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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 25 of 36 Research Studies DisplayedTummalapalli SL, Struthers SA, White D
Optimal care for kidney health: development of a Merit-based Incentive Payment System (MIPS) value pathway.
This article detailed the iterative consensus-building process used by the American Society of Nephrology Quality Committee to develop the Optimal Care for Kidney Health Merit-based Incentive Payment System (MIPS) Value Pathway (MVP). The Optimal Care for Kidney Health MVP, published in the 2023 Medicare Physician Fee Schedule Final Rule, included measures related to angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use, hypertension control, readmissions, acute kidney injury requiring dialysis, and advance care planning. The MVP nephrology’s goal was to streamline measure selection in MIPS and served as a case study of collaborative policymaking between one professional organization and national regulatory agencies.
AHRQ-funded; HS028684.
Citation: Tummalapalli SL, Struthers SA, White D .
Optimal care for kidney health: development of a Merit-based Incentive Payment System (MIPS) value pathway.
J Am Soc Nephrol 2023 Aug; 34(8):1315-28. doi: 10.1681/asn.0000000000000163..
Keywords: Kidney Disease and Health, Payment, Healthcare Costs, Medicare
Ko H, Martin BI, Nelson RE
How does the effect of the comprehensive Care for Joint Replacement model vary based on surgical volume and costs of care?
This article described differences in costs, quality, and patient selection between hospitals that continued to participate in the comprehensive Care for Joint Replacement (CJR) program after the CMS policy revision and those that withdrew from CJR before and after the implementation of CJR. Study subjects were Medicare beneficiaries who had undergone elective lower extremity joint replacement from 2013 to 2017. The results indicated that hospitals that continued to participate in CJR achieved a greater cost reduction. The authors noted that these the cost reductions were partly attributable to the avoidance of potential higher-cost patients.
AHRQ-funded; HS024714.
Citation: Ko H, Martin BI, Nelson RE .
How does the effect of the comprehensive Care for Joint Replacement model vary based on surgical volume and costs of care?
Med Care 2023 Jan;61(1):20-26. doi: 10.1097/mlr.0000000000001785..
Keywords: Orthopedics, Surgery, Healthcare Costs, Medicare, Payment
Likosky DS, Yang G, Zhang M
Interhospital variability in health care-associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries.
The purpose of this study was to examine differences in durable ventricular assist device implantation infection rates and associated costs across hospitals. The researchers utilized clinical data for 8,688 patients who received primary durable ventricular assist devices from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) hospitals (n = 120) and merged that data with post-implantation 90-day Medicare claims. The primary outcome included infections within 90 days of implantation and Medicare payments. The study found that 27.8% of patients developed 3982 identified infections. The median adjusted incidence of infections (per 100 patient-months) across hospitals was 14.3 and differed according to hospital. Total Medicare payments from implantation to 90 days were 9.0% more in high versus low infection tercile hospitals. The researchers concluded that health-care-associated infection rates post durable ventricular assist device implantation varied according to hospital and were associated with increased 90-day Medicare expenditures.
AHRQ-funded; HS026003.
Citation: Likosky DS, Yang G, Zhang M .
Interhospital variability in health care-associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries.
J Thorac Cardiovasc Surg 2022 Nov;164(5):1561-68. doi: 10.1016/j.jtcvs.2021.04.074..
Keywords: Healthcare-Associated Infections (HAIs), Medical Devices, Medicare, Heart Disease and Health, Cardiovascular Conditions, Hospitals, Payment, Healthcare Costs
Sood N, Yang Z, Huckfeldt P
Geographic variation in Medicare fee-for-service health care expenditures before and after the passage of the Affordable Care Act.
This cross-section study examined geographic variation in Medicare fee-for-service health care expenditures before and after the passage of the Affordable Care Act. The study included all fee-for-service Medicare enrollees aged 65 and older from 2007 to 2018 using data from the Medicare Geographic Variation Public Use File. Hospital referral regions (HRRs) were grouped in each year into deciles (10 equal groups) based on per-beneficiary total spending. Geographic variation was stable from 2007 to 2011 and declined steadily from 2012 through 2018. In specific spending categories, only home health had statistically significant reductions in geographic variation. The ratio of home health spending among HRRs in the top to bottom deciles of total Medicare spending fell from 5.14 in 2007 to 3.45 in 2018.
AHRQ-funded; HS025394.
Citation: Sood N, Yang Z, Huckfeldt P .
Geographic variation in Medicare fee-for-service health care expenditures before and after the passage of the Affordable Care Act.
JAMA Health Forum 2021 Dec;2(12):e214122. doi: 10.1001/jamahealthforum.2021.4122..
Keywords: Medicare, Policy, Healthcare Costs, Payment
Liao JM, Gupta A, Zhao Y
Association between hospital voluntary participation, mandatory participation, or nonparticipation in bundled payments and Medicare episodic spending for hip and knee replacements.
The purpose of this study was to examine and compare 2011-2017 spending for hip and joint replacements between hospitals with voluntary participation, mandatory participation and nonparticipation in the Medicare Bundled Payments for Care Improvement program.
Citation: Liao JM, Gupta A, Zhao Y .
Association between hospital voluntary participation, mandatory participation, or nonparticipation in bundled payments and Medicare episodic spending for hip and knee replacements.
JAMA 2021 Aug 3;326(5):438-40. doi: 10.1001/jama.2021.10046..
Keywords: Medicare, Hospitals, Payment, Surgery, Orthopedics, Healthcare Costs
Hambley BC, Anderson KE, Shanbhag SP
Payment incentives and the use of higher-cost drugs: a retrospective cohort analysis of intravenous iron in the Medicare population.
Researchers examined prescribing patterns in the context of intravenous (IV) iron, for which multiple similarly safe and efficacious formulations exist, with wide variations in price. Using Medicare data, they found an increase in the dispensing of a higher-priced IV iron formulation associated with a shortage of a less expensive drug that persisted once the shortage ended. They concluded that their findings in IV iron have broader implications for Part B drug payment policy because the price of the drug determines the physician and health system payment.
AHRQ-funded; HS000029.
Citation: Hambley BC, Anderson KE, Shanbhag SP .
Payment incentives and the use of higher-cost drugs: a retrospective cohort analysis of intravenous iron in the Medicare population.
Am J Manag Care 2020 Dec;26(12):516-22. doi: 10.37765/ajmc.2020.88539..
Keywords: Elderly, Medication, Medicare, Payment, Healthcare Costs, Practice Patterns
Ganguli I, Lupo C, Mainor AJ
Association between specialist compensation and Accountable Care Organization performance.
This study’s objective was to determine whether Medicare Shared Savings Program Accountable Care Organizations (ACOs) using cost reduction measures in specialist compensation demonstrated better performance. National cross-sectional survey data on ACOs from 2013-2015 was linked to public-use data on ACO performance from 2014-2016. Out of 160 ACOs surveys, 26% reported using cost reduction measures to help determine specialist compensation. However, these ACOs did not have savings in the short term.
AHRQ-funded; HS023812.
Citation: Ganguli I, Lupo C, Mainor AJ .
Association between specialist compensation and Accountable Care Organization performance.
Health Serv Res 2020 Oct;55(5):722-28. doi: 10.1111/1475-6773.13323..
Keywords: Provider Performance, Healthcare Costs, Payment, Medicare
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
He D, McHenry P, Mellor JM
Do financial incentives matter? Effects of Medicare price shocks on skilled nursing facility care.
The authors provided new evidence on how Medicare payment changes affect the amount of skilled nursing facility (SNF) care provided to Medicare patients. They found that increases in Medicare payment rates to SNFs increased the total number of Medicare resident days at SNFs. Further, the effects were asymmetric; although Medicare payment increases affected Medicare days, payment decreases did not. They conclude that their results have important implications for policies that alter the Medicare base payment rates to SNFs and other health care providers.
AHRQ-funded; HS025529.
Citation: He D, McHenry P, Mellor JM .
Do financial incentives matter? Effects of Medicare price shocks on skilled nursing facility care.
Health Econ 2020 Jun;29(6):655-70. doi: 10.1002/hec.4009..
Keywords: Medicare, Nursing Homes, Elderly, Payment, Healthcare Costs
Selden TM
Differences between public and private hospital payment rates narrowed, 2012-16.
In 2000-12 payments for inpatient hospital stays, emergency department visits, and outpatient hospital care for privately insured patients grew much faster than payments for Medicare and Medicaid patients. This widening of private-public payment gaps slowed or even reversed itself in 2012-16. In this paper, the author discusses the differences between public and private hospital payment rates, 2012-2016.
AHRQ-authored.
Citation: Selden TM .
Differences between public and private hospital payment rates narrowed, 2012-16.
Health Aff 2020 Jan;39(1):94-99. doi: 10.1377/hlthaff.2019.00415..
Keywords: Medical Expenditure Panel Survey (MEPS), Hospitals, Payment, Healthcare Costs, Medicaid, Medicare
Werner RM, Konetzka RT, Qi M
The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs.
The objective of this study was to investigate the impact of Medicare's skilled nursing facility (SNF) copayment policy, with a large increase in the daily copayment rate on the 20th day of a benefit period, on length of stay, patient outcomes, and costs. The investigators concluded that Medicare's SNF copayment policy was associated with shorter lengths of stay and worse patient outcomes, suggesting the copayment policy had unintended and negative effects on patient outcomes.
AHRQ-funded; HS024266.
Citation: Werner RM, Konetzka RT, Qi M .
The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs.
Health Serv Res 2019 Dec;54(6):1184-92. doi: 10.1111/1475-6773.13227..
Keywords: Medicare, Nursing Homes, Payment, Long-Term Care, Healthcare Costs, Elderly, Hospitalization, Hospital Discharge
Song LD, Newhouse JP, Garcia-De-Albeniz X
Changes in screening colonoscopy following Medicare reimbursement and cost-sharing changes.
This study examined changes in screening colonoscopy rates after Medicare reimbursement and cost-sharing changed when the Affordable Care Act (ACA) was implemented. A 20% random sample of fee-for-service (FFS) Medicare claims from 2002-2012 was used in this study. Screening colonoscopy rates did increase after 2001 when cost-sharing was eliminated but the amount varied depending on the algorithm used to classify the indication.
AHRQ-funded; HS023128.
Citation: Song LD, Newhouse JP, Garcia-De-Albeniz X .
Changes in screening colonoscopy following Medicare reimbursement and cost-sharing changes.
Health Serv Res 2019 Aug;54(4):839-50. doi: 10.1111/1475-6773.13150..
Keywords: Colonoscopy, Healthcare Costs, Healthcare Utilization, Medicare, Payment, Prevention, Screening
Markovitz 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
Sheetz KH, Dimick JB, Regenbogen SE
How patient complexity and surgical approach influence episode-based payment models for colectomy.
This study looked into how the use of bundled payment programs would affect hospital reimbursements for colectomies. National data from the 100% Medicare Provider Analysis and Review files for the years 2010 to 2014 was used. Patients undergoing colectomies were identified using diagnosis-related group codes and ICD-9, Clinical Modification codes. Reconciliation payments were simulated as the difference between actual price-standardized 90-day episode payments and estimated regional spending benchmarks. The simulated bundled payment conditions showed 51.8% of hospitals would achieve shared savings, but the average case would incur reconciliation penalties. Laparoscopies would achieve the highest savings.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Dimick JB, Regenbogen SE .
How patient complexity and surgical approach influence episode-based payment models for colectomy.
Dis Colon Rectum 2019 Jun;62(6):739-46. doi: 10.1097/dcr.0000000000001372..
Keywords: Surgery, Payment, Healthcare Costs, Medicare, Hospitals
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
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
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
Jubelt LE, Goldfeld KS, Blecker SB
Early lessons on bundled payment at an academic medical center.
This study was a difference-in-differences study of Medicare fee-for-service patients hospitalized from April 2011 to June 2012 and October 2013 to December 2014 for lower extremity joint arthroplasty, cardiac valve procedures, or spine surgery. It examined total episode costs and costs by service category. It concluded that opportunities for savings under bundled payment may be greater for lower extremity joint arthroplasty than for other conditions.
AHRQ-funded; HS023683.
Citation: Jubelt LE, Goldfeld KS, Blecker SB .
Early lessons on bundled payment at an academic medical center.
J Am Acad Orthop Surg 2017 Sep;25(9):654-63. doi: 10.5435/jaaos-d-16-00626.
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Keywords: Healthcare Costs, Payment, 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
Jacobs PD, Molloy E
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
Schulz J, DeCamp M, Berkowitz SA
Regional cost and experience, not size or hospital inclusion, helps predict ACO success.
This study investigated the extent to which organizational characteristics, regional cost of care, or experience in the Medicare Shared Savings Program (MSSP) are associated with the ability to achieve shared savings. It found that experience, as measured by years in the MSSP program, was associated with success and the ability to earn shared savings varied regionally. This variation was strongly associated with differences in regional Medicare fee-for-service per capita costs.
AHRQ-funded; HS023684.
Citation: Schulz J, DeCamp M, Berkowitz SA .
Regional cost and experience, not size or hospital inclusion, helps predict ACO success.
Medicine 2017 Jun;96(24):e7209. doi: 10.1097/md.0000000000007209.
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Keywords: Healthcare Costs, Medicare, Payment
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
Ouayogode MH, Colla CH, Lewis VA
Determinants of success in shared savings programs: an analysis of ACO and market characteristics.
This study examined Accountable Care Organization (ACO) and market factors associated with superior financial performance in Medicare ACO programs. No characteristic of organizational structure was significantly associated with both outcomes of savings per beneficiary and likelihood of achieving shared savings. ACO prior experience with risk-bearing contracts was positively correlated with savings and significantly increased the likelihood of receiving shared savings payments.
AHRQ-funded; HS024075.
Citation: Ouayogode MH, Colla CH, Lewis VA .
Determinants of success in shared savings programs: an analysis of ACO and market characteristics.
Healthc 2017 Mar;5(1-2):53-61. doi: 10.1016/j.hjdsi.2016.08.002.
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Keywords: Healthcare Costs, Payment, Policy, Medicare
