National Healthcare Quality and Disparities Report
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 5 of 5 Research Studies DisplayedRoberts ET, Nimgaonkar A, Aarons J
New evidence of state variation in Medicaid payment policies for dual Medicare-Medicaid enrollees.
The authors developed the first longitudinal database of state Medicaid policies for paying the cost sharing in Medicare Part B for services provided to dual Medicare-Medicaid enrollees (duals), and an index summarizing the impact of these policies on payments for physician office services. Information from 2004-2018 was consolidated from online Medicaid policy documents, state laws, and policy data reported to them by state Medicaid programs. The database showed that in 2018 42 states had policies to limit Medicaid payments of Medicare cost sharing when Medicaid’s fee schedule was lower than Medicare’s. This was an increase from 36 such states in 2004. In most states, combined Medicare and Medicare payments for evaluation and management services provided to duals averaged 78% of the Medicare allowed amount for these services.
AHRQ-funded; HS026727.
Citation: Roberts ET, Nimgaonkar A, Aarons J .
New evidence of state variation in Medicaid payment policies for dual Medicare-Medicaid enrollees.
Health Serv Res 2020 Oct;55(5):701-09. doi: 10.1111/1475-6773.13545..
Keywords: Medicaid, Medicare, Payment, Policy, Healthcare Costs, Health Insurance
Apathy NC, Everson J
High rates of partial participation in the first year of the merit-based incentive payment system.
This article discusses concerns over the implementation of the Merit-based Incentive Payment System (MIPS) for clinicians, which was authorized with the Medicare Access and CHIP Reauthorization Act of 2015. Data was analyzed from 2017, the first implementation year of MIPS. The authors found that although 90% of participating clinicians reported performance equal to or better than the lower performance threshold of 3 out of 100, almost half of clinicians did not participate in at least one of the three program categories. Even with the low participation rate, 74% of clinicians who only partially participated in the program received positive payment adjustments. The findings underline concerns that the design may have been too flexible to effectively incentivize clinicians to make incremental progress across all targeted aspects of the program (quality, advancing care information, and improvement activities).
AHRQ-funded; K12 HS026395.
Citation: Apathy NC, Everson J .
High rates of partial participation in the first year of the merit-based incentive payment system.
Health Aff 2020 Sep;39(9):1513-21. doi: 10.1377/hlthaff.2019.01648..
Keywords: Payment, Medicare, Medicaid, Children's Health Insurance Program (CHIP), 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
Jacobs PD, Molloy E
AHRQ Author: Jacobs PD
How do Medicare Advantage beneficiary payments vary with tenure?
This study compared how premiums and expected out-of-pocket medical costs (OOPC) vary with the length of time Medicare Advantage (MA) beneficiaries have been enrolled in their plans. Beneficiaries who remained in their plans for 6 or more years were paying $786 more than they would have spent in the lowest-cost plan compared with $552 for beneficiaries in their first year of enrollment.
AHRQ-authored.
Citation: Jacobs PD, Molloy E .
How do Medicare Advantage beneficiary payments vary with tenure?
Am J Manag Care 2017 Jun;23(6):372-77.
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Keywords: Medicare, Payment, Healthcare Costs, Health Insurance
Lepore MJ, Shield RR, Looze J
Medicare and Medicaid reimbursement rates for nursing homes motivate select culture change practices but not comprehensive culture change.
The researchers use mixed methods to examine the presence of culture change practices in the context of a nursing home’s (NH’s) payer sources. They concluded that qualitative data show how higher pay from Medicare versus Medicaid influences implementation of select culture change practices, and quantitative data show NHs with higher proportions of Medicare residents have significantly higher (measured) environmental culture change implementation.
AHRQ-funded; HS000011.
Citation: Lepore MJ, Shield RR, Looze J .
Medicare and Medicaid reimbursement rates for nursing homes motivate select culture change practices but not comprehensive culture change.
J Aging Soc Policy 2015;27(3):215-31. doi: 10.1080/08959420.2015.1022102..
Keywords: Nursing Homes, Medicare, Medicaid, Payment, Health Insurance