National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (1)
- Cardiovascular Conditions (1)
- Children/Adolescents (1)
- Dental and Oral Health (1)
- Electronic Health Records (EHRs) (1)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (3)
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- Health Information Technology (HIT) (1)
- Health Insurance (2)
- Health Systems (1)
- Heart Disease and Health (1)
- Hospital Readmissions (1)
- Hospitals (5)
- Medicaid (2)
- Medical Devices (1)
- Medicare (6)
- Patient Safety (1)
- (-) Payment (18)
- Policy (5)
- Primary Care (1)
- Provider: Physician (3)
- Provider Performance (6)
- Quality Improvement (3)
- Quality Indicators (QIs) (1)
- Quality Measures (1)
- Quality of Care (5)
- Risk (1)
- Surgery (2)
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 18 of 18 Research Studies DisplayedLiao JM, Wang E, Isidro U
The association between bundled payment participation and changes in medical episode outcomes among high-risk patients.
This research evaluated whether the association between participation in bundled payments for medical conditions and episode outcomes differed for clinically high-risk versus other patients in regard to length of stay (LOS) at skilled nursing facilities (SNFs). Participants included 471,421 Medicare patients hospitalized at bundled payment and propensity-matched non-participating hospitals. Primary outcomes were SNF LOS and 90-day unplanned readmissions. SNF length of stay was differentially lower among frail patients, patients with advanced age (>85 years), and those with prior institutional post-acute care provider utilization compared to non-frail, younger, and patients without prior utilization, respectively. Bundled payment participation was also associated with differentially greater SNF LOS among disabled patients. It was not associated with differential changes in readmissions in any high-risk group but was associated with changes in quality, utilization, and spending measures for some groups.
AHRQ-funded; HS027595.
Citation: Liao JM, Wang E, Isidro U .
The association between bundled payment participation and changes in medical episode outcomes among high-risk patients.
Healthcare 2022 Dec 12; 10(12). doi: 10.3390/healthcare10122510..
Keywords: Payment, Quality Improvement, Quality of Care, Risk, Policy
Collins CR, Abel MK, Shui A
Preparing for participation in the centers for Medicare and Medicaid Services' bundle care payment initiative-advanced for major bowel surgery.
This study aimed to assess where the largest opportunities for care improvement lay with the bundled payment reimbursement model and how best to identify patients at high risk of suffering costly complications, including hospital readmission. The authors used a cohort of patients from 2014 and 2016 who met inclusion criteria for the Major Bowel Bundled Payment Program and performed a cost analysis to identify opportunities for improved care efficiency. Using the results, they identified readmissions as a target for improvement and then assessed whether the American College of Surgeons' National Surgical Quality Improvement Program surgical risk calculator (ACS NSQIP SRC) could accurately identify patients within the bundled payment population who were at high risk of readmission using a logistic regression model. Patients who were readmitted within 90-days post-surgery were 2.53 times more likely to be high-cost (>$60,000) then non-readmitted patients. However, the ACS NSQIP SRC did not accurately predict patients at high risk of readmission within the first 30 days post-surgery.
AHRQ-funded; HS024532.
Citation: Collins CR, Abel MK, Shui A .
Preparing for participation in the centers for Medicare and Medicaid Services' bundle care payment initiative-advanced for major bowel surgery.
Perioper Med 2022 Dec 9;11(1):54. doi: 10.1186/s13741-022-00286-9..
Keywords: Provider Performance, Payment, Hospital Readmissions, Quality Improvement, Quality of Care, Surgery, Medicare, Medicaid
Liao JM, Huang Q, Wang E
Performance of physician groups and hospitals participating in bundled payments among Medicare beneficiaries.
This cohort study compared how physician group practices (PGPs) performed in bundled payments compared with hospitals. The authors used 2011 to 2018 Medicare claims data to compare the association of participants in the Bundled Payments for Care Improvement (BCPI) initiative with episode outcomes. Primary outcome was 90-day total episode spending. The total sampled comprised data from 1,288,781 Medicare beneficiaries, of whom mean age was 76.2 years, 59.7% women, and 85.5% White, with 592,071 individuals receiving care from 6405 physicians in in BPCI-participating PGPs and 24,758 propensity-matched physicians in non-BPCI-participating PGPs. For PGPs, BPCI participation was associated with greater reductions in episode spending for surgical (difference, -$1648 to -$1088) but not for medical episodes (difference, -$410 to $206). Hospital participation in BPCI was associated with greater reductions in episode spending for both surgical ($1345 to -$675) and medical -$1139 to -$386) episodes.
AHRQ-funded; HS027595.
Citation: Liao JM, Huang Q, Wang E .
Performance of physician groups and hospitals participating in bundled payments among Medicare beneficiaries.
JAMA Health Forum 2022 Dec 2; 3(12):e224889. doi: 10.1001/jamahealthforum.2022.4889..
Keywords: Provider Performance, Payment, Hospitals, Medicare, Quality of Care
Maganty A, Hollenbeck BK, Kaufman SR
Implications of the merit-based incentive payment system for urology practices.
The purpose of this cross-sectional study was to analyze urologist performance in the Medicare merit-based incentive payment system (MIPS) for urology practices for 2017 and 2019 using Medicare data. MIPS scores were estimated by practice organization. The study found that urologists from small practices performed worse in MIPS and had a significantly lower adjusted odds ratio of receiving bonus payments in both 2017 and 2019 compared to larger group practices. Urologists who received penalties in 2017 had greater rates of consolidation by 2019 compared to those who were not penalized. The researchers concluded that smaller urology practices and urology practices caring for a greater percentage of dual eligible beneficiaries typically performed worse in the Medicare merit-based incentive payment system.
AHRQ-funded; HS025707.
Citation: Maganty A, Hollenbeck BK, Kaufman SR .
Implications of the merit-based incentive payment system for urology practices.
Urology 2022 Nov;169:84-91. doi: 10.1016/j.urology.2022.05.052..
Keywords: Payment, Provider Performance, Provider: Physician
Likosky DS, Yang G, Zhang M
Interhospital variability in health care-associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries.
The purpose of this study was to examine differences in durable ventricular assist device implantation infection rates and associated costs across hospitals. The researchers utilized clinical data for 8,688 patients who received primary durable ventricular assist devices from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) hospitals (n = 120) and merged that data with post-implantation 90-day Medicare claims. The primary outcome included infections within 90 days of implantation and Medicare payments. The study found that 27.8% of patients developed 3982 identified infections. The median adjusted incidence of infections (per 100 patient-months) across hospitals was 14.3 and differed according to hospital. Total Medicare payments from implantation to 90 days were 9.0% more in high versus low infection tercile hospitals. The researchers concluded that health-care-associated infection rates post durable ventricular assist device implantation varied according to hospital and were associated with increased 90-day Medicare expenditures.
AHRQ-funded; HS026003.
Citation: Likosky DS, Yang G, Zhang M .
Interhospital variability in health care-associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries.
J Thorac Cardiovasc Surg 2022 Nov;164(5):1561-68. doi: 10.1016/j.jtcvs.2021.04.074..
Keywords: Healthcare-Associated Infections (HAIs), Medical Devices, Medicare, Heart Disease and Health, Cardiovascular Conditions, Hospitals, Payment, Healthcare Costs
Li J, Wu B, Flory J
Impact of the Affordable Care Act's Physician Payments Sunshine Act on branded statin prescribing.
The purpose of this study was to assess the impact of the Affordable Care Act's Physician Payments Sunshine Act (PPSA) and its mandate of disclosing pharmaceutical and medical industry payments to physicians for prescribing branded statins. The study found that the PPSA contributed to a 7% decrease in monthly new prescriptions of brand-name statins over the study period. There was no significant change in generic prescribing. The reduction was concentrated among physicians with the highest tercile of drug spending prior to the enactment of the PPSA, with a decrease of 15% in new branded statin prescriptions. The researchers concluded that the PPSA mandate reduced the prescribing of branded statin prescriptions in the time period following its announcement, especially in physicians who were taking part in excessive prescribing of the branded statins.
AHRQ-funded; HS027001.
Citation: Li J, Wu B, Flory J .
Impact of the Affordable Care Act's Physician Payments Sunshine Act on branded statin prescribing.
Health Serv Res 2022 Oct;57(5):1145-53. doi: 10.1111/1475-6773.14024..
Keywords: Payment, Policy, Medicare, Health Insurance
Lipton BJ, Decker SL, Stitt B
AHRQ Author: Decker SL Manski RJ
Association between Medicaid dental payment policies and children's dental visits, oral health, and school absences.
The purpose of this cross-sectional study was to assess the relationship between the ratio of Medicaid payment rates to dentist charges and children's preventive dental visits, oral health, and school absences. The researchers conducted a difference-in-differences analysis of 15,738 Medicaid-enrolled children and a control group of 16 867 privately insured children aged 6 to 17 years who participated in the 2016-2019 National Survey of Children's Health. The study found that 87% and 48% of Medicaid-enrolled children had at least 1 and at least 2 past-year dental visits, respectively, and 29% had parent-reported excellent oral health. Increasing the fee ratio by was associated with increases in at least 1 and 2 visits and in excellent oral health. Increases in at least 2 visits were larger for Hispanic children than for White children. By weighted baseline estimates, 28% and 15% of Medicaid-enrolled children had at least 4 and at least 7 past-year school absences, respectively. The researchers concluded that Medicaid policies with higher payments were associated with modest increases in children's preventive dental visits and excellent oral health.
AHRQ-authored.
Citation: Lipton BJ, Decker SL, Stitt B .
Association between Medicaid dental payment policies and children's dental visits, oral health, and school absences.
JAMA Health Forum 2022 Sep 2;3(9):e223041. doi: 10.1001/jamahealthforum.2022.3041..
Keywords: Children/Adolescents, Dental and Oral Health, Medicaid, Payment, Policy
Waters TM, Burns N, Kaplan CM
Combined impact of medicare's hospital pay for performance programs on quality and safety outcomes is mixed.
The authors examined the combined impact of Medicare's pay for performance (P4P) programs on clinical areas and populations targeted by the programs, as well as those outside their focus. Using HCUP data, and consistent with previous studies for individual programs, they detected minimal, if any, effect of Medicare's hospital P4P programs on quality and safety. They recommended a redesigning of the P4P programs before continuing to expand them.
AHRQ-funded; HS025148.
Citation: Waters TM, Burns N, Kaplan CM .
Combined impact of medicare's hospital pay for performance programs on quality and safety outcomes is mixed.
BMC Health Serv Res 2022 Jul 28;22(1):958. doi: 10.1186/s12913-022-08348-w..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicare, Payment, Provider Performance, Hospitals, Quality Indicators (QIs), Quality Measures, Quality Improvement, Quality of Care, Patient Safety
Post B, Norton EC, Hollenbeck BK
Hospital-physician integration and risk-coding intensity.
This study analyzed whether hospital-physician integration affects providers' coding of patient severity, because greater diagnostic severity will increase practices’ payment under risk-based arrangements. The authors used a two-way fixed effects model, an event study, and a stacked difference-in-differences analysis of 5 million patient-year observations from 2010 to 2015. They found that the integration of a patient's primary care doctor is associated with a robust 2%-4% increase in coded severity, the risk-score equivalent of aging a physician's patients by 4-8 months. This effect wasn’t driven by physicians treating different patients nor by physicians seeing patients more often. Their evidence is consistent with the hypothesis that hospitals share organizational resources with acquired physician practices to increase the measured clinical severity of patients. They believe that increases in the intensity of coding will improve vertically-integrated practices' performance in alternative payment models and pay-for-performance programs while raising overall health care spending.
AHRQ-funded; HS025707;HS027044.
Citation: Post B, Norton EC, Hollenbeck BK .
Hospital-physician integration and risk-coding intensity.
Health Econ 2022 Jul; 31(7):1423-37. doi: 10.1002/hec.4516..
Keywords: Hospitals, Provider: Physician, Payment
Apathy NC, Hare AJ, Fendrich S
Early changes in billing and notes after evaluation and management guideline change.
This study investigated whether the American Medical Association updated 2021 guidance for frequently used billing codes for outpatient evaluation and management (E/M) visits changed E/M visit use, documentation length, and time spent in the electronic health record (EHR). The authors used data from 303,547 advanced practice providers and physicians across 389 organizations who use the Epic Systems EHR. Data containing weekly provider-level E/M code and EHR use metadata were extracted from the Epic Signal database for visits from September 2020 through April 2021. Following the new guidelines, level 3 visits decreased by 2.41 percentage points to 38.5% of all E/M visits, a 5.9% relative decrease from fall 2020. Level 4 visits increased by 0.89 percentage points to 40.9% of E/M visits, a 2.2% relative increase. Level 5 visits (the highest acuity level) increased by 1.85 percentage points to 10.1% of E/M visits, a 22.6% relative increase. Changes varied by specialty. No meaning changes in measures of note length or time spent in the EHR were found. The authors noted that fully realizing the intended benefits of this guideline change will require more time, facilitation, and scaling of best practices that more directly address EHR documentation practices and associated burden.
AHRQ-funded; HS026116.
Citation: Apathy NC, Hare AJ, Fendrich S .
Early changes in billing and notes after evaluation and management guideline change.
Ann Intern Med 2022 Apr;175(4):499-504. doi: 10.7326/m21-4402..
Keywords: Payment, Electronic Health Records (EHRs), Health Information Technology (HIT)
Burstein DS, Liss DT, Linder JA
Association of primary care physician compensation incentives and quality of care in the United States, 2012-2016.
AHRQ-funded; 233201500020I; HS026506; HS028127.
Citation: Burstein DS, Liss DT, Linder JA .
Association of primary care physician compensation incentives and quality of care in the United States, 2012-2016.
J Gen Intern Med 2022 Feb;37(2):359-66. doi: 10.1007/s11606-021-06617-8..
Keywords: Primary Care, Payment, Quality of Care
Kilaru AS, Crider CR, Chiang J
Health care leaders' perspectives on the Maryland all-payer model.
The purpose of this study was to examine perspectives on the implementation of the Maryland All-Payer Model (MDAPM) among health care leaders who participated in its design and execution. Findings identified key themes: expectations, autonomy, communication, actionable data, global budget calibration, and shared commitment to change. Together, these themes suggested that implementing the payment model followed an evolving and collaborative process that required stakeholder communication, data to guide decisions, and commitment to operating within the new payment system.
AHRQ-funded; HS026372.
Citation: Kilaru AS, Crider CR, Chiang J .
Health care leaders' perspectives on the Maryland all-payer model.
JAMA Health Forum 2022 Feb;3(2):e214920. doi: 10.1001/jamahealthforum.2021.4920..
Keywords: Payment, Healthcare Costs
Gettel CJ, Han CR, Granovsky MA
Emergency clinician participation and performance in the Centers for Medicare & Medicaid Services merit-based incentive payment system.
Investigators sought to describe participation in the Merit-based Incentive Payment System (MIPS) and to examine differences in performance scores and payment adjustments based on reporting affiliation and reporting strategy. They found that clinicians reporting as individuals earned lower overall MIPS scores than those reporting within groups and MIPS alternative payment models (APMs) and more frequently incurred penalties with a negative payment adjustment. The authors concluded that emergency clinician participation is common, with one in four participating through MIPS APMs. Additionally, those employing specific strategies such as group reporting received the highest MIPS scores and payment adjustments, emphasizing the role that reporting strategy and affiliation play in the quality of care.
AHRQ-funded; HS027811.
Citation: Gettel CJ, Han CR, Granovsky MA .
Emergency clinician participation and performance in the Centers for Medicare & Medicaid Services merit-based incentive payment system.
Acad Emerg Med 2022 Jan;29(1):64-72. doi: 10.1111/acem.14373..
Keywords: Payment, Provider Performance
Reid RO, Tom AK, Ross RM
Physician compensation arrangements and financial performance incentives in US health systems.
This study examined physician compensation arrangements for primary care physicians (PCPs) and specialists among US health system-affiliated physician organizations (POs) and measured the portion of total physician compensation based on quality and cost performance. This study used a cross-sectional mixed-methods analysis of in-depth multimodal data (compensation document review, interviews with 40 PO leaders, and surveys conducted between November 2017 and July 2019) from 31 POs affiliated with 22 purposefully selected health systems in 4 states. The most common compensation arrangement was volume-based (68.2% mean for PCPs and 73.7% mean for specialists). Incentives for quality and cost performance were common, but compensation based on those were not common (9.0% mean for PCPs, 4.5% mean for specialists).
AHRQ-funded; HS024067.
Citation: Reid RO, Tom AK, Ross RM .
Physician compensation arrangements and financial performance incentives in US health systems.
JAMA Health Forum 2022 Jan;3(1):e214634. doi: 10.1001/jamahealthforum.2021.4634..
Keywords: Health Systems, Provider: Physician, Payment, Provider Performance
Hollingsworth JM, Birkmeyer JD, Ye Z
Specialty-specific trends in the prevalence and distribution of outpatient surgery: implications for payment and delivery system reforms.
The authors sought to assess the prevalence and distribution of outpatient surgery across specialties. They found that several specialties - urology, gastroenterology, plastic surgery, and ophthalmology - perform most of their cases in outpatient settings. They suggested that incorporating these findings into the design of future payment and delivery system reforms will help to ensure adequate surgeon exposure to the efficiency gains that evolve from them.
AHRQ-funded; HS020927; HS018346.
Citation: Hollingsworth JM, Birkmeyer JD, Ye Z .
Specialty-specific trends in the prevalence and distribution of outpatient surgery: implications for payment and delivery system reforms.
Surg Innov 2014 Dec;21(6):560-5. doi: 10.1177/1553350613520515.
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Keywords: Ambulatory Care and Surgery, Surgery, Healthcare Delivery, Payment
Ridgely MS, de Vries D, Bozic KJ
Bundled payment fails to gain a foothold in California: the experience of the IHA bundled payment demonstration.
This article reports on a meeting convened by California's Integrated Healthcare Association to determine whether bundled payment could be an effective payment model for California. An evaluation of the pilot documented a number of barriers, such as administrative burden, state regulatory uncertainty, and disagreements about bundle definition and assumption of risk; however, the evaluation provides lessons for future bundled payment initiatives.
AHRQ-funded; HS020098.
Citation: Ridgely MS, de Vries D, Bozic KJ .
Bundled payment fails to gain a foothold in California: the experience of the IHA bundled payment demonstration.
Health Aff 2014 Aug;33(8):1345-52. doi: 10.1377/hlthaff.2014.0114.
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Keywords: Payment, Policy
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
Ryan AM, Mushlin AI
The Affordable Care Act's payment reforms and the future of hospitals.
The author places likely hospital responses to the Affordable Care Act’s payment reforms in the historical context of their previous responses to such reforms as price controls, certificate-of-need laws, and prospective payment systems. He then discusses possible hospital responses to counter readmission penalties, revenue reductions, bundled payment strategies, and accountable care organizations.
AHRQ-funded; HS018546
Citation: Ryan AM, Mushlin AI .
The Affordable Care Act's payment reforms and the future of hospitals.
Ann Intern Med. 2014 May 20;160(10):729-30. doi: 10.7326/M13-2033..
Keywords: Healthcare Costs, Payment, Hospitals, Policy