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
26 to 33 of 33 Research Studies DisplayedMroz TM, Patterson DG, Frogner BK
The impact of Medicare's rural add-on payments on supply of home health agencies serving rural counties.
This analysis looked at the impact of Medicare’s rural add-on payments on supply of home health agencies serving rural counties. The authors used data from Home Health Compare. The results suggest that while supply changes are similar in rural counties adjacent to urban areas and urban counties regardless of add-on payments, only higher add-payments of 5 to 10 percent to rural counties keep them on pace with those in urban counties.
AHRQ-funded; HS024777.
Citation: Mroz TM, Patterson DG, Frogner BK .
The impact of Medicare's rural add-on payments on supply of home health agencies serving rural counties.
Health Aff 2020 Jun;39(6):949-57. doi: 10.1377/hlthaff.2019.00952..
Keywords: Elderly, Medicare, Home Healthcare, Rural Health, Payment, Access to Care
Dekhne MS, Nuliyalu U, Schoenfeld AJ
"Surprise" out-of-network billing in orthopedic surgery: charges from surprising sources.
This study examined “surprise” out-of-network billing in orthopedic surgery. Data was analyzed from the Clinformatics DataMart on commercial insured patients undergoing 4 different elective orthopedic procedures from 2012 to 2017: arthroscopic meniscal repair, lumbar discectomy, total knee replacement and total hip replacement. They defined surprise bills as out-of-network bills for procedures done at in-network hospitals. The rate of potential surprise bills was 24.8% for total knee replacement, 24.5% lumbar discectomy, 23.5% for total hip replacement, and 12.5% for meniscal repair. The largest number of surprise bills came from anesthesiologists (39% of all episodes), and durable medical equipment (15%). Per episode, the largest bills came from nonphysician surgical assistants, neurologists, and physician assistants.
AHRQ-funded; HS000053; HS023597.
Citation: Dekhne MS, Nuliyalu U, Schoenfeld AJ .
"Surprise" out-of-network billing in orthopedic surgery: charges from surprising sources.
Ann Surg 2020 May;271(5):e116-e18. doi: 10.1097/sla.0000000000003825..
Keywords: Orthopedics, Surgery, Payment, Healthcare Costs, Health Insurance
Hoffman GJ, Yakusheva O
Association between financial incentives in Medicare's hospital readmissions reduction program and hospital readmission performance.
This study compared the outcome of penalties versus rewards to prevent hospital readmission in Medicare’s Hospital Readmissions Reduction Program (HRRP). This retrospective cohort study used Medicare readmissions data from 2823 US short-term acute care hospitals participating in HRRP. Data from pre-HRRP in 2016 was compared with 2016-2019 3-year follow-up readmission performance classified by tertile of hospitals using baseline marginal incentives for 5 HRRP-targeted conditions: acute myocardial infarction (AMI), heart failure, chronic obstructive pulmonary disease (COPD), pneumonia, and hip and/or knee surgery. Of the 2823 hospitals participating in HRRP from baseline to follow-up, 81% had more than 1 excess readmission for 1 or more applicable condition and 19% did not. Financial incentives ranged from a mean range of $8762 to $58,158 per 1 avoided readmission. Hospitals with greater incentives for readmission avoidance had greater decreases than hospitals with smaller incentives. An additional $5000 in the incentive amount was associated with up to a 26% decrease in readmissions. The findings suggest that incentives work better than penalties to reduce hospital readmissions for those 5 conditions.
AHRQ-funded; HS025838.
Citation: Hoffman GJ, Yakusheva O .
Association between financial incentives in Medicare's hospital readmissions reduction program and hospital readmission performance.
JAMA Netw Open 2020 Apr;3(4):e202044. doi: 10.1001/jamanetworkopen.2020.2044..
Keywords: Medicare, Hospital Readmissions, Provider Performance, Payment, Health Insurance, Hospitals
Ouayogode MH, Fraze T, Rich EC
Association of organizational factors and physician practices' participation in alternative payment models.
Researchers examined the association of organizational characteristics, ownership, and integration with intensity of participation in alternative payment models (APMs) among physician practices. They conducted a cross-sectional descriptive study, adjusted for sampling and nonresponse weights, in U.S. physician practice respondents to the National Survey of Healthcare Organizations and Systems. Their results found that greater APM participation appears to be supported by integration and system ownership.
AHRQ-funded; HS24075.
Citation: Ouayogode MH, Fraze T, Rich EC .
Association of organizational factors and physician practices' participation in alternative payment models.
JAMA Netw Open 2020 Apr;3(4):e202019. doi: 10.1001/jamanetworkopen.2020.2019.
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Keywords: Payment
Chen LM, Samson LW, Zuckerman RB
Challenges of measuring costs of care for US practices.
Investigators sought to describe the feasibility of applying claims-based cost measures included in Merit-based Incentive Payment System (MIPS) to practices nationwide, and to assess whether feasibility varies by practice size or specialty mix. They found that most practices that qualify for MIPS are small, specialist-only practices that are unable to meet minimum case requirements for MIPS’ two required cost measures, due to a combination of size and provider mix, suggesting that clinicians in small, specialist-only practices are less likely to be evaluated on cost. They stressed the importance of identifying alternative approaches to ensure that value - both quality and cost - is rewarded.
AHRQ-funded; HS024698.
Citation: Chen LM, Samson LW, Zuckerman RB .
Challenges of measuring costs of care for US practices.
J Gen Intern Med 2020 Apr;35(4):1320-22. doi: 10.1007/s11606-019-05233-x..
Keywords: Healthcare Costs, Payment
Finch DJ, Pellegrini VD, Franklin PD
The effects of bundled payment programs for hip and knee arthroplasty on patient-reported outcomes.
This study compared outcomes for patients undergoing hip and knee arthroplasty at hospitals participating in Medicare’s bundled payment programs with hospitals that do not. They performed a prospective observational study using the Comparative Effectiveness of Pulmonary Embolism Prevention after Hip and Knee replacement trial. Differences through 6 months were observed. Outcomes were described using the brief Knee Injury and Osteoarthritis Outcomes Score or the brief Hip Disability and Osteoarthritis Outcomes Score, the Patient-Reported Outcomes Measurement Information System Physical Health Score, and the Numeric Pain Rating Scale. While there slightly lower improvement at nonbundled hospitals at first, overall the effects were small.
Citation: Finch DJ, Pellegrini VD, Franklin PD .
The effects of bundled payment programs for hip and knee arthroplasty on patient-reported outcomes.
J Arthroplasty 2020 Apr;35(4):918-25.e7. doi: 10.1016/j.arth.2019.11.028..
Keywords: Orthopedics, Surgery, Payment
Rathi VK, McWilliams JM, Roberts ET
Rathi VK, McWilliams JM, Roberts ET. Getting incentives right in payment reform: thinking beyond financial risk.
In this paper the authors discuss payment reform, global budget models and why incentives differ for health system versus physician group ACO’s. They indicate that incentives in new payment models are closely connected to the structure of the health care delivery system and that policies that ignore this relationship and focus only on the risk terms of payment contracts may miss opportunities for progress.
AHRQ-funded; HS026727.
Citation: Rathi VK, McWilliams JM, Roberts ET .
Rathi VK, McWilliams JM, Roberts ET. Getting incentives right in payment reform: thinking beyond financial risk.
Ann Intern Med 2020 Mar 17;172(6):423-24. doi: 10.7326/m19-3178..
Keywords: Healthcare Costs, Policy, Payment
Selden TM
AHRQ Author: Selden TM
Differences between public and private hospital payment rates narrowed, 2012-16.
In 2000-12 payments for inpatient hospital stays, emergency department visits, and outpatient hospital care for privately insured patients grew much faster than payments for Medicare and Medicaid patients. This widening of private-public payment gaps slowed or even reversed itself in 2012-16. In this paper, the author discusses the differences between public and private hospital payment rates, 2012-2016.
AHRQ-authored.
Citation: Selden TM .
Differences between public and private hospital payment rates narrowed, 2012-16.
Health Aff 2020 Jan;39(1):94-99. doi: 10.1377/hlthaff.2019.00415..
Keywords: Medical Expenditure Panel Survey (MEPS), Hospitals, Payment, Healthcare Costs, Medicaid, Medicare