morden NE, Sequist TD .
Payer type and low-value care: comparing Choosing Wisely services across commercial and Medicare populations.
Health Serv Res 2018 Apr;53(2):730-46. doi: 10.1111/1475-6773.12665.
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Keywords: Payment, Healthcare Utilization, Health Services Research (HSR), Medicare
Cohen DJ, Dorr DA, Knierim K
Primary care practices' abilities and challenges in using electronic health record data for quality improvement.
Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. This study concluded that the current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures.
AHRQ-funded; HS023940.
Citation: Cohen DJ, Dorr DA, Knierim K .
Primary care practices' abilities and challenges in using electronic health record data for quality improvement.
Health Aff 2018 Apr;37(4):635-43. doi: 10.1377/hlthaff.2017.1254.
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Keywords: Electronic Health Records (EHRs), Primary Care, Quality Improvement, Quality of Care, Health Information Technology (HIT), Payment
Gowrisankaran G, Lucarelli C, Schmidt-Dengler P
Can amputation save the hospital? The impact of the Medicare Rural Flexibility Program on demand and welfare.
This paper sought to understand the impact of the Medicare Rural Hospital Flexibility (Flex) Program on hospital choice and consumer welfare for rural residents. The Flex Program created a new class of hospital, the Critical Access Hospital (CAH), which received more generous Medicare reimbursements in return for limits on capacity and length of stay. The investigators found that conversion to CAH status resulted in a 4.7 percent drop in inpatient admissions to participating hospitals, almost all of which was driven by factors other than capacity constraints.
AHRQ-funded; HS018424.
Citation: Gowrisankaran G, Lucarelli C, Schmidt-Dengler P .
Can amputation save the hospital? The impact of the Medicare Rural Flexibility Program on demand and welfare.
J Health Econ 2018 Mar;58:110-22. doi: 10.1016/j.jhealeco.2018.01.004..
Keywords: Rural Health, Access to Care, Hospitals, Medicare, Payment
Riley AR, Grennan A, Menousek K
Pediatric primary care psychologists' reported level of integration, billing practices, and reimbursement frequency.
The aim of this study was to investigate the relationships between psychologists' reported billing practices, reimbursement rates, and model of integration in pediatric primary care. Survey results showed a clear pattern of higher integration being associated with greater utilization of health & behavior codes and better reimbursement for consultation activities.
AHRQ-funded; HS022981.
Citation: Riley AR, Grennan A, Menousek K .
Pediatric primary care psychologists' reported level of integration, billing practices, and reimbursement frequency.
Fam Syst Health 2018 Mar;36(1):108-12. doi: 10.1037/fsh0000306..
Keywords: Behavioral Health, Children/Adolescents, Payment, Primary Care, Provider