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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 8 of 8 Research Studies DisplayedMarkovitz AA, Mullangi S, Hollingsworth JM
ACOs and the 1%: changes in spending among high-cost patients following the Medicare shared savings program.
This paper analyzed changes in spending among high-cost patients following the creation of accountable care organizations (ACOs), specifically for the Medicare Shared Savings Program – which is Centers for Medicare and Medicaid Services (CMS) flagship program. Changes in spending for Medicare fee-for-services were analyzed for different spending percentiles (50th, 90th, and 99th) as well as regionally. While there was a reduction in spending, it was not considered statistically significant and has not affected spending within or across regions. However, the authors note that the study is limited by the program’s voluntary nature and may be not a full reflection of the changes.
AHRQ-funded; HS024525; HS024728; HS025615.
Citation: Markovitz AA, Mullangi S, Hollingsworth JM .
ACOs and the 1%: changes in spending among high-cost patients following the Medicare shared savings program.
J Gen Intern Med 2019 Jul;34(7):1116-18. doi: 10.1007/s11606-019-04963-2..
Keywords: Medicare, Healthcare Costs, Payment
Markovitz AA, Ramsay PP, Shortell SM
Financial incentives and physician practice participation in Medicare's value-based reforms.
The purpose of this study was to evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary value-based payment reforms. The authors concluded that Medicare must complement financial incentives with additional efforts to address the needs of practices with less experience with such incentives to promote value-based payment on a broader scale.
AHRQ-funded; HS018546.
Citation: Markovitz AA, Ramsay PP, Shortell SM .
Financial incentives and physician practice participation in Medicare's value-based reforms.
Health Serv Res 2018 Aug;53 Suppl 1:3052-69. doi: 10.1111/1475-6773.12743..
Keywords: Payment, Medicare, Provider Performance
Colla CH, Morden NE, Sequist TD
Payer type and low-value care: comparing Choosing Wisely services across commercial and Medicare populations.
This study compared low-value health service use among commercially insured and Medicare populations and explored the influence of payer type on the provision of low-value care. In measuring use of seven Choosing Wisely-identified low-value services, it concluded that low-value care appears driven by factors unrelated to payer type or anticipated reimbursement.
AHRQ-funded; HS023812.
Citation: Colla CH, Morden NE, Sequist TD .
Payer type and low-value care: comparing Choosing Wisely services across commercial and Medicare populations.
Health Serv Res 2018 Apr;53(2):730-46. doi: 10.1111/1475-6773.12665.
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Keywords: Payment, Healthcare Utilization, Health Services Research (HSR), 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
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.
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Keywords: Payment, Medicare, Healthcare Costs, 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
Layton TJ, Ryan AM
Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings.
The researchers evaluated the effects of the size of financial bonuses on quality of care and the number of plan offerings in the Medicare Advantage Quality Bonus Payment Demonstration. They concluded that at great expense to Medicare, double bonuses in the Medicare Advantage Quality Bonus Payment Demonstration were not associated with improved quality but were associated with more plan offerings.
AHRQ-funded; HS018546.
Citation: Layton TJ, Ryan AM .
Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings.
Health Serv Res 2015 Dec;50(6):1810-28. doi: 10.1111/1475-6773.12409..
Keywords: Medicare, Payment, Provider Performance, Health Services Research (HSR), Quality Improvement, Quality of Care
Ryan AM, Burgess JF, Pesko MF
The early effects of Medicare's mandatory hospital pay-for-performance program.
This study evaluated the impact of hospital value-based purchasing (HVBP) on clinical quality and patient experience during its initial implementation period. It found that hospitals that were exposed to HVBP did not show greater improvement for either the clinical process or patient experience measures during the program’s initial implementation period.
AHRQ-funded; HS018546
Citation: Ryan AM, Burgess JF, Pesko MF .
The early effects of Medicare's mandatory hospital pay-for-performance program.
Health Serv Res. 2015 Feb;50(1):81-97. doi: 10.1111/1475-6773.12206..
Keywords: Medicare, Provider Performance, Payment, Hospitals, Quality Improvement, Quality of Care, Patient Experience