National Healthcare Quality and Disparities Report
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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
176 to 200 of 201 Research Studies DisplayedCalderwood MS, Vaz LE, Tse Kawai A
Impact of hospital operating margin on central line-associated bloodstream infections following Medicare's hospital-acquired conditions payment policy.
In October 2008, Medicare ceased additional payment for hospital-acquired conditions not present on admission. The researchers evaluated the policy's differential impact in hospitals with high vs low operating margins. They concluded that Medicare's payment policy may have had an impact on reducing central line-associated bloodstream infections in hospitals with low operating margins.
AHRQ-funded; HS018414.
Citation: Calderwood MS, Vaz LE, Tse Kawai A .
Impact of hospital operating margin on central line-associated bloodstream infections following Medicare's hospital-acquired conditions payment policy.
Infect Control Hosp Epidemiol 2016 Jan;37(1):100-3. doi: 10.1017/ice.2015.250.
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Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Medicare, Quality of Care, Payment, Sepsis
Hawken SR, Ryan AM, Miller DC
Surgery and Medicare shared savings program accountable care organizations.
The researchers investigated the degree to which surgeons and other specialists are participating in Medicare Shared Savings Programs, and whether such specialist integration influences accountable care organization (ACO) performance. They found that participation by surgeons and other specialists in Medicare ACO programs is highly variable. Some ACOs include many specialists who are tightly integrated with primary care physicians, while others consist solely of primary care physicians.
AHRQ-funded; HS018546.
Citation: Hawken SR, Ryan AM, Miller DC .
Surgery and Medicare shared savings program accountable care organizations.
JAMA Surg 2016 Jan;151(1):5-6. doi: 10.1001/jamasurg.2015.2772.
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Keywords: Surgery, Medicare, Payment, Healthcare Costs
Kronick R, Casalino LP, Bindman AB
AHRQ Author: Kronick R
Apple pickers or federal judges: strong versus weak incentives in physician payment.
The authors provide an introduction for five papers commissioned by AHRQ focusing on incentives for physicians that are featured in this special issue of Health Services Research. These papers concentrate on suggesting a conceptual framework for the use of financial incentives in health care, key implications of the evidence to date on pay for performance and public reporting in health care and several related topics.
AHRQ-authored.
Citation: Kronick R, Casalino LP, Bindman AB .
Apple pickers or federal judges: strong versus weak incentives in physician payment.
Health Serv Res 2015 Dec;50 Suppl 2:2049-56. doi: 10.1111/1475-6773.12424.
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Keywords: Payment, Provider Performance, Policy, Health Services Research (HSR), Quality of Care, Healthcare Costs, Quality Improvement
Berenson RA, Rice T
Beyond measurement and reward: methods of motivating quality improvement and accountability.
The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. It concludes that public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation.
AHRQ-funded
Citation: Berenson RA, Rice T .
Beyond measurement and reward: methods of motivating quality improvement and accountability.
Health Serv Res 2015 Dec;50 Suppl 2:2155-86. doi: 10.1111/1475-6773.12413.
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Keywords: Quality Improvement, Policy, Provider Performance, Quality of Care, Payment
Layton TJ, Ryan AM
Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings.
The researchers evaluated the effects of the size of financial bonuses on quality of care and the number of plan offerings in the Medicare Advantage Quality Bonus Payment Demonstration. They concluded that at great expense to Medicare, double bonuses in the Medicare Advantage Quality Bonus Payment Demonstration were not associated with improved quality but were associated with more plan offerings.
AHRQ-funded; HS018546.
Citation: Layton TJ, Ryan AM .
Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings.
Health Serv Res 2015 Dec;50(6):1810-28. doi: 10.1111/1475-6773.12409..
Keywords: Medicare, Payment, Provider Performance, Health Services Research (HSR), Quality Improvement, Quality of Care
Berdahl C, Schuur JD, Fisher NL
Policy measures and reimbursement for emergency medical imaging in the era of payment reform: proceedings from a panel discussion of the 2015 Academic Emergency Medicine Consensus Conference.
In May 2015, Academic Emergency Medicine convened a consensus conference titled "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." As part of the conference, a panel of health care policy leaders and emergency physicians discussed the effect of the Affordable Casre Act and other quality programs on ED diagnostic imaging. This article discusses the content of the panel's presentations.
AHRQ-funded; HS023498.
Citation: Berdahl C, Schuur JD, Fisher NL .
Policy measures and reimbursement for emergency medical imaging in the era of payment reform: proceedings from a panel discussion of the 2015 Academic Emergency Medicine Consensus Conference.
Acad Emerg Med 2015 Dec;22(12):1393-9. doi: 10.1111/acem.12829.
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Keywords: Emergency Department, Healthcare Costs, Payment, Policy, Imaging, Policy, Quality Improvement
Luft HS
Policy-oriented research on improved physician incentives for higher value health care.
Policy makers (both public and private) are seeking ways to improve the value delivered within our health care system. To inform such policy changes, this paper identifies areas in which little is known about the effects of specific incentives (FFS, salary, etc.) on the two components of value: resource use and quality. Specific suggestions are offered focusing on fundamental "building block" studies.
AHRQ-funded.
Citation: Luft HS .
Policy-oriented research on improved physician incentives for higher value health care.
Health Serv Res 2015 Dec;50 Suppl 2:2187-215. doi: 10.1111/1475-6773.12423.
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Keywords: Policy, Health Insurance, Payment, Health Services Research (HSR)
Schlesinger M, Grob R, Shaller D
Using patient-reported information to improve clinical practice.
The purposes of this study were to assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. It concluded that unless public policies are attentive to patients' perspectives, stronger financial incentives for clinicians can threaten aspects of care that patients most value.
AHRQ-funded.
Citation: Schlesinger M, Grob R, Shaller D .
Using patient-reported information to improve clinical practice.
Health Serv Res 2015 Dec;50 Suppl 2:2116-54. doi: 10.1111/1475-6773.12420.
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Keywords: Quality Improvement, Quality of Care, Patient Experience, Provider Performance, Policy, Payment, Public Reporting
Chen LM, Meara E, Birkmeyer JD
Medicare's Bundled Payments for Care Improvement initiative: expanding enrollment suggests potential for large impact.
The researchers examined the cross-sectional association between Bundled Payments for Care Improvement (BPCI) participation and providers' structural and cost characteristics. Overall participation in BPCI increased from about 400 in October 2013 to more than 2000 in June 2014. The authors concluded that growing participation in BPCI suggests strong interest in bundled payments.
AHRQ-funded; HS020671.
Citation: Chen LM, Meara E, Birkmeyer JD .
Medicare's Bundled Payments for Care Improvement initiative: expanding enrollment suggests potential for large impact.
Am J Manag Care 2015 Nov;21(11):814-20.
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Keywords: Healthcare Costs, Payment, Medicare, Quality Improvement
Abdelsattar ZM, Birkmeyer JD, Wong SL
Variation in Medicare payments for colorectal cancer surgery.
The researchers assessed the contributions of index hospitalization, physician services, readmissions, and postacute care to the overall variation in payment for colorectal cancer surgery (CRC). They concluded that Medicare spending in the first year after CRC surgery varies across hospitals even after case-mix adjustment and price standardization. Variation is largely driven by postacute care and not the index surgical hospitalization.
AHRQ-funded; HS020937; HS000053.
Citation: Abdelsattar ZM, Birkmeyer JD, Wong SL .
Variation in Medicare payments for colorectal cancer surgery.
J Oncol Pract 2015 Sep;11(5):391-5. doi: 10.1200/jop.2015.004036.
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Keywords: Cancer, Cancer: Colorectal Cancer, Payment, Medicare, Surgery
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
Schulz J, DeCamp M, Berkowitz SA
Medicare Shared Savings Program: public reporting and shared savings distributions.
The objectives of this paper are to determine if Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) are meeting public reporting requirements related to shared savings plans, to quantitate the composition of shared savings distribution plans, and to investigate whether early ACO success is associated with specific plan or ACO characteristics. The authors found that just over one-half of MSSP ACOs report detailed shared savings distribution plans online, and these plans vary widely. They concluded that there appears to be no single shared savings distribution plan determinate of ACO success.
AHRQ-funded; HS023684.
Citation: Schulz J, DeCamp M, Berkowitz SA .
Medicare Shared Savings Program: public reporting and shared savings distributions.
Am J Manag Care 2015 Aug;21(8):546-53.
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Keywords: Quality of Care, Payment, Policy, Medicare, Public Reporting
Trish EE, Herring BJ
How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?
The authors examined the relationship between employer-sponsored fully-insured health insurance premiums and the level of concentration in local insurer and hospital markets using the nationally-representative 2006-2011 KFF/HRET Employer Health Benefits Survey. They found that premiums are higher for plans sold in markets with higher levels of concentration relevant to insurer transactions with employers, lower for plans in markets with higher levels of insurer concentration relevant to insurer bargaining with hospitals, and higher for plans in markets with higher levels of hospital market concentration.
AHRQ-funded; HS000046.
Citation: Trish EE, Herring BJ .
How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?
J Health Econ 2015 Jul;42:104-14. doi: 10.1016/j.jhealeco.2015.03.009.
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Keywords: Health Insurance, Healthcare Costs, Payment, Health Insurance, Hospitals
Conover MM, Jonsson Funk M, Kinlaw AC
Trends and patterns of urodynamic studies in U.S. males, 2000-2012.
This study evaluate trends in urodynamic procedures in U.S. males from 2000–2012 and determine if a 2010 decline in reimbursement was associated with decreased utilization. It found that Utilization of urodynamic procedures increased until 2010 and decreased thereafter. Utilization was greatest among men older than 65.
AHRQ-funded; HS017950.
Citation: Conover MM, Jonsson Funk M, Kinlaw AC .
Trends and patterns of urodynamic studies in U.S. males, 2000-2012.
PLoS One 2015 Jul 21;10(7):e0133657. doi: 10.1371/journal.pone.0133657..
Keywords: Healthcare Utilization, Payment
Kim N, Bernheim SM, Ott LS
An administrative claims measure of payments made for Medicare patients for a 30-day episode of care for acute myocardial infarction.
The authors developed a method for profiling hospitals by 30-day episode-of-care costs for acute myocardial infarction (AMI). Their final model included 30 variables and resulted in predictive ratios close to 1. When combined with quality measures, they think that their payment measure will help profile high-value care.
AHRQ-funded; HS016929.
Citation: Kim N, Bernheim SM, Ott LS .
An administrative claims measure of payments made for Medicare patients for a 30-day episode of care for acute myocardial infarction.
Med Care 2015 Jun;53(6):542-9. doi: 10.1097/mlr.0000000000000361.
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Keywords: Elderly, Payment, Medicare, Heart Disease and Health
Abrahamson K, Miech E, Davila HW
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
The researchers explored ways in which data were collected, thought about and used by nursing home employees as a result of participation in a pay-for-performance (P4P) program. Their findings indicated that participants in the Minnesota Performance-based Incentive Payment Program’s quality improvement (QI) projects perceived a change in the rate and manner in which they gathered, used, and considered data in their QI decisions.
AHRQ-funded; HS018464
Citation: Abrahamson K, Miech E, Davila HW .
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
BMJ Qual Saf. 2015 May;24(5):311-7. doi: 10.1136/bmjqs-2014-003362..
Keywords: Nursing Homes, Long-Term Care, Payment, Provider Performance, Shared Decision Making, Policy, Quality Improvement, Quality of Care
Conover MM, Jonsson Funk M, Kinlaw AC
Trends and patterns of urodynamic studies in U.S. women, 2000-2012.
The researchers estimated utilization rates for cystometrograms and described trends in urodynamic procedures among U.S. men from 2000 to 2012. They found that urodynamic investigations were most common in men older than 65 years and increased in use and complexity over the past decade.
AHRQ-funded; HS017950.
Citation: Conover MM, Jonsson Funk M, Kinlaw AC .
Trends and patterns of urodynamic studies in U.S. women, 2000-2012.
Obstet Gynecol 2015 Mar;125(3):559-65. doi: 10.1097/aog.0000000000000641..
Keywords: Healthcare Utilization, Payment
Michtalik HJ, Carolan HT, Haut ER
Use of provider-level dashboards and pay-for-performance in venous thromboembolism prophylaxis.
The researchers sequentially examined an individualized physician dashboard and pay-for-performance program to improve venous thromboembolism (VTE) prophylaxis rates among hospitalists. They found that direct feedback using dashboards was associated with significantly improved compliance, with further improvement after incorporating an individual physician pay-for-performance program.
AHRQ-funded; HS017952; HS022331.
Citation: Michtalik HJ, Carolan HT, Haut ER .
Use of provider-level dashboards and pay-for-performance in venous thromboembolism prophylaxis.
J Hosp Med 2015 Mar;10(3):172-8. doi: 10.1002/jhm.2303..
Keywords: Provider Performance, Payment, Blood Clots, Prevention, Quality Improvement, Quality of Care, Hospitals, Patient Safety
Ryan AM, Burgess JF, Pesko MF
The early effects of Medicare's mandatory hospital pay-for-performance program.
This study evaluated the impact of hospital value-based purchasing (HVBP) on clinical quality and patient experience during its initial implementation period. It found that hospitals that were exposed to HVBP did not show greater improvement for either the clinical process or patient experience measures during the program’s initial implementation period.
AHRQ-funded; HS018546
Citation: Ryan AM, Burgess JF, Pesko MF .
The early effects of Medicare's mandatory hospital pay-for-performance program.
Health Serv Res. 2015 Feb;50(1):81-97. doi: 10.1111/1475-6773.12206..
Keywords: Medicare, Provider Performance, Payment, Hospitals, Quality Improvement, Quality of Care, Patient Experience
Lepore MJ, Shield RR, Looze J
Medicare and Medicaid reimbursement rates for nursing homes motivate select culture change practices but not comprehensive culture change.
The researchers use mixed methods to examine the presence of culture change practices in the context of a nursing home’s (NH’s) payer sources. They concluded that qualitative data show how higher pay from Medicare versus Medicaid influences implementation of select culture change practices, and quantitative data show NHs with higher proportions of Medicare residents have significantly higher (measured) environmental culture change implementation.
AHRQ-funded; HS000011.
Citation: Lepore MJ, Shield RR, Looze J .
Medicare and Medicaid reimbursement rates for nursing homes motivate select culture change practices but not comprehensive culture change.
J Aging Soc Policy 2015;27(3):215-31. doi: 10.1080/08959420.2015.1022102..
Keywords: Nursing Homes, Medicare, Medicaid, Payment, Health Insurance
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
Zhang M, Shubina M, Morrison F
Following the money: copy-paste of lifestyle counseling documentation and provider billing.
To find out whether copied documentation of lifestyle counseling was used to justify higher evaluation and management (E&M) charges, researchers investigated 12,527 patient encounters in which lifestyle counseling was documented. When time spent on counseling was recorded, copied lifestyle counseling was associated with a decrease of 70.5% in the odds of higher E&M charges.
AHRQ-funded; HS017030
Citation: Zhang M, Shubina M, Morrison F .
Following the money: copy-paste of lifestyle counseling documentation and provider billing.
BMC Health Serv Res. 2013 Oct 2;13:377. doi: 10.1186/1472-6963-13-377..
Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Insurance, Lifestyle Changes, Payment