National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Arthritis (1)
- Cancer (1)
- Cancer: Prostate Cancer (2)
- Cardiovascular Conditions (1)
- Disabilities (1)
- Elderly (5)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
- (-) Healthcare Costs (19)
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- Patient-Centered Healthcare (1)
- Payment (5)
- Pneumonia (1)
- Policy (4)
- Primary Care (1)
- Provider: Physician (1)
- Provider Performance (1)
- Quality Indicators (QIs) (1)
- Quality of Care (1)
- Rural Health (1)
- Surgery (3)
- Transitions of Care (1)
- Vulnerable Populations (1)
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
1 to 19 of 19 Research Studies DisplayedSheetz KH, Ibrahim AM, Regenbogen SE
Surgeon experience and Medicare expenditures for laparoscopic compared to open colectomy.
This population-based study examined whether surgeon experience with laparoscopy influenced payments for laparoscopy versus open surgery colectomies. The study used 182,852 national Medicare beneficiaries undergoing colectomies between 2010 and 2012. Surgeons with the most laparoscopic experience did experience an average payment savings of $5456 per patient in laparoscopic versus open cases. For surgeons in the lowest quartile of experience there was no difference.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Ibrahim AM, Regenbogen SE .
Surgeon experience and Medicare expenditures for laparoscopic compared to open colectomy.
Ann Surg 2018 Dec;268(6):1036-42. doi: 10.1097/sla.0000000000002312..
Keywords: Elderly, Surgery, Medicare, Healthcare Costs, Provider: Physician
Makam AN, Nguyen OK, Kirby B
Effect of site-neutral payment policy on long-term acute care hospital use.
The purpose of this study was to assess the projected effect of the Centers for Medicare and Medicaid Services new site-neutral payment policy, which aims to decrease unnecessary long-term acute care hospital (LTACH) admissions by reducing reimbursements for less-ill individuals by 2020. The investigators concluded that the site-neutral payment policy may limit LTACH access in existing LTAC-scarce markets, with potential adverse implications for recovery of hospitalized older adults.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Kirby B .
Effect of site-neutral payment policy on long-term acute care hospital use.
J Am Geriatr Soc 2018 Nov;66(11):2104-11. doi: 10.1111/jgs.15539..
Keywords: Policy, Hospitalization, Payment, Long-Term Care, Healthcare Costs, Medicare, Elderly, Hospitals
Schulz J, DeCamp M, Berkowitz ASA
Spending patterns among Medicare ACOs that have reduced costs.
This study aimed to examine whether specific cost categories were disproportionately affected by accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) achieving overall spending reductions, and whether there were demonstrable differences in spending patterns between "low"- or "high"-cost ACOs. The investigators found that initial success in reducing the cost of care has been driven by reductions in inpatient costs due to a decline in the volume of patients admitted.
AHRQ-funded; HS023684.
Citation: Schulz J, DeCamp M, Berkowitz ASA .
Spending patterns among Medicare ACOs that have reduced costs.
J Healthc Manag 2018 Nov-Dec;63(6):374-81. doi: 10.1097/jhm-d-17-00178..
Keywords: Healthcare Costs, Medicare
Yazdany J, Dudley RA, Lin GA
Out-of-pocket costs for infliximab and its biosimilar for rheumatoid arthritis under Medicare Part D.
This paper discusses the out-of-pocket costs for infliximab and its biosimilar for rheumatoid arthritis under Medicare Part D. The investigators analyzed nationwide benefit design data for all Part D plans from the June 2017 Medicare Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files to calculate mean total cost and out-of-pocket cost requirements for infliximab-dyyb and infliximab assuming a standard 8-week dosing regimen.
AHRQ-funded; HS016772.
Citation: Yazdany J, Dudley RA, Lin GA .
Out-of-pocket costs for infliximab and its biosimilar for rheumatoid arthritis under Medicare Part D.
JAMA 2018 Sep 4;320(9):931-33. doi: 10.1001/jama.2018.7316..
Keywords: Healthcare Costs, Health Insurance, Medicare, Medication, Arthritis
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
Pelech D
Paying more for less? Insurer competition and health plan generosity in the Medicare Advantage program.
This paper explored the relationship between insurer competition and health plan benefit generosity by examining the impact of a regulatory change that caused the cancellation of 40% of the private plans in Medicare. The investigator found that insurers in markets affected by cancellation reduced the benefit generosity of the plans remaining in the market.
AHRQ-funded; HS023477; HS000055.
Citation: Pelech D .
Paying more for less? Insurer competition and health plan generosity in the Medicare Advantage program.
J Health Econ 2018 Sep;61:77-92. doi: 10.1016/j.jhealeco.2018.07.002..
Keywords: Healthcare Costs, Health Insurance, Medicare, Policy
Bindman AB, Cox DF
AHRQ Author: Bindman AB
Changes in health care costs and mortality associated with transitional care management services after a discharge among Medicare beneficiaries.
Medicare adopted transitional care management (TCM) payment codes in 2013 to encourage clinicians to furnish TCM services after beneficiaries were discharged to the community from medical facilities. The purpose of this study was to investigate whether the receipt of TCM services was associated with the subsequent health care costs and mortality of the beneficiaries in the month after the service was provided. The study concluded that despite the apparent benefits of TCM services for Medicare beneficiaries, the use of this service remains low.
AHRQ-authored.
Citation: Bindman AB, Cox DF .
Changes in health care costs and mortality associated with transitional care management services after a discharge among Medicare beneficiaries.
JAMA Intern Med 2018 Sep;178(9):1165-71. doi: 10.1001/jamainternmed.2018.2572..
Keywords: Healthcare Costs, Hospital Discharge, Medicare, Mortality, Transitions of Care
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
Comfort LN, Shortell SM, Rodriguez HP
Medicare accountable care organizations of diverse structures achieve comparable quality and cost performance.
The purpose of this study was to examine whether an empirically derived taxonomy of Accountable Care Organizations (ACOs) was associated with quality and spending performance among patients of ACOs in the Medicare Shared Savings Program (MSSP). The investigators found that there was greater heterogeneity within ACO types than between ACO types; there were no consistent differences in quality by ACO type, nor were there differences in likelihood of achieving savings or overall spending per-person-year; and was evidence for higher spending on physician services for physician-led ACOs.
AHRQ-funded; HS024075.
Citation: Comfort LN, Shortell SM, Rodriguez HP .
Medicare accountable care organizations of diverse structures achieve comparable quality and cost performance.
Health Serv Res 2018 Aug;53(4):2303-23. doi: 10.1111/1475-6773.12829..
Keywords: Medicare, Healthcare Costs, Quality Indicators (QIs), Quality of Care
Modi PK, Kaufman SR, Borza T
Variation in prostate cancer treatment and spending among Medicare shared savings program accountable care organizations.
This study assessed whether the level of engagement in accountable care organizations (ACOs) by urologists affected rates of treatment, overtreatment, and spending. The investigators found that ACOs vary widely in treatment, potential overtreatment, and spending for prostate cancer. ACOs with stronger urologist engagement were less likely to treat men with a high risk of noncancer mortality, and this suggests that organizations that better engage specialists may be able to improve the value of specialty care.
AHRQ-funded; HS024728; HS025707; HS024525.
Citation: Modi PK, Kaufman SR, Borza T .
Variation in prostate cancer treatment and spending among Medicare shared savings program accountable care organizations.
Cancer 2018 Aug;124(16):3364-71. doi: 10.1002/cncr.31573..
Keywords: Cancer: Prostate Cancer, Healthcare Costs, Healthcare Utilization, Medicare
Toth M, Holmes M, Toles M
Impact of postdischarge follow-up care on Medicare expenditures: does rural make a difference?
Reducing postdischarge Medicare expenditures is a key focus for hospitals. Early follow-up care is an important piece of this focus, but it is unclear whether there are rural-urban differences in the impact of follow-up care on Medicare expenditures. To assess this difference, the study authors used Medicare Current Beneficiary Survey, Cost and Use Files, 2000-2010 to conduct a retrospective analysis of 30-day postdischarge Medicare expenditures using two-stage residual inclusion with a quantile regression, where the receipt of 7-day follow-up care was the main independent variable.
AHRQ-funded; HS000032.
Citation: Toth M, Holmes M, Toles M .
Impact of postdischarge follow-up care on Medicare expenditures: does rural make a difference?
Med Care Res Rev 2018 Jun;75(3):327-53. doi: 10.1177/1077558716687499.
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Keywords: Healthcare Costs, Hospital Discharge, Medicare, Rural Health
Nathan H, Thumma JR, Norton EC
Strategies for reducing population surgical costs in Medicare: local referrals to low-cost hospitals.
An analysis was done of hospital cost variations for elective inpatient surgery in a small geographic area. Medicare payment data was used to calculate 30-day surgical episode costs for elderly patients undergoing 1 of 7 elective surgeries during 2010-2012. The highest and lowest cost hospitals were identified in their metropolitan statistical area. It was found that high-cost hospitals had higher complication and readmission rates than their lower-cost peers. Medicare expenditures at the high-cost hospitals were $4424 to $10,417 higher than the lowest-cost hospitals.
AHRQ-funded; HS024763.
Citation: Nathan H, Thumma JR, Norton EC .
Strategies for reducing population surgical costs in Medicare: local referrals to low-cost hospitals.
Ann Surg 2018 May;267(5):878-85. doi: 10.1097/sla.0000000000002340..
Keywords: Elderly, Healthcare Costs, Hospitals, Medicare, Surgery
Henke RM, Karaca Z, Gibson TB
AHRQ Author: Karaca Z, Wong HS
Medicare Advantage penetration and hospital costs before and after the Affordable Care Act.
This study investigated the relationship between Medicare Advantage (MA) program growth and inpatient hospital costs and utilization before and after the ACA. Its results suggest that MA enrollment growth is associated with diminished spillover reductions in hospital admission costs after the ACA. Researchers did not observe a strong relationship between MA enrollment and inpatient days per enrollee
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Henke RM, Karaca Z, Gibson TB .
Medicare Advantage penetration and hospital costs before and after the Affordable Care Act.
Med Care 2018 Apr;56(4):321-28. doi: 10.1097/mlr.0000000000000885.
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Keywords: Healthcare Costs, Policy, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Medicare
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
Keohane LM, Trivedi AN, Mor V
The role of Medicare's inpatient cost-sharing in Medicaid entry.
This study sought to isolate the effect of greater inpatient cost-sharing on Medicaid entry among Medicare beneficiaries. It concluded that Increasing Medicare cost-sharing requirements may promote Medicaid enrollment among low-income beneficiaries. Potential savings from an increased cost-sharing in the Medicare program may be offset by increased Medicaid participation.
AHRQ-funded; HS023016.
Citation: Keohane LM, Trivedi AN, Mor V .
The role of Medicare's inpatient cost-sharing in Medicaid entry.
Health Serv Res 2018 Apr;53(2):711-29. doi: 10.1111/1475-6773.12682.
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Keywords: Healthcare Costs, Inpatient Care, Medicaid, Medicare
Olszewski AJ, Zullo AR, Nering CR
Use of charity financial assistance for novel oral anticancer agents.
Novel oral targeted drugs are increasingly used for cancer therapy, but their extreme cost, often exceeding $10,000 per month, poses a significant barrier for patients and insurers alike. The findings findings of this study indicate that high out-of-pocket burden for expensive novel oral anticancer drugs leads to widespread use of charity support in the United States and that a significant financial barrier disparately affects older Medicare beneficiaries.
AHRQ-funded; HS022998.
Citation: Olszewski AJ, Zullo AR, Nering CR .
Use of charity financial assistance for novel oral anticancer agents.
J Oncol Pract 2018 Apr;14(4):e221-e28. doi: 10.1200/jop.2017.027896.
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Keywords: Cancer, Elderly, Healthcare Costs, Medicare, Medication
Desai S, McWilliams JM
Consequences of the 340B drug pricing program.
Researchers used Medicare claims and a regression-discontinuity design, taking advantage of the threshold for program eligibility among general acute care hospitals to isolate the effects of the 340B Drug Pricing Program on hospital-physician consolidation and on the outpatient administration of parenteral drugs. They concluded that the Program has been associated with hospital-physician consolidation in hematology-oncology and with more hospital-based administration of parenteral drugs in hematology-oncology and ophthalmology.
AHRQ-funded; HS024072.
Citation: Desai S, McWilliams JM .
Consequences of the 340B drug pricing program.
N Engl J Med 2018 Feb 8;378(6):539-48. doi: 10.1056/NEJMsa1706475.
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Keywords: Healthcare Costs, Payment, Hospitals, Medicare, Medication
Borza T, Kaufman SR, Yan P
Early effect of Medicare Shared Savings Program accountable care organization participation on prostate cancer care.
The purpose of this study was to understand the effect of Medicare Shared Savings Program accountable care organizations (ACOs) on prostate cancer care. The authors found that the treatment of prostate cancer and annual payments decreased significantly between 2010 and 2013, but ACO participation did not appear to impact these trends. Among men least likely to benefit, Medicare Shared Savings Program ACO alignment was associated with a significant decline in prostate cancer treatment.
AHRQ-funded; HS024728; HS024525.
Citation: Borza T, Kaufman SR, Yan P .
Early effect of Medicare Shared Savings Program accountable care organization participation on prostate cancer care.
Cancer 2018 Feb 1;124(3):563-70. doi: 10.1002/cncr.31081..
Keywords: Cancer: Prostate Cancer, Healthcare Costs, Medicare
Lewis VA, D'Aunno T, Murray GF
The hidden roles that management partners play in accountable care organizations.
This study sought to understand the prevalence of nonprovider management partners' involvement in accountable care organizations (ACOs), the services these partners provide, and the structure of ACOs that have such partners. It found that 37 percent of ACOs reported having a management partner, and two-thirds of these ACOs reported that the partner shared in the financial risks or rewards..
AHRQ-funded; HS024075.
Citation: Lewis VA, D'Aunno T, Murray GF .
The hidden roles that management partners play in accountable care organizations.
Health Aff 2018 Feb;37(2):292-98. doi: 10.1377/hlthaff.2017.1025.
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Keywords: Medicare, Policy, Health Insurance, Healthcare Costs