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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 10 of 10 Research Studies DisplayedMachta 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
Chan CW, Green LV, Lekwijit S
Assessing the impact of service level when customer needs are uncertain: an empirical investigation of hospital step-down units.
In this study, the authors focused on estimating costs and benefits in a complex healthcare setting where the major differentiation among server types is the intensity of the service provided. They used data from ten hospitals and found that a step-down unit may be a cost-effective way to treat patients when used for those who are post-intensive care unit. However, they also found that the impact of step-down-unit care is more nuanced for patients admitted from the emergency department and may result in increased mortality risk and hospital length of stay for patients who should be treated in the intensive care unit. The authors recommended more study in this area.
AHRQ-funded; HS018480.
Citation: Chan CW, Green LV, Lekwijit S .
Assessing the impact of service level when customer needs are uncertain: an empirical investigation of hospital step-down units.
Management Science 2019 Feb;65(2):751-75. doi: 10.1287/mnsc.2017.2974..
Keywords: Care Management, Healthcare Costs, Healthcare Delivery, Hospitals, Inpatient Care
Padula WV, Pronovost PJ, Makic MBF
Value of hospital resources for effective pressure injury prevention: a cost-effectiveness analysis.
The objective of this study was to analyze the cost-utility of repeated risk-assessments for pressure-injury prevention in all hospital patients or in high-risk groups. Hospitalized adults were classified by Braden Scale scores into five risk levels: very high risk, high risk, moderate risk, at-risk, and minimal risk. The costs of pressure-injury treatment and prevention, and quality-adjusted life years (QALYs) related to pressure injuries were weighted by transition probabilities to calculate the incremental cost-effectiveness ratio. The results of the study indicate that simulating prevention for all patients yielded greater QALYs at higher cost from societal and healthcare sector perspectives. Prevention for all patients was cost-effective in more than 99% of probabilistic simulations. The authors conclude that hospitals should invest in nursing compliance with international prevention guidelines.
AHRQ-funded; HS023710.
Citation: Padula WV, Pronovost PJ, Makic MBF .
Value of hospital resources for effective pressure injury prevention: a cost-effectiveness analysis.
BMJ Qual Saf 2019 Feb;28(2):132-41. doi: 10.1136/bmjqs-2017-007505..
Keywords: Healthcare Costs, Hospitals, Pressure Ulcers, Prevention
Shih YT, Shen C, Hu JC
Do robotic surgical systems improve profit margins? A cross-sectional analysis of California hospitals.
The aim of this study was to examine the association between ownership of robotic surgical systems and hospital profit margins. Hospitals with robotic surgical systems tended to report more favorable profit margins. However, multilevel logistic regression showed that this relationship (an association, not causality) became only marginally significant after controlling for other hospital characteristics.
AHRQ-funded; HS020263; HS024608.
Citation: Shih YT, Shen C, Hu JC .
Do robotic surgical systems improve profit margins? A cross-sectional analysis of California hospitals.
Value Health 2017 Sep;20(8):1221-25. doi: 10.1016/j.jval.2017.05.010.
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Keywords: Healthcare Costs, Hospitals, Surgery
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).
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Keywords: Healthcare Costs, Payment, Health Insurance, 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.
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Keywords: Payment, Medicare, Healthcare Costs, Hospitals
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
David G, Lindrooth RC, Helmchen LA
Do hospitals cross-subsidize?
The authors used repeated shocks to a profitable service in the market for hospital-based medical care to test for cross-subsidization of unprofitable services. They studied how incumbent hospitals adjusted their provision of three uncontested services that are widely considered to be unprofitable. They estimated that the hospitals most exposed to entry reduced their provision of psychiatric, substance-abuse, and trauma care services at a rate of about one uncontested-service admission for every four cardiac admissions they stood to lose.
AHRQ-funded; HS010730.
Citation: David G, Lindrooth RC, Helmchen LA .
Do hospitals cross-subsidize?
J Health Econ 2014 Sep;37:198-218. doi: 10.1016/j.jhealeco.2014.06.007.
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Keywords: Healthcare Costs, Quality of Care, Hospitals
Ryan AM, Mushlin AI
The Affordable Care Act's payment reforms and the future of hospitals.
The author places likely hospital responses to the Affordable Care Act’s payment reforms in the historical context of their previous responses to such reforms as price controls, certificate-of-need laws, and prospective payment systems. He then discusses possible hospital responses to counter readmission penalties, revenue reductions, bundled payment strategies, and accountable care organizations.
AHRQ-funded; HS018546
Citation: Ryan AM, Mushlin AI .
The Affordable Care Act's payment reforms and the future of hospitals.
Ann Intern Med. 2014 May 20;160(10):729-30. doi: 10.7326/M13-2033..
Keywords: Healthcare Costs, Payment, Hospitals, Policy