National Healthcare Quality and Disparities Report
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- Access to Care (1)
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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 25 of 31 Research Studies DisplayedBakre S, Hollingsworth JM, Yan PL
Accountable care organizations and spending for patients undergoing long-term dialysis.
This study analyzed Medicare data to examine time trends in long-term dialysis beneficiary alignment to Accountable Care Organizations (ACOs) and differences in spending for those who were Accountable Care Organization aligned versus nonaligned. Beneficiaries on long-term dialysis between 2009 and 2016 were identified using a 20% random sample of Medicare beneficiaries. Trends in alignment to an ACO alignment were compared with alignment of the general Medicare population. The cohort included 135,152 beneficiaries during the study period. Alignment to an ACO of long-term dialysis beneficiaries increased from 6% to 23% from 2012 to 2016. In the time series analysis, ACO spending was $143 less per beneficiary-quarter than spending for non-aligned beneficiaries. This savings was limited to care by a primary care physician.
AHRQ-funded; HS024525; HS026908; HS024728.
Citation: Bakre S, Hollingsworth JM, Yan PL .
Accountable care organizations and spending for patients undergoing long-term dialysis.
Clin J Am Soc Nephrol 2020 Dec 7;15(12):1777-84. doi: 10.2215/cjn.02150220..
Keywords: Healthcare Costs, Dialysis, Kidney Disease and Health, Medicare
Caram MEV, Oerline MK, Dusetzina S
Adherence and out-of-pocket costs among Medicare beneficiaries who are prescribed oral targeted therapies for advanced prostate cancer.
The authors investigated coping and material measures of the financial hardship of abiraterone and enzalutamide among patients with advanced prostate cancer with Medicare Part D coverage. They found substantial variations in the adherence rate and out-of-pocket payments, with sociodemographic patient and regional factors found to be associated with both aspects.
AHRQ-funded; HS025707.
Citation: Caram MEV, Oerline MK, Dusetzina S .
Adherence and out-of-pocket costs among Medicare beneficiaries who are prescribed oral targeted therapies for advanced prostate cancer.
Cancer 2020 Dec 1;126(23):5050-59. doi: 10.1002/cncr.33176..
Keywords: Patient Adherence/Compliance, Medicare, Cancer: Prostate Cancer, Cancer, Medication, Healthcare Costs
Ganguli 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
Hambley BC, Anderson KE, Shanbhag SP
Payment incentives and the use of higher-cost drugs: a retrospective cohort analysis of intravenous iron in the Medicare population.
Researchers examined prescribing patterns in the context of intravenous (IV) iron, for which multiple similarly safe and efficacious formulations exist, with wide variations in price. Using Medicare data, they found an increase in the dispensing of a higher-priced IV iron formulation associated with a shortage of a less expensive drug that persisted once the shortage ended. They concluded that their findings in IV iron have broader implications for Part B drug payment policy because the price of the drug determines the physician and health system payment.
AHRQ-funded; HS000029.
Citation: Hambley BC, Anderson KE, Shanbhag SP .
Payment incentives and the use of higher-cost drugs: a retrospective cohort analysis of intravenous iron in the Medicare population.
Am J Manag Care 2020 Dec;26(12):516-22. doi: 10.37765/ajmc.2020.88539..
Keywords: Elderly, Medication, Medicare, Payment, Healthcare Costs, Practice Patterns
Ibrahim AM, Nuliyalu U, Lawton EJ
Evaluation of US hospital episode spending for acute inpatient conditions after the Patient Protection and Affordable Care Act.
This study evaluated the association between enactment of Affordable Care Act (ACA) reforms and 30-day price standardized hospital episode spending for Medicare patients. Reforms to reduce spending were targeted to acute care hospitals and often focused on specific diagnoses such as acute myocardial infarction, heart failure, and pneumonia. The policy evaluation included index discharges between January 2008 and August 31, 2015 from a random 20% sample of Medicare beneficiaries. Three different estimation approaches were used to evaluate the association between reforms and episode spending: difference-in-difference (DID) analysis among acute care hospitals; a DID analysis comparing acute care hospitals and critical care hospitals; and a generalized synthetic control analysis, comparing acute care and critical access hospitals. A total of 7,634,242 index discharges were included. All 3 approaches found that ACA-associated spending reforms were associated with a significant reduction in episode spending.
AHRQ-funded; HS024525; HS024728.
Citation: Ibrahim AM, Nuliyalu U, Lawton EJ .
Evaluation of US hospital episode spending for acute inpatient conditions after the Patient Protection and Affordable Care Act.
JAMA Netw Open 2020 Nov 2;3(11):e2023926. doi: 10.1001/jamanetworkopen.2020.23926..
Keywords: Elderly, Policy, Hospitals, Medicare, Healthcare Costs
Roberts ET, McGarry BE, Glynn A
Cognition and take-up of the Medicare Savings Programs.
In this study, the investigators examined the association between cognition and Medicare Savings Program (MSP) enrollment among elderly Medicare beneficiaries who qualified for these programs. They also examined enrollment in the Low-Income Subsidy (LIS), a separate program that provides premium and cost-sharing assistance in Medicare Part D that Medicare beneficiaries automatically received if they are enrolled in an MSP.
AHRQ-funded; HS026727.
Citation: Roberts ET, McGarry BE, Glynn A .
Cognition and take-up of the Medicare Savings Programs.
JAMA Intern Med 2020 Nov;180(11):1529-31. doi: 10.1001/jamainternmed.2020.2783..
Keywords: Elderly, Medicare, Health Insurance, Healthcare Costs, Low-Income, Dementia, Neurological Disorders
Hill SC, Miller GE, Ding Y
AHRQ Author: Hill SC, Miller GE, Ding Y
Net spending on retail specialty drugs grew rapidly, especially for private insurance and Medicare Part D.
This study examined net spending trends on retail specialty drugs from 2010 to 2017. Spending has been difficult to measure due to proprietary rebate payments by manufacturers by insurers, pharmacy benefit managers and state Medicaid agencies. The authors incorporated those rebates into their research. They found that specialty drugs accounted for 37.7% of retail and mail-order prescription spending net of rebates in 2016-17. The spending net of rebates tripled for Medicare Part D beneficiaries and more than doubled for people with private insurance from 2010 to 2017. Medicaid net spending of rebates had a slower increase.
AHRQ-authored.
Citation: Hill SC, Miller GE, Ding Y .
Net spending on retail specialty drugs grew rapidly, especially for private insurance and Medicare Part D.
Health Aff 2020 Nov;39(11):1970-76. doi: 10.1377/hlthaff.2019.01830..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Medication, Medicare, Health Insurance
Fung V, Price M, Nierenberg AA
Assessment of behavioral health services use among low-income Medicare beneficiaries after reductions in coinsurance fees.
This study looked at outcomes from reducing behavioral health care Medicare coinsurance from 50% to 20% from 2009 to 2013. The sample of patients looked at included some diagnosed with SMI (serious mental illness) including schizophrenia, bipolar, or major depressive disorder). Data analysis was performed on 793,275 beneficiaries with SMI in 2008 and compared them with costs in 2013. The mean adjusted out-of-pocket costs for outpatient behavioral care decreased from $132 annually to $64, but the number of visits only increased slightly. No association was found between cost-sharing reductions and changes in behavioral health care visits.
AHRQ-funded; HS024725.
Citation: Fung V, Price M, Nierenberg AA .
Assessment of behavioral health services use among low-income Medicare beneficiaries after reductions in coinsurance fees.
JAMA Netw Open 2020 Oct;3(10):e2019854. doi: 10.1001/jamanetworkopen.2020.19854..
Keywords: Medicare, Health Insurance, Depression, Behavioral Health, Low-Income, Healthcare Costs, Healthcare Utilization
Ganguli I, Lupo C, Mainor AJ
Association between specialist compensation and Accountable Care Organization performance.
This study’s objective was to determine whether Medicare Shared Savings Program Accountable Care Organizations (ACOs) using cost reduction measures in specialist compensation demonstrated better performance. National cross-sectional survey data on ACOs from 2013-2015 was linked to public-use data on ACO performance from 2014-2016. Out of 160 ACOs surveys, 26% reported using cost reduction measures to help determine specialist compensation. However, these ACOs did not have savings in the short term.
AHRQ-funded; HS023812.
Citation: Ganguli I, Lupo C, Mainor AJ .
Association between specialist compensation and Accountable Care Organization performance.
Health Serv Res 2020 Oct;55(5):722-28. doi: 10.1111/1475-6773.13323..
Keywords: Provider Performance, Healthcare Costs, Payment, Medicare
Nicholas LH, Wu S
Do Medicare Advantage rebates reduce enrollees' out-of-pocket spending?
Researchers used survey data on Medicare Advantage (MA) beneficiaries' actual out-of-pocket spending linked to MA payment information to test whether higher plan payments and rebates lowered enrollee out-of-pocket spending. They found that beneficiaries recovered only $0.65 of every $1.00 in payments exceeding fee-for-service spending through lower out-of-pocket spending but more than fully recovered the value of the rebates supporting supplemental benefits.
AHRQ-funded; HS000029.
Citation: Nicholas LH, Wu S .
Do Medicare Advantage rebates reduce enrollees' out-of-pocket spending?
Med Care Res Rev 2020 Oct;77(5):474-82. doi: 10.1177/1077558718807847..
Keywords: Healthcare Costs, Medicare, Health Insurance
Roberts 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
Modi PK, Moloci N, Herrel LA
Medicare accountable care organizations reduce spending on surgery.
This study examined the impact that Medicare accountable care organization (ACO) alignment has on spending for inpatient and outpatient surgical care. Researchers identified adults 65 years of age and older enrolled in fee-for-service Medicare from among a 20% random sample of beneficiaries and distinguished between those aligned and unaligned with a Medicare ACO, then measured payments for surgical services made on the enrollees’ behalf. Findings showed that ACO alignment was associated with savings on surgical care. These savings resulted from increased outpatient surgery and reduced use of inpatient surgery as well as reduced spending per inpatient surgical episode. Greater focus on surgical care to improve the ability of ACOs to control healthcare spending was recommended.
AHRQ-funded; HS024728; HS024525; HS026908.
Citation: Modi PK, Moloci N, Herrel LA .
Medicare accountable care organizations reduce spending on surgery.
Am J Accountable Care 2020 Sep;8(3):12-19..
Keywords: Medicare, Surgery, Healthcare Costs, Health Insurance, Elderly
Sankaran R, Gulseren B, Nuliyalu U R, Gulseren B, Nuliyalu U
A comparison of estimated cost savings from potential reductions in hospital-acquired conditions to levied penalties under the CMS Hospital-Acquired Condition Reduction Program.
The Hospital-Acquired Condition Reduction Program (HACRP) from the Centers for Medicare & Medicaid Services (CMS) reduces Medicare payments to hospitals with high rates of hospital-acquired conditions (HACs) by 1% each year. It is not known how the savings accruing to CMS from such penalties compare to savings resulting from a reduction in HACs driven by this program. This study compared the reported savings to CMS from financial penalties levied under the HACRP with savings resulting from potential reductions in HACs.
AHRQ-funded; HS000053; HS026244.
Citation: Sankaran R, Gulseren B, Nuliyalu U R, Gulseren B, Nuliyalu U .
A comparison of estimated cost savings from potential reductions in hospital-acquired conditions to levied penalties under the CMS Hospital-Acquired Condition Reduction Program.
Jt Comm J Qual Patient Saf 2020 Aug;46(8):438-47. doi: 10.1016/j.jcjq.2020.05.002.
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Keywords: Healthcare Costs, Healthcare-Associated Infections (HAIs), Hospitals, Patient Safety, Medicare
Yakusheva O, Hoffman GJ
Does a reduction in readmissions result in net savings for most hospitals? An examination of Medicare's hospital readmissions reduction program.
This study aimed (1) to estimate the impact of an incremental reduction in excess readmissions on a hospital's Medicare reimbursement revenue, for hospitals subject to penalties under the Medicare's Hospital Readmissions Reduction Program and (2) to evaluate the economic case for an investment in a readmission reduction program.
AHRQ-funded; HS025838.
Citation: Yakusheva O, Hoffman GJ .
Does a reduction in readmissions result in net savings for most hospitals? An examination of Medicare's hospital readmissions reduction program.
Med Care Res Rev 2020 Aug;77(4):334-44. doi: 10.1177/1077558718795745..
Keywords: Medicare, Hospital Readmissions, Hospitals, Healthcare Costs, Policy
Hoffman GJ, Tilson S, Yakusheva O
The financial impact of an avoided readmission for teaching and safety-net hospitals under Medicare's hospital readmission reduction program.
This study examined the financial incentives to avoid readmissions under Medicare’s Hospital Readmission Reduction Program for teaching hospitals (THs) and safety-net hospitals (SNHs). Readmissions data for 2,465 hospitals was analyzed using Medicare’s FY 2016 Hospital Compare. The authors tested for differential revenue gains for SNHs relative to non-SNHs and for major and minor THs relative to non-THs. They found that revenue gains of an avoided readmission were 10-15% greater for major THs compared with non-THs, but no different for SNHs compared with non-SNHs.
AHRQ-funded; HS025838.
Citation: Hoffman GJ, Tilson S, Yakusheva O .
The financial impact of an avoided readmission for teaching and safety-net hospitals under Medicare's hospital readmission reduction program.
Med Care Res Rev 2020 Aug;77(4):324-33. doi: 10.1177/1077558718795733..
Keywords: Medicare, Hospital Readmissions, Hospitals, Healthcare Costs
He D, McHenry P, Mellor JM
Do financial incentives matter? Effects of Medicare price shocks on skilled nursing facility care.
The authors provided new evidence on how Medicare payment changes affect the amount of skilled nursing facility (SNF) care provided to Medicare patients. They found that increases in Medicare payment rates to SNFs increased the total number of Medicare resident days at SNFs. Further, the effects were asymmetric; although Medicare payment increases affected Medicare days, payment decreases did not. They conclude that their results have important implications for policies that alter the Medicare base payment rates to SNFs and other health care providers.
AHRQ-funded; HS025529.
Citation: He D, McHenry P, Mellor JM .
Do financial incentives matter? Effects of Medicare price shocks on skilled nursing facility care.
Health Econ 2020 Jun;29(6):655-70. doi: 10.1002/hec.4009..
Keywords: Medicare, Nursing Homes, Elderly, Payment, Healthcare Costs
Smith ME, Shubeck SP, Nuliyalu U
Local referral of high-risk patients to high-quality hospitals: surgical outcomes, cost savings, and travel burdens.
In this study, the investigators sought to assess the potential changes in Medicare payments and clinical outcomes of referring high-risk surgical patients to local high-quality hospitals within small geographic areas. The investigators concluded that complication rates and Medicare payments were significantly lower for high-risk patients treated at local high-quality hospitals. The investigators suggest that triaging high-risk patients to local high-quality hospitals within small geographic areas may serve as a template for improving the value of surgical care.
AHRQ-funded; HS024763.
Citation: Smith ME, Shubeck SP, Nuliyalu U .
Local referral of high-risk patients to high-quality hospitals: surgical outcomes, cost savings, and travel burdens.
Ann Surg 2020 Jun;271(6):1065-71. doi: 10.1097/sla.0000000000003208..
Keywords: Surgery, Healthcare Costs, Hospitals, Medicare, Outcomes
Cook BL, Flores M, Zuvekas SH
AHRQ Author: Zuvekas SH
The impact Of Medicare's mental health cost-sharing parity on use of mental health care services.
This study examined the impact of Medicare’s mental health cost-sharing parity on use of mental health care services, which was phased in from 2010 to 2014. The authors assessed whether the reduction in mental health cost sharing was associated with changes in specialty and primary care outpatient mental health visits and psychotropic medication fills. They compared people with Medicare and private insurance before and after implementation. Medicare beneficiaries’ use of psychotropic medication increased after implementation but there was not a detectable change in visits.
AHRQ-authored.
Citation: Cook BL, Flores M, Zuvekas SH .
The impact Of Medicare's mental health cost-sharing parity on use of mental health care services.
Health Aff 2020 May;39(5):819-27. doi: 10.1377/hlthaff.2019.01008..
Keywords: Medical Expenditure Panel Survey (MEPS), Medicare, Behavioral Health, Healthcare Costs, Policy, Health Insurance, Healthcare Utilization, Access to Care
Wang Y, Eldridge N, Metersky ML
AHRQ Author: Eldridge N, Rodrick D
Association between Medicare expenditures and adverse events for patients with acute myocardial infarction, heart failure, or pneumonia in the United States.
The purpose of this study was to evaluate whether hospital-specific adverse event rates were associated with hospital-specific risk-standardized 30-day episode-of-care Medicare expenditures for fee-for-service patients discharged with acute myocardial infarction (AMI), heart failure (HF), or pneumonia. Investigators concluded that hospitals with high adverse event rates were more likely to have high 30-day episode-of-care Medicare expenditures for patients discharged with AMI, HF, or pneumonia.
AHRQ-authored; AHRQ-funded; 290201200003C.
Citation: Wang Y, Eldridge N, Metersky ML .
Association between Medicare expenditures and adverse events for patients with acute myocardial infarction, heart failure, or pneumonia in the United States.
JAMA Netw Open 2020 Apr;3(4):e202142. doi: 10.1001/jamanetworkopen.2020.2142..
Keywords: Adverse Events, Patient Safety, Heart Disease and Health, Cardiovascular Conditions, Pneumonia, Medicare, Healthcare Costs
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
Tseng CW, Masuda C, Chen R
Impact of higher insulin prices on out-of-pocket costs in Medicare Part D.
In this study, the investigators examined how patients’ out-of-pocket costs for insulin would have dropped from 2014 to 2019 due to Part D policy changes and whether higher insulin prices offset these potential savings. The authors concluded that efforts to reduce patients’
out-of-pocket cost by closing the Medicare Part D coverage gap were largely negated by higher insulin prices.
out-of-pocket cost by closing the Medicare Part D coverage gap were largely negated by higher insulin prices.
AHRQ-funded; HS024227.
Citation: Tseng CW, Masuda C, Chen R .
Impact of higher insulin prices on out-of-pocket costs in Medicare Part D.
Diabetes Care 2020 Apr;43(4):e50-e51. doi: 10.2337/dc19-1294..
Keywords: Medication, Healthcare Costs, Medicare, Health Insurance, Policy
Lin SC, Yan PL, Moloci NM
Out-of-network primary care is associated with higher per beneficiary spending in Medicare ACOs.
Despite expectations that Medicare accountable care organizations (ACOs) would curb health care spending, their effect has been modest. One possible explanation is that ACOs' inability to prohibit out-of-network care limits their control over spending. To examine this possibility, the investigators evaluated the association between out-of-network care and per beneficiary spending using national Medicare data for 2012-15.
AHRQ-funded; HS024728; HS024525; HS025165; HS025875.
Citation: Lin SC, Yan PL, Moloci NM .
Out-of-network primary care is associated with higher per beneficiary spending in Medicare ACOs.
Health Aff 2020 Feb;39(2):310-18. doi: 10.1377/hlthaff.2019.00181..
Keywords: Healthcare Costs, Primary Care, Medicare, Health Insurance
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
Wickwire EM, Vadlamani A, Tom SE
Economic aspects of insomnia medication treatment among Medicare beneficiaries.
The purpose of this study was to examine economic aspects of insomnia and insomnia medication treatment among a nationally representative sample of older adult Medicare beneficiaries. A total of 23,079 beneficiaries with insomnia were included. Of these, 5,154 (22%) received >1 fills for an FDA-approved insomnia medication following insomnia diagnosis. For both treated and untreated individuals, healthcare utilization and costs increased during the 12 months prior to diagnosis. Insomnia treatment was associated with significantly increased ED visits and prescription fills in the year following insomnia diagnosis.
AHRQ-funded; HS024560.
Citation: Wickwire EM, Vadlamani A, Tom SE .
Economic aspects of insomnia medication treatment among Medicare beneficiaries.
Sleep 2020 Jan;43(1):pii: zsz192. doi: 10.1093/sleep/zsz192..
Keywords: Medication, Sleep Problems, Medicare, Healthcare Costs
Carey K, Dor A
Hospital response to CMS public reports of hospital charge information.
This study examined trends in charge increases for Medicare inpatients treated in approximately 3400 hospitals after the Centers for Medicare and Medicaid Services (CMS) began reporting charges online in 2013 for Medicare inpatients. The investigators applied difference-in-differences analysis to comprehensive inpatient charge data from New York and Florida for the years 2011-2016. After public reporting was implemented the growth in reported charges in New York hospitals was 4-9% lower than unreported diagnosis-related groups and in Florida it was 2-8% lower.
AHRQ-funded; HS025074.
Citation: Carey K, Dor A .
Hospital response to CMS public reports of hospital charge information.
Med Care 2020 Jan;58(1):70-73. doi: 10.1097/mlr.0000000000001232..
Keywords: Hospitals, Healthcare Costs, Public Reporting, Medicare, Hospitalization