National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (2)
- Disparities (2)
- Health Insurance (1)
- Hospital Readmissions (1)
- (-) Medicare (7)
- Outcomes (2)
- Patient Experience (3)
- Payment (3)
- Provider Performance (5)
- Quality Improvement (3)
- Quality Measures (2)
- (-) Quality of Care (7)
- Racial and Ethnic Minorities (2)
- Sepsis (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 7 of 7 Research Studies DisplayedWilcock AD, Joshi S, Escarce J
Luck of the draw: role of chance in the assignment of Medicare readmissions penalties.
Pay-for-performance programs are one strategy used by health plans to improve the efficiency and quality of care delivered to beneficiaries. Under such programs, providers are often compared against their peers in order to win bonuses or face penalties in payment. The purpose of this study was to investigate the impact luck can have on the assessment of performance, the researchers investigated its role in assigning penalties under Medicare's Hospital Readmissions Reduction Policy (HRRP), a program that penalizes hospitals with excess readmissions.
AHRQ-funded; HS024284.
Citation: Wilcock AD, Joshi S, Escarce J .
Luck of the draw: role of chance in the assignment of Medicare readmissions penalties.
PLoS One 2021 Dec 21;16(12):e0261363. doi: 10.1371/journal.pone.0261363..
Keywords: Medicare, Payment, Hospital Readmissions, Provider Performance, Quality of Care
Roberts ET, Song Z, Ding L
Changes in patient experiences and assessment of gaming among large clinician practices in precursors of the merit-based incentive payment system.
Medicare's Merit-Based Incentive Payment System (MIPS), a public reporting and pay-for-performance program, adjusts clinician payments based on publicly reported measures that are chosen primarily by clinicians or their practices. Within precursor programs of the MIPS, this study examined 1) practices' selection of Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience measures for quality scoring under pay-for-performance and 2) the association between mandated public reporting on CAHPS measures and performance on those measures.
AHRQ-funded; HS026727.
Citation: Roberts ET, Song Z, Ding L .
Changes in patient experiences and assessment of gaming among large clinician practices in precursors of the merit-based incentive payment system.
JAMA Health Forum 2021 Oct;2(10). doi: 10.1001/jamahealthforum.2021.3105..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Medicare, Provider Performance, Payment, Quality Improvement, Quality of Care
Markovitz AA, Ayanian JZ, Warrier A
Medicare Advantage plan double bonuses drive racial disparity in payments, yield no quality or enrollment improvements.
Using national data for 2008-18, investigators found that double bonuses were not associated with either improvements in plan quality or increased Medicare Advantage enrollment. Additionally, double bonuses increased payments to plans to care for Black beneficiaries by $60 per year, compared with $91 for White beneficiaries. These findings suggest that double bonuses not only fail to improve quality and enrollment but also foster a racially inequitable distribution of Medicare funds that disfavors Black beneficiaries. This study supports eliminating double bonuses, thereby saving Medicare an estimated $1.8 billion per year.
AHRQ-funded; HS000053.
Citation: Markovitz AA, Ayanian JZ, Warrier A .
Medicare Advantage plan double bonuses drive racial disparity in payments, yield no quality or enrollment improvements.
Health Aff 2021 Sep;40(9):1411-19. doi: 10.1377/hlthaff.2021.00349..
Keywords: Medicare, Health Insurance, Payment, Quality Improvement, Quality of Care, Disparities, Racial and Ethnic Minorities
Barbash IJ, Davis BS, Yabes JG
Treatment patterns and clinical outcomes after the introduction of the Medicare Sepsis Performance Measure (SEP-1).
This study evaluated the effect of Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) on treatment patterns and patient outcomes. Findings showed that, two years after its implementation, SEP-1 was associated with variable changes in process measures, with the greatest effect being an increase in lactate measurement within 3 hours of sepsis onset. There were small increases in antibiotic administration and fluid administration, a small increase in ICU admissions, and no changes in mortality or discharge to home.
Citation: Barbash IJ, Davis BS, Yabes JG .
Treatment patterns and clinical outcomes after the introduction of the Medicare Sepsis Performance Measure (SEP-1).
Ann Intern Med 2021 Jul;174(7):927-35. doi: 10.7326/m20-5043..
Keywords: Sepsis, Medicare, Outcomes, Quality Measures, Quality of Care
Meyers DJ, Rahman M, Mor V
Association of Medicare Advantage Star Ratings with racial, ethnic, and socioeconomic disparities in quality of care.
This cross-sectional study looked at racial/ethnic minority and socioeconomic disparities in ratings for Medicare Advantage (MA) plans, which disproportionately enroll these populations. A total of 1,578,564 enrollees were included in this analysis that used 22 measures of quality and satisfaction at the individual enrollee level, aggregated into simulated star ratings from 2-5 stratified by socioeconomic status (SES) and race/ethnicity. Low SES enrollees had simulated stratified star ratings 0.5 stars lower than individuals with high SES in the same contract. Black enrollees had simulated star ratings that were 0.3 stars lower and Hispanic enrollees had 0.1 lower simulated star ratings than White enrollees in the same contract. There was a larger difference in ratings with 4.5 to 5-star contracts with Black and Hispanic enrollees with Whites, and no statistical difference in 2.0 to 2.5 star-rated contracts. There was only low correlation between simulated ratings for enrollees of low SES and high SES.
AHRQ-funded; HS02705101.
Citation: Meyers DJ, Rahman M, Mor V .
Association of Medicare Advantage Star Ratings with racial, ethnic, and socioeconomic disparities in quality of care.
JAMA Health Forum 2021 Jun;2(6):e210793..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Medicare, Patient Experience, Disparities, Quality Measures, Provider Performance, Quality of Care, Racial and Ethnic Minorities
Sen AP, Meiselbach MK, Anderson KE
Physician network breadth and plan quality ratings in Medicare Advantage.
This research letter describes a cross-sectional study that was conducted to examine the extent of narrow networks across Medicare Advantage (MA), types of counties where they are common, enrollment in narrow network plans, and how networks are associated with star ratings. The authors used Vericred physician networks data, publicly available CMS MA plan data, and Census and Area Health Resources File data on county characteristics. Network breadth was defined as the percentage of eligible county-level physicians in network, with narrow defined as fewer than 25% of eligible physicians. The authors examined the 2019 physician breadth among the most prevalent MA plan designs (HMOs and PPOs), described the percentage of enrollees in narrow network plans by state, and assessed whether network breadth was associated with star ratings, adjusting for plan and county characteristics. The sample included 44,715 plan-counties and 18,448,434 MA enrollees. The mean MA network included 41.2% of local physicians. From the 44,715 plan-counties, 28% had narrow networks and 72% were non-narrow. The majority of narrow networks were HMOs (79.8%) compared with 50.7% among non-narrow plans. More narrow networks were in large metropolitan counties (40%) than in non-narrow networks (26.7%). Counties with higher narrow networks had more mean MA penetration and a larger mean percentage of population older than 65 years who self-identified as Hispanic. Six states had more than 50% of beneficiaries in a narrow network plan, including California, Florida, Minnesota, Maryland, Wyoming, and Kansas.
AHRQ-funded; HS000029.
Citation: Sen AP, Meiselbach MK, Anderson KE .
Physician network breadth and plan quality ratings in Medicare Advantage.
JAMA Health Forum 2021 Jul 30; 2(7):e211816. doi: 10.1001/jamahealthforum.2021.1816..
Keywords: Medicare, Quality of Care, Provider Performance
Meyers DJ, Trivedi AN, Wilson IB, DJ, Trivedi AN, Wilson IB
Higher Medicare Advantage Star Ratings are associated with improvements In patient outcomes.
Researchers examined CMS' five-star rating system for the overall quality of Medicare Advantage (MA) contracts. They found that enrollees experiencing a one-star MA rating increase were 20.8 percent less likely to leave their plan voluntarily to enroll in another plan or traditional Medicare. When hospitalized, enrollees were 3.4 percent more likely to use a higher-quality hospital and 2.6 percent less likely to be readmitted within ninety days. These findings suggest that MA star ratings may capture key domains of an MA plan's quality.
AHRQ-funded; HS027051.
Citation: Meyers DJ, Trivedi AN, Wilson IB, DJ, Trivedi AN, Wilson IB .
Higher Medicare Advantage Star Ratings are associated with improvements In patient outcomes.
Health Aff 2021 Feb;40(2):243-50. doi: 10.1377/hlthaff.2020.00845..
Keywords: Patient Experience, Provider Performance, Medicare, Quality Improvement, Quality of Care, Outcomes