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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 11 of 11 Research Studies DisplayedJubelt LE, Goldfeld KS, Blecker SB
Early lessons on bundled payment at an academic medical center.
This study was a difference-in-differences study of Medicare fee-for-service patients hospitalized from April 2011 to June 2012 and October 2013 to December 2014 for lower extremity joint arthroplasty, cardiac valve procedures, or spine surgery. It examined total episode costs and costs by service category. It concluded that opportunities for savings under bundled payment may be greater for lower extremity joint arthroplasty than for other conditions.
AHRQ-funded; HS023683.
Citation: Jubelt LE, Goldfeld KS, Blecker SB .
Early lessons on bundled payment at an academic medical center.
J Am Acad Orthop Surg 2017 Sep;25(9):654-63. doi: 10.5435/jaaos-d-16-00626.
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Keywords: Healthcare Costs, Payment, Medicare
Chen LM, Epstein AM, Orav EJ
Association of practice-level social and medical risk with performance in the Medicare physician value-based payment modifier program.
The objective of this cross-sectional observational study was to compare performance in the Physician Value-Based Payment Modifier (PVBM) Program by practice characteristics. The investigators found that during the first year of the Medicare Physician Value-Based Payment Modifier Program, physician practices that served more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs.
AHRQ-funded; HS024698.
Citation: Chen LM, Epstein AM, Orav EJ .
Association of practice-level social and medical risk with performance in the Medicare physician value-based payment modifier program.
JAMA 2017 Aug 1;318(5):453-61. doi: 10.1001/jama.2017.9643..
Keywords: Healthcare Costs, Medicaid, Medicare, Payment, Quality of Care
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
Schulz J, DeCamp M, Berkowitz SA
Regional cost and experience, not size or hospital inclusion, helps predict ACO success.
This study investigated the extent to which organizational characteristics, regional cost of care, or experience in the Medicare Shared Savings Program (MSSP) are associated with the ability to achieve shared savings. It found that experience, as measured by years in the MSSP program, was associated with success and the ability to earn shared savings varied regionally. This variation was strongly associated with differences in regional Medicare fee-for-service per capita costs.
AHRQ-funded; HS023684.
Citation: Schulz J, DeCamp M, Berkowitz SA .
Regional cost and experience, not size or hospital inclusion, helps predict ACO success.
Medicine 2017 Jun;96(24):e7209. doi: 10.1097/md.0000000000007209.
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Keywords: Healthcare Costs, Medicare, Payment
Bhatt SP, Wells JM, Iyer AS
Results of a Medicare bundled payments for care improvement initiative for chronic obstructive pulmonary disease readmissions.
This study evaluated whether a comprehensive chronic obstructive pulmonary disease (COPD) multidisciplinary intervention focusing on inpatient, transitional, and outpatient care as part of an institution's Bundled Payments for Care Improvement (BPCI) participation would reduce 30-day all-cause readmission rates for COPD exacerbations and reduce overall costs. It concluded that a Medicare BPCI intervention did not reduce 30-day all-cause readmission rates or overall costs after hospitalization for acute exacerbation of COPD.
AHRQ-funded; HS013852.
Citation: Bhatt SP, Wells JM, Iyer AS .
Results of a Medicare bundled payments for care improvement initiative for chronic obstructive pulmonary disease readmissions.
Ann Am Thorac Soc 2017 May;14(5):643-48. doi: 10.1513/AnnalsATS.201610-775BC.
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Keywords: Respiratory Conditions, Payment, Hospital Readmissions, Medicare, Quality Improvement
Colla CH, Fisher ES
Moving forward with accountable care organizations: some answers, more questions.
The U.S. health care system is moving from traditional fee-for-service payment to value-based alternative payment models, such as accountable care organizations (ACOs).This paper comments on the research presented in the April 2017 issue of JAMA Internal Medicine which provides insights from 3 different ACO payment models.
AHRQ-funded; HS024075.
Citation: Colla CH, Fisher ES .
Moving forward with accountable care organizations: some answers, more questions.
JAMA Intern Med 2017 Apr;177(4):527-28. doi: 10.1001/jamainternmed.2016.9122..
Keywords: Payment, Quality of Care, Medicare
Krinsky S, Ryan AM, Mijanovich T
Variation in payment rates under Medicare's Inpatient Prospective Payment System.
The researchers measured variation in payment rates under Medicare's Inpatient Prospective Payment System (IPPS) and identified the main payment adjustments that drive variation. In 2013, Medicare paid for acute inpatient discharges at a rate 31 percent above the IPPS base. For the top 10 percent of discharges, the mean rate was double the IPPS base. Variations were driven by adjustments for medical education and care to low-income populations.
AHRQ-funded; HS018546.
Citation: Krinsky S, Ryan AM, Mijanovich T .
Variation in payment rates under Medicare's Inpatient Prospective Payment System.
Health Serv Res 2017 Apr;52(2):676-96. doi: 10.1111/1475-6773.12490.
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Keywords: Payment, Medicare, Healthcare Costs, Hospitals
Ouayogode MH, Colla CH, Lewis VA
Determinants of success in shared savings programs: an analysis of ACO and market characteristics.
This study examined Accountable Care Organization (ACO) and market factors associated with superior financial performance in Medicare ACO programs. No characteristic of organizational structure was significantly associated with both outcomes of savings per beneficiary and likelihood of achieving shared savings. ACO prior experience with risk-bearing contracts was positively correlated with savings and significantly increased the likelihood of receiving shared savings payments.
AHRQ-funded; HS024075.
Citation: Ouayogode MH, Colla CH, Lewis VA .
Determinants of success in shared savings programs: an analysis of ACO and market characteristics.
Healthc 2017 Mar;5(1-2):53-61. doi: 10.1016/j.hjdsi.2016.08.002.
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Keywords: Healthcare Costs, Payment, Policy, Medicare
Nathan H, Dimick JB
Medicare's shift to mandatory alternative payment models: why surgeons should care.
This opinion piece addresses alternative payment models and mandatory payment reforms that will affect many surgical professionals. The authors use the example of the recent implementation of the Comprehensive Care for Joint Replacement (CJR) program, the first mandatory alternative payment model (APM) to guide the discussion.
AHRQ-funded; HS024763.
Citation: Nathan H, Dimick JB .
Medicare's shift to mandatory alternative payment models: why surgeons should care.
JAMA Surg 2017 Feb;152(2):125-26. doi: 10.1001/jamasurg.2016.4005..
Keywords: Payment, Medicare, Surgery
Ellimoottil C, Ryan AM, Hou H
Implications of the definition of an episode of care used in the comprehensive care for joint replacement model.
The researchers compared the Comprehensive Care for Joint Replacement (CJR) program's broad definition of an episode of care with a clinically narrow definition of an episode of care. The 90-day episode payments using the broad definition of the CJR model ranged from $17,349 to $29,465 (mean payment, $22,122). Episode payments were slightly lower (mean payment, $21,670) when the Hospital Compare definition was used.
AHRQ-funded; HS024193; HS018546.
Citation: Ellimoottil C, Ryan AM, Hou H .
Implications of the definition of an episode of care used in the comprehensive care for joint replacement model.
JAMA Surg 2017 Jan;152(1):49-54. doi: 10.1001/jamasurg.2016.3098.
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Keywords: Surgery, Healthcare Costs, Medicare, Payment
Kronick R, Welch WP
AHRQ Author: Kronick R
Measuring coding intensity in the Medicare Advantage program.
Each year from 2004-2013, the average Medicare Advantage risk score increased faster than the average fee-for-service score. The intensity of coding varies widely by contract. The authors suggested that with the continuous relative increase in the average Medicare Advantage risk score, further policy changes will likely be necessary.
AHRQ-authored.
Citation: Kronick R, Welch WP .
Measuring coding intensity in the Medicare Advantage program.
Medicare Medicaid Res Rev 2014 Jul 17;4(2). doi: 10.5600/mmrr2014-004-02-a06.
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Keywords: Medicare, Health Insurance, Payment