scholarly journals Quality of care at safety‐net hospitals and the impact on pay‐for‐performance reimbursement

Cancer ◽  
2020 ◽  
Vol 126 (20) ◽  
pp. 4584-4592
Author(s):  
Reith R. Sarkar ◽  
P. Travis Courtney ◽  
Katie Bachand ◽  
Paige E. Sheridan ◽  
Paul J. Riviere ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Pay For Performance ◽  
Safety Net ◽  
The Impact

scholarly journals Quality of Care at Safety-Net Hospitals and the Impact on Pay-for-Performance Reimbursement

2019 ◽  
Vol 105 (1) ◽  
pp. S179
Author(s):  
R.R. Sarkar ◽  
K. Bachand ◽  
P. Sheridan ◽  
P. Riviere ◽  
Z.D. Guss ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Pay For Performance ◽  
Safety Net ◽  
The Impact

scholarly journals Quality of care at safety-net hospitals and the impact on pay-for-performance reimbursement

2019 ◽  
Author(s):  
Reith R. Sarkar ◽  
Patrick T. Courtney ◽  
Katie Bachand ◽  
Paige Sheridan ◽  
Paul Riviere ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Cancer Patients ◽  
Low Income ◽  
Pay For Performance ◽  
Young Male ◽  
Quality Measures ◽  
Safety Net ◽  
High Burden ◽  
The Impact

AbstractBackgroundPay-for-performance reimbursement ties hospital payments to standardized quality of care metrics. The impact of pay-for-performance reimbursement models on safety-net hospitals, which care primarily for uninsured or underinsured patients, remains poorly defined. This study evaluates how standardized quality of care metrics vary by a hospital’s safety-net status, and helps us better understand the potential impact that pay-for-performance reimbursement could have on funding of safety-net hospitals.MethodsWe identified 1,703,865 bladder, breast, cervix, colon, endometrium, gastric, lung, ovary, or rectum cancer patients treated at 1,344 hospitals diagnosed between 2004 and 2015. Safety-net burden was defined for each hospital as the percentage of uninsured or Medicaid patients cared for by that hospital. Hospitals were grouped into low-, medium-, and high-burden hospitals. We evaluated the impact of safety-net burden on concordance with 20 standardized quality of care measures, adjusting for differences in patient age, gender, stage at diagnosis, and comorbidity.ResultsPatients seen at high-burden hospitals were more likely to be young, male, black, Hispanic, and to reside in a low-income and low-educated region. High-burden hospitals had lower adherence to 13 of 20 quality measures compared to low-burden hospitals (all p<0.05). Among the 350 high-burden hospitals, the quality measures were lowest for those caring for the highest fraction of uninsured or Medicaid patients, minority serving hospitals, and those caring for less educated patients (all p<0.001).DiscussionCancer care at safety-net hospitals was associated with lower concordance to standardized quality of care measures. Under a pay-for-performance reimbursement model these lower quality of care scores could decrease payments to safety-net hospitals, potentially increasing health disparities for at-risk cancer patients.

scholarly journals Luck of the draw: Role of chance in the assignment of medicare readmissions penalties

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261363
Author(s):  
Andrew D. Wilcock ◽  
Sushant Joshi ◽  
José Escarce ◽  
Peter J. Huckfeldt ◽  
Teryl Nuckols ◽  
...  
Keyword(s):  
Pay For Performance ◽  
Hospital Readmissions ◽  
Safety Net ◽  
Teaching Hospitals ◽  
Health Plans ◽  
Random Events ◽  
Discharged Patients ◽  
The Impact

Pay-for-performance programs are one strategy used by health plans to improve the efficiency and quality of care delivered to beneficiaries. Under such programs, providers are often compared against their peers in order to win bonuses or face penalties in payment. Yet luck has the potential to affect performance assessment through randomness in the sorting of patients among providers or through random events during the evaluation period. To investigate the impact luck can have on the assessment of performance, we investigated its role in assigning penalties under Medicare’s Hospital Readmissions Reduction Policy (HRRP), a program that penalizes hospitals with excess readmissions. We performed simulations that estimated program hospitals’ 2015 readmission penalties in 1,000 different hypothetical fiscal years. These hypothetical fiscal years were created by: (a) randomly varying which patients were admitted to each hospital and (b) randomly varying the readmission status of discharged patients. We found significant differences in penalty sizes and probability of penalty across hypothetical fiscal years, signifying the importance of luck in readmission performance under the HRRP. Nearly all of the impact from luck arose from events occurring after hospital discharge. Luck played a smaller role in determining penalties for hospitals with more beds, teaching hospitals, and safety-net hospitals.

scholarly journals COVID-19 Effect on Access to Maternal Health Services in Kenya

2020 ◽  
Vol 1 ◽  
Author(s):  
Jackline Oluoch-Aridi ◽  
Tecla Chelagat ◽  
Mary M. Nyikuri ◽  
Joseph Onyango ◽  
Danice Guzman ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Maternal Health ◽  
Health Services ◽  
Maternal Mortality ◽  
Informal Settlements ◽  
Safety Net ◽  
Mitigation Strategies ◽  
Access To Health ◽  
The Impact

Introduction: Maternal mortality continues to be one of the biggest challenges of the health system in Kenya. Informal settlements in Kenya have been known to have higher rates of maternal mortality and also receive maternity services of varied quality. Data assessing progress on key maternal health indicators within informal settlements are also often scarce. The COVID-19 pandemic hit Kenya in March this year and so far, the impact of the pandemic on access to maternal health has not been established. This study aims to add to the body of knowledge by investigating the effects of the COVID-19 pandemic and mitigation strategies on access to health care services in informal settlements.Methods: Qualitative methods using in-depth interviews were used to assess women's experiences of maternity care during the COVID-19 era and the impact of proposed mitigation strategies such as the lockdown and the curfew. Other aspects of the maternity experience such as women's knowledge of COVID-19, their perceived risk of infection, access to health facilities, perceived quality of care were assessed. Challenges that women facing as a result of the lockdown and curfew with respect to maternal health access and quality were also assessed.Results: Our findings illustrate that there was a high awareness of the symptoms and preventative measures for COVID-19 amongst women in informal settlements. Our findings also show that women's perception of risk to themselves was high, whereas risk to family and friends, and in their neighborhood was perceived as low. Less than half of women reported reduced access due to fear of contracting Coronavirus, Deprioritization of health services, economic constraints, and psychosocial effects were reported due to the imposed lockdown and curfew. Most respondents perceived improvements in quality of care due to short-waiting times, hygiene measures, and responsive health personnel. However, this was only reported for the outpatient services and not in-patient services.Conclusion: The most important recommendation was for the Government to provide food followed by financial support and other basic amenities. This has implications for the Government's mitigation measures that are focused on public health measures and lack social safety-net approaches for the most vulnerable communities.

Reduced influence of affective disorders on perioperative complication rates, length of hospital stay, and healthcare costs following spinal fusion for adolescent idiopathic scoliosis

2019 ◽  
Vol 24 (6) ◽  
pp. 722-727
Author(s):  
Aladine A. Elsamadicy ◽  
Andrew B. Koo ◽  
Megan Lee ◽  
Adam J. Kundishora ◽  
Christopher S. Hong ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Idiopathic Scoliosis ◽  
Affective Disorder ◽  
Affective Disorders ◽  
Complication Rates ◽  
Total Cost ◽  
Adolescent Patients ◽  
Perioperative Complication ◽  
The Impact

OBJECTIVEIn the past decade, a gradual transition of health policy to value-based healthcare has brought increased attention to measuring the quality of care delivered. In spine surgery, adolescents with scoliosis are a population particularly at risk for depression, anxious feelings, and impaired quality of life related to back pain and cosmetic appearance of the deformity. With the rising prevalence of mental health ailments, it is necessary to evaluate the impact of concurrent affective disorders on patient care after spinal surgery in adolescents. The aim of this study was to investigate the impact that affective disorders have on perioperative complication rates, length of stay (LOS), and total costs in adolescents undergoing elective posterior spinal fusion (PSF) (≥ 4 levels) for idiopathic scoliosis.METHODSA retrospective study of the Kids’ Inpatient Database for the year 2012 was performed. Adolescent patients (age range 10–17 years old) with AIS undergoing elective PSF (≥ 4 levels) were selected using the International Classification of Diseases, Ninth Revision, Clinical Modification coding system. Patients were categorized into 2 groups at discharge: affective disorder or no affective disorder. Patient demographics, comorbidities, complications, LOS, discharge disposition, and total cost were assessed. The primary outcomes were perioperative complication rates, LOS, total cost, and discharge dispositions.RESULTSThere were 3759 adolescents included in this study, of whom 164 (4.4%) were identified with an affective disorder (no affective disorder: n = 3595). Adolescents with affective disorders were significantly older than adolescents with no affective disorders (affective disorder: 14.4 ± 1.9 years vs no affective disorder: 13.9 ± 1.8 years, p = 0.001), and had significantly different proportions of race (p = 0.005). Aside from hospital region (p = 0.016), no other patient- or hospital-level factors differed between the cohorts. Patient comorbidities did not differ significantly between cohorts. The number of vertebral levels involved was similar between the cohorts, with the majority of patients having 9 or more levels involved (affective disorder: 76.8% vs no affective disorder: 79.5%, p = 0.403). Postoperative complications were similar between the cohorts, with no significant difference in the proportion of patients experiencing a postoperative complication (p = 0.079) or number of complications (p = 0.124). The mean length of stay and mean total cost were similar between the cohorts. Moreover, the routine and nonroutine discharge dispositions were also similar between the cohorts, with the majority of patients having routine discharges (affective disorder: 93.9% vs no affective disorder: 94.9%, p = 0.591).CONCLUSIONSThis study suggests that affective disorders may not have a significant impact on surgical outcomes in adolescent patients undergoing surgery for scoliosis in comparison with adults. Further studies are necessary to elucidate how affective disorders affect adolescent patients with idiopathic scoliosis, which may improve provider approach in managing these patients perioperatively and at follow-up in hopes to better the overall patient satisfaction and quality of care delivered.

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