Quality

Quality of Care at Teaching Hospitals

Medicare pays higher reimbursement to teaching hospitals through indirect medical education (IME) payments to hospitals that train a high share of residents. IME inflate standard reimbursements in an attempt to compensate hospitals for these additional costs. Medicare also pay hospitals directly for some cost of training residents through the graduate medical education (GME). A key …

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Do we need outcomes-based contracts for drugs?

In the provider space, alternative payment models are increasingly common. These models aim to pay more money when providers improve quality and lower total cost and pay providers less when quality is suboptimal or total cost rise. Because there is significant uncertainty in quality of care and variability across providers, value-based purchasing is sensible in …

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CMMI and its revised strategy

Created by Section 3021 of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Innovation (CMMI; aka The CMS Innovation Center) has been tasked with creating new reimbursement strategies to improve quality and decrease costs. Over the past decade, CMMI has tested over 50 new payment models, and in just the last 3 …

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Which health systems are providing low value care?

That is the question posted by Ganguli et al. (2021). The define low value care as one of 41 specific services. They then use data across 556 health systems serving more than 11m beneficiaries to answer this question. Which types of low value care are most commonly used? The most common low-value services were preoperative …

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GAO Report on MIPS

The Government Accountability Office (GAO) last week published a report evaluating the Merit-based Incentive Payment System (MIPS). MIPS is an approach for CMS to pay physicians caring for Medicare beneficiaries based not just on volume but on value. MIPS evaluates provider value along four dimensions: (1) quality, (2) improvement activities, (3) promoting interoperability, and (4) …

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Study: Rural hospitals that merged or were bought saw death rates drop

The mortality rates at rural hospitals for certain conditions, including heart attacks and stroke, decreased in the years following a merger or an acquisition compared with facilities that remained independent, a new study shows. This is a departure from research done on the effects of M&A on urban hospitals.

Impact of star ratings on provider demand

For years, Medicare and other payers have used quality measures to evaluate the quality of care patients receive at various types of providers settings (e.g., hospital, home health agencies, skilled nursing homes). For some payers, higher quality scores/higher star ratings lead to direct increases in reimbursement through a value-based purchasing arrangement. Typically, value-based payment systems …

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CareMax to add 50 new senior care centers through Anthem collaboration

The senior care provider currently operates 34 medical centers offering healthcare and social services, like transportation. Through the collaboration, the companies will bring more seniors into value-based arrangements with the goal of improving outcomes for Anthem patients.

Goal Attainment Scaling

What outcomes should be used to measure if a medicine is a “good” medicine? Improved survival? Improved ability to function? Few side effects? Ability to get back to work? Living to attend your daughter’s wedding? All of the above? Oftentimes, health economists measure value of a treatment for the average person. Preferences for efficacy, safety, …

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Medicare Advantage vs. Medicare FFS: A Systematic Review

Medicare Advantage has grown over time. In 2020, nearly four in ten (39%) of all Medicare beneficiaries – 24.1 million people out of 62.0 million Medicare beneficiaries overall – were enrolled in Medicare Advantage (MA) plans. With MA enrollment growing, a key question is who provides higher quality care: Medicare fee-for-service (FFS) or MA? Who …

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Impact of COVID-19 on CMS’ value-based programs

Many Medicare payment initiatives aim to link reimbursement to value. Value includes both cost and quality of care. However, measuring quality of care during a pandemic is problematic. Further, most of CMS’ value-based purchasing programs–such as Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program (HRRP) and the Hospital-Acquired Condition (HAC) Reduction Program all …

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Limitations of CMS’s Hospital Star Ratings System

Is your hospital high quality? Well, this depends on what quality means. Does it have low readmission rates? Low rates of mortality? Do they follow clinical guidelines? Are patients satisfied? Are they good at cardiology care? What about cancer treatment? Combining all these different dimensions of quality is a complex task. The Centers for Medicare …

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Providers to HHS: ACO quality reporting changes create undue burdens

Eleven provider organizations sent a letter to HHS urging them to reconsider the new rules around quality measurement and reporting for ACOs. One of the reasons these rules are burdensome and should be revised is the lack of EHR interoperability, they said.

Is nursing home staff turnover a good quality metric?

There are a few sub-questions we need to break down to answer before answering this one larger question. These sub-questions include: Is nursing staff turnover at nursing homes a big problem? Is nursing staff turnover correlated with quality of care? Does using nursing staff turnover as a quality metric provide the right incentives? A paper …

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The Oncology Care Model is dead. Long Live the Oncology Care First Model.

The Oncology Care Model is slated to end soon. Specifically, the last set of six-month episodes would initiate no later than December 31, 2020 and thus all episodes will be completed in June 30, 2021. Nevertheless, CMS is proposing a successor to the Oncology Care Model called the Oncology Care First (OCF) Model. CMS describes …

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The Dawn of a European Health Data Space – Challenges

The European data strategy aims to construct common data spaces for all, create a single EU market for data, and catalyze a dynamic data economy. In a previous post, we briefly described the essence of the envisioned heath data space and pointed at opportunities and possible starting points to transform this vision into reality. However, …

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