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
1 to 13 of 13 Research Studies DisplayedGanguli I, Lupo C, Mainor AJ
Assessment of prevalence and cost of care cascades after routine testing during the Medicare annual wellness visit.
This observational cohort study looked at the prevalence and cost of care cascades after routine tests considered low value in fee-for-service Medicare patients from January 2013 through March 2015 who had gone for an annual wellness visit (AWV). Among the 75,275 AWV recipients identified, 18.6% received at least 1 low-value test including an ECG, urinalysis, or thyrotropin tests. Patients who were younger, White, and lived in urban, high-income areas were most likely to receive those tests. The cost-cascade was considered notable but of modest cost.
AHRQ-funded; HS023812.
Citation: Ganguli I, Lupo C, Mainor AJ .
Assessment of prevalence and cost of care cascades after routine testing during the Medicare annual wellness visit.
JAMA Netw Open 2020 Dec;3(12):e2029891. doi: 10.1001/jamanetworkopen.2020.29891..
Keywords: Elderly, Medicare, Healthcare Costs, Diagnostic Safety and Quality
Socal MP, Anderson KE, Sen A
Biosimilar uptake in Medicare Part B varied across hospital outpatient departments and physician practices: the case of filgrastim.
The purpose of this study was to examine the uptake of filgrastim-sndz (Zarxio), the first biosimilar to launch in the United States, in the Medicare Part B fee-for-service program from its launch in September 2015 to December 2017 and compare characteristics of patients and facilities that used filgrastim-sndz or originator filgrastim (Neupogen). The investigators concluded that uptake of biosimilar filgrastim in the Medicare Part B program occurred despite multiple challenges to the adoption of biosimilars in the US market, suggesting that substantial potential savings could be generated by improving biosimilar uptake.
AHRQ-funded; HS000029.
Citation: Socal MP, Anderson KE, Sen A .
Biosimilar uptake in Medicare Part B varied across hospital outpatient departments and physician practices: the case of filgrastim.
Value Health 2020 Apr;23(4):481-86. doi: 10.1016/j.jval.2019.12.007..
Keywords: Medicare, Practice Patterns, Medication, Healthcare Costs
Markovitz AA, Rozier MD, Ryan AM
Low-value care and clinician engagement in a large Medicare shared savings program ACO: a survey of frontline clinicians.
The purpose of this study was to assess Accountable Care Organization (ACO) engagement of clinicians and whether engagement was associated with clinicians' reported difficulty implementing recommendations against low-value care. Participants included 1289 clinicians in the Physician Organization of Michigan ACO. Results showed that clinicians participating in a large Medicare ACO were broadly unaware of and unengaged with ACO objectives and activities. Whether low clinician engagement limits ACO efforts to reduce low-value care warrants further longitudinal study.
AHRQ-funded; HS024525; HS024728; HS025615.
Citation: Markovitz AA, Rozier MD, Ryan AM .
Low-value care and clinician engagement in a large Medicare shared savings program ACO: a survey of frontline clinicians.
J Gen Intern Med 2020 Jan;35(1):133-41. doi: 10.1007/s11606-019-05511-8..
Keywords: Medicare, Policy, Provider
Layton TJ, Ryan AM
Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings.
The researchers evaluated the effects of the size of financial bonuses on quality of care and the number of plan offerings in the Medicare Advantage Quality Bonus Payment Demonstration. They concluded that at great expense to Medicare, double bonuses in the Medicare Advantage Quality Bonus Payment Demonstration were not associated with improved quality but were associated with more plan offerings.
AHRQ-funded; HS018546.
Citation: Layton TJ, Ryan AM .
Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings.
Health Serv Res 2015 Dec;50(6):1810-28. doi: 10.1111/1475-6773.12409..
Keywords: Medicare, Payment, Provider Performance, Health Services Research (HSR), Quality Improvement, Quality of Care
He D, Konetzka RT
Public reporting and demand rationing: evidence from the nursing home industry.
The authors examined a consequence of public reporting: the potential for demand rationing. They found that high-quality nursing homes facing capacity constraints reduced admissions of less profitable Medicaid residents while increasing the more profitable Medicare and private-pay admissions, relative to low-quality nursing homes facing no capacity constraints.
AHRQ-funded; HS021877.
Citation: He D, Konetzka RT .
Public reporting and demand rationing: evidence from the nursing home industry.
Health Econ 2015 Nov;24(11):1437-51. doi: 10.1002/hec.3097.
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Keywords: Public Reporting, Medicare, Nursing Homes
Zhang Y, Talisa V, Baik SH
Part D plan switching among Medicare beneficiaries with schizophrenia.
The authors examined Medicare plan switching and factors affecting switching among beneficiaries with schizophrenia. They found several factors that affected the likelihood of switching, including age, geographic region, and proportion of prescriptions filled by beneficiaries who were covered or whose prescriptions required utilization review in the original plan. They concluded that plan switching among Medicare beneficiaries with schizophrenia was relatively infrequent but may be driven by the need for better drug coverage and less restrictive utilization policies.
AHRQ-funded; HS018657.
Citation: Zhang Y, Talisa V, Baik SH .
Part D plan switching among Medicare beneficiaries with schizophrenia.
Psychiatr Serv 2015 Oct;66(10):1105-8. doi: 10.1176/appi.ps.201400476.
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Keywords: Healthcare Costs, Medicare, Behavioral Health
Carey K
Measuring the hospital length of stay/readmission cost trade-off under a bundled payment mechanism.
This paper investigates the relationship between length of stay and readmission within 30 days of discharge from an acute care hospitalization. It found that the cost of an additional day of stay was offset by expected cost savings from an avoided readmission in the range of 15 to 65 percent.
AHRQ-funded; HS020995.
Citation: Carey K .
Measuring the hospital length of stay/readmission cost trade-off under a bundled payment mechanism.
Health Econ 2015 Jul;24(7):790-802. doi: 10.1002/hec.3061..
Keywords: Hospital Readmissions, Hospitalization, Elderly, Hospital Discharge, Medicare
Zhang Y, Baik SH, Newhouse JP
Use of intelligent assignment to Medicare Part D plans for people with schizophrenia could produce substantial savings.
The investigators simulated Medicare Part D savings from replacing random assignment with an "intelligent assignment" algorithm that would assign beneficiaries to the least expensive plan in 2010 based on their drug usage in the previous year. They found that intelligent assignment could have saved about $150 million for Medicare and beneficiaries with schizophrenia combined in 2010.
AHRQ-funded; HS018657.
Citation: Zhang Y, Baik SH, Newhouse JP .
Use of intelligent assignment to Medicare Part D plans for people with schizophrenia could produce substantial savings.
Health Aff 2015 Mar;34(3):455-60. doi: 10.1377/hlthaff.2014.1227.
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Keywords: Healthcare Costs, Medicare, Medication, Behavioral Health
Ryan AM, Burgess JF, Pesko MF
The early effects of Medicare's mandatory hospital pay-for-performance program.
This study evaluated the impact of hospital value-based purchasing (HVBP) on clinical quality and patient experience during its initial implementation period. It found that hospitals that were exposed to HVBP did not show greater improvement for either the clinical process or patient experience measures during the program’s initial implementation period.
AHRQ-funded; HS018546
Citation: Ryan AM, Burgess JF, Pesko MF .
The early effects of Medicare's mandatory hospital pay-for-performance program.
Health Serv Res. 2015 Feb;50(1):81-97. doi: 10.1111/1475-6773.12206..
Keywords: Medicare, Provider Performance, Payment, Hospitals, Quality Improvement, Quality of Care, Patient Experience
Schwartz AL, Landon BE, Elshaug AG
Measuring low-value care in Medicare.
To study health care overuse, this study developed claims-based measures of low-value services ranging from low-value cancer screening and preoperative testing to low-value surgical procedures. Services detected by a limited number of measures of low-value care constituted modest proportions of overall spending, but affected substantial proportions of Medicare beneficiaries and may reflect overuse.
AHRQ-funded; HS00055
Citation: Schwartz AL, Landon BE, Elshaug AG .
Measuring low-value care in Medicare.
JAMA Intern Med. 2014 Jul;174(7):1067-76. doi: 10.1001/jamainternmed.2014.1541..
Keywords: Medicare, Healthcare Costs
Zhang Y, Zhou C, Baik SH
A simple change to the Medicare Part D low-income subsidy program could save $5 billion.
The authors used an intelligent reassignment algorithm and 2008-09 Medicare Part D drug use and spending data to match enrollees to available Part D plans according to their medication needs. They found that such a reassignment approach, compared to the current approach, could have saved the federal government over $5 billion in 2009.
AHRQ-funded; HS018657.
Citation: Zhang Y, Zhou C, Baik SH .
A simple change to the Medicare Part D low-income subsidy program could save $5 billion.
Health Aff 2014 Jun;33(6):940-5. doi: 10.1377/hlthaff.2013.1083.
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Keywords: Healthcare Costs, Low-Income, Medicare, Medication
Rocke DJ, Beumer HW, Taylor DH, Jr.
Physician and patient and caregiver health attitudes and their effect on Medicare resource allocation for patients with advanced cancer.
The investigators sought to determine how baseline attitudes toward quality vs quantity of life affect end-of-life resource allocation. They found that, compared with patients and caregivers, otolaryngology-head and neck surgery (OHNS) physician allocations differed significantly in all 15 benefit categories except home care. They concluded that understanding the effect of baseline attitudes is important for effective end-of-life discussions.
AHRQ-funded; HS018360.
Citation: Rocke DJ, Beumer HW, Taylor DH, Jr. .
Physician and patient and caregiver health attitudes and their effect on Medicare resource allocation for patients with advanced cancer.
JAMA Otolaryngol Head Neck Surg 2014 Jun;140(6):497-503. doi: 10.1001/jamaoto.2014.494.
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Keywords: Cancer, Caregiving, Medicare, Palliative Care, Provider: Physician, Quality of Life
Huckfeldt PJ, Sood N, Escarce JJ
Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.
The researchers contrasted the effects of two Medicare payment reforms for home health agencies: the interim payment system (IPS) and the prospective payment system (PPS). The 1997 IPS reform lowered payments for both fee-for-service and episode-based care, as predicted by their conceptual model. The PPS in 2000 raised average but lowered marginal payment.
AHRQ-funded; HS018541
Citation: Huckfeldt PJ, Sood N, Escarce JJ .
Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.
J Health Econ. 2014 Mar;34:1-18. doi: 10.1016/j.jhealeco.2013.11.005..
Keywords: Medicare, Healthcare Costs, Home Healthcare