National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (1)
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- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Elderly (1)
- Healthcare-Associated Infections (HAIs) (1)
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- Urinary Tract Infection (UTI) (1)
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 DisplayedEverson 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
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, 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
Reynolds EL, Kerber KA, Hill C
The effects of the Medicare NCS reimbursement policy: utilization, payments, and patient access.
The purpose of this research was to determine whether the 2013 nerve conduction study (NCS) reimbursement reduction changed Medicare use, payments, and patient access to Medicare physicians by performing a retrospective analysis of Medicare data. The investigators found that the Medicare NCS reimbursement policy resulted in a larger decrease in NCS providers than in EMG providers. Despite fewer neurologists and physiatrists performing NCS, Medicare access to these physicians for E/M services was not affected.
AHRQ-funded; HS017690; HS022258.
Citation: Reynolds EL, Kerber KA, Hill C .
The effects of the Medicare NCS reimbursement policy: utilization, payments, and patient access.
Neurology 2020 Aug 18;95(7):e930-e35. doi: 10.1212/wnl.0000000000010090..
Keywords: Payment, Medicare, Policy, Practice Patterns
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
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
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
Markovitz AA, Rozier MD, Ryan AM
Low-value care and clinician engagement in a large Medicare shared savings program ACO: a survey of frontline clinicians.
The purpose of this study was to assess Accountable Care Organization (ACO) engagement of clinicians and whether engagement was associated with clinicians' reported difficulty implementing recommendations against low-value care. Participants included 1289 clinicians in the Physician Organization of Michigan ACO. Results showed that clinicians participating in a large Medicare ACO were broadly unaware of and unengaged with ACO objectives and activities. Whether low clinician engagement limits ACO efforts to reduce low-value care warrants further longitudinal study.
AHRQ-funded; HS024525; HS024728; HS025615.
Citation: Markovitz AA, Rozier MD, Ryan AM .
Low-value care and clinician engagement in a large Medicare shared savings program ACO: a survey of frontline clinicians.
J Gen Intern Med 2020 Jan;35(1):133-41. doi: 10.1007/s11606-019-05511-8..
Keywords: Medicare, Policy, Provider
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
Keohane LM, Grebla RC, Mor V
Medicare Advantage members' expected out-of-pocket spending for inpatient and skilled nursing facility services.
In 2011, new federal regulations restricted inpatient and skilled nursing facility cost sharing and mandated limits on out-of-pocket spending in Medicare Advantage (MA) plans. The authors found that some MA beneficiaries may still have difficulty affording acute and postacute care despite greater regulation of cost sharing.
AHRQ-funded; HS000011.
Citation: Keohane LM, Grebla RC, Mor V .
Medicare Advantage members' expected out-of-pocket spending for inpatient and skilled nursing facility services.
Health Aff 2015 Jun;34(6):1019-27. doi: 10.1377/hlthaff.2014.1146.
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Keywords: Healthcare Costs, Hospitalization, Policy, Medicare, Nursing Homes