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Search All Research Studies
AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (1)
- Diagnostic Safety and Quality (1)
- Dialysis (1)
- Elderly (2)
- (-) Healthcare Costs (23)
- Health Insurance (5)
- Health Systems (2)
- Hospital Discharge (1)
- Hospitalization (1)
- Hospitals (6)
- Intensive Care Unit (ICU) (1)
- Kidney Disease and Health (1)
- Medicaid (4)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medicare (13)
- Medication (1)
- Nursing Homes (2)
- Orthopedics (3)
- (-) Payment (23)
- Policy (3)
- Practice Patterns (2)
- Provider: Health Personnel (1)
- Provider Performance (4)
- Quality of Care (2)
- Surgery (4)
- Vulnerable Populations (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 23 of 23 Research Studies DisplayedHambley BC, Anderson KE, Shanbhag SP
Payment incentives and the use of higher-cost drugs: a retrospective cohort analysis of intravenous iron in the Medicare population.
Researchers examined prescribing patterns in the context of intravenous (IV) iron, for which multiple similarly safe and efficacious formulations exist, with wide variations in price. Using Medicare data, they found an increase in the dispensing of a higher-priced IV iron formulation associated with a shortage of a less expensive drug that persisted once the shortage ended. They concluded that their findings in IV iron have broader implications for Part B drug payment policy because the price of the drug determines the physician and health system payment.
AHRQ-funded; HS000029.
Citation: Hambley BC, Anderson KE, Shanbhag SP .
Payment incentives and the use of higher-cost drugs: a retrospective cohort analysis of intravenous iron in the Medicare population.
Am J Manag Care 2020 Dec;26(12):516-22. doi: 10.37765/ajmc.2020.88539..
Keywords: Elderly, Medication, Medicare, Payment, Healthcare Costs, Practice Patterns
Ganguli I, Lupo C, Mainor AJ
Association between specialist compensation and Accountable Care Organization performance.
This study’s objective was to determine whether Medicare Shared Savings Program Accountable Care Organizations (ACOs) using cost reduction measures in specialist compensation demonstrated better performance. National cross-sectional survey data on ACOs from 2013-2015 was linked to public-use data on ACO performance from 2014-2016. Out of 160 ACOs surveys, 26% reported using cost reduction measures to help determine specialist compensation. However, these ACOs did not have savings in the short term.
AHRQ-funded; HS023812.
Citation: Ganguli I, Lupo C, Mainor AJ .
Association between specialist compensation and Accountable Care Organization performance.
Health Serv Res 2020 Oct;55(5):722-28. doi: 10.1111/1475-6773.13323..
Keywords: Provider Performance, Healthcare Costs, Payment, Medicare
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
Encinosa WE
AHRQ Author: Encinosa WE
Is it time for ACOs to start tackling the high costs of surgery?
This article discusses an article appearing in the same issue revisiting the impact of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) on surgery expenditures. The author suggests that, in order to engage even more surgeons, it is likely that MSSP ACOs will have to work with surgeons in the various Medicare bundled payment programs for surgery. He concludes that the next stage is to examine how these different programs can work together to produce even more savings in surgical care.
AHRQ-authored.
Citation: Encinosa WE .
Is it time for ACOs to start tackling the high costs of surgery?
Am J Accountable Care 2020 Sep 15;8(3):26-27..
Keywords: Surgery, Healthcare Costs, Medicaid, Health Insurance, Payment
Machta RM, Reschovsky J, Jones DJ
AHRQ Author: Furukawa MF
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
The authors sought to assess whether system providers perform better than non-system providers under an alternative payment model that incentivizes high-quality, cost-efficient care. Using CMS data linked to AHRQ’s Compendium of US Health Systems, along with secondary sources, they found that when operating under alternative payment model incentives, vertical integration may enable hospitals to lower costs with similar quality scores.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Machta RM, Reschovsky J, Jones DJ .
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
Health Serv Res 2020 Aug;55(4):541-47. doi: 10.1111/1475-6773.13313..
Keywords: Health Systems, Hospitals, Orthopedics, Healthcare Costs, Payment, Quality of Care
Kennedy G, Lewis VA, Kundu S
Kennedy G, Lewis VA, Kundu S, Mousqués J, Colla CH. Accountable care organizations and post-acute care: a focus on preferred SNF networks.
This study examined the relationship between accountable care organizations (ACOs) and skilled nursing facilities (SNFs) for patients who are discharged from a hospital into a SNF. A mixed-method design was used and survey data was examined from 366 respondents to the National Survey of ACOs along with 16 semi-structured interviews with ACOs who performed well on cost and quality measures. Over half of ACOs had no formal relationship with SNFs; however the majority of ACO interviewees had preferred SNF networks. These preferred networks are beginning to transform the ACO post-acute care landscape.
AHRQ-funded; HS024075.
Citation: Kennedy G, Lewis VA, Kundu S .
Kennedy G, Lewis VA, Kundu S, Mousqués J, Colla CH. Accountable care organizations and post-acute care: a focus on preferred SNF networks.
Med Care Res Rev 2020 Aug;77(4):312-23. doi: 10.1177/1077558718781117..
Keywords: Nursing Homes, Healthcare Costs, Payment
He D, McHenry P, Mellor JM
Do financial incentives matter? Effects of Medicare price shocks on skilled nursing facility care.
The authors provided new evidence on how Medicare payment changes affect the amount of skilled nursing facility (SNF) care provided to Medicare patients. They found that increases in Medicare payment rates to SNFs increased the total number of Medicare resident days at SNFs. Further, the effects were asymmetric; although Medicare payment increases affected Medicare days, payment decreases did not. They conclude that their results have important implications for policies that alter the Medicare base payment rates to SNFs and other health care providers.
AHRQ-funded; HS025529.
Citation: He D, McHenry P, Mellor JM .
Do financial incentives matter? Effects of Medicare price shocks on skilled nursing facility care.
Health Econ 2020 Jun;29(6):655-70. doi: 10.1002/hec.4009..
Keywords: Medicare, Nursing Homes, Elderly, Payment, Healthcare Costs
Brown TT, Guo C, Whaley C
Reference-based benefits for colonoscopy and arthroscopy: large differences in patient payments across procedures but similar behavioral responses.
This study examined how reference-based benefits (RBB) affect out-of-pocket payments across outpatient procedures. The California Public Employees’ Retirement System (CalPERS) applied RBB only to outpatient procedures performed in a hospital outpatient department (HOPD) and not to outpatient procedures performed in a lower cost ambulatory surgery center. Claims from 2009-2013 on arthroscopy and colonoscopy services were analyzed. CalPERS patients paid an average of 63.9% more for HOPDs than ambulatory surgery centers in 2012, but for arthroscopy there was no statistically different cost sharing. This led to high-priced HOPDs being less likely to be chosen by CalPERS patients for both procedures.
AHRQ-funded; HS022098.
Citation: Brown TT, Guo C, Whaley C .
Reference-based benefits for colonoscopy and arthroscopy: large differences in patient payments across procedures but similar behavioral responses.
Med Care Res Rev 2020 Jun;77(3):261-73. doi: 10.1177/1077558718793325..
Keywords: Payment, Healthcare Costs, Health Insurance, Ambulatory Care and Surgery
Dekhne MS, Nuliyalu U, Schoenfeld AJ
"Surprise" out-of-network billing in orthopedic surgery: charges from surprising sources.
This study examined “surprise” out-of-network billing in orthopedic surgery. Data was analyzed from the Clinformatics DataMart on commercial insured patients undergoing 4 different elective orthopedic procedures from 2012 to 2017: arthroscopic meniscal repair, lumbar discectomy, total knee replacement and total hip replacement. They defined surprise bills as out-of-network bills for procedures done at in-network hospitals. The rate of potential surprise bills was 24.8% for total knee replacement, 24.5% lumbar discectomy, 23.5% for total hip replacement, and 12.5% for meniscal repair. The largest number of surprise bills came from anesthesiologists (39% of all episodes), and durable medical equipment (15%). Per episode, the largest bills came from nonphysician surgical assistants, neurologists, and physician assistants.
AHRQ-funded; HS000053; HS023597.
Citation: Dekhne MS, Nuliyalu U, Schoenfeld AJ .
"Surprise" out-of-network billing in orthopedic surgery: charges from surprising sources.
Ann Surg 2020 May;271(5):e116-e18. doi: 10.1097/sla.0000000000003825..
Keywords: Orthopedics, Surgery, Payment, Healthcare Costs, Health Insurance
Chen LM, Samson LW, Zuckerman RB
Challenges of measuring costs of care for US practices.
Investigators sought to describe the feasibility of applying claims-based cost measures included in Merit-based Incentive Payment System (MIPS) to practices nationwide, and to assess whether feasibility varies by practice size or specialty mix. They found that most practices that qualify for MIPS are small, specialist-only practices that are unable to meet minimum case requirements for MIPS’ two required cost measures, due to a combination of size and provider mix, suggesting that clinicians in small, specialist-only practices are less likely to be evaluated on cost. They stressed the importance of identifying alternative approaches to ensure that value - both quality and cost - is rewarded.
AHRQ-funded; HS024698.
Citation: Chen LM, Samson LW, Zuckerman RB .
Challenges of measuring costs of care for US practices.
J Gen Intern Med 2020 Apr;35(4):1320-22. doi: 10.1007/s11606-019-05233-x..
Keywords: Healthcare Costs, Payment
Rathi VK, McWilliams JM, Roberts ET
Rathi VK, McWilliams JM, Roberts ET. Getting incentives right in payment reform: thinking beyond financial risk.
In this paper the authors discuss payment reform, global budget models and why incentives differ for health system versus physician group ACO’s. They indicate that incentives in new payment models are closely connected to the structure of the health care delivery system and that policies that ignore this relationship and focus only on the risk terms of payment contracts may miss opportunities for progress.
AHRQ-funded; HS026727.
Citation: Rathi VK, McWilliams JM, Roberts ET .
Rathi VK, McWilliams JM, Roberts ET. Getting incentives right in payment reform: thinking beyond financial risk.
Ann Intern Med 2020 Mar 17;172(6):423-24. doi: 10.7326/m19-3178..
Keywords: Healthcare Costs, Policy, Payment
Selden TM
AHRQ Author: Selden TM
Differences between public and private hospital payment rates narrowed, 2012-16.
In 2000-12 payments for inpatient hospital stays, emergency department visits, and outpatient hospital care for privately insured patients grew much faster than payments for Medicare and Medicaid patients. This widening of private-public payment gaps slowed or even reversed itself in 2012-16. In this paper, the author discusses the differences between public and private hospital payment rates, 2012-2016.
AHRQ-authored.
Citation: Selden TM .
Differences between public and private hospital payment rates narrowed, 2012-16.
Health Aff 2020 Jan;39(1):94-99. doi: 10.1377/hlthaff.2019.00415..
Keywords: Medical Expenditure Panel Survey (MEPS), Hospitals, Payment, Healthcare Costs, Medicaid, Medicare
Nathan H, Dimick JB
Opportunities for surgical leadership in managing population health costs.
The concept of population health management—long a mainstay in primary care and chronic disease management—is taking root in surgery. The 2010 Affordable Care Act (ACA) ushered in the implementation of several innovative payment models that shift accountability for population costs to health systems and providers. The authors discuss the implications of th trends for the surgical profession.
AHRQ-funded; HS024763.
Citation: Nathan H, Dimick JB .
Opportunities for surgical leadership in managing population health costs.
Ann Surg 2016 Dec;264(6):909-10. doi: 10.1097/sla.0000000000001759.
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Keywords: Healthcare Costs, Payment, Provider: Health Personnel, Surgery
Peiris D, Phipps-Taylor MC, Stachowski CA
ACOs holding commercial contracts are larger and more efficient than noncommercial ACOs.
The researchers examined differences between commercial accountable care organizations (ACOs) and noncommercial ACOs. They found that among all ACOs, there was low uptake of quality and efficiency activities; commercial ACOs reported more use of disease monitoring tools, patient satisfaction data, and quality improvement methods; and about two-thirds of the ACOs had established processes for distributing any savings accrued. They concluded that ACO delivery systems remain at a nascent stage.
AHRQ-funded; HS024075.
Citation: Peiris D, Phipps-Taylor MC, Stachowski CA .
ACOs holding commercial contracts are larger and more efficient than noncommercial ACOs.
Health Aff 2016 Oct;35(10):1849-56. doi: 10.1377/hlthaff.2016.0387.
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Keywords: Healthcare Costs, Payment, Health Systems, Medicaid, Medicare
Ellimoottil C, Ryan AM, Hou H
Medicare's new bundled payment for joint replacement may penalize hospitals that treat medically complex patients.
Using Medicare claims for patients in Michigan who underwent lower extremity joint replacement in the period 2011-13, the researchers applied payment methods analogous to those CMS intends to use in determining annual bonuses or penalties (reconciliation payments) to hospitals. Their findings suggest that CMS should include risk adjustment in the Comprehensive Care for Joint Replacement program and in future bundled payment programs.
AHRQ-funded; HS024193; HS018546.
Citation: Ellimoottil C, Ryan AM, Hou H .
Medicare's new bundled payment for joint replacement may penalize hospitals that treat medically complex patients.
Health Aff 2016 Sep;35(9):1651-7. doi: 10.1377/hlthaff.2016.0263.
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Keywords: Medicare, Payment, Healthcare Costs, Orthopedics, Provider Performance
Colla CH, Lewis VA, Kao LS
Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries.
The purpose of this cohort study was to examine the effect of Medicare accountable care organization (ACO) contracts on both spending and high-cost institutional utilization for all Medicare beneficiaries and for clinically vulnerable beneficiaries. The main outcomes and measures for this study were total spending per beneficiary-quarter, spending categories, utilization of hospitals and emergency departments, ambulatory care sensitive admissions, and 30-day readmissions. The study found that total spending decreased by $34 per beneficiary-quarter after implementation of ACO contracts across the overall Medicare population and decreased $114 in clinically vulnerable patients. In the overall Medicare cohort, hospitalizations and emergency department visits decreased by 1.3 and 3.0 events per 1000 beneficiaries per quarter, respectively. Hospitalizations and emergency department visits decreased in the clinically vulnerable cohort by 2.9 and 4.1 events per 1000 beneficiaries per quarter, respectively. Variations in total spending related with ACOs did not differ by clinical condition of beneficiaries.
AHRQ-funded; HS024075.
Citation: Colla CH, Lewis VA, Kao LS .
Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries.
JAMA Intern Med 2016 Aug;176(8):1167-75. doi: 10.1001/jamainternmed.2016.2827.
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Keywords: Medicare, Policy, Healthcare Costs, Payment, Vulnerable Populations
Erickson KF, Winkelmayer WC, Chertow GM
Effects of physician payment reform on provision of home dialysis.
The investigators evaluated whether Medicare payment reform influenced dialysis modality assignment. They concluded that transition from a capitated to a tiered fee-for-service payment model for in-center hemodialysis care resulted in fewer patients receiving home dialysis.
AHRQ-funded; HS019178.
Citation: Erickson KF, Winkelmayer WC, Chertow GM .
Effects of physician payment reform on provision of home dialysis.
Am J Manag Care 2016 Jun;22(6):e215-23.
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Keywords: Dialysis, Healthcare Costs, Kidney Disease and Health, Payment, Practice Patterns
Brown TT, Robinson JC
Reference pricing with endogenous or exogenous payment limits: impacts on insurer and consumer spending.
The authors extended reference pricing (RP) models to a hospital context focusing on insurer and consumer payments. They found that, for 2 years following RP implementation, insurer payments to high-price and low-price hospitals moved downward, consistent with endogenous RP. When the reference price was not reset to account for changes in market prices, insurer payments to low-price hospitals reverted to pre-implementation levels, consistent with exogenous RP.
AHRQ-funded; HS022098.
Citation: Brown TT, Robinson JC .
Reference pricing with endogenous or exogenous payment limits: impacts on insurer and consumer spending.
Health Econ 2016 Jun;25(6):740-9. doi: 10.1002/hec.3181.
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Keywords: Payment, Healthcare Costs, Health Insurance, Hospitals
Das A, Norton EC, Miller DC
Adding a spending metric to Medicare's value-based purchasing program rewarded low-quality hospitals.
In fiscal year 2015 the Centers for Medicare and Medicaid Services expanded its Hospital Value-Based Purchasing program by rewarding or penalizing hospitals for their performance on both spending and quality. Using data from 2,679 US hospitals that participated in the program in fiscal years 2014 and 2015, researchers found that the new emphasis on spending rewarded not only low-spending hospitals but some low-quality hospitals as well.
AHRQ-funded; HS020671.
Citation: Das A, Norton EC, Miller DC .
Adding a spending metric to Medicare's value-based purchasing program rewarded low-quality hospitals.
Health Aff 2016 May;35(5):898-906. doi: 10.1377/hlthaff.2015.1190.
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Keywords: Medicare, Provider Performance, Payment, Hospitals, Healthcare Costs, Quality of Care
Callaghan BC, Burke JF, Skolarus LE
Medicare's reimbursement reduction for nerve conduction studies: effect on use and payments.
The purpose of this research letter was to investigate the effect of the sharp reduction in Medicare reimbursement for electromyography (EMG) while the reimbursement for nerve conduction studies (NCS) remained unchanged. They found that the use of EMG by neurologists and physiatrists changed little, whereas a decrease in its use among other health care providers was observed. They concluded that the pattern of change in use of EMG and NCS suggests findings similar to those in past studies of Medicare reimbursement with regard to reducing inappropriate, but not appropriate, testing and treatment.
AHRQ-funded; HS022258.
Citation: Callaghan BC, Burke JF, Skolarus LE .
Medicare's reimbursement reduction for nerve conduction studies: effect on use and payments.
JAMA Intern Med 2016 May;176(5):697-9. doi: 10.1001/jamainternmed.2016.0162.
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Keywords: Diagnostic Safety and Quality, Healthcare Costs, Payment, Medicare
Sjoding MW, Valley TS, Prescott HC
Rising billing for intermediate intensive care among hospitalized Medicare bbetween 1996 and 2010.
This study characterized trends in intermediate care use among U.S. hospitals. Only 8.2 percent of Medicare hospitalizations in 1996 were billed for intermediate care, but billing steadily increased to 22.8 percent by 2010, whereas the percentage billed for ICU care and ward-only care declined. Patients billed for intermediate care had more acute organ failures diagnoses codes compared with general ward patients.
AHRQ-funded; HS020672.
Citation: Sjoding MW, Valley TS, Prescott HC .
Rising billing for intermediate intensive care among hospitalized Medicare bbetween 1996 and 2010.
Am J Respir Crit Care Med 2016 Jan 15;193(2):163-70. doi: 10.1164/rccm.201506-1252OC.
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Keywords: Payment, Hospitals, Intensive Care Unit (ICU), Healthcare Costs, Medicare
Das A, Norton EC, Miller DC
Association of postdischarge spending and performance on new episode-based spending measure.
The Centers for Medicare and Medicaid Services recently added the Medicare Spending per Beneficiary (MSPB) metric to its Hospital Value-Based Purchasing (HVBP) program. The researchers evaluated whether hospital performance was driven by spending before, during, or after hospitalization. They found that compared with low-cost hospitals, high-cost hospitals had significantly higher preadmission and index admission spending, but the largest differences were in postdischarge spending.
AHRQ-funded; HS020671.
Citation: Das A, Norton EC, Miller DC .
Association of postdischarge spending and performance on new episode-based spending measure.
JAMA Intern Med 2016 Jan;176(1):117-9. doi: 10.1001/jamainternmed.2015.6261.
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Keywords: Healthcare Costs, Medicare, Hospitals, Provider Performance, Hospitalization, Payment, Hospital Discharge
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