National Healthcare Quality and Disparities Report
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Topics
- Access to Care (2)
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- Ambulatory Care and Surgery (1)
- Behavioral Health (1)
- Cancer (1)
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- Care Coordination (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (2)
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- Healthcare-Associated Infections (HAIs) (7)
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- Quality Indicators (QIs) (3)
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- Quality of Care (16)
- Racial and Ethnic Minorities (2)
- Respiratory Conditions (1)
- Risk (1)
- Rural/Inner-City Residents (1)
- Rural Health (3)
- Social Determinants of Health (1)
- Surgery (17)
- Transitions of Care (3)
- Uninsured (2)
- Urinary Tract Infection (UTI) (2)
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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 90 Research Studies DisplayedHenke RM, Fingar KR, Liang L
AHRQ Author: Liang L, Jiang HJ
Medicare Advantage in rural areas: implications for hospital sustainability.
This study examined the association between Medicare Advantage penetration levels in rural areas and hospital financial distress and closure. This retrospective study followed rural general acute hospitals open from 2008-2019 or until closure using HCUP State Inpatient Databases for 14 states. Medicare Advantage penetration at rural hospitals grew from 6.5% in 2008 to 20.6% in 2019. A 1-percentage point increase in hospital penetration was associated with an increase in financial stability of 0.04 units on the Altman Z score and a 4% reduction in risk of closure (HR, 0.96).
AHRQ-authored; AHRQ-funded; 290201800005C.
Citation: Henke RM, Fingar KR, Liang L .
Medicare Advantage in rural areas: implications for hospital sustainability.
Am J Manag Care 2023 Nov; 29(11):594-600. doi: 10.37765/ajmc.2023.89455..
Keywords: Medicare, Rural Health, Rural/Inner-City Residents, Hospitals
Mullens CL, Lussiez A, Scott JW
Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries.
This study’s objective was to compare surgical outcomes and expenditures at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries. This cross-sectional retrospective study used data from 842,787 Medicare beneficiary patient admissions to hospitals with and without Health Professional Shortage Area designations for common operations including appendectomy, cholecystectomy, colectomy, and hernia repair from 2014 to 2018. Primary outcomes measures were 30-day mortality, hospital readmissions, and 30-day surgical episode payments. Patients (mean age=75.6 years, males=44.4%) undergoing common surgical procedures in shortage area hospitals were less likely to be White (84.6% vs 88.4%) and less likely to have≥2 Elixhauser comorbidities (75.5% vs 78.2%). Patients undergoing surgery at Health Professional Shortage Area hospitals had lower risk-adjusted rates of 30-day mortality (6.05% vs 6.69%) and readmission (14.99% vs 15.74%). Medicare expenditures at Health Professional Shortage Area hospitals were also lower than nonshortage designated hospitals ($28,517 vs $29,685).
AHRQ-funded; HS028606; HS028672.
Citation: Mullens CL, Lussiez A, Scott JW .
Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries.
Ann Surg 2023 Oct 1; 278(4):e733-e39. doi: 10.1097/sla.0000000000005762..
Keywords: Hospitals, Surgery, Medicare, Healthcare Costs, Workforce, Outcomes
Mullens CL, Lussiez A, Scott JW
High-risk surgery among Medicare beneficiaries living in health professional shortage areas.
This study’s objective was to compare high-risk surgical outcomes at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries. The authors performed a retrospective review of Medicare beneficiaries living in health professional shortage areas and nonshortage areas who underwent abdominal aortic aneurysm repair, coronary artery bypass graft, esophagectomy, liver resection, pancreatectomy, or rectal resection between 2014 and 2018. They compared rates of postoperative complications and 30-day mortality between the patient cohorts. They used beneficiary and hospital ZIP codes to quantify travel time to obtain care. Compared with patients living in nonshortage areas, patients living in health professional shortage areas traveled longer (median 60.0 vs 28.0 minutes). There were no differences in risk-adjusted rates of complications (28.5% vs 28.6%) and small differences in rates of 30-day mortality (4.2% vs 4.4%) between beneficiaries living in shortage areas versus those not in shortage areas, respectively.
AHRQ-funded; HS028606; HS028672; HS027788.
Citation: Mullens CL, Lussiez A, Scott JW .
High-risk surgery among Medicare beneficiaries living in health professional shortage areas.
J Rural Health 2023 Sep; 39(4):824-32. doi: 10.1111/jrh.12748..
Keywords: Surgery, Hospitals, Workforce, Medicare, Outcomes
McGarry BE, Mao Y, Nelson D
Hospital proximity and emergency department use among assisted living residents.
The purpose of this retrospective cohort study was to explore the association between the distance of assisted living (AL) communities to the nearest hospital and AL residents' rates of emergency department (ED) utilization. The researchers hypothesized that when access to an ED is a shorter distance, AL-to-ED transfers are more common, especially for non-emergency conditions. The study found that among 540,944 resident-years from 16,514 AL communities, the median distance to the closest hospital was 2.5 miles. After statistical adjustment, a doubling of distance to the closest hospital was related with 43.5 fewer ED treat-and-release visits per 1000 resident years and no significant difference in the rate of ED visits resulting in an inpatient admission. Among ED treat-and-release visits, a doubling of distance was related with a 3.0% decrease in visits classified as nonemergent, and a 1.6% decrease in visits classified as emergent, not primary care treatable.
AHRQ-funded; HS026893.
Citation: McGarry BE, Mao Y, Nelson D .
Hospital proximity and emergency department use among assisted living residents.
J Am Med Dir Assoc 2023 Sep; 24(9):1349-55.e.5. doi: 10.1016/j.jamda.2023.05.002..
Keywords: Emergency Department, Elderly, Long-Term Care, Medicare, Hospitals
Mullens CL, Scott JW, Mead M
Surgical procedures at critical access hospitals within hospital networks.
Critical access hospitals provide vital care to more than 80 million Americans. These facilities, often rural, are located greater than 35 miles away from another hospital and are required to maintain patient transfer agreements with other facilities capable of providing higher levels of care. The purpose of this cross-sectional retrospective study was to assess surgical outcomes and expenditures at critical access hospitals that do participate in a hospital network compared with those who do not participate in a hospital network among Medicare beneficiaries. From 2014 to 2018 the researchers compared 16,128 Medicare beneficiary admissions for appendectomy, cholecystectomy, colectomy, or hernia repair at critical access hospitals. The study found that Medicare beneficiaries who received care at critical access hospitals in a hospital network were more likely to carry 2 or more Elixhauser comorbidities. Rates of 30-day mortality and readmission rates were higher at critical access hospitals in a hospital network. Finally, total payments per episode were discovered to be $960 greater per patient at critical access hospitals that were in a hospital network ($23,878) when compared with critical access hospitals that were not in a hospital network ($22,918).
AHRQ-funded; HS028606; HS028672; HS027788.
Citation: Mullens CL, Scott JW, Mead M .
Surgical procedures at critical access hospitals within hospital networks.
Ann Surg 2023 Sep 1; 278(3):e496-e502. doi: 10.1097/sla.0000000000005772..
Keywords: Surgery, Hospitals, Medicare
Arbaje AI, Woodman S, Keita Fakeye MB
Senior services in US hospitals and readmission risk or mortality among Medicare beneficiaries since the Affordable Care Act.
This study examined whether there was an association between readmission risk or mortality among Medicare beneficiaries and passage of the Affordable Care Act. The study updated the Senior Care Services Scale (SCSS) which describes hospital provision of older adult services before the passage of the Affordable Care Act. The authors conducted a retrospective cohort analysis of older adults ≥65 years (n = 1,416,669), admitted to 2570 US acute-care hospitals from 2014 to 2015. Outcomes were hospital readmission, or death, within 30 and 90 days of discharge. The updated SCSS included three service groups: Inpatient Specialty Care, Post-Acute Community Care, and Home Care and Hospice. Older adults admitted to high Inpatient-Specialty-Care-scoring hospitals had lower risk of death within 30 days, and 90 days. There was no significant association between the other two groups and study outcomes.
AHRQ-funded; HS022916.
Citation: Arbaje AI, Woodman S, Keita Fakeye MB .
Senior services in US hospitals and readmission risk or mortality among Medicare beneficiaries since the Affordable Care Act.
J Appl Gerontol 2023 Jul; 42(7):1424-32. doi: 10.1177/07334648231161925..
Keywords: Elderly, Hospitals, Hospital Readmissions, Medicare
Trenaman L, Harrison M, Hoch JS
Medicare beneficiaries' perspectives on the quality of hospital care and their implications for value-based payment.
The objective of this study was to estimate the relative importance of the 4 quality domains in the Medicare's Hospital Value-Based Purchasing (HVBP) program from the perspective of Medicare beneficiaries and the impact of using beneficiary value weights on incentive payments for hospitals enrolled in FY 2019. A nationally representative sample of 1025 Medicare beneficiaries was recruited through Ipsos KnowledgePanel for an online survey. Hospital performance on clinical outcomes was most highly valued by beneficiaries, followed by safety, patient experience, and efficiency. The authors concluded that current HVBP program value weights do not reflect beneficiary preferences, suggesting that the use of beneficiary value weights may exacerbate disparities by rewarding larger, high-volume hospitals.
AHRQ-funded; HS027853.
Citation: Trenaman L, Harrison M, Hoch JS .
Medicare beneficiaries' perspectives on the quality of hospital care and their implications for value-based payment.
JAMA Netw Open 2023 Jun; 6(6):e2319047. doi: 10.1001/jamanetworkopen.2023.19047..
Keywords: Medicare, Inpatient Care, Hospitals
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
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
Friedman HR, Holmes GM
Rural Medicare beneficiaries are increasingly likely to be admitted to urban hospitals.
This study looked at trends in admission to urban hospitals by rural Medicare FFS beneficiaries from 2010 to 2018. The authors combined data from the 2010 to 2018 Hospital Service Area File (HSAF) and the 2010-2017 American Hospital Association (AHA) survey. They found that controlling for distance to the nearest hospitals, an increase of 1 year was associated with a 2.0% increase in the number of admissions to urban hospitals from each rural ZIP code. New system affiliation of the nearest rural hospital was associated with an increase of 1.7%.
AHRQ-funded; HS000032.
Citation: Friedman HR, Holmes GM .
Rural Medicare beneficiaries are increasingly likely to be admitted to urban hospitals.
Health Serv Res 2022 Oct;57(5):1029-34. doi: 10.1111/1475-6773.14017..
Keywords: Medicare, Rural Health, Hospitals, Access to Care
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
Taylor K, Diaz A, Nuliyalu U
Association of dual Medicare and Medicaid eligibility with outcomes and spending for cancer surgery in high-quality hospitals.
The purpose of this study was to assess whether treatment at high-quality hospitals mitigates dual-eligibility-associated disparities in outcomes and spending for cancer surgery. Medicare beneficiaries 65 years or older who underwent colectomy, rectal resection, lung resection, or pancreatectomy were evaluated. The findings indicate that, even among the highest-quality hospitals, dual-eligibility patients had poorer outcomes and higher spending. Dually eligible patients were more likely to be discharged to a facility and thus incurred higher post-acute care costs. Although treatment at high-quality hospitals is associated with reduced differences in outcomes, dual-eligibility patients remain at high risk for adverse post-operative outcomes as well as increased readmissions and post-acute care use.
AHRQ-funded; HS024763.
Citation: Taylor K, Diaz A, Nuliyalu U .
Association of dual Medicare and Medicaid eligibility with outcomes and spending for cancer surgery in high-quality hospitals.
JAMA Surg 2022 Apr;157(4):e217586. doi: 10.1001/jamasurg.2021.7586..
Keywords: Cancer, Surgery, Medicare, Medicaid, Outcomes, Hospitals
Everson J, Adler-Milstein JR, Hollingsworth JM
Dispersion in the hospital network of shared patients is associated with less efficient care.
The purpose of this study was to examine the level of distribution of patient-sharing networks across U.S. hospitals and its relationship with 3 measures of care delivered by hospitals that were likely to relate to coordination. The researchers utilized data from 2016 Medicare Fee-for-Service claims to measure the volume of patients that hospitals treated in common, and then calculated a measure of dispersion for each hospital. The relationship between network dispersion, Medicare spending per beneficiary, readmission rates, and emergency department (ED) throughput rates were then estimated. The study reported that hospitals with more dispersed networks had greater spending rates but not higher admission rates or slower ED processes. Among hospitals with less resources, more dispersion was associated with higher readmission rates and slower ED processes. The researchers concluded that dispersed interhospital networks create difficulties in coordinating patients who are treated at multiple hospitals, and that the structure of patient-sharing networks may be an overlooked factor that influences the delivery of care in health care organizations.
AHRQ-funded; HS026395, HS024525, HS024728, HS024454.
Citation: Everson J, Adler-Milstein JR, Hollingsworth JM .
Dispersion in the hospital network of shared patients is associated with less efficient care.
Health Care Manage Rev 2022 Apr-Jun;47(2):88-99. doi: 10.1097/hmr.0000000000000295..
Keywords: Medicare, Hospitals, Care Coordination, Healthcare Delivery
Herrin J, Yu H, Venkatesh AK
Identifying high-value care for Medicare beneficiaries: a cross-sectional study of acute care hospitals in the USA.
Investigators sought to define hospital value and identify the characteristics of hospitals which provide high-value care. Participants were Medicare beneficiaries with claims included in CMS Overall Star Ratings or in publicly available Medicare spending per beneficiary data. The researchers found that there are high quality hospitals that are not high value, and a number of factors are strongly associated with being low or high value. They suggested that their findings can inform efforts of policymakers and hospitals to increase the value of care.
AHRQ-funded; HS022882; HS026980.
Citation: Herrin J, Yu H, Venkatesh AK .
Identifying high-value care for Medicare beneficiaries: a cross-sectional study of acute care hospitals in the USA.
BMJ Open 2022 Mar 31;12(3):e053629. doi: 10.1136/bmjopen-2021-053629..
Keywords: Medicare, Quality of Care, Hospitals
Hua CL, Thomas KS, Bunker JN
Dementia diagnosis in the hospital and outcomes among patients with advanced dementia documented in the Minimum Data Set.
This retrospective cohort study examined the association between a dementia diagnosis listed on a hospital claim and patient outcomes among individuals with a Minimum Data Set (MDS) assessment. The cohort was comprised of hospitalized patients aged 66 years and older with advanced dementia noted on an MDS assessment completed within 120 days prior to their first hospitalization in 2017. Among 120,989 patients with advanced dementia and a nursing home stay, 90.6% had a dementia diagnosis on their hospital claims. Documentation of a dementia diagnosis was associated with lower use of intensive care unit or coronary care unit, use of invasive mechanical ventilation, and 30-day mortality. These patients also had a shorter hospital length of stay.
AHRQ-funded; HS000011.
Citation: Hua CL, Thomas KS, Bunker JN .
Dementia diagnosis in the hospital and outcomes among patients with advanced dementia documented in the Minimum Data Set.
J Am Geriatr Soc 2022 Mar;70(3):846-53. doi: 10.1111/jgs.17564..
Keywords: Dementia, Diagnostic Safety and Quality, Medicare, Hospitals, Neurological Disorders
Liao JM, Chatterjee P, Wang E
The effect of hospital safety net status on the association between bundled payment participation and changes in medical episode outcomes.
This study evaluated whether hospital safety net status affected the association between bundled payment participation and medical outcomes. The hospitals included were participants in Medicare’s Bundled Payments for Care Improvement (BCPI) program from 2011-2016. Data from Medicare fee-for-service beneficiaries hospitalized for acute myocardial infarction, pneumonia, congestive heart failure, and chronic obstructive pulmonary disease were used. Among BCPI hospitals, safety net status was not associated with differential postdischarge spending or quality. However, BPCI safety net hospitals had differentially greater discharge due to institutional post-acute care and lower discharge home with home health than BPCI non-safety net hospitals.
AHRQ-funded; HS027595.
Citation: Liao JM, Chatterjee P, Wang E .
The effect of hospital safety net status on the association between bundled payment participation and changes in medical episode outcomes.
J Hosp Med 2021 Dec;16(12):716-23. doi: 10.12788/jhm.3722..
Keywords: Medicare, Payment, Hospitals
Chhabra KR, Sheetz KH, Regenbogen SE
Wide variation in surgical spending within hospital systems: a missed opportunity for bundled payment success.
Researchers sought to measure the extent of variation in episode spending around total hip replacement for fee-for-service Medicare patients within and across hospital systems identified in the American Hospital Association Annual Survey. They found that average episode payments varied nearly as much within hospital systems as they did between the lowest- and highest-cost quintiles of systems, with variation driven by post-acute care utilization.
AHRQ-funded; HS000053.
Citation: Chhabra KR, Sheetz KH, Regenbogen SE .
Wide variation in surgical spending within hospital systems: a missed opportunity for bundled payment success.
Ann Surg 2021 Dec 1;274(6):e1078-e84. doi: 10.1097/sla.0000000000003741..
Keywords: Surgery, Health Systems, Medicare, Healthcare Costs, Hospitals
Arntson E, Dimick JB, Nuliyalu U
Changes in hospital-acquired conditions and mortality associated with the hospital-acquired condition reduction program.
This study evaluated changes in Hospital-Acquired Conditions (HACs) and 30-day mortality after the announcement of the Centers for Medicare and Medicare Services’ Hospital-Acquired Condition Reduction Program (HACRP) in August 2013. The authors evaluated models to test for changes in HACs and 30-day mortality before and after the Affordable Care Act (ACA), and after the HACRP. Fee-for-service Medicare claims from 2009 to 2015 were used. The HAC rate declined after the ACA was passed and declined further after the HACRP announcement. However, 30-day mortality rates were unchanged.
AHRQ-funded; HS026244.
Citation: Arntson E, Dimick JB, Nuliyalu U .
Changes in hospital-acquired conditions and mortality associated with the hospital-acquired condition reduction program.
Ann Surg 2021 Oct 1;274(4):e301-e07. doi: 10.1097/sla.0000000000003641..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Mortality, Medicare, Payment, Prevention, Patient Safety
Liao JM, Gupta A, Zhao Y
Association between hospital voluntary participation, mandatory participation, or nonparticipation in bundled payments and Medicare episodic spending for hip and knee replacements.
The purpose of this study was to examine and compare 2011-2017 spending for hip and joint replacements between hospitals with voluntary participation, mandatory participation and nonparticipation in the Medicare Bundled Payments for Care Improvement program.
Citation: Liao JM, Gupta A, Zhao Y .
Association between hospital voluntary participation, mandatory participation, or nonparticipation in bundled payments and Medicare episodic spending for hip and knee replacements.
JAMA 2021 Aug 3;326(5):438-40. doi: 10.1001/jama.2021.10046..
Keywords: Medicare, Hospitals, Payment, Surgery, Orthopedics, Healthcare Costs
Valdez S
Do Medicare's facility fees incentivize hospitals to vertically integrate with oncologists?
Within the past decade, the U.S. health care market has undergone massive vertical integration, prompting economists to study the underlying causes and consequences of hospital-physician integration. This paper examined whether or not hospitals strategically chose to vertically integrate with clinical oncologists in order to capture facility fees, a commonly cited reason for increased consolidation in the health care market.
AHRQ-funded; HS000046.
Citation: Valdez S .
Do Medicare's facility fees incentivize hospitals to vertically integrate with oncologists?
Inquiry 2021 Jan-Dec;58:469580211022968. doi: 10.1177/00469580211022968..
Keywords: Medicare, Hospitals, Provider: Physician
Eisenberg MD, Meiselbach MK, Bai G
Large self-insured employers lack power to effectively negotiate hospital prices.
This study examined the ability of self-insured employers to negotiate hospital prices and investigated the relationship between hospital prices and employer market power in the United States. Findings showed that employer market power was low in most metropolitan statistical areas. Recommendations included encouraging self-insured employers to consider building purchase alliances with state and local government employee groups in order to enhance their market power and to lower negotiated prices for hospital services.
AHRQ-funded; HS000029.
Citation: Eisenberg MD, Meiselbach MK, Bai G .
Large self-insured employers lack power to effectively negotiate hospital prices.
Am J Manag Care 2021 Jul;27(7):290-96. doi: 10.37765/ajmc.2021.88702..
Keywords: Health Insurance, Medicare, Medicaid, Healthcare Costs, Hospitals
Post B, Norton EC, Hollenbeck B
Hospital-physician integration and Medicare's site-based outpatient payments.
AHRQ-funded; HS027044.
Citation: Post B, Norton EC, Hollenbeck B .
Hospital-physician integration and Medicare's site-based outpatient payments.
Health Serv Res 2021 Feb;56(1):7-15. doi: 10.1111/1475-6773.13613..
Keywords: Hospitals, Payment, Medicare, Ambulatory Care and Surgery, Healthcare Delivery
Hsuan C, Braun TM, Ponce NA
Are improvements still needed to the modified hospital readmissions reduction program: a health and retirement study (2000-2014)?
This study examined whether modifications to the Medicare Hospital Readmissions Reduction Program (HRRP) addressed concerns that it unfairly penalized safety net hospitals treating patients with high social and functional risks. Data from 2000-2014 Medicare hospital discharge, Health and Retirement Study, and other community-level data was used. The authors estimated risk-standardized readmission rates (RSRRs) for peer groups and by safety net status using four hierarchical logistic regression models. Patient data used was from 20,255 fee-for-service Medicare beneficiaries (65+) with eligible index hospitalizations. Hospitals were categorized by peer group, with 1 having the lowest number of at-risk patients, and 5 categorized as a safety-net hospital. Under the modifications fewer safety-net hospitals were penalized, but worsened for those in peer groups 1,2, and 3.
AHRQ-funded; HS025838.
Citation: Hsuan C, Braun TM, Ponce NA .
Are improvements still needed to the modified hospital readmissions reduction program: a health and retirement study (2000-2014)?
J Gen Intern Med 2020 Dec;35(12):3564-71. doi: 10.1007/s11606-020-06222-1..
Keywords: Hospital Readmissions, Hospitals, Medicare
Everson J, Adler-Milstein J, Ryan AM
Hospitals strengthened relationships with close partners after joining accountable care organizations.
This study tested the hypothesis that hospitals participating in Medicare Accountable Care Organizations (ACOs) try to influence where their patients receive care in order to achieve quality and cost containment goals. The authors studied hospitals participating in ACO from 2010 to 2014. ACO hospitals shared patients 4.4% more than non-ACO hospitals. This occurred disproportionately at hospitals that already shared a high proportion of their patients prior to participation and among hospitals in ACOs characterized as physician-hospital collaborations.
AHRQ-funded; HS024525; HS024728.
Citation: Everson J, Adler-Milstein J, Ryan AM .
Hospitals strengthened relationships with close partners after joining accountable care organizations.
Med Care Res Rev 2020 Dec;77(6):549-58. doi: 10.1177/1077558718818336..
Keywords: Hospitals, Medicare, Policy, Health Insurance
Jacobs PD, Basu J
AHRQ Author: Jacobs PD, Basu J
Medicare Advantage and postdischarge quality: evidence from hospital readmissions.
This study compared relative readmission rates for beneficiaries enrolled in Medicare Advantage (MA) and traditional Medicare (TM). HCUP State Inpatient Databases data for 4 states was used from 2009 and 2014. The outcome compared was the probability of a hospital readmission within 30 days of an index admission. There were significantly lower all-cause readmission rates among MA enrollees relative to those in TM in both 2009 and 2014, but MA enrollment was not associated with an increased reduction in readmission rates relative to TM during that time period.
AHRQ-authored
Citation: Jacobs PD, Basu J .
Medicare Advantage and postdischarge quality: evidence from hospital readmissions.
Am J Manag Care 2020 Dec;26(12):524-29. doi: 10.37765/ajmc.2020.88540..
Keywords: Healthcare Cost and Utilization Project (HCUP), Elderly, Medicare, Hospital Readmissions, Hospitals, Quality of Care, Provider Performance