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AHRQ Research Studies Date
Topics
- Cardiovascular Conditions (1)
- Disabilities (1)
- Elderly (2)
- Healthcare-Associated Infections (HAIs) (1)
- (-) Healthcare Costs (12)
- Health Insurance (5)
- Health Systems (1)
- Heart Disease and Health (1)
- Hospitalization (1)
- Hospitals (2)
- Long-Term Care (1)
- Low-Income (1)
- Medicaid (2)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medicare (5)
- Medication (1)
- Obesity (1)
- Obesity: Weight Management (1)
- Outcomes (1)
- Patient-Centered Healthcare (1)
- (-) Payment (12)
- Pneumonia (1)
- Policy (2)
- Primary Care (2)
- Provider Performance (1)
- Quality of Care (1)
- Surgery (5)
- 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 12 of 12 Research Studies DisplayedKelsall AC, Cassidy R, Ghaferi AA
Variation in bariatric surgery episode costs in the commercially insured: implications for bundled payments in the private sector.
The authors described hospital-level variation in roux-en-Y gastric bypass and sleeve gastrectomy in Michigan. Their findings suggested that there are previously underappreciated differences in episode payment variation between bariatric surgery procedures. The authors also suggested that sleeve gastrectomy may be more amenable to cost containment under bundled payment initiatives by virtue of the greater share of variation explained by readmission and post-discharge payments.
AHRQ-funded; HS023621; HS024403.
Citation: Kelsall AC, Cassidy R, Ghaferi AA .
Variation in bariatric surgery episode costs in the commercially insured: implications for bundled payments in the private sector.
Ann Surg 2018 Dec;268(6):1014-18. doi: 10.1097/sla.0000000000002462..
Keywords: Surgery, Obesity: Weight Management, Obesity, Payment, Health Insurance, Healthcare Costs
Makam AN, Nguyen OK, Kirby B
Effect of site-neutral payment policy on long-term acute care hospital use.
The purpose of this study was to assess the projected effect of the Centers for Medicare and Medicaid Services new site-neutral payment policy, which aims to decrease unnecessary long-term acute care hospital (LTACH) admissions by reducing reimbursements for less-ill individuals by 2020. The investigators concluded that the site-neutral payment policy may limit LTACH access in existing LTAC-scarce markets, with potential adverse implications for recovery of hospitalized older adults.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Kirby B .
Effect of site-neutral payment policy on long-term acute care hospital use.
J Am Geriatr Soc 2018 Nov;66(11):2104-11. doi: 10.1111/jgs.15539..
Keywords: Policy, Hospitalization, Payment, Long-Term Care, Healthcare Costs, Medicare, Elderly, Hospitals
Thompson MP, Cabrera L, Strobel RJ
Association between postoperative pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery.
Postoperative pneumonia is the most common healthcare-associated infection in cardiac surgical patients, yet their impact across a 90-day episode of care remains unknown. The objective of this study was to examine the relationship between pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery. The investigators concluded that postoperative pneumonia was associated with significantly higher 90-day episode payments and inferior outcomes at the patient and hospital level.
AHRQ-funded; HS022535.
Citation: Thompson MP, Cabrera L, Strobel RJ .
Association between postoperative pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery.
Circ Cardiovasc Qual Outcomes 2018 Sep;11(9):e004818. doi: 10.1161/circoutcomes.118.004818..
Keywords: Elderly, Surgery, Medicare, Cardiovascular Conditions, Heart Disease and Health, Pneumonia, Payment, Healthcare Costs, Outcomes, Healthcare-Associated Infections (HAIs), Health Insurance
Whaley CM, Brown TT
Firm responses to targeted consumer incentives: evidence from reference pricing for surgical services.
This study examined how health care providers respond to a reference pricing insurance program that increases consumer cost sharing when they chose high-priced surgical providers. Geographic variation was used to estimate supply-side responses. Limited evidence of market segmentation and price reductions for providers with baseline prices above the reference price was found. However, 75% of the reduction in provider prices benefited a population that was not subject to the program.
AHRQ-funded; HS022098.
Citation: Whaley CM, Brown TT .
Firm responses to targeted consumer incentives: evidence from reference pricing for surgical services.
J Health Econ 2018 Sep;61:111-33. doi: 10.1016/j.jhealeco.2018.06.012..
Keywords: Health Insurance, Surgery, Payment, Healthcare Costs
Sen AP, Chen LM, Wong Samson L
Performance in the Medicare Shared Savings Program by accountable care organizations disproportionately serving dual and disabled populations.
The purpose of this study was to examine performance by accountable care organizations (ACOs) in the top quintile of their proportion of beneficiaries who were dually enrolled in Medicare and Medicaid (high-dual), and the top quintile of disabled beneficiaries (high-disabled). Measures used were quality scores, savings per beneficiary, whether or not the ACO shared savings and the amount of shared savings. The researchers found that high-dual and high-disabled ACOs had similar or higher spending than other ACOs at baseline, but achieved greater savings and were equally or more likely to earn shared savings; alternative payment models can have positive financial outcomes for providers serving vulnerable populations.
AHRQ-funded; HS024698.
Citation: Sen AP, Chen LM, Wong Samson L .
Performance in the Medicare Shared Savings Program by accountable care organizations disproportionately serving dual and disabled populations.
Med Care 2018 Sep;56(9):805-11. doi: 10.1097/mlr.0000000000000968..
Keywords: Disabilities, Medicare, Healthcare Costs, Provider Performance, Payment, Low-Income, Vulnerable Populations
Decker SL
AHRQ Author: Decker SL
No association found between the Medicaid primary care fee bump and physician-reported participation in Medicaid.
The Affordable Care Act required states in 2013 and 2014 to raise Medicaid payment rates to primary care physicians for certain services to the level of Medicare rates. The result was an average 73 percent increase in primary care Medicaid payments for qualifying physicians. This study used nationally representative data to examine the association between this Medicaid "fee bump" and physician-reported measures of participation in Medicaid. No such association was found. The lack of a sizable change in measures of physician participation in Medicaid may have been due to the temporary nature of the fee bump.
AHRQ-authored.
Citation: Decker SL .
No association found between the Medicaid primary care fee bump and physician-reported participation in Medicaid.
Health Aff 2018 Jul;37(7):1092-98. doi: 10.1377/hlthaff.2018.0078..
Keywords: Healthcare Costs, Payment, Medicaid, Policy, Primary Care
Perez V
Does capitated managed care affect budget predictability? Evidence from Medicaid programs.
This study is the first to test whether managed care enrollment reduces the variance of Medicaid spending, in contrast to the focus of the existing literature on spending levels. Although the majority of Medicaid enrollees are in managed care, the study shows that managed care use has been concentrated among the enrollees with the most stable spending, resulting in only small gains to budget predictability. Perez concludes that this finding is robust to the exclusion of the claims expenditures that exhibit the most variance.
AHRQ-funded; HS022797.
Citation: Perez V .
Does capitated managed care affect budget predictability? Evidence from Medicaid programs.
Int J Health Econ Manag 2018 Jun;18(2):123-52. doi: 10.1007/s10754-017-9227-7.
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Keywords: Healthcare Costs, Payment, Medicaid, Health Insurance
Funk RJ, Owen-Smith J, Kaufman SA
Association of informal clinical integration of physicians with cardiac surgery payments.
This study examined how physician interaction patterns vary between health systems and to assess whether variation in informal integration is associated with care delivery payments. It found that when beneficiaries were treated in health systems with higher informal integration, the greatest savings of lower estimated payments were from hospital readmissions (13.0 percent) and postacute care services (5.8 percent).
AHRQ-funded; HS024728.
Citation: Funk RJ, Owen-Smith J, Kaufman SA .
Association of informal clinical integration of physicians with cardiac surgery payments.
JAMA Surg 2018 May;153(5):446-53. doi: 10.1001/jamasurg.2017.5150.
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Keywords: Healthcare Costs, Payment, Health Systems, Surgery
Chen LM, Ryan AM, Shih T
Medicare's acute care episode demonstration: effects of bundled payments on costs and quality of surgical care.
This study evaluated whether participation in Medicare's Acute Care Episode (ACE) Demonstration Program-an early, small, voluntary episode-based payment program-was associated with a change in expenditures or quality of care. Participation in Medicare's ACE Demonstration Program was not associated with a change in 30-day episode-based Medicare payments or 30-day mortality for cardiac or orthopedic surgery, but it was associated with lower total 30-day post-acute care payments.
AHRQ-funded; HS018546; HS024698; HS020671.
Citation: Chen LM, Ryan AM, Shih T .
Medicare's acute care episode demonstration: effects of bundled payments on costs and quality of surgical care.
Health Serv Res 2018 Apr;53(2):632-48. doi: 10.1111/1475-6773.12681.
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Keywords: Healthcare Costs, Payment, Quality of Care, Surgery
da Graca B, Ogola GO, Fullerton C
Offsetting patient-centered medical homes investment costs through per-member-per-month or Medicare merit-based incentive payment system incentive payments.
The purpose of this study was to examine potential offsets through commercial payer per-member-per-month (PMPM) payments and the Medicare Merit-based Incentive Payment System (MIPS). The researchers found that with PMPM, breaking even required that 2.4% to 6.4% of commercially insured patients per physician to be covered; with MIPS incentive payments, they would exceed PCMH costs by 2022.
AHRQ-funded; HS022621.
Citation: da Graca B, Ogola GO, Fullerton C .
Offsetting patient-centered medical homes investment costs through per-member-per-month or Medicare merit-based incentive payment system incentive payments.
J Ambul Care Manage 2018 Apr/Jun;41(2):105-13. doi: 10.1097/jac.0000000000000224..
Keywords: Healthcare Costs, Medicare, Patient-Centered Healthcare, Payment, Primary Care
Desai S, McWilliams JM
Consequences of the 340B drug pricing program.
Researchers used Medicare claims and a regression-discontinuity design, taking advantage of the threshold for program eligibility among general acute care hospitals to isolate the effects of the 340B Drug Pricing Program on hospital-physician consolidation and on the outpatient administration of parenteral drugs. They concluded that the Program has been associated with hospital-physician consolidation in hematology-oncology and with more hospital-based administration of parenteral drugs in hematology-oncology and ophthalmology.
AHRQ-funded; HS024072.
Citation: Desai S, McWilliams JM .
Consequences of the 340B drug pricing program.
N Engl J Med 2018 Feb 8;378(6):539-48. doi: 10.1056/NEJMsa1706475.
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Keywords: Healthcare Costs, Payment, Hospitals, Medicare, Medication
Nyman JA, Koc C, Dowd BE
Decomposition of moral hazard.
This study sought to simulate the portion of moral hazard that is due to the income transfer contained in the coinsurance price reduction. The investigators found that the efficient proportion of moral hazard varied from disease to disease, but was the highest for those with diabetes and cancer.
Citation: Nyman JA, Koc C, Dowd BE .
Decomposition of moral hazard.
J Health Econ 2018 Jan;57:168-78. doi: 10.1016/j.jhealeco.2017.12.003..
Keywords: Health Insurance, Healthcare Costs, Medical Expenditure Panel Survey (MEPS), Payment