Hospital Quality, Medical Charge Variation, and Patient Care Efficiency: Implications for Bundled Payment Reform Models

2016 ◽  
Author(s):  
Seokjun Youn ◽  
Gregory R. Heim
Keyword(s):  
Patient Care ◽  
Hospital Quality ◽  
Payment Reform ◽  
Bundled Payment ◽  
Charge Variation ◽  
Medical Charge

Bridging hospital quality leadership to patient care quality

2021 ◽  
Vol 233 ◽  
pp. 108010
Author(s):  
Subhajit Chakraborty ◽  
Hale Kaynak ◽  
José A. Pagán
Keyword(s):  
Patient Care ◽  
Care Quality ◽  
Hospital Quality ◽  
Patient Care Quality

How payment reform drives innovation in interventional oncology.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 276-276
Author(s):  
Joseph Rodgers Steele ◽  
Ryan Kristopher Clarke ◽  
Elizabeth Priya Ninan ◽  
Armeen Mahvash
Keyword(s):  
Cost Savings ◽  
Standard Of Care ◽  
Prospective Payment System ◽  
Balloon Occlusion ◽  
Payment System ◽  
Fee For Service ◽  
Payment Reform ◽  
Similar Clinical Outcome ◽  
Bundled Payment ◽  
Group Purchasing Organization

276 Background: Innovation has transformed healthcare; however, our current fee-for-service payment system can actually stifle creativity. When procedures are streamlined, fewer CPT codes may be charged, resulting in lower total reimbursement. Payment reform is necessary not only to control costs, but also to support constructive innovation. We describe how an innovative, lower reimbursed, technique of catheter-directed cancer therapy failed widespread acceptance in spite of being faster, safer and cheaper than the standard of care. Methods: Retrospective patient review was performed using the radiology information system and electronic health record. Medicare Part A and Part B payments were obtained from the Hospital Outpatient Prospective Payment System (HOPPS) for Harris County, Texas, and disposable supply costs were obtained from Premier Group Purchasing Organization. Results: From May 2008 to May 2013, 292 Yttrium-90 hepatic radioembolization procedures were performed for primary and metastatic disease. Eighty patients received the innovated balloon occlusion technique. This technique resulted in less fluoroscopy dose to the patient, faster procedure times, similar clinical outcome and a disposable cost savings of $1,138.72. However, because numerous procedure steps were avoided, the total average per-patient reimbursement was decreased by $8,044.05. Conclusions: Innovation that simplifies a procedure frequently obviates process steps that correspond to specific CPT codes. Hence, in a fee-for-service payment system, a faster, safer and cheaper option may result in fewer CPT codes and lower reimbursement, a disincentive that slows adoption. Our experience resulted in lost profit of over $8,000 per case for a total exceeding $640,000. Not surprisingly, this technique has not been widely embraced since we described it nearly two years ago. Conversely, a bundled payment model would have resulted in better aligned incentives, increased profit, and cost savings shared by patients, providers, and payers.

scholarly journals Restructuring the Nursing Staff and its Influence on Care Hours

2010 ◽  
Vol 18 (2) ◽  
pp. 175-181 ◽  
Author(s):  
Danielle Fabiana Cucolo ◽  
Márcia Galan Perroca
Keyword(s):  
Quality Of Care ◽  
Patient Care ◽  
Nursing Staff ◽  
Descriptive Study ◽  
Hospital Quality ◽  
Care Needs ◽  
Nursing Team ◽  
The Mean

This descriptive study aimed to calculate and compare the nursing staff at the medical-surgical clinical units of a philanthropic hospital in current and projected situations, and to investigate how much time the nursing team delivers patient care in the current and projected situations. Gaidzinski's method was used to calculate the nursing staff, and the equation proposed by the Hospital Quality Commitment (HQC) to estimate care hours. The findings showed an increase of 33% in the staff, with a 68.4% increase in the number of nurses and 15.6% in the number of technicians / nursing auxiliaries. According to the projected situation, the care hours varied from 5.7 to 7.2. The number of nursing and the mean care time provided to the patients were inadequate according to the clientele's care needs. This could impair the quality of care.

scholarly journals Lessons for the Australian healthcare system from the Berwick report

2014 ◽  
Vol 38 (1) ◽  
pp. 106 ◽  
Author(s):  
Lesley Russell ◽  
Paresh Dawda
Keyword(s):  
United Kingdom ◽  
Patient Care ◽  
Healthcare System ◽  
System Performance ◽  
System Of Care ◽  
Hospital Quality ◽  
Quality And Safety ◽  
Safety Issues ◽  
Performance Targets ◽  
The United Kingdom

There are common key recommendations in the raft of recent reports from inquiries into hospital quality and safety issues, both in Australia and in the United Kingdom. Prime among these is that governments, bureaucrats, clinicians and administrators must work together to place the quality and safety of patient care above all other aims in the healthcare system. Performance targets and enforcement, although needed, are not the route to improvement; what is required is a change in culture to drive a system of care that is open to learning, capable of identifying and admitting its problems and acting to correct them, and where the patient’s voice is always heard.

scholarly journals Bundled Payment Reform and Dialysis Facility Closures in ESKD

2020 ◽  
Vol 31 (3) ◽  
pp. 579-590 ◽  
Author(s):  
Sayna Norouzi ◽  
Bo Zhao ◽  
Ahmed Awan ◽  
Wolfgang C. Winkelmayer ◽  
Vivian Ho ◽  
...  
Keyword(s):  
Care Delivery ◽  
Interrupted Time Series ◽  
Patient Characteristics ◽  
Payment Reform ◽  
Small Hospital ◽  
Logistic Regression Models ◽  
Bundled Payment ◽  
Dialysis Facility ◽  
Dual Eligible ◽  
Dialysis Facilities

BackgroundIn 2011, inclusion of injectable medications into an expanded ESKD payment bundle prompted concerns that dialysis facilities facing higher costs might close, disrupting care delivery and access to care. Whether this policy change influenced dialysis facility closures is unknown.MethodsTo examine whether facility closures increased after 2011 and whether factors influencing closures changed, we analyzed US Renal Data System registry data to identify all patients receiving in-center hemodialysis from 2006 through 2015 and to track dialysis facility closures. We used interrupted time series logistic regression models and estimated marginal effects to examine immediate and longer-term changes in the likelihood of being affected by facility closures following payment reform. We also examined whether associations between selected predictors of closures indicating populations at “high risk” of closure (patient characteristics, facility characteristics, and geography-related characteristics) and closures changed after payment reform.ResultsDialysis facility closures were uncommon over the study period. In adjusted models, the relative odds of experiencing a closure declined by 37% (odds ratio [OR], 0.63; 95% confidence interval [95% CI], 0.59 to 0.67) immediately after payment reform and declined by an additional 6% (OR, 0.94; 95% CI, 0.91 to 0.97) annually thereafter, corresponding to a 0.3% lower absolute probability of closure in 2015 in association with payment reform. Patients who were black and who dialyzed at small, hospital-based facilities experienced slight increases in closures following payment reform, whereas Hispanic and Medicare/Medicaid dual-eligible patients experienced slight decreases in closures.ConclusionsExpansion of the ESKD payment bundle was not associated with increased closure of dialysis facilities, although the likelihood of closures changed slightly for some higher-risk populations.

Abstract 16468: Upcoding of Complication May Account for Declining Failure to Rescue Rates Following Major Cardiac Surgery

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Andrew A Gonzalez ◽  
Amir A Ghaferi ◽  
Donald S Likosky
Keyword(s):  
Cardiac Surgery ◽  
Hospital Performance ◽  
Pulmonary Complications ◽  
Hospital Quality ◽  
Fee For Service ◽  
Failure To Rescue ◽  
Payment Reform ◽  
Surgical Performance ◽  
Diagnostic Codes ◽  
Hospital Revenue

Introduction: To guide public reporting and payment reform initiatives, payers are increasingly tying reimbursement to hospital performance on administratively-derived quality measures. This has created tension with the existing fee-for-service model where “upcoding” of post-operative complications may increase hospital revenue. Hypothesis: We hypothesized that current complication measures may inaccurately reflect hospital quality, due to increased upcoding. Methods: We used Medicare data (2000-8) for patients undergoing cardiac surgery. We compared rates of post-operative pulmonary complications and pulmonary-specific failure to rescue (FTR, ie mortality after a pulmonary complication) under one of two definitions: (1) allowing diagnostic codes solely for pulmonary failure to define a complication (unconditioned definition, UCD), or (2) conditioning the identification of a complication on having a treatment code for mechanical ventilation or intubation (procedure-conditioned definition, PCD). We considered PCD to be a better reflection of true hospital quality. Results: We studied 1,248,765 operations in 1027 hospitals. Over this time period, pulmonary complications decreased 0.3% under the PCD criteria but increased 14.3% under an UCD, p<0.001. Since the PCD rate remained essentially unchanged (6.2% vs 5.9%, p<0.001), this divergence was driven almost entirely by the prodigious increase in UCD complications (12.5% vs 20.3%, p<0.001), Figure. There was no change in PCD-FTR rate (15.4% vs 15.5%, p=0.876) but a sizable decline in UCD-FTR rate (18.9% vs 11.7%, p<0.001). Conclusions: Our findings suggest that current hospital surgical performance measures are sensitive to upcoding, and may provide qualitatively different reflections of quality depending on how they are derived. Measure developers should consider the implications of hospital upcoding, especially given its increasing incidence.

Impact of health plan reforms in Washington on employment decisions

2019 ◽  
Vol 18 (04) ◽  
pp. 579-593
Author(s):  
Norma B. Coe
Keyword(s):  
Labor Market ◽  
Health Insurance ◽  
The State ◽  
Fee For Service ◽  
Payment Reform ◽  
Employment Decisions ◽  
Bundled Payment ◽  
State Employment ◽  
State Employees ◽  
State Employee

AbstractThe State of Washington, as part of a State Innovation Model (SIM) grant, is changing the payment model within state employee health insurance plans. The system is moving away from traditional fee-for-service reimbursement to value-based payment, through insurance design (the creation of accountable care network insurance products) and bundled payment strategies. New plans were rolled out January 2016 (enrollment occurred in late 2015), with the stated goal of getting 80% of state employees covered by plans that contain value-based purchasing within the next 5 years. The goal of payment reform is to improve member experience, member health, and cut costs. However, changing health insurance during employment can directly and indirectly change labor market outcomes. Decreasing costs of insurance could lead people to remain in the state-employment sector longer. However, it could also influence retirement timing, through changing the relative costs of insurance and through improving health.This paper examines who switches to value-based insurance, where the insurance explicitly decreases premiums without changing out-of-pocket costs. We find that the peak age for switching insurance plans is 35–45, even among the subsample of individuals who would not need to change their usual sources of care. Second, we look at the labor market activity – both leaving the state-employee sector and retiring from state-employment – and find that younger workers with value-based insurance plans are less likely to leave state employment. Further, we find evidence of value-based insurance, available at a reduced cost to both employees and retirees, leads to a shifting downward in the distribution of retirement age. While these findings support the existence of both the price and income effects, the effect sizes are rather small.

Using sound Clinical Paths and Diagnosis-related Groups (DRGs)-based payment reform to bring benefits to patient care: A case study of leukemia therapy

2010 ◽  
Vol 4 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Zhi-Ruo Zhang ◽  
Jian-Qing Mi ◽  
Long-Jun Gu ◽  
Jing-Yan Tang ◽  
Shu-Hong Shen ◽  
...  
Keyword(s):  
Patient Care ◽  
Diagnosis Related Groups ◽  
Payment Reform

scholarly journals VOLUNTARY Regulation: Evidence from Medicare Payment Reform

2021 ◽  
Author(s):  
Liran Einav ◽  
Amy Finkelstein ◽  
Yunan Ji ◽  
Neale Mahoney
Keyword(s):  
Healthcare Services ◽  
Medical Provider ◽  
Medicare Payment ◽  
Payment Reform ◽  
Design Elements ◽  
Bundled Payment ◽  
Voluntary Regulation ◽  
Market Participants ◽  
Level Data ◽  
Mandatory Participation

Abstract Government programs are often offered on an optional basis to market participants. We explore the economics of such voluntary regulation in the context of a Medicare payment reform, in which one medical provider receives a single, predetermined payment for a sequence of related healthcare services, instead of separate service-specific payments. This “bundled payment” program was originally implemented as a five-year randomized trial, with mandatory participation by hospitals assigned to the new payment model; however, after two years, participation was made voluntary for half of these hospitals. Using detailed claim-level data, we document that voluntary participation is more likely for hospitals that can increase revenue without changing behavior (“selection on levels”) and for hospitals that had large changes in behavior when participation was mandatory (“selection on slopes”). To assess outcomes under counterfactual regimes, we estimate a stylized model of responsiveness to and selection into the program. We find that the current voluntary regime generates inefficient transfers to hospitals, and that alternative (feasible) designs could reduce these inefficient transfers and raise welfare. Our analysis highlights key design elements to consider under voluntary regulation.

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