1
|
Adler‐Milstein J, Linden A, Bernstein S, Hollingsworth J, Ryan A. Longitudinal participation in delivery and payment reform programs among US Primary Care Organizations. Health Serv Res 2022; 57:47-55. [PMID: 33644870 PMCID: PMC8763277 DOI: 10.1111/1475-6773.13646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To assess longitudinal primary care organization participation patterns in large-scale reform programs and identify organizational characteristics associated with multiprogram participation. DATA SOURCES Secondary data analysis of national program participation data over an eight-year period (2009-2016). STUDY DESIGN We conducted a retrospective, observational study by creating a unique set of data linkages (including Medicare and Medicaid Meaningful Use and Medicare Shared Savings Program Accountable Care Organization (MSSP ACO) participation from CMS, Patient-Centered Medical Home (PCMH) participation from the National Committee for Quality Assurance, and organizational characteristics) to measure longitudinal participation and identify what types of organizations participate in one or more of these reform programs. We used multivariate models to identify organizational characteristics that differentiate those that participate in none, one, or two-to-three programs. DATA EXTRACTION METHODS We used Medicare claims to identify organizations that delivered primary care services (n = 56 ,287) and then linked organizations to program participation data and characteristics. PRINCIPAL FINDINGS No program achieved more than 50% participation across the 56,287 organizations in a given year, and participation levels flattened or decreased in later years. 36% of organizations did not participate in any program over the eight-year study period; 50% participated in one; 13% in two; and 1% in all three. 14.31% of organizations participated in five or more years of Meaningful Use while 3.84% of organizations participated in five years of the MSSP ACO Program and 0.64% participated in at least five years of PCMH. Larger organizations, those with younger providers, those with more primary care providers, and those with larger Medicare patient panels were more likely to participate in more programs. CONCLUSIONS AND RELEVANCE Primary care transformation via use of voluntary programs, each with their own participation requirements and approach to incentives, has failed to broadly engage primary care organizations. Those that have chosen to participate in multiple programs are likely those already providing high-quality care.
Collapse
Affiliation(s)
| | - Ariel Linden
- University of California, San FranciscoSan FranciscoCaliforniaUSA
| | | | | | | |
Collapse
|
2
|
|
3
|
Martin B, Jones J, Miller M, Johnson-Koenke R. Health Care Professionals' Perceptions of Pay-for-Performance in Practice: A Qualitative Metasynthesis. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 57:46958020917491. [PMID: 32448014 PMCID: PMC7249558 DOI: 10.1177/0046958020917491] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Incentive-based pay-for-performance (P4P) models have been introduced during the
last 2 decades as a mechanism to improve the delivery of evidence-based care
that ensures clinical quality and improves health outcomes. There is mixed
evidence that P4P has a positive effect on health outcomes and researchers cite
lack of engagement from health care professionals as a limiting factor. This
qualitative metasynthesis of existing qualitative research was conducted to
integrate health care professionals’ perceptions of P4P in clinical practice.
Four themes emerged during the research process: positive perceptions of the
value of performance measurement and associated financial incentives; negative
perceptions of the performance measurement and associated financial incentives;
perceptions of how P4P programs influence the quality/appropriateness of care;
and perceptions of the influence of P4P program on professional roles and
workplace dynamics. Identifying factors that influence health care
professionals’ perceptions about this type of value-based payment model will
guide future research.
Collapse
Affiliation(s)
| | | | - Matthew Miller
- University of Colorado, Aurora, USA.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, USA
| | - Rachel Johnson-Koenke
- University of Colorado, Aurora, USA.,Rocky Mountain Regional VA Medical Center, Denver, CO, USA
| |
Collapse
|
4
|
|
5
|
Bond AM, Volpp KG, Emanuel EJ, Caldarella K, Hodlofski A, Sacks L, Patel P, Sokol K, Vittore S, Calgano D, Nelson C, Weng K, Troxel A, Navathe A. Real-time Feedback in Pay-for-Performance: Does More Information Lead to Improvement? J Gen Intern Med 2019; 34:1737-1743. [PMID: 31041590 PMCID: PMC6712150 DOI: 10.1007/s11606-019-05004-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/08/2018] [Accepted: 03/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pay-for-performance (P4P) has been used expansively to improve quality of care delivered by physicians. However, to what extent P4P works through the provision of information versus financial incentives is poorly understood. OBJECTIVE To determine whether an increase in information feedback without changes to financial incentives resulted in improved physician performance within an existing P4P program. INTERVENTION/EXPOSURE Implementation of a new registry enabling real-time feedback to physicians on quality measure performance. DESIGN Observational, predictive piecewise model at the physician-measure level to examine whether registry introduction associated with performance changes. We used detailed physician quality measure data 3 years prior to registry implementation (2010-2012) and 2 years after implementation (2014-2015). We also linked physician-level data including age, gender, and board certification; group-level data including registry click rates; and patient panel data including chronic conditions. PARTICIPANTS Four hundred thirty-four physicians continuously affiliated with Advocate from 2010 to 2015. MAIN MEASURES Physician performance on ten quality metrics. KEY RESULTS We found no consistent pattern of improvement associated with the availability of real-time information across ten measures. Relative to predicted performance without the registry, average performance increased for two measures (childhood immunization status-rotavirus (p < 0.001) and diabetes care-medical attention for nephropathy (p = 0.024)) and decreased for three measures (childhood immunization status-influenza (p < 0.001) and diabetes care-HbA1c testing (p < 0.001) and poor HbA1c control (p < 0.001)). Results were consistent for subgroup analysis on those most able to improve, i.e., physicians in the bottom tertile of performance prior to registry introduction. Physicians who improved most were in groups that accessed the registry more than those who improved least (8.0 vs 10.0 times per week, p = 0.010). CONCLUSIONS More frequent provision of information, provided in real-time, was insufficient to improve physician performance in an existing P4P program with high baseline performance. Results suggest that electronic registries may not themselves drive performance improvement. Future work should consider testing information feedback enhancements with financial incentives.
Collapse
Affiliation(s)
- Amelia M Bond
- Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA.
| | - Kevin G Volpp
- Leonard Davis Institute of Health Economics, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Ezekiel J Emanuel
- Leonard Davis Institute of Health Economics, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristen Caldarella
- Division of Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Lee Sacks
- Advocate Health System, Chicago, IL, USA
| | | | - Kara Sokol
- Advocate Health System, Chicago, IL, USA
| | | | | | | | - Kevin Weng
- Advocate Health System, Chicago, IL, USA
| | - Andrea Troxel
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Amol Navathe
- Leonard Davis Institute of Health Economics, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
6
|
D’Angelo ALD, Lawson EH. Assessing quality in payment reform initiatives. SEMINARS IN COLON AND RECTAL SURGERY 2018. [DOI: 10.1053/j.scrs.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
7
|
Affiliation(s)
- Kathleen M Stacy
- Kathleen M. Stacy is Critical Care Clinical Nurse Specialist and Clinical Associate Professor, Hahn School of Nursing and Health Science, University of San Diego, 5998 Alcala Park, San Diego, CA 92110-2492
| |
Collapse
|
8
|
Ryan AM, Krinsky S, Maurer KA, Dimick JB. Changes in Hospital Quality Associated with Hospital Value-Based Purchasing. N Engl J Med 2017; 376:2358-2366. [PMID: 28614675 PMCID: PMC5841552 DOI: 10.1056/nejmsa1613412] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Starting in fiscal year 2013, the Hospital Value-Based Purchasing (HVBP) program introduced quality performance-based adjustments of up to 1% to Medicare reimbursements for acute care hospitals. METHODS We evaluated whether quality improved more in acute care hospitals that were exposed to HVBP than in control hospitals (Critical Access Hospitals, which were not exposed to HVBP). The measures of quality were composite measures of clinical process and patient experience (measured in units of standard deviations, with a value of 1 indicating performance that was 1 standard deviation [SD] above the hospital mean) and 30-day risk-standardized mortality among patients who were admitted to the hospital for acute myocardial infarction, heart failure, or pneumonia. The changes in quality measures after the introduction of HVBP were assessed for matched samples of acute care hospitals (the number of hospitals included in the analyses ranged from 1364 for mortality among patients admitted for acute myocardial infarction to 2615 for mortality among patients admitted for pneumonia) and control hospitals (number of hospitals ranged from 31 to 617). Matching was based on preintervention performance with regard to the quality measures. We evaluated performance over the first 4 years of HVBP. RESULTS Improvements in clinical-process and patient-experience measures were not significantly greater among hospitals exposed to HVBP than among control hospitals, with difference-in-differences estimates of 0.079 SD (95% confidence interval [CI], -0.140 to 0.299) for clinical process and -0.092 SD (95% CI, -0.307 to 0.122) for patient experience. HVBP was not associated with significant reductions in mortality among patients who were admitted for acute myocardial infarction (difference-in-differences estimate, -0.282 percentage points [95% CI, -1.715 to 1.152]) or heart failure (-0.212 percentage points [95% CI, -0.532 to 0.108]), but it was associated with a significant reduction in mortality among patients who were admitted for pneumonia (-0.431 percentage points [95% CI, -0.714 to -0.148]). CONCLUSIONS In our study, HVBP was not associated with improvements in measures of clinical process or patient experience and was not associated with significant reductions in two of three mortality measures. (Funded by the National Institute on Aging.).
Collapse
Affiliation(s)
- Andrew M Ryan
- From the Department of Health Management and Policy, University of Michigan School of Public Health (A.M.R., S.K., K.A.M.), and the Department of Surgery, University of Michigan Medical School (J.B.D.) - both in Ann Arbor
| | - Sam Krinsky
- From the Department of Health Management and Policy, University of Michigan School of Public Health (A.M.R., S.K., K.A.M.), and the Department of Surgery, University of Michigan Medical School (J.B.D.) - both in Ann Arbor
| | - Kristin A Maurer
- From the Department of Health Management and Policy, University of Michigan School of Public Health (A.M.R., S.K., K.A.M.), and the Department of Surgery, University of Michigan Medical School (J.B.D.) - both in Ann Arbor
| | - Justin B Dimick
- From the Department of Health Management and Policy, University of Michigan School of Public Health (A.M.R., S.K., K.A.M.), and the Department of Surgery, University of Michigan Medical School (J.B.D.) - both in Ann Arbor
| |
Collapse
|
9
|
Herbst T, Emmert M. Characterization and effectiveness of pay-for-performance in ophthalmology: a systematic review. BMC Health Serv Res 2017; 17:385. [PMID: 28583141 PMCID: PMC5460462 DOI: 10.1186/s12913-017-2333-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 05/25/2017] [Indexed: 11/11/2022] Open
Abstract
Background To identify, characterize and compare existing pay-for-performance approaches and their impact on the quality of care and efficiency in ophthalmology. Methods A systematic evidence-based review was conducted. English, French and German written literature published between 2000 and 2015 were searched in the following databases: Medline (via PubMed), NCBI web site, Scopus, Web of Knowledge, Econlit and the Cochrane Library. Empirical as well as descriptive articles were included. Controlled clinical trials, meta-analyses, randomized controlled studies as well as observational studies were included as empirical articles. Systematic characterization of identified pay-for-performance approaches (P4P approaches) was conducted according to the “Model for Implementing and Monitoring Incentives for Quality” (MIMIQ). Methodological quality of empirical articles was assessed according to the Critical Appraisal Skills Programme (CASP) checklists. Results Overall, 13 relevant articles were included. Eleven articles were descriptive and two articles included empirical analyses. Based on these articles, four different pay-for-performance approaches implemented in the United States were identified. With regard to quality and incentive elements, systematic comparison showed numerous differences between P4P approaches. Empirical studies showed isolated cost or quality effects, while a simultaneous examination of these effects was missing. Conclusion Research results show that experiences with pay-for-performance approaches in ophthalmology are limited. Identified approaches differ with regard to quality and incentive elements restricting comparability. Two empirical studies are insufficient to draw strong conclusions about the effectiveness and efficiency of these approaches. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2333-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tim Herbst
- nordBLICK Augenklinik Bellevue, Lindenallee 21-23, 24105, Kiel, Germany.
| | - Martin Emmert
- Friedrich-Alexander-University Erlangen-Nuremberg, School of Business and Economics, Institute of Management (IFM), Lange Gasse 20, 90403, Nuremberg, Germany.
| |
Collapse
|
10
|
Abstract
BACKGROUND Taiwan's National Health Insurance program implemented a pay-for-performance (P4P) program based on process measures in 2001. In late 2006, the P4P was revised to also include achievement of outcome measures. OBJECTIVES This study examined whether a change in P4P incentive design structure affected diabetes outcomes. RESEARCH DESIGN AND METHOD We used a longitudinal cohort study design using 2 population-based databases. Newly enrolled P4P patients with diabetes in 2002-2003 (phase 1) and 2007-2008 (phase 2) made up the study cohorts. Propensity score matching was used to match comparable cohorts in each phase. In total, 46,286 matched cohorts in phase 1 and 2 were analyzed. Process measures were defined as the provision of tests of glycosylated hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol, and blood pressure, and outcome measures as changes in those values between baseline and last follow-up within 3 years. Patient-level generalized linear regression models were used and patient characteristics, physician characteristics, and health care facility characteristics were adjusted for. RESULTS Our results indicated that the process measures of HbA1c and low-density lipoprotein cholesterol tests did not differ significantly between the 2 phases. In addition, better improvements were noted in outcome measures for the phase 2 patients (ie, HbA1c level and lipid profiles), whereas nonincentivized intermediate measures (eg, blood pressure) showed no negative unintended consequences. CONCLUSIONS Quality of care tended to be better when both process and targeted outcome measures were combined as quality metrics in the P4P program in Taiwan.
Collapse
|
11
|
Abstract
The use of financial incentives to improve quality in health care has become widespread. Yet evidence on the effectiveness of incentives suggests that they have generally had limited impact on the value of care and have not led to better patient outcomes. Lessons from social psychology and behavioral economics indicate that incentive programs in health care have not been effectively designed to achieve their intended impact. In the United States, Medicare's Hospital Readmission Reduction Program and Hospital Value-Based Purchasing Program, created under the Affordable Care Act (ACA), provide evidence on how variations in the design of incentive programs correspond with differences in effect. As financial incentives continue to be used as a tool to increase the value and quality of health care, improving the design of programs will be crucial to ensure their success.
Collapse
Affiliation(s)
- Tim Doran
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, United Kingdom;
| | - Kristin A Maurer
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan 48109; ,
| | - Andrew M Ryan
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan 48109; ,
| |
Collapse
|
12
|
Ryan AM, Krinsky S, Kontopantelis E, Doran T. Long-term evidence for the effect of pay-for-performance in primary care on mortality in the UK: a population study. Lancet 2016; 388:268-74. [PMID: 27207746 DOI: 10.1016/s0140-6736(16)00276-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Introduced in 2004, the UK's Quality and Outcomes Framework (QOF) is the world's largest primary care pay-for-performance programme. We tested whether the QOF was associated with reduced population mortality. METHODS We used population-level mortality statistics between 1994 and 2010 for the UK and other high-income countries that were not exposed to pay-for-performance. The primary outcome was age-adjusted and sex-adjusted mortality per 100,000 people for a composite outcome of chronic disorders that were targeted by the QOF. Secondary outcomes were age-adjusted and sex-adjusted mortality for ischaemic heart disease, cancer, and a composite of all non-targeted conditions. For each study outcome, we created a so-called synthetic UK as a weighted combination of comparison countries. We then estimated difference-in-differences models to test whether mortality fell more in the UK than in the synthetic UK after the QOF. FINDINGS Introduction of the QOF was not significantly associated with changes in population mortality for the composite outcome (-3.68 per 100,000 population [95% CI -8.16 to 0.80]; p=0.107), ischaemic heart disease (-2.21 per 100,000 [-6.86 to 2.44]; p=0.357), cancer (0.28 per 100,000 [-0.99 to 1.55]; p=0.679), or all non-targeted conditions (11.60 per 100,000 [-3.91 to 27.11]; p=0.143). INTERPRETATION Although we noted small mortality reductions for a composite outcome of targeted disorders, the QOF was not associated with significant changes in mortality. Our findings have implications for the probable effects of similar programmes on population health outcomes. The relation between incentives and mortality needs to be assessed in specific disease domains. FUNDING None.
Collapse
Affiliation(s)
- Andrew M Ryan
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Sam Krinsky
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Evangelos Kontopantelis
- Centre for Health Informatics, University of Manchester, Manchester, UK; National Institute for Health Research, School for Primary Care Research, Radcliffe Observatory Quarter, Oxford, UK
| | - Tim Doran
- Department of Health Sciences, University of York, Heslington, York, UK
| |
Collapse
|
13
|
Ryan AM, Tompkins CP, Markovitz AA, Burstin HR. Linking Spending and Quality Indicators to Measure Value and Efficiency in Health Care. Med Care Res Rev 2016; 74:452-485. [DOI: 10.1177/1077558716650089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Policy makers and stakeholders have reached a consensus that both quality and spending or resource use indicators should be jointly measured and prioritized to meet the objectives of our health system. However, the relative merits of alternative approaches that combine quality and spending indicators are not well understood. We conducted a literature review to identify different approaches that combine indicators of quality and spending measures to profile provider efficiency in the context of specific applications in health care. Our investigation identified seven alternative models that are either in use or have been proposed to evaluate provider efficiency. We then used publicly available data to profile hospitals using these approaches. Profiles of hospital efficiency using alternative models yielded wide variation in performance, underscoring the importance of model selection. By identifying the current efficiency models and evaluating their trade-offs within specific programmatic contexts, our analysis informs stakeholder and policy maker decisions about how to link quality and spending indicators when measuring efficiency in health care.
Collapse
Affiliation(s)
- Andrew M. Ryan
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | | | | |
Collapse
|
14
|
|
15
|
Hsieh HM, Tsai SL, Mau LW, Chiu HC. Effects of Changes in Diabetes Pay-for-Performance Incentive Designs on Patient Risk Selection. Health Serv Res 2015; 51:667-86. [PMID: 26152649 DOI: 10.1111/1475-6773.12338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Taiwan's National Health Insurance (NHI) Program implemented a Diabetes Pay-for-Performance Program (P4P) based on process-of-care measures in 2001. In late 2006, that P4P program was reformed to also include achievement of intermediate health outcomes. This study examined how the change in design affected patient risk selection. DESIGNS/STUDY POPULATIONS Study populations were identified from a 2002 to 2003 period (Phase 1) and a 2007 to 2008 period (Phase 2), spanning pre- and postimplementation of reforms in the P4P incentive design. Phase 1 had 74,529 newly enrolled P4P patients and 215,572 non-P4P patients, and Phase 2 had 76,901 newly enrolled P4P patients and 299,573 non-P4P patients. Logistic regression models were used to estimate the effect of changes in design on P4P patient selection. PRINCIPAL FINDINGS Patients with greater disease severity and comorbidity were more likely to be excluded from the P4P program in both phases. Furthermore, the additional financial incentive for patients' intermediate outcomes moderately worsened patient risk selection. CONCLUSIONS Policy makers need to carefully monitor the care of the diabetes patients with more severe and complex disease statuses after the changes of P4P financial incentive design.
Collapse
Affiliation(s)
- Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Ling Tsai
- National Health Insurance Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Lih-Wen Mau
- Patient & Health Professional Services, National Marrow Donor Organization, Edina, MN
| | - Herng-Chia Chiu
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
16
|
Lemak CH, Nahra TA, Cohen GR, Erb ND, Paustian ML, Share D, Hirth RA. Michigan’s Fee-For-Value Physician Incentive Program Reduces Spending And Improves Quality In Primary Care. Health Aff (Millwood) 2015; 34:645-52. [DOI: 10.1377/hlthaff.2014.0426] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Christy Harris Lemak
- Christy Harris Lemak ( ) is a professor in and chair of the Department of Health Services Administration at the University of Alabama at Birmingham. At the time this research was conducted, she was an associate professor in the Department of Health Management and Policy, University of Michigan, in Ann Arbor
| | - Tammie A. Nahra
- Tammie A. Nahra is an assistant research scientist in the Department of Health Management and Policy, University of Michigan
| | - Genna R. Cohen
- Genna R. Cohen is a doctoral candidate in the Department of Health Management and Policy, University of Michigan
| | - Natalie D. Erb
- Natalie D. Erb is a program manager at the Health Research and Educational Trust in Chicago, Illinois
| | - Michael L. Paustian
- Michael L. Paustian is a health care manager in the Department of Clinical Epidemiology and Biostatistics at Blue Cross Blue Shield of Michigan in Ann Arbor
| | - David Share
- David Share is senior vice president, value partnerships, at Blue Cross Blue Shield of Michigan in Detroit
| | - Richard A. Hirth
- Richard A. Hirth is a professor in the Department of Health Management and Policy, University of Michigan
| |
Collapse
|
17
|
Shortell SM, McClellan SR, Ramsay PP, Casalino LP, Ryan AM, Copeland KR. Physician practice participation in accountable care organizations: the emergence of the unicorn. Health Serv Res 2014; 49:1519-36. [PMID: 24628449 PMCID: PMC4213047 DOI: 10.1111/1475-6773.12167] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To provide the first nationally based information on physician practice involvement in ACOs. DATA SOURCES/STUDY SETTING Primary data from the third National Survey of Physician Organizations (January 2012-May 2013). STUDY DESIGN We conducted a 40-minute phone survey in a sample of physician practices. A nationally representative sample of practices was surveyed in order to provide estimates of organizational characteristics, care management processes, ACO participation, and related variables for four major chronic illnesses. DATA COLLECTION/EXTRACTION METHODS We evaluated the associations between ACO participation, organizational characteristics, and a 25-point index of patient-centered medical home processes. PRINCIPAL FINDINGS We found that 23.7 percent of physician practices (n = 280) reported joining an ACO; 15.7 percent (n = 186) were planning to become involved within the next 12 months and 60.6 percent (n = 717) reported no involvement and no plans to become involved. Larger practices, those receiving patients from an IPA and/or PHO, those that were physician-owned versus hospital/health system-owned, those located in New England, and those with greater patient-centered medical home (PCMH) care management processes were more likely to have joined an ACO. CONCLUSIONS Physician practices that are currently participating in ACOs appear to be relatively large, or to be members of an IPA or PHO, are less likely to be hospital-owned and are more likely to use more care management processes than nonparticipating practices.
Collapse
Affiliation(s)
- Stephen M Shortell
- School of Public Health, University of California, Berkeley50 University Hall, MC 7360, Berkeley, CA 94720
| | | | - Patricia P Ramsay
- School of Public Health, University of California, BerkeleyBerkeley, CA
| | | | - Andrew M Ryan
- Department of Public Health, Weill Cornell Medical College New YorkNY
| | | |
Collapse
|
18
|
Mortensen K, Perman C, Chen J. Innovative Payment Mechanisms in Maryland Hospitals: An Empirical Analysis of Readmissions under Total Patient Revenue. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2014; 2:177-183. [PMID: 25264518 DOI: 10.1016/j.hjdsi.2014.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The state of Maryland implemented innovative budgeting of outpatient and inpatient services in eight rural hospitals under the Total Patient Revenue (TPR) system in July, 2010. METHODS This paper uses data on Maryland discharges from the 2009-2011 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID). Individual inpatient discharges from eight treatment hospitals and three rural control hospitals (n=374,353) are analyzed. To get robust estimates and control for trends in the state, we also compare treatment hospitals to all hospitals in Maryland that report readmissions (n=1,997,164). Linear probability models using the difference-in-differences approach with hospital fixed effects are estimated to determine the effect of the innovative payment mechanisms on hospital readmissions, controlling for patient demographics and characteristics. RESULTS Difference-in-differences estimates show that after implementation of TPR in the treatment hospitals, there were no statistically significant changes in the predicted probability of readmissions. CONCLUSIONS Early evidence from the TPR program shows that readmissions were not affected in the 18 months after implementation. IMPLICATIONS : As the health care system innovates, it is important to evaluate the success of these innovations. One of the goals of TPR was to lower readmission rates, however these rates did not show consistent downward trends after implementation. Our results suggest that payment innovations that provide financial incentives to ensure patients receive care in the most appropriate setting while maintaining quality of care may not have immediate effects on commonly used measures of hospital quality, particularly for rural hospitals that may lack coordinated care delivery infrastructure.
Collapse
Affiliation(s)
- Karoline Mortensen
- Department of Health Services Administration 3310 School of Public Health Building University of Maryland College Park, MD 20742-2611 301 405-6545
| | - Chad Perman
- Health Management Associates 1350 Connecticut Ave. NW, Suite 605 Washington, D.C. 20036 202 785-3669
| | - Jie Chen
- Department of Health Services Administration 3310 School of Public Health Building University of Maryland College Park, MD 20742-2611 301 405-9053
| |
Collapse
|
19
|
David Prologo J, Meltzer CC. Health Care Reform in the United States: An Opportunity for Interventional Radiologists. J Vasc Interv Radiol 2014; 25:881-7. [DOI: 10.1016/j.jvir.2014.02.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/26/2014] [Accepted: 02/27/2014] [Indexed: 01/17/2023] Open
|