National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (2)
- Behavioral Health (1)
- Children/Adolescents (1)
- (-) Healthcare Costs (16)
- Health Insurance (4)
- Home Healthcare (1)
- Hospitals (3)
- Medicaid (2)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medicare (7)
- (-) Payment (16)
- Policy (2)
- Practice Patterns (1)
- Provider Performance (1)
- Quality Improvement (1)
- Quality of Care (3)
- Respiratory Conditions (1)
- Surgery (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 16 of 16 Research Studies DisplayedParekh TM, Bhatt SP, Westfall AO
Implications of DRG classification in a bundled payment initiative for COPD.
The researchers hypothesized that patients included in a the Medicare Bundled Payments for Care Improvement (BPCI) initiative for chronic obstructive pulmonary disease (COPD) would have less severe illness and decreased hospital utilization compared with those excluded from the bundled payment initiative. They concluded that the use of DRGs to identify patients with COPD for inclusion in the BPCI initiative led to the exclusion of more than one-third of patients with acute exacerbations.
AHRQ-funded; HS013852.
Citation: Parekh TM, Bhatt SP, Westfall AO .
Implications of DRG classification in a bundled payment initiative for COPD.
Am J Accountable Care 2017 Dec;5(4):12-18.
.
.
Keywords: Respiratory Conditions, Healthcare Costs, Payment
Biener AI, Selden TM
AHRQ Author: Biener AI, Selden TM
Public and private payments for physician office visits.
Using data for 2014-15 from the Medical Expenditure Panel Survey to estimate standardized payments for nonelderly adults' physician office visits by type of insurance, researchers found that adults with public insurance, especially Medicaid, had substantially lower provider payments, out-of-pocket spending, and third-party payments than their peers with employer-sponsored or Marketplace insurance.
AHRQ-authored.
Citation: Biener AI, Selden TM .
Public and private payments for physician office visits.
Health Aff 2017 Dec;36(12):2160-64. doi: 10.1377/hlthaff.2017.0749.
.
.
Keywords: Healthcare Costs, Payment, Health Insurance, Ambulatory Care and Surgery, Medical Expenditure Panel Survey (MEPS)
Joyce NR, Huskamp HA, Hadland SE
The alternative quality contract: impact on service use and spending for children with ADHD.
The authors used Blue Cross-Blue Shield of Massachusetts (BCBSMA) claims for 2006-2011 to compare youths enrolled in provider organizations participating in the alternative quality contract (AQC) with those not participating. They found that the AQC was associated with small increases in the probability of any outpatient visits and in the probability and number of medication management visits among children with attention-deficit hyperactivity disorder (ADHD). Further, spending did not change, and there was no evidence of reductions in service utilization or spending for children with ADHD in the first three years of AQC implementation.
AHRQ-funded; HS022998.
Citation: Joyce NR, Huskamp HA, Hadland SE .
The alternative quality contract: impact on service use and spending for children with ADHD.
Psychiatr Serv 2017 Dec;68(12):1210-12. doi: 10.1176/appi.ps.201700143.
.
.
Keywords: Children/Adolescents, Behavioral Health, Payment, Quality of Care, Healthcare Costs
Whaley CM, Guo C, Brown TT
The moral hazard effects of consumer responses to targeted cost-sharing.
This paper examines the effects of the reference pricing program implemented by the California Public Employees Retirement System (CalPERS) in 2012. The investigators found that the cost savings from the reference pricing program was about two to three times as large as the reduction from implementing a high-deductible health plan, while the accompanying consumer surplus reduction was much smaller under reference pricing.
AHRQ-funded; HS022098.
Citation: Whaley CM, Guo C, Brown TT .
The moral hazard effects of consumer responses to targeted cost-sharing.
J Health Econ 2017 Dec;56:201-21. doi: 10.1016/j.jhealeco.2017.09.012..
Keywords: Healthcare Costs, Health Insurance, Payment
Paddock SM, Damberg CL, Yanagihara D
What role does efficiency play in understanding the relationship between cost and quality in physician organizations?
Previous studies demonstrate overuse of a narrow set of services, suggesting provider inefficiency, but existing studies neither quantify inefficiency more broadly nor assess its variation across physician organizations (POs). This study found that POs had substantial variation in efficiency, producing widely differing levels of quality for the same cost.
AHRQ-funded; HS021860.
Citation: Paddock SM, Damberg CL, Yanagihara D .
What role does efficiency play in understanding the relationship between cost and quality in physician organizations?
Med Care 2017 Dec;55(12):1039-45. doi: 10.1097/mlr.0000000000000823.
.
.
Keywords: Practice Patterns, Healthcare Costs, Quality of Care, Quality Improvement, Payment, Provider Performance
Jubelt LE, Goldfeld KS, Blecker SB
Early lessons on bundled payment at an academic medical center.
This study was a difference-in-differences study of Medicare fee-for-service patients hospitalized from April 2011 to June 2012 and October 2013 to December 2014 for lower extremity joint arthroplasty, cardiac valve procedures, or spine surgery. It examined total episode costs and costs by service category. It concluded that opportunities for savings under bundled payment may be greater for lower extremity joint arthroplasty than for other conditions.
AHRQ-funded; HS023683.
Citation: Jubelt LE, Goldfeld KS, Blecker SB .
Early lessons on bundled payment at an academic medical center.
J Am Acad Orthop Surg 2017 Sep;25(9):654-63. doi: 10.5435/jaaos-d-16-00626.
.
.
Keywords: Healthcare Costs, Payment, Medicare
Chen LM, Epstein AM, Orav EJ
Association of practice-level social and medical risk with performance in the Medicare physician value-based payment modifier program.
The objective of this cross-sectional observational study was to compare performance in the Physician Value-Based Payment Modifier (PVBM) Program by practice characteristics. The investigators found that during the first year of the Medicare Physician Value-Based Payment Modifier Program, physician practices that served more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs.
AHRQ-funded; HS024698.
Citation: Chen LM, Epstein AM, Orav EJ .
Association of practice-level social and medical risk with performance in the Medicare physician value-based payment modifier program.
JAMA 2017 Aug 1;318(5):453-61. doi: 10.1001/jama.2017.9643..
Keywords: Healthcare Costs, Medicaid, Medicare, Payment, Quality of Care
Jacobs PD, Molloy E
AHRQ Author: Jacobs PD
How do Medicare Advantage beneficiary payments vary with tenure?
This study compared how premiums and expected out-of-pocket medical costs (OOPC) vary with the length of time Medicare Advantage (MA) beneficiaries have been enrolled in their plans. Beneficiaries who remained in their plans for 6 or more years were paying $786 more than they would have spent in the lowest-cost plan compared with $552 for beneficiaries in their first year of enrollment.
AHRQ-authored.
Citation: Jacobs PD, Molloy E .
How do Medicare Advantage beneficiary payments vary with tenure?
Am J Manag Care 2017 Jun;23(6):372-77.
.
.
Keywords: Medicare, Payment, Healthcare Costs, Health Insurance
Carey K, Dor A
http://www.healthfinancejournal.com/index.php/johcf/article/view/114
Price variations and their trends in U.S. hospitals.
This study tracked trends in prices paid to hospitals by commercial insurers over the period 2008 to 2014 using private sector claims data that contain actual payments. It contrasted these with trends in the CMS published charges. Results indicated that variation in actual commercially-transacted prices is substantially lower than variation in published charges.
AHRQ-funded; HS023610.
Citation: Carey K, Dor A .
Price variations and their trends in U.S. hospitals.
J Health Care Finance 2017 Sum;44(1).
.
.
Keywords: Healthcare Costs, Payment, Health Insurance, Hospitals
Schulz J, DeCamp M, Berkowitz SA
Regional cost and experience, not size or hospital inclusion, helps predict ACO success.
This study investigated the extent to which organizational characteristics, regional cost of care, or experience in the Medicare Shared Savings Program (MSSP) are associated with the ability to achieve shared savings. It found that experience, as measured by years in the MSSP program, was associated with success and the ability to earn shared savings varied regionally. This variation was strongly associated with differences in regional Medicare fee-for-service per capita costs.
AHRQ-funded; HS023684.
Citation: Schulz J, DeCamp M, Berkowitz SA .
Regional cost and experience, not size or hospital inclusion, helps predict ACO success.
Medicine 2017 Jun;96(24):e7209. doi: 10.1097/md.0000000000007209.
.
.
Keywords: Healthcare Costs, Medicare, Payment
Carey K
Ambulatory surgery centers and prices in hospital outpatient departments.
Specialty providers claim to offer a new competitive benchmark for efficient delivery of health care. This article explores this view by examining evidence for price competition between ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). For the procedures examined, HOPDs received payments from commercial insurers in the range of 3.25 percent to 5.15 percent lower for each additional ASC per 100,000 persons in a market.
AHRQ-funded; HS023780.
Citation: Carey K .
Ambulatory surgery centers and prices in hospital outpatient departments.
Med Care Res Rev 2017 Apr;74(2):236-48. doi: 10.1177/1077558716633010.
.
.
Keywords: Ambulatory Care and Surgery, Healthcare Costs, Payment, Hospitals
Krinsky S, Ryan AM, Mijanovich T
Variation in payment rates under Medicare's Inpatient Prospective Payment System.
The researchers measured variation in payment rates under Medicare's Inpatient Prospective Payment System (IPPS) and identified the main payment adjustments that drive variation. In 2013, Medicare paid for acute inpatient discharges at a rate 31 percent above the IPPS base. For the top 10 percent of discharges, the mean rate was double the IPPS base. Variations were driven by adjustments for medical education and care to low-income populations.
AHRQ-funded; HS018546.
Citation: Krinsky S, Ryan AM, Mijanovich T .
Variation in payment rates under Medicare's Inpatient Prospective Payment System.
Health Serv Res 2017 Apr;52(2):676-96. doi: 10.1111/1475-6773.12490.
.
.
Keywords: Payment, Medicare, Healthcare Costs, Hospitals
Ouayogode MH, Colla CH, Lewis VA
Determinants of success in shared savings programs: an analysis of ACO and market characteristics.
This study examined Accountable Care Organization (ACO) and market factors associated with superior financial performance in Medicare ACO programs. No characteristic of organizational structure was significantly associated with both outcomes of savings per beneficiary and likelihood of achieving shared savings. ACO prior experience with risk-bearing contracts was positively correlated with savings and significantly increased the likelihood of receiving shared savings payments.
AHRQ-funded; HS024075.
Citation: Ouayogode MH, Colla CH, Lewis VA .
Determinants of success in shared savings programs: an analysis of ACO and market characteristics.
Healthc 2017 Mar;5(1-2):53-61. doi: 10.1016/j.hjdsi.2016.08.002.
.
.
Keywords: Healthcare Costs, Payment, Policy, Medicare
Sood N, Alpert A, Barnes K
Effects of payment reform in more versus less competitive markets.
In this paper, the authors exploit a major payment reform for home health care to examine whether reductions in reimbursement lead to differential changes in treatment intensity and provider costs depending on the level of competition in a market. Using Medicare claims, they find that while providers in more competitive markets had higher average costs in the pre-reform period, these markets experienced larger proportional reductions in treatment intensity and costs after the reform relative to less competitive markets..
AHRQ-funded; HS018541.
Citation: Sood N, Alpert A, Barnes K .
Effects of payment reform in more versus less competitive markets.
J Health Econ 2017 Jan;51:66-83. doi: 10.1016/j.jhealeco.2016.12.006.
.
.
Keywords: Healthcare Costs, Payment, Home Healthcare, Policy
Ellimoottil C, Ryan AM, Hou H
Implications of the definition of an episode of care used in the comprehensive care for joint replacement model.
The researchers compared the Comprehensive Care for Joint Replacement (CJR) program's broad definition of an episode of care with a clinically narrow definition of an episode of care. The 90-day episode payments using the broad definition of the CJR model ranged from $17,349 to $29,465 (mean payment, $22,122). Episode payments were slightly lower (mean payment, $21,670) when the Hospital Compare definition was used.
AHRQ-funded; HS024193; HS018546.
Citation: Ellimoottil C, Ryan AM, Hou H .
Implications of the definition of an episode of care used in the comprehensive care for joint replacement model.
JAMA Surg 2017 Jan;152(1):49-54. doi: 10.1001/jamasurg.2016.3098.
.
.
Keywords: Surgery, Healthcare Costs, Medicare, Payment
DeLia D
Spending carveouts substantially improve the accuracy of performance measurement in shared savings arrangements: findings from simulation analysis of Medicaid ACOs.
This study uses data from New Jersey Medicaid accountable care organizations (ACOs) to examine how carving out uncontrollable components of spending affects the accuracy of performance measures in shared savings arrangements. It concluded that failure to carve out uncontrollable spending above $100,000 per person generates bias ranging from -5 to +5 percentage points and increases mean squared error by factors of 13 or more.
AHRQ-funded; HS023493.
Citation: DeLia D .
Spending carveouts substantially improve the accuracy of performance measurement in shared savings arrangements: findings from simulation analysis of Medicaid ACOs.
Inquiry 2017 Jan 1;54:46958017734047. doi: 10.1177/0046958017734047.
.
.
Keywords: Healthcare Costs, Medicaid, Payment