National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Cardiovascular Conditions (1)
- Children's Health Insurance Program (CHIP) (1)
- Disparities (1)
- Elderly (2)
- Healthcare-Associated Infections (HAIs) (2)
- Healthcare Costs (3)
- (-) Health Insurance (13)
- Heart Disease and Health (1)
- Hospital Readmissions (1)
- Hospitals (2)
- Kidney Disease and Health (1)
- Medicaid (5)
- (-) Medicare (13)
- Nursing Homes (1)
- Outcomes (2)
- Patient Safety (1)
- (-) Payment (13)
- Pneumonia (1)
- Policy (2)
- Primary Care (1)
- Provider Performance (2)
- Quality Improvement (1)
- Quality Indicators (QIs) (1)
- Quality of Care (2)
- Racial and Ethnic Minorities (1)
- Surgery (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 13 of 13 Research Studies DisplayedLi J, Wu B, Flory J
Impact of the Affordable Care Act's Physician Payments Sunshine Act on branded statin prescribing.
The purpose of this study was to assess the impact of the Affordable Care Act's Physician Payments Sunshine Act (PPSA) and its mandate of disclosing pharmaceutical and medical industry payments to physicians for prescribing branded statins. The study found that the PPSA contributed to a 7% decrease in monthly new prescriptions of brand-name statins over the study period. There was no significant change in generic prescribing. The reduction was concentrated among physicians with the highest tercile of drug spending prior to the enactment of the PPSA, with a decrease of 15% in new branded statin prescriptions. The researchers concluded that the PPSA mandate reduced the prescribing of branded statin prescriptions in the time period following its announcement, especially in physicians who were taking part in excessive prescribing of the branded statins.
AHRQ-funded; HS027001.
Citation: Li J, Wu B, Flory J .
Impact of the Affordable Care Act's Physician Payments Sunshine Act on branded statin prescribing.
Health Serv Res 2022 Oct;57(5):1145-53. doi: 10.1111/1475-6773.14024..
Keywords: Payment, Policy, Medicare, Health Insurance
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
Fung V, McCarthy S, Price M
Payment discrepancies and access to primary care physicians for dual-eligible Medicare-Medicaid beneficiaries.
This study examined whether the Affordable Care Act (ACA) primary care fee bump for dual-eligible Medicare-Medicaid beneficiaries impacted primary care physicians (PCP) acceptance of duals. The authors assessed differences in the likelihood that PCPs had dual caseloads of ≥10% or 20% in states with lower versus full dual reimbursement using linear probability models adjusted for physician and area-level traits. The proportion of PCPs with dual caseloads of ≥10% or 20% decreased significantly between 2012 and 2017. The fee bump was not consistently associated with increases in dual caseloads.
AHRQ-funded; HS024725.
Citation: Fung V, McCarthy S, Price M .
Payment discrepancies and access to primary care physicians for dual-eligible Medicare-Medicaid beneficiaries.
Med Care 2021 Jun;59(6):487-94. doi: 10.1097/mlr.0000000000001525..
Keywords: Primary Care, Medicaid, Medicare, Health Insurance, Payment, Access to Care
Roberts ET, Nimgaonkar A, Aarons J
New evidence of state variation in Medicaid payment policies for dual Medicare-Medicaid enrollees.
The authors developed the first longitudinal database of state Medicaid policies for paying the cost sharing in Medicare Part B for services provided to dual Medicare-Medicaid enrollees (duals), and an index summarizing the impact of these policies on payments for physician office services. Information from 2004-2018 was consolidated from online Medicaid policy documents, state laws, and policy data reported to them by state Medicaid programs. The database showed that in 2018 42 states had policies to limit Medicaid payments of Medicare cost sharing when Medicaid’s fee schedule was lower than Medicare’s. This was an increase from 36 such states in 2004. In most states, combined Medicare and Medicare payments for evaluation and management services provided to duals averaged 78% of the Medicare allowed amount for these services.
AHRQ-funded; HS026727.
Citation: Roberts ET, Nimgaonkar A, Aarons J .
New evidence of state variation in Medicaid payment policies for dual Medicare-Medicaid enrollees.
Health Serv Res 2020 Oct;55(5):701-09. doi: 10.1111/1475-6773.13545..
Keywords: Medicaid, Medicare, Payment, Policy, Healthcare Costs, Health Insurance
Apathy NC, Everson J
High rates of partial participation in the first year of the merit-based incentive payment system.
This article discusses concerns over the implementation of the Merit-based Incentive Payment System (MIPS) for clinicians, which was authorized with the Medicare Access and CHIP Reauthorization Act of 2015. Data was analyzed from 2017, the first implementation year of MIPS. The authors found that although 90% of participating clinicians reported performance equal to or better than the lower performance threshold of 3 out of 100, almost half of clinicians did not participate in at least one of the three program categories. Even with the low participation rate, 74% of clinicians who only partially participated in the program received positive payment adjustments. The findings underline concerns that the design may have been too flexible to effectively incentivize clinicians to make incremental progress across all targeted aspects of the program (quality, advancing care information, and improvement activities).
AHRQ-funded; K12 HS026395.
Citation: Apathy NC, Everson J .
High rates of partial participation in the first year of the merit-based incentive payment system.
Health Aff 2020 Sep;39(9):1513-21. doi: 10.1377/hlthaff.2019.01648..
Keywords: Payment, Medicare, Medicaid, Children's Health Insurance Program (CHIP), Health Insurance
Hoffman GJ, Yakusheva O
Association between financial incentives in Medicare's hospital readmissions reduction program and hospital readmission performance.
This study compared the outcome of penalties versus rewards to prevent hospital readmission in Medicare’s Hospital Readmissions Reduction Program (HRRP). This retrospective cohort study used Medicare readmissions data from 2823 US short-term acute care hospitals participating in HRRP. Data from pre-HRRP in 2016 was compared with 2016-2019 3-year follow-up readmission performance classified by tertile of hospitals using baseline marginal incentives for 5 HRRP-targeted conditions: acute myocardial infarction (AMI), heart failure, chronic obstructive pulmonary disease (COPD), pneumonia, and hip and/or knee surgery. Of the 2823 hospitals participating in HRRP from baseline to follow-up, 81% had more than 1 excess readmission for 1 or more applicable condition and 19% did not. Financial incentives ranged from a mean range of $8762 to $58,158 per 1 avoided readmission. Hospitals with greater incentives for readmission avoidance had greater decreases than hospitals with smaller incentives. An additional $5000 in the incentive amount was associated with up to a 26% decrease in readmissions. The findings suggest that incentives work better than penalties to reduce hospital readmissions for those 5 conditions.
AHRQ-funded; HS025838.
Citation: Hoffman GJ, Yakusheva O .
Association between financial incentives in Medicare's hospital readmissions reduction program and hospital readmission performance.
JAMA Netw Open 2020 Apr;3(4):e202044. doi: 10.1001/jamanetworkopen.2020.2044..
Keywords: Medicare, Hospital Readmissions, Provider Performance, Payment, Health Insurance, Hospitals
Childrers CP, Dworsky JQ, Kominski G
A comparison of payments to a for-profit dialysis firm from government and commercial insurers.
The authors assessed differences in payments from government and commercial insurers to dialysis clinics through analysis of DaVita’s financial records. They found that, in 2017, commercial insurers paid one of the largest dialysis suppliers 4 times the rate of their government peers. They recommended that reducing payments from commercial insurers, perhaps through increased competition or fixing charges at a percent of Medicare reimbursement, may help alleviate excess spending on dialysis.
AHRQ-funded; HS025079.
Citation: Childrers CP, Dworsky JQ, Kominski G .
A comparison of payments to a for-profit dialysis firm from government and commercial insurers.
JAMA Intern Med 2019 Aug;179(8):1136-38. doi: 10.1001/jamainternmed.2019.0431..
Keywords: Payment, Health Insurance, Kidney Disease and Health, Medicare, Medicaid
Sankaran R, Sukul D, Nuliyalu U
Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study.
This study evaluated the association between hospital penalization in the US Hospital Acquired Condition Reduction Program (HACRP) and changes in clinical outcomes. Out of the total of 724 hospitals were penalized in fiscal year 2015, 708 were included in the study. The majority of the penalized hospitals were large teaching institutions and have a greater share of low-income patients than non-penalized hospitals. After penalization, there was a non-significant change in hospital acquired conditions, 30-day readmission rates, and 30-day mortality. This might mean that disparities in care could be exacerbated.
AHRQ-funded; HS026244.
Citation: Sankaran R, Sukul D, Nuliyalu U .
Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study.
BMJ 2019 Jul 3;366:l4109. doi: 10.1136/bmj.l4109..
Keywords: Health Insurance, Healthcare-Associated Infections (HAIs), Hospitals, Medicare, Patient Safety, Provider Performance, Payment, Quality of Care, Quality Indicators (QIs)
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
Koroukian SM, Basu J, Schiltz NK
AHRQ Author: Basu J
Changes in case-mix and health outcomes of Medicare fee-for-service beneficiaries and managed care enrollees during the years 1992-2011.
This study examined changes in differentials between managed care enrollees (MCEs) and fee-for-service beneficiaries (FFSBs) both in case-mix and health outcomes over time. It found that the case-mix differential between MCEs and FFSBs persisted over time. Both MCEs and FFSBs were as likely to die within 2 years from the Health and Retirement Study interview.
AHRQ-authored; AHRQ-funded; HS023113.
Citation: Koroukian SM, Basu J, Schiltz NK .
Changes in case-mix and health outcomes of Medicare fee-for-service beneficiaries and managed care enrollees during the years 1992-2011.
Med Care 2018 Jan;56(1):39-46. doi: 10.1097/mlr.0000000000000847.
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Keywords: Elderly, Payment, Medicare, Health Insurance, Outcomes
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.
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Keywords: Medicare, Payment, Healthcare Costs, Health Insurance
Lepore MJ, Shield RR, Looze J
Medicare and Medicaid reimbursement rates for nursing homes motivate select culture change practices but not comprehensive culture change.
The researchers use mixed methods to examine the presence of culture change practices in the context of a nursing home’s (NH’s) payer sources. They concluded that qualitative data show how higher pay from Medicare versus Medicaid influences implementation of select culture change practices, and quantitative data show NHs with higher proportions of Medicare residents have significantly higher (measured) environmental culture change implementation.
AHRQ-funded; HS000011.
Citation: Lepore MJ, Shield RR, Looze J .
Medicare and Medicaid reimbursement rates for nursing homes motivate select culture change practices but not comprehensive culture change.
J Aging Soc Policy 2015;27(3):215-31. doi: 10.1080/08959420.2015.1022102..
Keywords: Nursing Homes, Medicare, Medicaid, Payment, Health Insurance
Kronick R, Welch WP
AHRQ Author: Kronick R
Measuring coding intensity in the Medicare Advantage program.
Each year from 2004-2013, the average Medicare Advantage risk score increased faster than the average fee-for-service score. The intensity of coding varies widely by contract. The authors suggested that with the continuous relative increase in the average Medicare Advantage risk score, further policy changes will likely be necessary.
AHRQ-authored.
Citation: Kronick R, Welch WP .
Measuring coding intensity in the Medicare Advantage program.
Medicare Medicaid Res Rev 2014 Jul 17;4(2). doi: 10.5600/mmrr2014-004-02-a06.
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Keywords: Medicare, Health Insurance, Payment