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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 11 of 11 Research Studies DisplayedHaque W, Ahmadzada M, Janumpally S
Adherence to a federal hospital price transparency rule and associated financial and marketplace factors.
This research letter describes a study that evaluated adherence to the federal Hospital Price Transparency Rule 6 to 9 months after the final rule effective date (January 1, 2021). The rule’s aim is to increase health price transparency and facilitation patient price shopping online. Hospitals were required to post 5 price types: gross charges, discounted prices, payer-specific negotiated prices, minimum and maximum prices in a machine-readable file, and a separate accessible display or price estimator for at least 300 shoppable items. The authors used the Herfindahl-Hirschman Index (HHI) to measure inpatient hospital market concentration. The data was collected for 185 of 929 core-based statistical areas from 2019. HHI is divided into the following categories: unconcentrated, moderately concentrated, or highly or very concentrated. Results showed that out of 5239 total hospitals, 729 (13.9%) had an adherent machine-readable file but no shoppable display, 1542 (29.4%) had an adherent shoppable display but no machine-readable file, and 300 (5.7%) had both. The most adherent hospitals tended to be acute care hospitals with lesser revenue per patient-day, within unconcentrated health care markets, and in urban areas.
AHRQ-funded; HS026980.
Citation: Haque W, Ahmadzada M, Janumpally S .
Adherence to a federal hospital price transparency rule and associated financial and marketplace factors.
JAMA 2022 Jun 7;327(21):2143-45. doi: 10.1001/jama.2022.5363..
Keywords: Policy, Hospitals, Healthcare Costs
Eliason EL, MacDougall H, Peterson L
Understanding the aggressive practices of nonprofit hospitals in pursuit of patient debt.
This study examined the prevalence of extraordinary collection actions (ECAs) and characteristics of nonprofit hospitals that reported this behavior from 2010 to 2016. The authors used Community Benefit Insight data to compare these hospitals with ones that did not report these practices. ECAs include reporting patient debt to credit and collection agencies, filing lawsuits, placing liens on residences, and issuing civil arrest. Hospitals that reported ECAs significantly differed in total revenue, system membership, bed size, urban location, financial assistance policy use, and use of poverty guidelines for discounted care. Lower total hospital revenue was a significant predictor of ECAs.
AHRQ-funded; HS000084.
Citation: Eliason EL, MacDougall H, Peterson L .
Understanding the aggressive practices of nonprofit hospitals in pursuit of patient debt.
Health Soc Work 2022 Jan 31;47(1):36-44. doi: 10.1093/hsw/hlab034..
Keywords: Hospitals, Healthcare Costs, Policy
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
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
Pickens G, Karaca Z, Gibson TB
AHRQ Author: Karaca Z, Wong HS
Changes in hospital service demand, cost, and patient illness severity following health reform.
This study examined the effects of expanded Medicaid coverage and the health insurance exchange on the number of hospital inpatient and emergency department (ED) utilization rates, cost, and patient illness severity. There was a significant drop in uninsured inpatient discharges and ED visits in states where Medicaid was expanded. For all by young females, uninsured inpatient discharge rates fell by 39% or greater. In nonexpansion states, the rates remained unchanged or increased slightly. Changes in all-payer and private insurance rates were not as dramatic, as was inpatient costs per discharge and all-payer inpatient costs.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Pickens G, Karaca Z, Gibson TB .
Changes in hospital service demand, cost, and patient illness severity following health reform.
Health Serv Res 2019 Aug;54(4):739-51. doi: 10.1111/1475-6773.13165..
Keywords: Access to Care, Health Insurance, Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Healthcare Utilization, Hospitals, Medicaid, Policy, Uninsured
Johnson EK, Hardy R, Santos T
State laws and nonprofit hospital community benefit spending.
The authors of this article sought to determine the association of state laws on nonprofit hospital community benefit spending. Participants included 2421 nonprofit short-term acute care hospital organizations. The authors found that state laws are associated with nonprofit hospital community benefit spending and recommended that policymakers use community benefit laws to increase nonprofit hospital engagement with public health.
AHRQ-funded; HS024959.
Citation: Johnson EK, Hardy R, Santos T .
State laws and nonprofit hospital community benefit spending.
J Public Health Manag Pract 2019 Jul/Aug;25(4):E9-e17. doi: 10.1097/phh.0000000000000885.
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Keywords: Hospitals, Policy, Healthcare Costs
Makam AN, Nguyen OK, Kirby B
Effect of site-neutral payment policy on long-term acute care hospital use.
The purpose of this study was to assess the projected effect of the Centers for Medicare and Medicaid Services new site-neutral payment policy, which aims to decrease unnecessary long-term acute care hospital (LTACH) admissions by reducing reimbursements for less-ill individuals by 2020. The investigators concluded that the site-neutral payment policy may limit LTACH access in existing LTAC-scarce markets, with potential adverse implications for recovery of hospitalized older adults.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Kirby B .
Effect of site-neutral payment policy on long-term acute care hospital use.
J Am Geriatr Soc 2018 Nov;66(11):2104-11. doi: 10.1111/jgs.15539..
Keywords: Policy, Hospitalization, Payment, Long-Term Care, Healthcare Costs, Medicare, Elderly, Hospitals
Lindrooth RC, Perraillon MC, Hardy RY
Understanding the relationship between Medicaid expansions and hospital closures.
The investigators hypothesized that Medicaid expansion of eligibility for childless adults prevents hospital closures because increased Medicaid coverage for previously uninsured people reduces uncompensated care expenditures and strengthens hospitals' financial position. They tested this hypothesis using data for the period 2008-16 on hospital closures and financial performance and discuss their findings in this paper.
AHRQ-funded; HS024959; HS025208.
Citation: Lindrooth RC, Perraillon MC, Hardy RY .
Understanding the relationship between Medicaid expansions and hospital closures.
Health Aff 2018 Jan;37(1):111-20. doi: 10.1377/hlthaff.2017.0976..
Keywords: Healthcare Costs, Policy, Hospitals, Medicaid, Rural Health
Leider JP, Tung GJ, Lindrooth RC
Establishing a baseline: community benefit spending by not-for-profit hospitals prior to implementation of the Affordable Care Act.
This article examines how not-for-profit hospitals spent Community Benefit dollars prior to full implementation of the Affordable Care Act (ACA). Using data from 2009 to 2012 hospital tax and other governmental filings, the researchers constructed national, hospital-referral-region, and facility-level estimates of Community Benefit spending.
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AHRQ-funded; HS024959
Citation: Leider JP, Tung GJ, Lindrooth RC .
Establishing a baseline: community benefit spending by not-for-profit hospitals prior to implementation of the Affordable Care Act.
J Public Health Manag Pract 2017 Nov/Dec;23(6):e1-e9. doi: 10.1097/phh.0000000000000493.
Keywords: Healthcare Costs, Policy, Hospitals
Kawai AT, Calderwood MS, Jin R
Impact of the Centers for Medicare and Medicaid services hospital-acquired conditions policy on billing rates for 2 targeted healthcare-associated infections.
The 2008 Centers for Medicare & Medicaid Services (CMS) hospital-acquired conditions policy limited additional payment for conditions deemed reasonably preventable. This study examined whether this policy was associated with decreases in billing rates for 2 targeted conditions, vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infections (CAUTI). The CMS policy appears to have been associated with immediate reductions in billing rates for VCAI and CAUTI, followed by a slight decreasing trend or leveling-off in rates.
AHRQ-funded; HS018414.
Citation: Kawai AT, Calderwood MS, Jin R .
Impact of the Centers for Medicare and Medicaid services hospital-acquired conditions policy on billing rates for 2 targeted healthcare-associated infections.
Infect Control Hosp Epidemiol 2015 Aug;36(8):871-7. doi: 10.1017/ice.2015.86.
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Keywords: Healthcare-Associated Infections (HAIs), Policy, Medicare, Payment, Hospitals, Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Healthcare Costs
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