National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (1)
- Colonoscopy (1)
- Elderly (1)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Costs (4)
- Healthcare Utilization (1)
- Health Insurance (3)
- Hospital Discharge (2)
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- Hospital Readmissions (1)
- Hospitals (4)
- Kidney Disease and Health (1)
- Long-Term Care (1)
- Medicaid (1)
- (-) Medicare (13)
- Nursing Homes (3)
- Patient Safety (1)
- (-) Payment (13)
- Policy (2)
- Practice Patterns (1)
- Prevention (1)
- Provider Performance (1)
- Quality Indicators (QIs) (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (1)
- Screening (1)
- Social Determinants of Health (1)
- Surgery (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 13 of 13 Research Studies DisplayedWerner RM, Konetzka RT, Qi M
The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs.
The objective of this study was to investigate the impact of Medicare's skilled nursing facility (SNF) copayment policy, with a large increase in the daily copayment rate on the 20th day of a benefit period, on length of stay, patient outcomes, and costs. The investigators concluded that Medicare's SNF copayment policy was associated with shorter lengths of stay and worse patient outcomes, suggesting the copayment policy had unintended and negative effects on patient outcomes.
AHRQ-funded; HS024266.
Citation: Werner RM, Konetzka RT, Qi M .
The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs.
Health Serv Res 2019 Dec;54(6):1184-92. doi: 10.1111/1475-6773.13227..
Keywords: Medicare, Nursing Homes, Payment, Long-Term Care, Healthcare Costs, Elderly, Hospitalization, Hospital Discharge
Chatterjee P, Qi M, Coe NB
Association between high discharge rates of vulnerable patients and skilled nursing facility copayments.
The authors sought to determine whether patterns of skilled nursing facility (SNF) discharge are associated with the change in Medicare payment responsibility on day 20. They found that Medicare beneficiaries were more often discharged from SNFs on benefit day 20 than on benefit days 19 or 21. Those discharged on day 20 were more likely to be racial/ethnic minorities and to live in areas of lower socioeconomic status compared with those discharged before or after day 20. Their findings suggested an association between disproportionately high SNF discharge rates of vulnerable patients and existing Medicare payment policies. The authors recommended that payment policies be designed with consideration of the potential for such unintended consequences, and that any potential consequences be mitigated by balancing existing payment structures with incentives to provide optimal patient care.
AHRQ-funded; HS024266.
Citation: Chatterjee P, Qi M, Coe NB .
Association between high discharge rates of vulnerable patients and skilled nursing facility copayments.
JAMA Intern Med 2019 Sep;179(9):1296-98. doi: 10.1001/jamainternmed.2019.1209.
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Keywords: Vulnerable Populations, Nursing Homes, Medicare, Payment, Policy, Social Determinants of Health
Childrers CP, Dworsky JQ, Kominski G
A comparison of payments to a for-profit dialysis firm from government and commercial insurers.
The authors assessed differences in payments from government and commercial insurers to dialysis clinics through analysis of DaVita’s financial records. They found that, in 2017, commercial insurers paid one of the largest dialysis suppliers 4 times the rate of their government peers. They recommended that reducing payments from commercial insurers, perhaps through increased competition or fixing charges at a percent of Medicare reimbursement, may help alleviate excess spending on dialysis.
AHRQ-funded; HS025079.
Citation: Childrers CP, Dworsky JQ, Kominski G .
A comparison of payments to a for-profit dialysis firm from government and commercial insurers.
JAMA Intern Med 2019 Aug;179(8):1136-38. doi: 10.1001/jamainternmed.2019.0431..
Keywords: Payment, Health Insurance, Kidney Disease and Health, Medicare, Medicaid
Song LD, Newhouse JP, Garcia-De-Albeniz X
Changes in screening colonoscopy following Medicare reimbursement and cost-sharing changes.
This study examined changes in screening colonoscopy rates after Medicare reimbursement and cost-sharing changed when the Affordable Care Act (ACA) was implemented. A 20% random sample of fee-for-service (FFS) Medicare claims from 2002-2012 was used in this study. Screening colonoscopy rates did increase after 2001 when cost-sharing was eliminated but the amount varied depending on the algorithm used to classify the indication.
AHRQ-funded; HS023128.
Citation: Song LD, Newhouse JP, Garcia-De-Albeniz X .
Changes in screening colonoscopy following Medicare reimbursement and cost-sharing changes.
Health Serv Res 2019 Aug;54(4):839-50. doi: 10.1111/1475-6773.13150..
Keywords: Colonoscopy, Healthcare Costs, Healthcare Utilization, Medicare, Payment, Prevention, Screening
Sankaran R, Sukul D, Nuliyalu U
Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study.
This study evaluated the association between hospital penalization in the US Hospital Acquired Condition Reduction Program (HACRP) and changes in clinical outcomes. Out of the total of 724 hospitals were penalized in fiscal year 2015, 708 were included in the study. The majority of the penalized hospitals were large teaching institutions and have a greater share of low-income patients than non-penalized hospitals. After penalization, there was a non-significant change in hospital acquired conditions, 30-day readmission rates, and 30-day mortality. This might mean that disparities in care could be exacerbated.
AHRQ-funded; HS026244.
Citation: Sankaran R, Sukul D, Nuliyalu U .
Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study.
BMJ 2019 Jul 3;366:l4109. doi: 10.1136/bmj.l4109..
Keywords: Health Insurance, Healthcare-Associated Infections (HAIs), Hospitals, Medicare, Patient Safety, Provider Performance, Payment, Quality of Care, Quality Indicators (QIs)
Markovitz AA, Mullangi S, Hollingsworth JM
ACOs and the 1%: changes in spending among high-cost patients following the Medicare shared savings program.
This paper analyzed changes in spending among high-cost patients following the creation of accountable care organizations (ACOs), specifically for the Medicare Shared Savings Program – which is Centers for Medicare and Medicaid Services (CMS) flagship program. Changes in spending for Medicare fee-for-services were analyzed for different spending percentiles (50th, 90th, and 99th) as well as regionally. While there was a reduction in spending, it was not considered statistically significant and has not affected spending within or across regions. However, the authors note that the study is limited by the program’s voluntary nature and may be not a full reflection of the changes.
AHRQ-funded; HS024525; HS024728; HS025615.
Citation: Markovitz AA, Mullangi S, Hollingsworth JM .
ACOs and the 1%: changes in spending among high-cost patients following the Medicare shared savings program.
J Gen Intern Med 2019 Jul;34(7):1116-18. doi: 10.1007/s11606-019-04963-2..
Keywords: Medicare, Healthcare Costs, Payment
Zhu JM, Navathe A, Yuan Y
Medicare's bundled payment model did not change skilled nursing facility discharge patterns.
The purpose of this study was to evaluate whether participation in Medicare's voluntary Bundled Payments for Care Improvement (BPCI) model was associated with changes in discharge referral patterns to skilled nursing facilities (SNFs), specifically number of SNF partners and discharge concentration. The investigators concluded that hospital participation in BPCI was not associated with changes in the number of SNF partners or in discharge concentration relative to non-BPCI hospitals.
AHRQ-funded; HS024266.
Citation: Zhu JM, Navathe A, Yuan Y .
Medicare's bundled payment model did not change skilled nursing facility discharge patterns.
Am J Manag Care 2019 Jul;25(7):329-34..
Keywords: Medicare, Payment, Practice Patterns, Hospital Discharge, Nursing Homes
Kaplan CM, Thompson MP, Waters TM
How have 30-day readmission penalties affected racial disparities in readmissions?: an analysis from 2007 to 2014 in five US states.
The purpose of this study was to examine changes in Black-White disparities in 30-day readmissions for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia following the passage and implementation of the Hospital Readmission Reduction Program (HRRP), and to compare disparities across safety-net and non-safety-net hospitals. Prior to the passage of HRRP, Black and White readmission rates and disparities in readmissions were decreasing, with largest reductions at safety-net hospitals. Findings showed that improvements in readmissions have not reversed following the implementation of HRRP. In contrast, disparities continue to persist at non-safety-net hospitals.
AHRQ-funded; HS023783.
Citation: Kaplan CM, Thompson MP, Waters TM .
How have 30-day readmission penalties affected racial disparities in readmissions?: an analysis from 2007 to 2014 in five US states.
J Gen Intern Med 2019 Jun;34(6):878-83. doi: 10.1007/s11606-019-04841-x..
Keywords: Hospital Readmissions, Racial and Ethnic Minorities, Hospitals, Medicare, Payment
Sheetz KH, Dimick JB, Regenbogen SE
How patient complexity and surgical approach influence episode-based payment models for colectomy.
This study looked into how the use of bundled payment programs would affect hospital reimbursements for colectomies. National data from the 100% Medicare Provider Analysis and Review files for the years 2010 to 2014 was used. Patients undergoing colectomies were identified using diagnosis-related group codes and ICD-9, Clinical Modification codes. Reconciliation payments were simulated as the difference between actual price-standardized 90-day episode payments and estimated regional spending benchmarks. The simulated bundled payment conditions showed 51.8% of hospitals would achieve shared savings, but the average case would incur reconciliation penalties. Laparoscopies would achieve the highest savings.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Dimick JB, Regenbogen SE .
How patient complexity and surgical approach influence episode-based payment models for colectomy.
Dis Colon Rectum 2019 Jun;62(6):739-46. doi: 10.1097/dcr.0000000000001372..
Keywords: Surgery, Payment, Healthcare Costs, Medicare, Hospitals
Chukmaitov AS, Harless DW, Bazzoli GJ
Factors associated with hospital participation in Centers for Medicare and Medicaid Services' Accountable Care Organization programs.
The aim of this study was to assess the organizational and environmental characteristics associated with hospital participation in the Medicare Shared Savings Program (MSSP) and Pioneer Accountable Care Organizations (ACOs). The investigators found that hospital participation in both Centers for Medicare and Medicaid Services ACO programs was associated with prior experience with risk-based payments and care management programs, advanced health information technology, and location in higher-income and more competitive areas.
AHRQ-funded; HS023332.
Citation: Chukmaitov AS, Harless DW, Bazzoli GJ .
Factors associated with hospital participation in Centers for Medicare and Medicaid Services' Accountable Care Organization programs.
Health Care Manage Rev 2019 Apr/Jun;44(2):104-14. doi: 10.1097/hmr.0000000000000182..
Keywords: Payment, Medicare, Hospitals
Modi PK, Kaufman SR, Caram MV
Impact of Medicare office visit payment reform on urologic practices.
This study analyzed the impact of the 2019 Medicare Physician Fee Schedule on urologic practices. This new payment system modifies reimbursement for office evaluation and management visits. Researchers used a sample of 20% of National Medicare claims. They identified 2822 practices ranging from solo to multispecialty groups. Solo practices had the least benefit in reimbursement with most practices having a small increase in payment.
AHRQ-funded; HS025707.
Citation: Modi PK, Kaufman SR, Caram MV .
Impact of Medicare office visit payment reform on urologic practices.
Urology 2019 Apr;126:83-88. doi: 10.1016/j.urology.2019.01.013..
Keywords: Medicare, Ambulatory Care and Surgery, Payment, Policy
Markovitz AA, Hollingsworth JM, Ayanian JZ
Risk adjustment in Medicare ACO program deters coding increases but may lead ACOs to drop high-risk beneficiaries.
The purpose of this study was to examine whether beneficiaries' exposure to the Medicare Shared Savings Program (MSSP) was associated with changes in risk scores and whether risk scores were associated with entry to or exit from the MSSP. Findings indicate that MSSP was not associated with consistent changes in within-beneficiary risk scores, but that beneficiaries at the 95th percentile of risk score had a higher chance of exiting the MSSP when compared to beneficiaries at the 50th percentile. The researchers conclude that decision not to upwardly adjust risk scores in the MSSP has successfully deterred coding increases, but this might discourage accountable care organizations to care for high-risk beneficiaries.
AHRQ-funded; HS024525; HS024728; HS025615.
Citation: Markovitz AA, Hollingsworth JM, Ayanian JZ .
Risk adjustment in Medicare ACO program deters coding increases but may lead ACOs to drop high-risk beneficiaries.
Health Aff 2019 Feb;38(2):253-61. doi: 10.1377/hlthaff.2018.05407..
Keywords: 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