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Han KT, Kim S, Kim GO, Lee S, Kwon YU. Medical institutions' quality control efforts: The impacts of a value-based payment system on medical staff and healthcare-associated infections. J Hosp Infect 2024:S0195-6701(24)00260-3. [PMID: 39094740 DOI: 10.1016/j.jhin.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/07/2024] [Accepted: 06/18/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND In South Korea, various quality assessments have been introduced to improve the quality of care; thus, the overall quality level of medical institutions has improved. However, gaps still exist between medical institutions. AIM This study evaluated the impact of medical institutions' quality management efforts on securing medical staff and healthcare-associated infections in intensive care units (ICUs). METHODS This study used data from the second and third ICU quality assessments conducted by the Health Insurance Review and Assessment Service, which included 265 hospitals and 39,096 inpatients. The continuous quality improvement efforts of medical institutions were measured according to changes in their grade based on quality assessment results. We also measured healthcare-associated infection rates, including rates for ventilator-associated pneumonia and catheter-associated infections. The incidence rate ratio (IRR) was calculated using generalized estimating equation Poisson regression models that included hospital and patient characteristics. RESULTS Healthcare-associated infections occurred in approximately 2% of patients with ventilators or catheters. Ventilator-associated pneumonia significantly increased in institutions with a decline in grade (IRR: 2.038, 95% CI: 1.426‒2.915). In institutions with an upgrade in grade, infections associated with the central venous catheter (IRR: 0.484; 95% CI: 0.330‒0.711) and urinary catheter (IRR: 0.587, 95% CI: 0.398‒0.866) decreased. CONCLUSIONS Although quality assessment has been introduced in ICUs in South Korea, some gaps remain among medical institutions. Differences were observed in securing medical resources through the quality management efforts of medical institutions, and the infection rate was low in hospitals with high-quality management and high in hospitals with low-quality management.
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Affiliation(s)
- Kyu-Tae Han
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
| | - Seungju Kim
- Department of Health System, College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea; Research Institute for Hospice/Palliative care, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Gui Ok Kim
- Department of Quality assessment, Health Insurance Review and Assessment Service, Wonju, Republic of Korea.
| | - Syalrom Lee
- Department of Quality assessment, Health Insurance Review and Assessment Service, Wonju, Republic of Korea.
| | - Yong Uk Kwon
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, Republic of Korea.
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Schwarz J, Hoetger C, Pluschke LS, Muehlensiepen F, Schneider M, Thoma S, Esch T. Psychiatrists' perceptions of conditions and consequences associated with the implementation of open notes: qualitative investigation. BMC Psychiatry 2024; 24:430. [PMID: 38858711 PMCID: PMC11163720 DOI: 10.1186/s12888-024-05845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE In a growing list of countries, patients are granted access to their clinical notes ("open notes") as part of their online record access. Especially in the field of mental health, open notes remain controversial with some clinicians perceiving open notes as a tool for improving therapeutic outcomes by increasing patient involvement, while others fear that patients might experience psychological distress and perceived stigmatization, particularly when reading clinicians' notes. More research is needed to optimize the benefits and mitigate the risks. METHODS Using a qualitative research design, we conducted semi-structured interviews with psychiatrists practicing in Germany, to explore what conditions they believe need to be in place to ensure successful implementation of open notes in psychiatric practice as well as expected subsequent changes to their workload and treatment outcomes. Data were analyzed using thematic analysis. RESULTS We interviewed 18 psychiatrists; interviewees believed four key conditions needed to be in place prior to implementation of open notes including careful consideration of (1) diagnoses and symptom severity, (2) the availability of additional time for writing clinical notes and discussing them with patients, (3) available resources and system compatibility, and (4) legal and data protection aspects. As a result of introducing open notes, interviewees expected changes in documentation, treatment processes, and doctor-physician interaction. While open notes were expected to improve transparency and trust, participants anticipated negative unintended consequences including the risk of deteriorating therapeutic relationships due to note access-related misunderstandings and conflicts. CONCLUSION Psychiatrists practiced in Germany where open notes have not yet been established as part of the healthcare data infrastructure. Interviewees were supportive of open notes but had some reservations. They found open notes to be generally beneficial but anticipated effects to vary depending on patient characteristics. Clear guidelines for managing access, time constraints, usability, and privacy are crucial. Open notes were perceived to increase transparency and patient involvement but were also believed to raise issues of stigmatization and conflicts.
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Affiliation(s)
- Julian Schwarz
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, DE, Germany.
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany.
| | - Cosima Hoetger
- Institute for Integrative Health Care and Health Promotion (IGVF), Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Lena-Sophie Pluschke
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, DE, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Felix Muehlensiepen
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
- Center for Health Services Research, Brandenburg Medical School, Rüdersdorf, Germany
| | - Michael Schneider
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, DE, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Samuel Thoma
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, DE, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Tobias Esch
- Institute for Integrative Health Care and Health Promotion (IGVF), Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
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Gifford R, Molleman E, van der Vaart T. It's a jungle out there: Understanding physician payment and its role in group dynamics. Soc Sci Med 2024; 350:116945. [PMID: 38733732 DOI: 10.1016/j.socscimed.2024.116945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/02/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
Although collaboration between healthcare professionals is essential for the delivery of effective, efficient, and high-quality care, it remains an ongoing and critical challenge across health systems. As a result, many countries are experimenting with innovative payment and employment models. The literature tends to focus on improving collaboration across organizational and sectoral boundaries, and largely ignores potential barriers to collaborative work between members of the same profession within a single organization. Despite intergroup dynamics and professional boundaries having been shown to restrict patient flow and collaboration between specialties, studies have so far tended to overlook the potential effects of differentiated organizational and payment models on physicians' behaviors and intergroup dynamics. In the present study, we seek to unpack the influence of physicians' payment and employment models on their collaborative behaviors and on intergroup dynamics between specialties, adding to the current scholarship on physician payment and employment by considering how physicians' view and act in response to different structural arrangements. The findings suggest that adopting hybrid models, in which physicians are employed or paid differently within the same organization or practice, creates a bifurcation of the profession whereby physicians across different models are perceived to behave differently and have conflicting professional values. These models are perceived to inhibit collaboration between physicians and complicate hospital governance, restricting the ability to move towards new models of care delivery. These findings can be used as a basis for future work that aims to unpack the reality of physician payment and offer important insights for policies surrounding physician employment.
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Affiliation(s)
- Rachel Gifford
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
| | - Eric Molleman
- Department of Organizational Behavior, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Taco van der Vaart
- Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
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Xu P, Ying Y, Xu D, Huan S, Zhao L, Wang H. Impact of an innovative bundled payment to TB health care providers in China: an economic simulation analysis. BMC Health Serv Res 2024; 24:577. [PMID: 38702650 PMCID: PMC11069261 DOI: 10.1186/s12913-024-11034-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 04/23/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Tuberculosis is the second most deadly infectious disease after COVID-19 and the 13th leading cause of death worldwide. Among the 30 countries with a high burden of TB, China ranks third in the estimated number of TB cases. China is in the top four of 75 countries with a deficit in funding for TB strategic plans. To reduce costs and improve the effectiveness of TB treatment in China, the NHSA developed an innovative BP method. This study aimed to simulate the effects of this payment approach on different stakeholders, reduce the economic burden on TB patients, improve the quality of medical services, facilitate policy optimization, and offer a model for health care payment reforms that can be referenced by other regions throughout the world. METHODS We developed a simulation model based on a decision tree analysis to project the expected effects of the payment method on the potential financial impacts on different stakeholders. Our analysis mainly focused on comparing changes in health care costs before and after receiving BPs for TB patients with Medicare in the pilot areas. The data that were used for the analysis included the TB service claim records for 2019-2021 from the health insurance agency, TB prevalence data from the local Centre for Disease Control, and health care facilities' revenue and expenditure data from the Statistic Yearbook. A Monte Carlo randomized simulation model was used to estimate the results. RESULTS After adopting the innovative BP method, for each TB patient per year, the total annual expenditure was estimated to decrease from $2,523.28 to $2,088.89, which is a reduction of $434.39 (17.22%). The TB patient out-of-pocket expenditure was expected to decrease from $1,249.02 to $1,034.00, which is a reduction of $215.02 (17.22%). The health care provider's revenue decreased from $2,523.28 to $2,308.26, but the health care provider/institution's revenue-expenditure ratio increased from -6.09% to 9.50%. CONCLUSIONS This study highlights the potential of BPs to improve medical outcomes and control the costs associated with TB treatment. It demonstrates its feasibility and advantages in enhancing the coordination and sustainability of medical services, thus offering valuable insights for global health care payment reform.
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Affiliation(s)
- Pengyu Xu
- School of Economics & Management, Southeast University, No. 2, Sipailou, Xuanwu District, Nanjing, Jiangsu Province, 210096, China
| | - Yazhen Ying
- National Institute of Healthcare Security Capital Medical University, Beijing, China
| | - Debin Xu
- National Institute of Healthcare Security Capital Medical University, Beijing, China
| | - Shitong Huan
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Lindu Zhao
- School of Economics & Management, Southeast University, No. 2, Sipailou, Xuanwu District, Nanjing, Jiangsu Province, 210096, China.
| | - Hong Wang
- Bill & Melinda Gates Foundation, Seattle, WA, USA
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Brouwers J, Seys D, Claessens F, Van Wilder A, Bruyneel L, De Ridder D, Eeckloo K, Vanhaecht K. Effect on hospital incentive payments and quality performance of a hospital pay for performance (P4P) programme in Belgium. J Healthc Qual Res 2024; 39:147-154. [PMID: 38594161 DOI: 10.1016/j.jhqr.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/15/2024] [Accepted: 02/22/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Belgium initiated a hospital pay for performance (P4P) programme after a decade of fixed bonus budgets for "quality and safety contracts". This study examined the effect of P4P on hospital incentive payments, performance on quality measures, and the association between changes in quality performance and incentive payments over time. METHODS The Belgian government provided information on fixed bonus budgets in 2013-2017 and hospital incentive payments as well as hospital performance on quality measures for the P4P programmes in 2018-2020. Descriptive analyses were conducted to map the financial repercussion between the two systems. A difference-in-difference analysis evaluated the association between quality indicator performance and received incentive payments over time. RESULTS Data from 87 acute-care hospitals were analyzed. In the transition to a P4P programme, 29% of hospitals received lower incentive payments per bed. During the P4P years, quality performance scores increased yearly for 55% of hospitals and decreased yearly for 5% of hospitals. There was a significant larger drop in incentive payments for hospitals that scored above median with the start of the P4P programme. CONCLUSIONS The transition from fixed bonus budgets for quality efforts to a new incentive payment in a P4P programme has led to more hospitals being financially impacted, although the effect is marginal given the small P4P budget. Quality indicators seem to improve over the years, but this does not correlate with an increase in reward per bed for all hospitals due to the closed nature of the budget.
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Affiliation(s)
- J Brouwers
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Orthopaedics, University Hospitals Leuven, Belgium.
| | - D Seys
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - F Claessens
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - A Van Wilder
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - L Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - D De Ridder
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Belgium
| | - K Eeckloo
- Department of Public Health and Primary Care, UGent & Strategic Policy Unit, Ghent University Hospital, Ghent, Belgium
| | - K Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Belgium
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Reindersma T, Fabbricotti I, Ahaus K, Bangma C, Sülz S. Inciting maintenance: Tiered institutional work during value-based payment reform in oncology. Soc Sci Med 2024; 347:116798. [PMID: 38537332 DOI: 10.1016/j.socscimed.2024.116798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 02/19/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024]
Abstract
Value-based payment aims to shift the focus from traditional volume-driven arrangements to a system that rewards providers for the quality and value of care delivered. Previous research has shown that it is difficult for providers to change their medical and organizational practices to adopt value-based payment, but the role of actors in these reforms has remained underexposed. This paper unravels the motives of non-clinical and clinical professionals to maintain institutionalized payment practices when faced with value-based payment. To illuminate these motives, a case study was conducted in a Dutch hospital alliance that aimed to implement value-based payment to incentivize the transition to novel interventions in a prostate cancer care pathway. Data collection consisted of observations and interviews with actors on multiple levels in the hospital (sales departments, medical specialist enterprises (MSEs) and physicians). On each actor level, motives for maintaining currently prevailing institutional practices were present. Regulative maintenance motives were more common for sales managers whereas cultural-cognitive and normative motives seemed to play an important role for physicians. An overarching motive was that desired transitions to novel interventions proved possible under the currently prevailing institutional logic, dismissing an urgent need for payment reform. Our analysis further revealed that actors engage in diverse institutional maintenance work, and that some actor groups' institutional work carries more weight than others because of the dependency relationships that exist between hospitals, MSEs and physicians. Physicians depend on MSEs and sales departments, who act as gatekeepers and buffers, to decide whether the value-based payment reform is either adopted or abandoned.
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Affiliation(s)
- Thomas Reindersma
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands.
| | - Isabelle Fabbricotti
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Kees Ahaus
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Chris Bangma
- Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Sandra Sülz
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
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Piri S. Pay-for-performance programs effectiveness in healthcare: the case of the end-stage renal disease quality incentive program. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:221-236. [PMID: 36966480 DOI: 10.1007/s10198-023-01582-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
This paper focuses on Medicare's End-Stage Renal Disease Quality Incentive Program (QIP). QIP aims to promote high-quality services in outpatient dialysis facilities by tying their payments to their performance on pre-specified quality measures. In this paper, employing principal-agent theory, we examine the effectiveness of QIP by exploring the changes in various clinical/operational measures when they become a part of the program as a performance measure. We study five QIP quality measures; two are operational: hospitalization and readmission. And three others are clinical: blood transfusion, hypercalcemia, and dialysis adequacy. Overall, we observe a significant improvement in all QIP quality measures after being included in the program, except for readmission. We recommend adjusting the weight and redesigning the readmission measure for Medicare to incentivize providers to reduce readmission. We also discuss establishing care coordination and employing data-driven clinical decision support systems as opportunities for dialysis facilities to improve the care delivery process.
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Affiliation(s)
- Saeed Piri
- Department of Operations and Business Analytics, Lundquist College of Business, University of Oregon, Eugene, OR, 97403, USA.
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Kim S, Kim GO, Lee S, Kwon YU. Effects of intensive care unit quality assessment on changes in medical staff in medical institutions and in-hospital mortality. HUMAN RESOURCES FOR HEALTH 2024; 22:12. [PMID: 38308311 PMCID: PMC10835892 DOI: 10.1186/s12960-024-00893-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Quality assessments are being introduced in many countries to improve the quality of care and maintain acceptable quality levels. In South Korea, various quality assessments are being conducted to improve the quality of care, but there is insufficient evidence on intensive care units (ICUs). This study aims to evaluate the impact of ICU quality assessments on the structural indicators in medical institutions and the resulting in-hospital mortality of patients. METHODS This study used data collected in the 2nd and 3rd ICU quality assessments in 2017 and 2019. A total of 72,879 patients admitted to ICUs were included during this period, with 265 institutions that received both assessments. As for structural indicators, changes in medical personnel and equipment were assessed, and in-hospital deaths were evaluated as patient outcomes. To evaluate the association between medical staff and in-hospital mortality, a generalized estimating equation model was performed considering both hospital and patient variables. RESULTS Compared to the second quality evaluation, the number of intensivist physicians and experienced nurses increased in the third quality evaluation; however, there was still a gap in the workforce depending on the type of medical institution. Among all ICU patients admitted during the evaluation period, 12.0% of patients died in the hospital. In-hospital mortality decreased at the 3rd assessment, and hospitals employing intensivist physicians were associated with reduced in-hospital deaths. In addition, an increase in the number of experienced nurses was associated with a decrease in in-hospital mortality, while an increase in the nurse-to-bed ratio increased mortality. CONCLUSIONS ICU quality assessments improved overall structural indicators, but the gap between medical institutions has not improved and interventions are required to bridge this gap. In addition, it is important to maintain skilled medical personnel to bring about better results for patients, and various efforts should be considered. This requires continuous monitoring and further research on long-term effects.
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Affiliation(s)
- Seungju Kim
- Department of Health System, College of Nursing, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea.
- Research Institute for Hospice/Palliative Care, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Gui Ok Kim
- Department of Quality Assessment, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Syalrom Lee
- Department of Quality Assessment, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Yong Uk Kwon
- Healthcare Review and Assessment CommitteeHealth Insurance Review and Assessment Service, Wonju, Republic of Korea
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Ali KJ, Goeschel CA, DeLia DM, Blackall LM, Singh H. The PRIDx framework to engage payers in reducing diagnostic errors in healthcare. Diagnosis (Berl) 2024; 11:17-24. [PMID: 37795579 DOI: 10.1515/dx-2023-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 08/26/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES No framework currently exists to guide how payers and providers can collaboratively develop and implement incentives to improve diagnostic safety. We conducted a literature review and interviews with subject matter experts to develop a multi-component 'Payer Relationships for Improving Diagnoses (PRIDx)' framework, that could be used to engage payers in diagnostic safety efforts. CONTENT The PRIDx framework, 1) conceptualizes diagnostic safety links to care provision, 2) illustrates ways to promote payer and provider engagement in the design and adoption of accountability mechanisms, and 3) explicates the use of data analytics. Certain approaches suggested by PRIDx were refined by subject matter expert interviewee perspectives. SUMMARY The PRIDx framework can catalyze public and private payers to take specific actions to improve diagnostic safety. OUTLOOK Implementation of the PRIDx framework requires new types of partnerships, including external support from public and private payer organizations, and requires creation of strong provider incentives without undermining providers' sense of professionalism and autonomy. PRIDx could help facilitate collaborative payer-provider approaches to improve diagnostic safety and generate research concepts, policy ideas, and potential innovations for engaging payers in diagnostic safety improvement activities.
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Affiliation(s)
- Kisha J Ali
- MedStar Institute for Quality and Safety, Columbia, MD, USA
| | - Christine A Goeschel
- MedStar Institute for Quality and Safety, Columbia, MD, USA
- Georgetown University School of Medicine, Washington, DC, USA
| | - Derek M DeLia
- Rutgers University, Bloustein School of Planning and Public Policy, New Brunswick, NJ, USA
| | | | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
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Javanparast S, Roeger L, Reed RL. General practice staff and patient experiences of a multicomponent intervention for people at high risk of poor health outcomes: a qualitative study. BMC PRIMARY CARE 2024; 25:18. [PMID: 38191349 PMCID: PMC10775450 DOI: 10.1186/s12875-023-02256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND This study reports the experiences of general practice staff and patients at high risk of poor health outcomes who took part in a clustered randomised controlled trial of a multicomponent general practice intervention. The intervention comprised patient enrolment to a preferred General Practitioner (GP) to promote continuity of care, access to longer GP appointments, and timely general practice follow-up after hospital care episodes. The aims of the study were to better understand participant's (practice staff and patients) perspectives of the intervention, their views on whether the intervention had improved general practice services, reduced hospital admissions and finally whether they believed the intervention would be sustainable after the trial had completed. METHODS A qualitative study design with semi-structured interviews was employed. The practice staff sample was drawn from both the control and intervention groups. The patient sample was drawn from those who had expressed an interest in taking part in an interview during the trial and who had also experienced a recent hospital care episode. RESULTS Interviews were conducted with 41 practice staff and 45 patients. Practice staff and patients expressed support for the value of appointments with a regular GP and having sufficient time in appointments for the provision of comprehensive care. There were mixed views with respect to the extent to which the intervention had improved services. The positive changes reported were related to services being provided in a more proactive, thorough, and systematic manner with a greater emphasis on team based care involving the Practice Nurse. Patients nominated after hours care and financial considerations as the key reasons for seeking hospital care. Practice staff noted that the intervention would be difficult to sustain financially in the absence of additional funding. CONCLUSIONS The multicomponent intervention was supported by practice staff and patients and some patients perceived that it had led to improvements in care.
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Affiliation(s)
- Sara Javanparast
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Leigh Roeger
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Richard L Reed
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.
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Scheefhals ZTM, de Vries EF, Struijs JN, Numans ME, van Exel J. Stakeholder perspectives on payment reform in maternity care in the Netherlands: A Q-methodology study. Soc Sci Med 2024; 340:116413. [PMID: 38000174 DOI: 10.1016/j.socscimed.2023.116413] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/29/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023]
Abstract
Based on theoretical notions, there is consensus that alternative payment models to the common fee-for-service model have the potential to improve healthcare quality through increased collaboration and reduced under- and overuse. This is particularly relevant for maternity care in the Netherlands because perinatal mortality rates are relatively high in comparison to other Western countries. Therefore, an experiment with bundled payments for maternity care was initiated in 2017. However, the uptake of this alternative payment model remains low, as also seen in other countries, and fee-for-service models prevail. A deeper understanding of stakeholders' perspectives on payment reform in maternity care is necessary to inform policy makers about the obstacles to implementing alternative payment models and potential ways forward. We conducted a Q-methodology study to explore perspectives of stakeholders (postpartum care managers, midwives, gynecologists, managers, health insurers) in maternity care in the Netherlands on payment reform. Participants were asked to rank a set of statements relevant to payment reform in maternity care and explain their ranking during an interview. Factor analysis was used to identify patterns in the rankings of statements. We identified three distinct perspectives on payment reform in maternity care. One general perspective, broadly supported within the sector, focusing mainly on outcomes, and two complementary perspectives, one focusing more on equality and one focusing more on collaboration. This study shows there is consensus among stakeholders in maternity care in the Netherlands that payment reform is required. However, stakeholders have different views on the purpose and desired design of the payment reform and set different conditions. Working towards payment reform in co-creation with all involved parties may improve the general attitude towards payment reform, may enhance the level of trust among stakeholders, and may contribute to a higher uptake in practice.
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Affiliation(s)
- Zoë T M Scheefhals
- Department of National Health and Healthcare, Center for Public Health, Healthcare and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Eline F de Vries
- Department of Health Economics and Healthcare, Center for Public Health, Healthcare and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Jeroen N Struijs
- Department of National Health and Healthcare, Center for Public Health, Healthcare and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, the Netherlands.
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Loomer L, Dauner KN, Schultz J. Association of Pay-for-Performance Reimbursement With Clinical Quality for Minnesota Nursing Homes Residents. Med Care Res Rev 2023; 80:484-495. [PMID: 37183707 DOI: 10.1177/10775587231170064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
In 2016, Minnesota implemented a new pay-for-performance reimbursement scheme for Medicaid residents in nursing homes, known as Value-Based Reimbursement (VBR). This study seeks to understand whether there is an association between VBR and quality improvement. We use data from 2013 to 2019 including Centers for Medicare and Medicaid Services, Nursing Home Compare, and Long-term care Facts in the US. Using multivariate regression with commuting zone fixed effects, we compare five long-stay and two short-stay clinical quality metrics in Minnesota nursing homes to nursing homes bordering states, before and after VBR was implemented. We find minimal significant changes in quality in Minnesota nursing homes after VBR. Minnesota should reconsider its pay-for-performance efforts.
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ShahAli S, Shahabi S, Etemadi M, Hedayati M, Anne BC, Mojgani P, Behzadifar M, Lankarani KB. Barriers and facilitators of integrating physiotherapy into primary health care settings: A systematic scoping review of qualitative research. Heliyon 2023; 9:e20736. [PMID: 37860510 PMCID: PMC10582494 DOI: 10.1016/j.heliyon.2023.e20736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
Purpose This scoping review investigated the barriers and facilitators to integrating physiotherapy into primary health care (PHC). Materials and methods PubMed, Scopus, Web of Science, Embase, ProQuest, and REHABDATA were searched. Two independent reviewers were involved in screening, selecting, and extracting data. Data were synthesized using thematic analysis. Results Of the 483 screened documents, 44 qualitative studies, primarily from high-income countries, were included. All of the studies had good methodological quality. Barriers and facilitators of integrating physiotherapy into PHC were extracted within the WHO six building blocks framework. In total, 41 items were identified as barriers to the integration process. The studies included 49 recommendations to facilitate integrating physiotherapy services into PHC. Conclusion Integrating physiotherapy services into PHC faces many barriers. The most commonly suggested potential barriers are poor knowledge of physicians about physiotherapy, ineffective teamwork, physiotherapists' time constraints/workload, a lack of clarity over the role and knowledge of physiotherapists, unawareness of physiotherapy users about these services, and lack of intra- and inter-professional collaborations. The most commonly suggested recommendations to facilitate the integration process include: Clarifying the role of involved professionals, strengthening teamwork, improving intra- and inter-professional collaborations, and providing comprehensive training programs for physiotherapists.
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Affiliation(s)
- Shabnam ShahAli
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Manal Etemadi
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Maryam Hedayati
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Barth Cornelia Anne
- School of Public Health, Physiotherapy and Sports Science, University College Dublin (UCD), Dublin, Ireland
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Parviz Mojgani
- Iran-Helal Institute of Applied Science and Technology, Tehran, Iran
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of The Islamic Republic of Iran, Tehran, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Salet N, Buijck BI, van Dam-Nolen DHK, Hazelzet JA, Dippel DWJ, Grauwmeijer E, Schut FT, Roozenbeek B, Eijkenaar F. Factors Influencing the Introduction of Value-Based Payment in Integrated Stroke Care: Evidence from a Qualitative Case Study. Int J Integr Care 2023; 23:7. [PMID: 37601033 PMCID: PMC10437137 DOI: 10.5334/ijic.7566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023] Open
Abstract
Background To address issues related to suboptimal insight in outcomes, fragmentation, and increasing costs, stakeholders are experimenting with value-based payment (VBP) models, aiming to facilitate high-value integrated care. However, insight in how, why and under what circumstances such models can be successful is limited. Drawing upon realist evaluation principles, this study identifies context factors and associated mechanisms influencing the introduction of VBP in stroke care. Methods Existing knowledge on context-mechanism relations impacting the introduction of VBP programs (in real-world settings) was summarized from literature. These relations were then tested, refined, and expanded based on a case study comprising interviews with representatives from organizations involved in the introduction of a VBP model for integrated stroke care in Rotterdam, the Netherlands. Results Facilitating factors were pre-existing trust-based relations, shared dissatisfaction with the status quo, regulatory compatibility and simplicity of the payment contract, gradual introduction of down-side risk for providers, and involvement of a trusted third party for data management. Yet to be addressed barriers included friction between short- and long-term goals within and among organizations, unwillingness to forgo professional and organizational autonomy, discontinuity in resources, and limited access to real-time data for improving care delivery processes. Conclusions Successful payment and delivery system reform require long-term commitment from all stakeholders stretching beyond the mere introduction of new models. Careful consideration of creating the 'right' contextual circumstances remains crucially important, which includes willingness among all involved providers to bear shared financial and clinical responsibility for the entire care chain, regardless of where care is provided.
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Affiliation(s)
- Newel Salet
- Erasmus School of Health Policy & Management, Erasmus University, NL
| | - Bianca I. Buijck
- Rotterdam Stroke Service, The Netherlands
- Erasmus MC University Medical Center, Department of Neurology, Rotterdam, NL
| | - Dianne H. K. van Dam-Nolen
- Erasmus MC University Medical Center, Department of Neurology, Rotterdam, The Netherlands
- Erasmus MC University Medical Center, Department of Radiology & Nuclear Medicine, NL
| | - Jan A. Hazelzet
- Erasmus MC University Medical Center, Department of Public Health, NL
| | | | - Erik Grauwmeijer
- Rijndam Rehabilitation, The Netherlands
- Erasmus MC University Medical Center, Department of Rehabilitation, Rotterdam, NL
| | - F. T. Schut
- Erasmus School of Health Policy & Management, Erasmus University, NL
| | - Bob Roozenbeek
- Erasmus MC University Medical Center, Department of Neurology, Rotterdam, NL
| | - Frank Eijkenaar
- Erasmus School of Health Policy & Management, Erasmus University, NL
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15
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Leao DLL, Cremers HP, van Veghel D, Pavlova M, Groot W. The Impact of Value-Based Payment Models for Networks of Care and Transmural Care: A Systematic Literature Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:441-466. [PMID: 36723777 PMCID: PMC10119264 DOI: 10.1007/s40258-023-00790-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Value-based healthcare has potential for cost control and quality improvement. To assess this, we review the evidence on the impact of value-based payment (VBP) models in the context of networks of care (NOC) and transmural care. METHODS We used the PRISMA guidelines for this systematic literature review. We searched eight databases in July 2021. Subsequently, we conducted title and abstract and full-text screenings, and extracted information in an extraction matrix. Based on this, we assessed the evidence on the effects of VBP models on clinical outcomes, patient-reported outcomes/experiences, organization-related outcomes/experiences, and costs. Additionally, we reviewed the facilitating and inhibiting factors per VBP model. FINDINGS Among articles studying shared savings and pay-for-performance models, most outline positive effects on both clinical and cost outcomes, such as preventable hospitalizations and total expenditures, respectively. Most studies show no change in patient satisfaction and access to care when adopting VBP models. Providers' opinions towards the models are frequently negative. Transparency and communication among involved stakeholders are found to be key facilitating factors, transversal to all models. Additionally, a lack of trust is an inhibitor found in all VBP models, together with inadequate targets and insufficient incentives. In bundled payment and pay-for-performance models, complexity in the structure of the program and lack of experience in implementing required mechanisms are key inhibitors. CONCLUSIONS The overall positive effect on clinical and cost outcomes validates the success of VBP models. The mostly negative effects on organization-reported outcomes/experiences are corroborated by findings regarding providers' lack of awareness, trust, and engagement with the model. This may be justified by their exclusion from the design of the models, decreasing their sense of ownership and, therefore, motivation. Incentives, targets, benchmarks, and quality measures, if adequately designed, seem to be important facilitators, and if lacking or inadequate, they are key inhibitors. These are prominent facilitators and inhibitors for P4P and shared savings models but not as prominent for bundled payments. The complexity of the scheme and lack of experience are prominent inhibitors in all VBP models, since all require changes in several areas, such as behavioral, process, and infrastructure.
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Affiliation(s)
- Diogo L L Leao
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAHPRI, Maastricht University Medical Center, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | | | | | - Milena Pavlova
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAHPRI, Maastricht University Medical Center, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Wim Groot
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAHPRI, Maastricht University Medical Center, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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16
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Hoerger K, Hue JJ, Elshami M, Ammori JB, Hardacre JM, Winter JM, Ocuin LM. Facility Volume Thresholds for Optimization of Short- and Long-Term Outcomes in Patients Undergoing Hepatectomy for Primary Liver Tumors. J Gastrointest Surg 2023; 27:273-282. [PMID: 36443556 DOI: 10.1007/s11605-022-05541-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Volume-outcome relationships have been described for a variety of surgical procedures. We aimed to define the facility volume threshold at which postoperative mortality after hepatectomy was optimal. METHODS We determined volume percentiles for institutions performing hepatectomy for any primary liver tumor within the National Cancer Database (2004-2017). Marginal structural logistic regression defined the volume percentile (Vmin) at which the odds of 90-day mortality were optimally reduced in patients with hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC). Short-term postoperative and survival outcomes were compared between patients treated at facilities above and below Vmin. RESULTS Thresholds for the 10th/25th/50th/75th/90th percentiles were 2/7/26/46/59 hepatectomies/year. A total of 17,833 patients underwent resection of HCC or ICC. The 90-day postoperative mortality was optimized at the 75th percentile for all hepatectomies (IP-weighted OR = 0.67, 95% CI = 0.52-0.87) and major hepatectomy (IP-weighted OR = 0.62, 95% CI = 0.49-0.80). Seven of 446 facilities met the Vmin threshold. The odds of 30-day mortality were also reduced for all hepatectomies (IP-weighted OR = 0.55, 95% CI = 0.42-0.73) and major hepatectomy (IP-weighted OR = 0.58, 95% CI = 0.41-0.75). There were no differences in length of stay or 30-day readmission rate. Patients with HCC or ICC treated at facilities ≥ 10th percentile had an associated improvement in overall survival. CONCLUSIONS Resection of HCC and ICC is performed at a large number of facilities. Postoperative mortality is optimally reduced at facilities performing at least 46 liver operations annually. Regionalization of surgical care among patients with primary liver malignancies to high-volume centers may result in improved outcomes.
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Affiliation(s)
- Kelly Hoerger
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Jonathan J Hue
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Mohamedraed Elshami
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - John B Ammori
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Jeffrey M Hardacre
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Jordan M Winter
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Lee M Ocuin
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA.
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17
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Gajadien CS, Dohmen PJG, Eijkenaar F, Schut FT, van Raaij EM, Heijink R. Financial risk allocation and provider incentives in hospital-insurer contracts in The Netherlands. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:125-138. [PMID: 35412163 PMCID: PMC9002227 DOI: 10.1007/s10198-022-01459-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
In healthcare systems with a purchaser-provider split, contracts are an important tool to define the conditions for the provision of healthcare services. Financial risk allocation can be used in contracts as a mechanism to influence provider behavior and stimulate providers to provide efficient and high-quality care. In this paper, we provide new insights into financial risk allocation between insurers and hospitals in a changing contracting environment. We used unique nationwide data from 901 hospital-insurer contracts in The Netherlands over the years 2013, 2016, and 2018. Based on descriptive and regression analyses, we find that hospitals were exposed to more financial risk over time, although this increase was somewhat counteracted by an increasing use of risk-mitigating measures between 2016 and 2018. It is likely that this trend was heavily influenced by national cost control agreements. In addition, alternative payment models to incentivize value-based health care were rarely used and thus seemingly of lower priority, despite national policies being explicitly directed at this goal. Finally, our analysis shows that hospital and insurer market power were both negatively associated with financial risk for hospitals. This effect becomes stronger if both hospital and insurer have strong market power, which in this case may indicate a greater need to reduce (financial) uncertainties and to create more cooperative relationships.
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Affiliation(s)
- Chandeni S Gajadien
- Dutch Healthcare Authority (Nederlandse Zorgautoriteit; NZa), Utrecht, The Netherlands.
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Peter J G Dohmen
- Dutch Healthcare Authority (Nederlandse Zorgautoriteit; NZa), Utrecht, The Netherlands
- Rotterdam School of Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Frank Eijkenaar
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Frederik T Schut
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Erik M van Raaij
- Rotterdam School of Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Richard Heijink
- The Council of Public Health & Society (Raad voor Volksgezondheid & Samenleving; RVS), The Hague, The Netherlands
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18
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Fang LB, Wang X, Tang L. What condition leads to an unreasonable pharmaceutical price? Impact research on the effect of medical service provision on pharmaceutical price regulation based on fuss-set QCA. PLoS One 2023; 18:e0284129. [PMID: 37053139 PMCID: PMC10101374 DOI: 10.1371/journal.pone.0284129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/25/2023] [Indexed: 04/14/2023] Open
Abstract
Given that the pharmaceutical market has experienced severe market failures, it is necessary that we regulate pharmaceutical prices for many countries. Toward ensuring that pharmaceutical price regulation is efficient, this study investigated the antecedents that lead to an unreasonable pharmaceutical price. Based on 33 case-study countries, this study utilized QCA to analyze the conditional configuration of unreasonable pharmaceutical prices from the perspective of medical service provision. The results showed that the causes of unreasonable pharmaceutical prices are configured by medical service provision, especially cost compensation systems and payment mechanism. This study's conclusions contribute to the research on pharmaceutical price regulation and the institution of medical service provision.
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Affiliation(s)
| | - Xinmeng Wang
- School of Management, Fudan University, Shanghai, China
| | - Liu Tang
- School of Journalism, Fudan University, Shanghai, China
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19
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Ryskina KL, Unruh MA, Qian Y, Jung HY. US Generalist Physicians and Groups That Focused Practice in a Single Care Setting: 2014-2017. Med Care 2022; 60:831-838. [PMID: 36075814 PMCID: PMC9588651 DOI: 10.1097/mlr.0000000000001778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Some generalist physicians whose training prepared them for primary care practice increasingly practice in a facility (eg, hospitals, nursing homes); however, whether this trend was accompanied by a complimentary rise in generalist physicians who focused their practice on office-based care is unknown. OBJECTIVES Our objective in this study was to examine trends in the prevalence of generalist physicians and physician groups that practice in a single setting. RESEARCH DESIGN This was a retrospective cross-sectional study of generalist physicians trained in family medicine, internal medicine, or geriatrics. We used 2014-2017 billing data for Medicare fee-for-service beneficiaries to measure the proportion of all patient visits made by physicians in the following care settings: office, outpatient hospital department, inpatient hospital, and other sites. RESULTS From 2014 to 2017, the proportion of generalist physicians who narrowed their practice to a single setting increased by 6.69% (from 62.80% to 67.00%, p for trend <0.001). In 2017, 4.63% of physician groups included more than 1 type of setting-based physicians. CONCLUSIONS Generalist physicians treating older adults increasingly narrowed their practice focus to a single type of health care setting. This trend was not accompanied by growth among physician groups that included different types of setting-based physicians. Further evaluation of the consequences of these trends on the fragmentation of primary care delivery across different health care settings and primary care outcomes is needed.
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Affiliation(s)
- Kira L Ryskina
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, PA
| | - Mark Aaron Unruh
- Department of Population Health Sciences, Weill Cornell Medical College, NY
| | - Yuting Qian
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
| | - Hye-Young Jung
- Department of Population Health Sciences, Weill Cornell Medical College, NY
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20
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Markowitz W, Kausar K, Coffield E. Relationship between Patient Experience Scores and Health Insurance. Healthcare (Basel) 2022; 10:healthcare10112128. [PMID: 36360469 PMCID: PMC9690600 DOI: 10.3390/healthcare10112128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/01/2022] [Accepted: 10/12/2022] [Indexed: 12/04/2022] Open
Abstract
(1) Background: the patient experience may be a performance indicator in value-based reimbursement. Accordingly, providers have an incentive to understand factors that affect their patients’ experiences. This study evaluated the relationship between health insurance type and patient experience ratings. (2) Methods: individual-level demographic, health/healthcare, and patient experience data were extracted from the Full-Year Consolidated Data File of the 2019 Medical Expenditure Panel Surveys. A logistic regression was used to evaluate whether how persons—included in this study’s analytic sample (aged 18 and over with complete covariate information)—rated the healthcare they received from all their providers was associated with their health insurance types controlling for covariates. (3) Results: relative to people 18−64 years of age with private health insurance, people 18−64 years of age without health insurance were less likely to rank their healthcare as a 9 or 10—where a 10 indicates the best possible care—(OR: 0.69; p = 0.015) while people aged 65 years or over with Medicare (OR: 1.34; p = 0.002) or with Medicare/private health insurance (OR: 1.48; p < 0.001) were more likely to rank their healthcare as a 9 or 10. (4) Conclusions: Select health insurance types were associated with how patients rate their healthcare. Stakeholders could use this information to create programs aimed to improve patient experience.
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Affiliation(s)
- Walter Markowitz
- Department of Population Health, Hofstra University, Hempstead, NY 11549, USA
| | | | - Edward Coffield
- Department of Population Health, Hofstra University, Hempstead, NY 11549, USA
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21
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Kim H, Mahmood A, Hammarlund NE, Chang CF. Hospital value-based payment programs and disparity in the United States: A review of current evidence and future perspectives. Front Public Health 2022; 10:882715. [PMID: 36299751 PMCID: PMC9589294 DOI: 10.3389/fpubh.2022.882715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/12/2022] [Indexed: 01/21/2023] Open
Abstract
Beginning in the early 2010s, an array of Value-Based Purchasing (VBP) programs has been developed in the United States (U.S.) to contain costs and improve health care quality. Despite documented successes in these efforts in some instances, there have been growing concerns about the programs' unintended consequences for health care disparities due to their built-in biases against health care organizations that serve a disproportionate share of disadvantaged patient populations. We explore the effects of three Medicare hospital VBP programs on health and health care disparities in the U.S. by reviewing their designs, implementation history, and evidence on health care disparities. The available empirical evidence thus far suggests varied impacts of hospital VBP programs on health care disparities. Most of the reviewed studies in this paper demonstrate that hospital VBP programs have the tendency to exacerbate health care disparities, while a few others found evidence of little or no worsening impacts on disparities. We discuss several policy options and recommendations which include various reform approaches and specific programs ranging from those addressing upstream structural barriers to health care access, to health care delivery strategies that target service utilization and health outcomes of vulnerable populations under the VBP programs. Future studies are needed to produce more explicit, conclusive, and consistent evidence on the impacts of hospital VBP programs on disparities.
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Affiliation(s)
- Hyunmin Kim
- School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, United States
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, TN, United States
| | - Asos Mahmood
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, TN, United States
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
- Department of Medicine-General Internal Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Noah E. Hammarlund
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, United States
| | - Cyril F. Chang
- Department of Economics, Fogelman College of Business and Economics, The University of Memphis, Memphis, TN, United States
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22
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Sperl-Hillen JM, Anderson JP, Margolis KL, Rossom RC, Kopski KM, Averbeck BM, Rosner JA, Ekstrom HL, Dehmer SP, O'Connor PJ. Bolstering the Business Case for Adoption of Shared Decision-Making Systems in Primary Care: Randomized Controlled Trial. JMIR Form Res 2022; 6:e32666. [PMID: 36201392 PMCID: PMC9585448 DOI: 10.2196/32666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 07/27/2022] [Accepted: 08/23/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Limited budgets may often constrain the ability of health care delivery systems to adopt shared decision-making (SDM) systems designed to improve clinical encounters with patients and quality of care. OBJECTIVE This study aimed to assess the impact of an SDM system shown to improve diabetes and cardiovascular patient outcomes on factors affecting revenue generation in primary care clinics. METHODS As part of a large multisite clinic randomized controlled trial (RCT), we explored the differences in 1 care system between clinics randomized to use an SDM intervention (n=8) versus control clinics (n=9) regarding the (1) likelihood of diagnostic coding for cardiometabolic conditions using the 10th Revision of the International Classification of Diseases (ICD-10) and (2) current procedural terminology (CPT) billing codes. RESULTS At all 24,138 encounters with care gaps targeted by the SDM system, the proportion assigned high-complexity CPT codes for level of service 5 was significantly higher at the intervention clinics (6.1%) compared to that in the control clinics (2.9%), with P<.001 and adjusted odds ratio (OR) 1.64 (95% CI 1.02-2.61). This was consistently observed across the following specific care gaps: diabetes with glycated hemoglobin A1c (HbA1c)>8% (n=8463), 7.2% vs 3.4%, P<.001, and adjusted OR 1.93 (95% CI 1.01-3.67); blood pressure above goal (n=8515), 6.5% vs 3.7%, P<.001, and adjusted OR 1.42 (95% CI 0.72-2.79); suboptimal statin management (n=17,765), 5.8% vs 3%, P<.001, and adjusted OR 1.41 (95% CI 0.76-2.61); tobacco dependency (n=7449), 7.5% vs. 3.4%, P<.001, and adjusted OR 2.14 (95% CI 1.31-3.51); BMI >30 kg/m2 (n=19,838), 6.2% vs 2.9%, P<.001, and adjusted OR 1.45 (95% CI 0.75-2.8). Compared to control clinics, intervention clinics assigned ICD-10 diagnosis codes more often for observed cardiometabolic conditions with care gaps, although the difference did not reach statistical significance. CONCLUSIONS In this randomized study, use of a clinically effective SDM system at encounters with care gaps significantly increased the proportion of encounters assigned high-complexity (level 5) CPT codes, and it was associated with a nonsignificant increase in assigning ICD-10 codes for observed cardiometabolic conditions. TRIAL REGISTRATION ClinicalTrials.gov NCT02451670; https://clinicaltrials.gov/ct2/show/NCT02451670.
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Affiliation(s)
- JoAnn M Sperl-Hillen
- HealthPartners Institute, Bloomington, MN, United States
- Research Department, HealthPartners Center for Chronic Care Innovation, Bloomington, MN, United States
| | | | | | | | | | | | | | - Heidi L Ekstrom
- HealthPartners Institute, Bloomington, MN, United States
- Research Department, HealthPartners Center for Chronic Care Innovation, Bloomington, MN, United States
| | | | - Patrick J O'Connor
- HealthPartners Institute, Bloomington, MN, United States
- Research Department, HealthPartners Center for Chronic Care Innovation, Bloomington, MN, United States
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23
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Usage of a Value-based Triaging Methodology for Assessing Improvements in Value for Hip Fracture Inpatient Episodes of Care From 2014 to 2019: A Pilot Study. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202210000-00005. [PMID: 36734647 PMCID: PMC9584192 DOI: 10.5435/jaaosglobal-d-22-00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of this study was to demonstrate a novel technology used to measure improvements in quality and value of care for treatment of hip fracture patients. METHODS A novel value-based triaging methodology uses a risk prediction (risk M) and inpatient cost prediction (risk C) algorithm and has been demonstrated to accurately predict high-risk:high-cost episodes of care. Two hundred twenty-nine hip fracture patients from 2014 to 2016 were used to establish baseline length of stay (LOS) and total inpatient cost for each (16) risk:cost quadrants. Two hundred sixty-five patients between 2017 and 2019 with hip fractures were input into the algorithm, and historical LOS and cost for each patient were calculated. Historical values were compared with actual values to determine whether the value of the inpatient episode of care differed from the 2014 to 16 cohort. RESULTS When evaluated without risk or cost stratification, the mean actual LOS and cost of the baseline cohort compared with the 2017 to 2019 cohort were 8.0 vs 7.5 days (P = 0.43) and $25,446 vs $29,849 (P = 0.15), respectively. This analysis demonstrates that there was only a small change in value of care provided to patients based on LOS/cost over the studied period; however, risk:cost analysis using the novel methodology demonstrated that for select risk:cost quadrants, value of care measured by LOS/cost improved, whereas for others it decreased and for others there was no change. CONCLUSION Risk-cost-adjusted analysis of inpatient episodes of care rendered by a value-based triaging methodology provides a robust method of assessing improvements and/or decreases in value-based care when compared with a historical cohort. This methodology provides the tools to both track hospital interventions designed to improve quality and decrease cost as well as determine whether these interventions are effective in improving value.
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van Delft E, Lopes Barreto D, Han KH, Tchetverikov I, Evertse A, Kuijper TM, Hazes J, Weel-Koenders A. Impact of triage by a rheumatologist on appropriateness of referrals from primary to secondary care: a cluster randomized trial. Scand J Rheumatol 2022:1-9. [PMID: 36173970 DOI: 10.1080/03009742.2022.2112833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The quality of referrals is often criticized, and the effectiveness of improvement efforts remains uncertain. We assessed the impact of a rheumatologist triaging patients in primary care on the appropriateness of referrals to secondary care, healthcare utilization, and patient experience and outcomes. METHOD A cluster randomized controlled trial was conducted with patients experiencing musculoskeletal complaints. Intervention practices deployed an experienced rheumatologist triaging patients through in-person review. Usual care was performed in control practices, where practitioners referred patients based on their own judgement. The primary outcome was the proportion of inflammatory rheumatic diseases (IRDs) diagnosed by rheumatologists in referred patients. Healthcare utilization (iMTA Medical Consumption Questionnaire), quality of life (EuroQol 5 Dimensions), and experience of care (Consumer Quality Index) were determined after 3 months of follow-up. Data were analysed according to the intention-to-treat principle. RESULTS In total, 544 participants were included [mean age 51.4 (range 18-87) years; 24% were men]. Of all referred patients, 51% had an IRD in the intervention group versus 21% in the control group (p = 0.035). After 3 months of follow-up, patients from the triage intervention showed lower healthcare utilization (p = 0.006) and higher quality of life (p = 0.011), without a decline in experienced quality of care (p = 0.712), compared to controls. CONCLUSION Triage by a rheumatologist in primary care provides appropriate care and adequate experience of care, leading to a higher quality of life. Long-term evidence is needed to assess the value on cost-effectiveness before implementing this strategy nationwide.
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Affiliation(s)
- Etam van Delft
- Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - D Lopes Barreto
- Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - K H Han
- Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - I Tchetverikov
- Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - A Evertse
- Medical Center Molenaar, Oud-Beijerland, The Netherlands
| | - T M Kuijper
- Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Jmw Hazes
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Aeam Weel-Koenders
- Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands.,Health Technology Assessment, Erasmus University, Rotterdam, The Netherlands
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Value-based surgery physician compensation model: Review of the literature. J Pediatr Surg 2022; 57:118-123. [PMID: 35093253 DOI: 10.1016/j.jpedsurg.2022.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/15/2021] [Accepted: 01/08/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND In recent history, healthcare payment reform and legislative initiatives have drastically altered the practice environment for many physicians. Individual providers have migrated from self-managed smaller practices toward employed positions with larger entities, in which provider productivity is tracked. In academic institutions, surgical departments are tasked with meeting clinical productivity metrics while maintaining research and education missions. The objective was to review the current literature regarding the status of physician compensation. METHODS A narrative review of the literature with a defined search strategy using Pubmed and MEDLINE was performed. Using keywords of physician reimbursement, physician compensation, performance-based incentives, relative value unit, RVU, searches were completed and subsequently reviewed by the authors for inclusion. Subsequently, all review articles had their included studies hand searched by the research team and any relevant articles were included in our review. RESULTS In total, fifteen papers were deemed to meet inclusion criteria. Articles were then divided into 7 domains (Origins of the Work Relative Value Unit, Adjusting for Clinical Complexity, Alternative Compensation Strategies, Aligning Compensation with Department Goals, Individual versus Group Incentives, Minimizing Complexity, Maximize Efficiency, Minimize Loss). CONCLUSION As external powers continue to apply pressure to surgeon compensation, leaders have had to increasingly focus on clinical productivity, while the missions of research and education become more neglected. One solution could be the development of metrics to best align incentives for clinical, research, and education activities with institutional goals.
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Healthcare Providers’ Knowledge of Value-Based Care in Germany: An Adapted, Mixed-Methods Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148466. [PMID: 35886327 PMCID: PMC9322307 DOI: 10.3390/ijerph19148466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 12/04/2022]
Abstract
Background: Value-Based Care (VBC) is being discussed to provide better outcomes to patients, with an aim to reimburse healthcare providers (HCPs) based on the quality of care they deliver. Little is known about German HCPs’ knowledge of VBC. This study aims to investigate the knowledge of HCPs of VBC and to identify potential needs for further education toward implementation of VBC in Germany. Methods: For evidence generation, we performed a literature search and conducted an online survey among HCPs at 89 hospitals across Germany. The questionnaire was based on published evidence and co-developed with an expert panel using a mixed methods approach. Results: We found HCPs to believe that VBC is more applicable in surgery than internal medicine and that well-defined cycles of care are essential for its application. HCPs believe that VBC can reduce health care costs significantly. However, they also assume that implementing VBC will be challenging. Conclusions: The concept in general is well perceived, however, HCPs do not want to participate in any financial risk sharing. Installing an authority/independent agency that measures achieved value, digital transformation, and that improves the transition between the inpatient and the outpatient sectors are top interests of HCPs.
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Katragadda C, Fung C, Yousefi-Nooraie R, Cupertino P, Joseph J, Kim Y, Li Y. Medicare accountable care organizations: post-acute care use and post-surgical outcomes in urologic cancer surgery. Urology 2022; 167:102-108. [PMID: 35772480 DOI: 10.1016/j.urology.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 05/17/2022] [Accepted: 06/15/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate association between Medicare accountable care organizations (ACOs) participation of hospitals on post-acute care (PAC) use and spending, and post-surgical outcomes in Medicare beneficiaries undergoing urologic cancer surgeries. Despite increasing prevalence of urologic cancer and surgical care contributing to a large proportion of total health care costs, and recent Medicare payment reforms such as accountable care organizations, the role of ACOs in urologic cancer care has been unexplored. METHODS We conducted a longitudinal analysis of 2011-2017 Medicare claims data to compare post-surgical outcomes between Medicare ACO and non-ACO patients before and after implementation of Medicare shared savings program (MSSP). Our outcomes of interest were Post-acute care (PAC) use (overall, institutional, and home health), Skilled Nursing Facility (SNF) length of stay and Medicare spending for SNF patients, 30-day and 90-day unplanned readmissions and complications after index procedure. RESULTS Study sample included a total of 334,514 Medicare patients undergoing bladder, prostate, kidney cancer surgeries at 524 Medicare ACO and 2066 non-ACO hospitals. For bladder cancer surgery, Medicare ACO participation was associated with significantly reduced overall post-acute care use, but not with changes in readmission or complication rate. For prostate cancer and kidney cancer surgery, we found no significant association between hospital participation in Medicare ACOs and PAC use or post-surgical outcomes. CONCLUSIONS Hospital participation in MSSP ACOs leads to lower post-acute care use without compromising patient outcomes for Medicare beneficiaries undergoing bladder cancer surgery. Future research is needed to understand longer-term impact of ACO participation on urologic cancer surgery outcomes.
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Affiliation(s)
- Chinmayee Katragadda
- Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY.
| | - Chunkit Fung
- Division of Hematology, Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY; James P. Wilmot Cancer Institute, Rochester, NY; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Reza Yousefi-Nooraie
- Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Paula Cupertino
- James P. Wilmot Cancer Institute, Rochester, NY; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Jean Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | | | - Yue Li
- Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
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Mahoney West H, Milliren CE, Manne-Goehler J, Davis J, Gallegos J, Perez JH, Köhler JR. Effect of clinician information sessions on diagnostic testing for Chagas disease. PLoS Negl Trop Dis 2022; 16:e0010524. [PMID: 35709253 PMCID: PMC9242495 DOI: 10.1371/journal.pntd.0010524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 06/29/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Chagas disease is a potentially life-threatening neglected disease of poverty that is endemic in continental Latin America. Caused by Trypanosoma cruzi (T. cruzi), it is one of six parasitic diseases in the United States targeted by the Centers for Disease Control as a public health problem in need of action. An estimated 300,000 people are infected with T. cruzi in the United States (US). Although its morbidity, mortality and economic burden are high, awareness of Chagas disease is lacking among many healthcare providers in the US. The purpose of this analysis is to determine if the number of diagnostic tests performed at a community health center serving an at-risk population for Chagas disease increased after information sessions. A secondary aim was to determine if there was a difference by provider type, i.e., nurse practitioner vs. physician, or by specialty in the number of patients screened. Methodology/Principal findings We conducted a retrospective data analysis of the number of Chagas serology tests performed at a community health center before and after information sessions for clinicians. A time series analysis was conducted focusing on the Adult and Family Medicine Departments at East Boston Neighborhood Health Center (EBNHC). Across all departments there were 1,957 T. cruzi tests performed before the sessions vs. 2,623 after the sessions. Interrupted time series analysis across departments indicated that testing volume was stable over time prior to the sessions (pre-period slope = +4.1 per month; p = 0.12), followed by an immediate shift after the session (+51.6; p = 0.03), while testing volume remained stable over time after the session (post-period slope = -6.0 per month; p = 0.11). Conclusion/Significance In this study, Chagas testing increased after information sessions. Clinicians who began testing their patients for Chagas disease after learning of the importance of this intervention added an extra, potentially time-consuming task to their already busy workdays without external incentives or recognition. Chagas disease is a potentially fatal neglected disease of poverty. It is endemic in continental Latin America with an estimated 300,000 cases in the United States, primarily among low-income people who have immigrated to the US from Latin America. Few Chagas screening programs have been established in the US. Existing recommendations for Chagas disease testing and treatment are rarely followed for many reasons including a paucity of knowledge among providers. We aimed to determine if the number of Chagas tests performed increased after information sessions at a community health center. A secondary aim was to determine if there was a difference in number of tests performed by provider type. We found that the number of T. cruzi serologies performed in the ten months after information sessions increased significantly over that in the ten preceding months. Chagas testing increased across departments, though Chagas diagnostics were an extra and unmitigated time burden on clinicians. Increasing provider knowledge is a major step to increase diagnosis and treatment of this neglected disease, when clinicians are motivated by their inherent prosocial preferences including altruism i.e., by the positive impact of their work on patients’ lives.
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Affiliation(s)
- Helen Mahoney West
- Division of Infectious Disease Boston Children’s Hospital, Boston, Massachusetts, United States of America
- * E-mail:
| | - Carly E. Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | | | - Jillian Davis
- East Boston Neighborhood Health Center, Boston, Massachusetts, United States of America
| | - Jaime Gallegos
- East Boston Neighborhood Health Center, Boston, Massachusetts, United States of America
| | - Juan Huanuco Perez
- East Boston Neighborhood Health Center, Boston, Massachusetts, United States of America
| | - Julia R. Köhler
- Division of Infectious Disease Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
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The monetary costs of pediatric upper urinary tract stone disease: Analysis in a contemporary United States cohort. J Pediatr Urol 2022; 18:311.e1-311.e8. [PMID: 35314112 DOI: 10.1016/j.jpurol.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/11/2022] [Accepted: 02/20/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The prevalence of upper urinary tract stone disease (USD) in the United States is rising among both adults and children. Studies on the contemporary economic burden of USD management in the pediatric population are lacking. OBJECTIVE To comprehensively analyze the economic impact of USD in a contemporary United States pediatric cohort, and to evaluate drivers of cost. STUDY DESIGN A retrospective cohort study of pediatric patients (aged 0-17), diagnosed with USD between 2011 and 2018 were identified from PearlDiver-Mariner, an all-payer claims database containing diagnostic, treatment and prescription data provided in all treatment settings. Relevant International Classification of Disease (ICD-9 and ICD-10) and Current Procedural Terminology (CPT) codes were used for identification, and only patients with claims recorded for at least one year before and after entry of a diagnosis code for USD were selected (N = 10,045). Patients were stratified into those undergoing operative vs. non-operative management and for each patient, total 1-year healthcare costs following USD diagnosis, including same day and non-same day encounters, were analyzed. Factors associated with increased spending, as well as economic trends were analyzed. RESULTS Overall, 8498 (85%) patients were managed non-operatively, while 1547 (15%) underwent a total of 1880 procedural interventions. Total overall cost was $117.1 million, while median annual expenditure was $15.8 million. Proportion of spending for outpatient, inpatient and prescription services was 52%, 32% and 16%, respectively (Table). Outpatient management accounted for 67% of overall spending. The proportion of patients managed non-operatively increased significantly over time, in parallel with spending for non-operative care. Comorbidity burden, treatment year and geographic region were among predictors of costs. DISCUSSION Our study is the first to report actual insurance reimbursements for pediatric USD management using actual reimbursement data, examined across all treatment settings. We found that majority of the costs were for outpatient services and for non-operative management, with a rising tendency toward non-operative management over time. Regional variation in expenditures was evident. Specific reasons underlying these observed patterns could not directly be discerned from our dataset, but merit further investigation. CONCLUSION Non-operative and outpatient management for pediatric USD are increasingly common, resulting in parallel shifts in spending. Notably, 52% of overall spending was for outpatient care. These insights into the contemporary economic burden of pediatric USD could provide value in shaping future healthcare policy.
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Hass Z, Abrahamson K, Arling G. Ownership Change and Care Quality: Lessons from Minnesota’s Experience with Value-Based Purchasing. Innov Aging 2022; 6:igac022. [PMID: 35712326 PMCID: PMC9196681 DOI: 10.1093/geroni/igac022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives Minnesota’s implementation of a new nursing home value-based reimbursement (VBR) system in 2016 presented an opportunity to compare the response of nursing homes (NHs) to financial incentives to improve their quality and efficiency. The state substantially increased reimbursement for care-related costs and tied this rate increase to a composite quality score. Coinciding with rate increases of the new VBR system was an increase in ownership changes, with new owners being primarily for-profit entities from outside of Minnesota, including several private equity firms. Our objective was to examine NHs that underwent a change in ownership to determine their cost and quality response to the change. Research Design and Methods Our sample consists of 342 Minnesota NHs that submitted Medicaid cost reports each year from 2013 to 2019. A time differential two-way fixed-effects difference-in-difference model is used to assess changes in quality metrics by comparing measures in years prior to and years following the sale for NHs that changed ownership versus NHs with consistent ownership. Nursing home characteristics, revenue, and spending patterns are examined to understand differences in performance. Results Those NHs with ownership change experienced a decline in quality scores with notable changes to expenditure patterns. They performed worse on Minnesota Department of Health inspection scores and had nonsignificant declines in measures of quality of life and clinical care. They had declining staff dental and medical benefits and occupancy rates, greater revenue growth from Medicare Part B, and larger increases in administrative management fees. Discussion and Implications Minnesota like many other states has given wide latitude for nursing home ownership changes, without specific oversight for the quality of care and expenditure patterns of new owners. Recommendations include strict guidelines for the transparency of ownership structures, quality performance targets, rigorous financial auditing, and enhanced regulatory oversight.
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Affiliation(s)
- Zachary Hass
- Schools of Nursing and Industrial Engineering, Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Kathleen Abrahamson
- School of Nursing, Center for Aging and the Life Course, Purdue University, West Lafayette, Indiana, USA
| | - Greg Arling
- School of Nursing, Center for Aging and the Life Course, Purdue University, West Lafayette, Indiana, USA
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Reindersma T, Sülz S, Ahaus K, Fabbricotti I. The Effect of Network-Level Payment Models on Care Network Performance: A Scoping Review of the Empirical Literature. Int J Integr Care 2022; 22:3. [PMID: 35431706 PMCID: PMC8973838 DOI: 10.5334/ijic.6002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/16/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Traditional payment models reward volume rather than value. Moving away from reimbursing separate providers to network-level reimbursement is assumed to support structural changes in health care organizations that are necessary to improve patient care. This scoping review evaluates the performance of care networks that have adopted network-level payment models. Methods A scoping review of the empirical literature was conducted according to the five-step York framework. We identified indicators of performance, categorized them in four categories (quality, utilization, spending and other consequences) and scored whether performance increased, decreased, or remained stable due to the payment model. Results The 76 included studies investigated network-level capitation, disease-based bundled payments, pay-for-performance and blended global payments. The majority of studies stem from the USA. Studies generally concluded that performance in terms of quality and utilization increased or remained stable. Most payment models were associated with improved spending performance. Overall, our review shows that network-level payment models are moderately successful in improving network performance. Discussion/conclusion As health care networks are increasingly common, it seems fruitful to continue experimenting with reimbursement models for health care networks. It is also important to broaden the scope to not only scrutinize outcomes, but also the contexts and mechanisms that lead to certain outcomes.
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Affiliation(s)
- Thomas Reindersma
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Sandra Sülz
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Kees Ahaus
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Isabelle Fabbricotti
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Huang AW, Haslberger M, Coulibaly N, Galárraga O, Oganisian A, Belbasis L, Panagiotou OA. Multivariable prediction models for health care spending using machine learning: a protocol of a systematic review. Diagn Progn Res 2022; 6:4. [PMID: 35321760 PMCID: PMC8943988 DOI: 10.1186/s41512-022-00119-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/18/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND With rising cost pressures on health care systems, machine-learning (ML)-based algorithms are increasingly used to predict health care costs. Despite their potential advantages, the successful implementation of these methods could be undermined by biases introduced in the design, conduct, or analysis of studies seeking to develop and/or validate ML models. The utility of such models may also be negatively affected by poor reporting of these studies. In this systematic review, we aim to evaluate the reporting quality, methodological characteristics, and risk of bias of ML-based prediction models for individual-level health care spending. METHODS We will systematically search PubMed and Embase to identify studies developing, updating, or validating ML-based models to predict an individual's health care spending for any medical condition, over any time period, and in any setting. We will exclude prediction models of aggregate-level health care spending, models used to infer causality, models using radiomics or speech parameters, models of non-clinically validated predictors (e.g., genomics), and cost-effectiveness analyses without predicting individual-level health care spending. We will extract data based on the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies (CHARMS), previously published research, and relevant recommendations. We will assess the adherence of ML-based studies to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement and examine the inclusion of transparency and reproducibility indicators (e.g. statements on data sharing). To assess the risk of bias, we will apply the Prediction model Risk Of Bias Assessment Tool (PROBAST). Findings will be stratified by study design, ML methods used, population characteristics, and medical field. DISCUSSION Our systematic review will appraise the quality, reporting, and risk of bias of ML-based models for individualized health care cost prediction. This review will provide an overview of the available models and give insights into the strengths and limitations of using ML methods for the prediction of health spending.
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Affiliation(s)
- Andrew W Huang
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Rhode Island, Providence, USA.
| | - Martin Haslberger
- QUEST Center, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Neto Coulibaly
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Rhode Island, Providence, USA
| | - Omar Galárraga
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Rhode Island, Providence, USA
| | - Arman Oganisian
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Lazaros Belbasis
- Meta-Research Innovation Center Berlin, QUEST Center, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Orestis A Panagiotou
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Rhode Island, Providence, USA
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island, USA
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Buck B, Gagen EC, Halverson TF, Nagendra A, Ludwig KA, Fortney JC. A systematic search and critical review of studies evaluating psychometric properties of patient-reported outcome measures for schizophrenia. J Psychiatr Res 2022; 147:13-23. [PMID: 35007807 PMCID: PMC8882143 DOI: 10.1016/j.jpsychires.2021.12.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/09/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
Measurement-based care (MBC) involves the regular administration of outcome assessments to track and evaluate treatment progress and requires psychometrically sound instruments. While there are widely used patient-reported outcome measures (PROMs) for several psychiatric disorders and symptom categories (e.g., depression, anxiety), there is less consensus about self-report assessments for measurement-based care of schizophrenia. The present review provides an initial guide to this area by reporting on psychometric studies that introduce or evaluate PROMs designed for the ongoing treatment of schizophrenia. Out of an initial database of 6,153 articles, and review of 141 full-text articles, an analysis of 21 articles examining 12 measures is presented in this review. Findings suggest robust options exist for clinical and research institutions aiming to assess symptom outcomes in schizophrenia, with most measures showing strengths in internal consistency, test-retest reliability, and a number of measures with evidence of convergent or criterion validity. While there exist heterogeneous options, multiple measures demonstrated promising psychometric strengths. Future work validating consistent psychometric validity could involve measures which could be valuable in context of MBC for schizophrenia.
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Affiliation(s)
- Benjamin Buck
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
| | - Emily C. Gagen
- Department of Psychiatry, Harvard Medical School, Boston, MA,Massachusetts Mental Health Center, Boston, MA
| | | | - Arundati Nagendra
- Department of Psychiatry, Harvard Medical School, Boston, MA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Kelsey A. Ludwig
- Durham VA Health Care System – Durham, NC,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill – Chapel Hill, NC
| | - John C. Fortney
- Division of Population Health, Department of Psychiatry and Behavioral Sciences, University of Washington,VA Puget Sound Health Services Research & Development, Denver-Seattle Center of Innovation for Veteran-Centered Value-Driven Care
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Participation in Value-Based Payment Programs and U.S. Acute Care Hospital Population Health Partnerships. J Healthc Manag 2022; 67:103-119. [PMID: 35271521 DOI: 10.1097/jhm-d-20-00338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
GOAL The goal of this study was to describe the prevalence and pattern of population health partnerships by hospitals and examine whether these partnerships were associated with different types of payment model programs. METHODS We conducted a cross-sectional analysis of 3,012 U.S. hospitals using data from the American Hospital Association's Annual Survey, the Area Health Resources File, and the County Health Rankings & Roadmaps data. We ran a multivariable Poisson regression model to examine the relationship between value-based payment designs and the number of population health partnerships. Binary logistic regression models were used to assess whether participation in value-based payment design programs was associated with specific types of population health partnerships. PRINCIPAL FINDINGS We found that two thirds or more of hospitals used more informal collaborative partnerships with local or state government, faith-based organizations, and local businesses; formal alliances were most common with health insurance companies and other healthcare providers. Accountable care organizations and bundled payment program participation were associated with greater numbers of population health partnerships, whereas hospital ownership of a health plan was not associated with significantly greater numbers of population health partnerships. APPLICATIONS TO PRACTICE Hospitals were engaged in an intermediate number of partnerships (mean = 3.5, out of 8.0 possible), with opportunities for more partnerships with specific types of organizations (faith-based organizations, health insurance companies). Our findings also suggest that certain types of payment models, particularly those that are less capital intensive and entail less extensive organizational transformation on the part of hospitals, may support hospital engagement in population health partnerships. Hospital leaders need to monitor these partnerships continually to determine if they can capitalize on opportunities to play a more prominent role in population health management in local communities.
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Krishnan S, Bader AM, Urman RD, Hepner DL. Shifting from volume to value: a new era in perioperative care. Int Anesthesiol Clin 2022; 60:74-79. [PMID: 34897223 DOI: 10.1097/aia.0000000000000348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Sindhu Krishnan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Angela M Bader
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - David L Hepner
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Issahaku Y, Thoumi A, Abiiro GA, Ogbouji O, Nonvignon J. Is value-based payment for healthcare feasible under Ghana's National Health Insurance Scheme? Health Res Policy Syst 2021; 19:145. [PMID: 34895235 PMCID: PMC8665306 DOI: 10.1186/s12961-021-00794-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective payment mechanisms for healthcare are critical to the quality of care and the efficiency and responsiveness of health systems to meet specific population health needs. Since its inception, Ghana's National Health Insurance Scheme (NHIS) has adopted fee-for-service, diagnostic-related groups and capitation methods, which have contributed to provider reimbursement delays, rising costs and poor quality of care rendered to the scheme's clients. The aim of this study was to explore stakeholder perceptions of the feasibility of value-based payment (VBP) for healthcare in Ghana. Value-based payment refers to a system whereby healthcare providers are paid for the value of services rendered to patients instead of the volume of services. METHODS This study employed a cross-sectional qualitative design. National-level stakeholders were purposively selected for in-depth interviews. The participants included policy-makers (n = 4), implementers (n = 5), public health insurers (n = 3), public and private healthcare providers (n = 7) and civil society organization officers (n = 1). Interviews were audio-recorded and transcribed. Data analysis was performed using both deductive and inductive thematic analysis. The data were analysed using QSR NVivo 12 software. RESULTS Generally, participants perceived VBP to be feasible if certain supporting systems were in place and potential implementation constraints were addressed. Although the concept of VBP was widely accepted, study participants reported that efficient resource management, provider motivation incentives and community empowerment were required to align VBP to the Ghanaian context. Weak electronic information systems and underdeveloped healthcare infrastructure were seen as challenges to the integration of VBP into the Ghanaian health system. Therefore, improvement of existing systems beyond healthcare, including public education, politics, data, finance, regulation, planning, infrastructure and stakeholder attitudes towards VBP, will affect the overall feasibility of VBP in Ghana. CONCLUSION Value-based payment could be a feasible policy option for the NHIS in Ghana if potential implementation challenges such as limited financial and human resources and underdeveloped health system infrastructure are addressed. Governmental support and provider capacity-building are therefore essential for VBP implementation in Ghana. Future feasibility and acceptability studies will need to consider community and patient perspectives.
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Affiliation(s)
- Yussif Issahaku
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana.,Fuu D/A Junior High School, Ghana Education Service, Fuu, North East Gonja, Ghana
| | - Andrea Thoumi
- Robert J. Margolis, MD, Center for Health Policy, Duke University, 1201 Pennsylvania Ave, NW, Suite 500, Washington DC, 20004, USA.,Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Gilbert Abotisem Abiiro
- Department of Health Services, Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Osondu Ogbouji
- Fuu D/A Junior High School, Ghana Education Service, Fuu, North East Gonja, Ghana.,Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana.
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Wise S, Hall J, Haywood P, Khana N, Hossain L, van Gool K. Paying for value: options for value-based payment reform in Australia. AUST HEALTH REV 2021; 46:129-133. [PMID: 34782063 DOI: 10.1071/ah21115] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/26/2021] [Indexed: 11/23/2022]
Abstract
Value-based health care has gained increasing prominence among funders and providers in efforts to improve the outcomes important to patients relative to the resources used to deliver care. In Australia, the value-based healthcare agenda has focused on reducing the use of 'low-value' interventions, redesigning models of care to improve integration between providers and increasing the use of patient-reported measures to drive improvement; all have occurred within existing payment structures. In this paper we describe options for value-based payment reform and highlight two challenges critical for success: attributing financial risk fairly and organisational structures.What is known about the topic?'Fee for service' is the dominant payment method in Australia and creates incentives to increase service volume, rewarding inputs rather than improvements in longer-term health outcomes. There is increasing recognition that payment reform is needed to support the shift to value-based health care in Australia.What does this paper add?This paper describes the three main options for value-based payment reform: episode-based bundled payments chronic condition bundled payments and comprehensive capitation payments. Each involves some degree of funds pooling, and the shifting of risk from the funder to provider to stimulate the more efficient use of resources.What are the implications for practitioners?We conclude that local hospital authorities in the states, private health insurers and primary health networks could implement reform as payment holders, but that capacity development in coordination and risk adjustment will be required. Successful implementation of payment reform will also require investment in data collection and information technology to track patients' care and measure outcomes and costs.
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Affiliation(s)
- Sarah Wise
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia
| | - Jane Hall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia
| | - Philip Haywood
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia
| | - Nikita Khana
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia
| | - Lutfun Hossain
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia
| | - Kees van Gool
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia
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Zwaagstra Salvado E, van Elten HJ, van Raaij EM. The Linkages Between Reimbursement and Prevention: A Mixed-Methods Approach. Front Public Health 2021; 9:750122. [PMID: 34778183 PMCID: PMC8578935 DOI: 10.3389/fpubh.2021.750122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/29/2021] [Indexed: 11/21/2022] Open
Abstract
Background: The benefits of prevention are widely recognized; ranging from avoiding disease onset to substantially reducing disease burden, which is especially relevant considering the increasing prevalence of chronic diseases. However, its delivery has encountered numerous obstacles in healthcare. While healthcare professionals play an important role in stimulating prevention, their behaviors can be influenced by incentives related to reimbursement schemes. Purpose: The purpose of this research is to obtain a detailed description and explanation of how reimbursement schemes specifically impact primary, secondary, tertiary, and quaternary prevention. Methods: Our study takes a mixed-methods approach. Based on a rapid review of the literature, we include and assess 27 studies. Moreover, we conducted semi-structured interviews with eight Dutch healthcare professionals and two representatives of insurance companies, to obtain a deeper understanding of healthcare professionals' behaviors in response to incentives. Results: Nor fee-for-service (FFS) nor salary can be unambiguously linked to higher or lower provision of preventive services. However, results suggest that FFS's widely reported incentive to increase production might work in favor of preventive services such as immunizations but provide less incentives for chronic disease management. Salary's incentive toward prevention will be (partially) determined by provider-organization's characteristics and reimbursement. Pay-for-performance (P4P) is not always necessarily translated into better health outcomes, effective prevention, or adequate chronic disease management. P4P is considered disruptive by professionals and our results expose how it can lead professionals to resort to (over)medicalization in order to achieve targets. Relatively new forms of reimbursement such as population-based payment may incentivize professionals to adapt the delivery of care to facilitate the delivery of some forms of prevention. Conclusion: There is not one reimbursement scheme that will stimulate all levels of prevention. Certain types of reimbursement work well for certain types of preventive care services. A volume incentive could be beneficial for prevention activities that are easy to specify. Population-based capitation can help promote preventive activities that require efforts that are not incentivized under other reimbursements, for instance activities that are not easily specified, such as providing education on lifestyle factors related to a patient's (chronic) disease.
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Affiliation(s)
| | - Hilco J van Elten
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Erik M van Raaij
- Rotterdam School of Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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Urick BY. Improving the evidence base for performance-based pharmacy payment models. J Am Pharm Assoc (2003) 2021. [DOI: 10.1016/j.japh.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Jella TK, Cwalina TB, Sachdev R, Otteson T, Fowler N. Prevalence, trends, and demographic characteristics associated with self-reported financial stress among head and neck cancer patients in the United States of America. Am J Otolaryngol 2021; 42:103154. [PMID: 34214715 DOI: 10.1016/j.amjoto.2021.103154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Understanding the economic burden imposed by head and neck cancer diagnoses essential to contextualize healthcare decision-making for these patients. METHODS A retrospective, cross-sectional analysis of the US National Health Interview Survey was performed between 2013 and 2018. Demographic and socioeconomic characteristics of adult head and neck cancer patients were analyzed in relation to survey responses related to financial stress factors. RESULTS Among 710 head and neck cancer patients, 21.39% (95% Cl, 17.69%-25.09%) reported difficulty paying medical bills within the previous 12 months. Multivariable logistic regression revealed insurance status [aOR 2.17 (95% CI, 1.15-4.07), p < 0.001] and poverty status [aOR 2.55 (95% CI, 1.48-4.37), p = 0.017] to be significantly associated with difficulty paying medical bills. CONCLUSION A large proportion of HNC patients may experience financial stress related not only to out-of-pocket health care costs, but also exogenous financial challenges. These findings suggest that a significant proportion of HNC patients may experience financial stress related not only to out-of-pocket health care costs, but also exogenous financial challenges. Such barriers may impede patients' ability to access and adhere to treatment or force detrimental tradeoffs between health care and other essential needs.
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Richard C, Urick BY, Pathak S, Jackson J, Livet M. Performance-based pharmacy payment models: key components and critical implementation considerations for successful uptake and integration. J Manag Care Spec Pharm 2021; 27:1568-1578. [PMID: 34714107 PMCID: PMC10390937 DOI: 10.18553/jmcp.2021.27.11.1568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: In the United States, the shift towards value-based health care seeks to improve patient outcomes while reducing health care spending. Although the federal government has led the implementation of performance-based models for physicians and health care systems, commercial entities have largely been responsible for the development of similar models within pharmacy. For the purposes of this study, performance-based pharmacy payment models (PBPPMs) were defined as prescription drug payment models that determine reimbursement or fees for community pharmacies based in part on measured performance. These PBPPMs incentivize pharmacies to improve patient care by linking reimbursement to performance measures. However, the design and implementation of PBPPMs lack transparency and have not been described in the literature. OBJECTIVES: To (1) describe the structure of PBPPMs in the United States and (2) identify contextual and motivational influences that need to be considered for successful uptake and integration of these models. METHODS: A search of peer-reviewed and grey literature was undertaken. In addition, semi-structured stakeholder interviews were conducted with a convenience sample of 17 individuals who were community pharmacists, payers, quality measure developers and vendors, academics, and pharmacy advocacy organization leaders. Data were analyzed to understand the current structure of PBPPMs and opportunities for improvement, as well as implementation considerations that included facilitators, barriers, and key insights. RESULTS: This study identified 4 major components of US PBPPMs: attribution, performance and quality measures, incentive structures, and patient care services. A number of barriers (eg, lack of alignment) and recommendations to improve the current structure of PBPPMs (eg, the need for adequate incentives to facilitate change) were highlighted. Notable implementation considerations centered around (1) establishing common ground among stakeholders to avoid misalignment and encourage engagement; (2) the importance of a quality-driven, innovative, and flexible organizational culture with access to data infrastructure, adjusted workflows, and relevant trainings; (3) supporting the cultural transition to value-based health care; and (4) application of financial incentives at the pharmacy or pharmacist level. CONCLUSIONS: To better develop and implement PBPPMs, it is first critical to understand the key components that define these models and the needed changes to their structure. In addition, identifying the contextual and motivational factors that influence their successful integration can improve future uptake. This study illustrates the landscape of PBPPMs in the United States, as well as makes recommendations for improvement in their design. To improve future development and implementation of these models, the following recommendations are highlighted: (1) increase transparency and alignment of measures with the incentive structure; (2) embrace innovative business models; (3) carefully plan and use roadmaps that outline successful uptake and implementation; and (4) foster culture of quality at all levels of health care. DISCLOSURES: This study was sponsored by Pharm-Alliance, an alliance between the pharmacy schools of the University of North Carolina at Chapel Hill, Monash University, and University College London. Urick reports consulting fees from Pharmacy Quality Solutions and Cardinal Health, unrelated to this work. The other authors have nothing to disclose. This study was a podium presentation under the title "What Makes Performance-Based Pharmacy Payment Models Work?" at AMCP Nexus Virtual, October 2020.
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Affiliation(s)
- Chloe Richard
- Center for Medication Optimization (CMO), Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
| | - Benjamin Y Urick
- Center for Medication Optimization (CMO), Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
| | - Shweta Pathak
- Center for Medication Optimization (CMO), Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
| | - John Jackson
- Center for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria, Australia
| | - Melanie Livet
- Center for Medication Optimization (CMO), Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
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van den Broek-Altenburg E, Atherly A, Cheney N, Fama T. Understanding the factors that affect the appropriateness of rheumatology referrals. BMC Health Serv Res 2021; 21:1124. [PMID: 34666756 PMCID: PMC8527790 DOI: 10.1186/s12913-021-07036-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reducing inappropriate referrals to specialists is a challenge for the healthcare system as it seeks to transition from volume to value-based healthcare. Given the projection of a severe shortage of rheumatologists in the near future, innovative strategies to decrease demand for rheumatology services may prove more fruitful than increasing the supply of rheumatologists. Efforts to increase appropriate utilization through reductions in capacity may have the unintended consequence of reducing appropriate care as well. This highlights the challenges in increasing the appropriate use of high cost services as the health system transitions to value based care. The objective of this study was to analyze factors affecting appropriateness of rheumatology services. METHODS This was a cross-sectional study of patients receiving Rheumatology services between November 2013 and October 2019. We used a proxy for "appropriateness": whether or not there was any follow-up care after the first appointment. Results from regression analysis and physicians' chart reviews were compared using an inter-rater reliability measure (kappa). Data was drawn from the EHR 2013-2019. RESULTS We found that inappropriate referrals increased 14.3% when a new rheumatologist was hired, which increased to 14.8% after wash-out period of 6 months; 15.7% after 12 months; 15.5% after 18 months and 16.7% after 18 months. Other factors influencing appropriateness of referrals included severity of disease, gender and insurance type, but not specialty of referring provider. CONCLUSIONS Given the projection of a severe shortage of rheumatologists in the near future, innovative strategies to decrease demand for rheumatology services may prove more fruitful than increasing the supply of rheumatologists. Innovative strategies to decrease demand for rheumatology services may prove more fruitful than increasing the supply of rheumatologists. These findings may apply to other specialties as well. This study is relevant for health care systems that are implementing value-based payment models aimed at reducing inappropriate care.
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Affiliation(s)
- Eline van den Broek-Altenburg
- Department of Radiology, Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA.
| | - Adam Atherly
- Center for Health Services Research, Larner College of Medicine, University of Vermont, Burlington, USA
| | - Nick Cheney
- Department of Computer Science, University of Vermont, Burlington, USA
| | - Teresa Fama
- Department of Rheumatology, Central Vermont Medical Center, Berlin, USA
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Taber DJ, Fleming JN, Su Z, Mauldin P, McGillicuddy JW, Posadas A, Gebregziabher M. Significant hospitalization cost savings to the payer with a pharmacist-led mobile health intervention to improve medication safety in kidney transplant recipients. Am J Transplant 2021; 21:3428-3435. [PMID: 34197699 DOI: 10.1111/ajt.16737] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/10/2021] [Accepted: 06/27/2021] [Indexed: 01/25/2023]
Abstract
This was an economic analysis of a 12-month, parallel arm, randomized controlled trial in adult kidney recipients 6 to 36 months posttransplant (NCT03247322). All participants received usual posttransplant care, while the intervention arm received supplemental clinical pharmacist-led medication therapy monitoring and management, via a smartphone-enabled mHealth app, integrated with risk-based televisits. Hospitalization charges were captured from the study institution accounts payable and non-study institution hospitalization charges were estimated using multiple imputation. Multivariable modeling was used to assess the impact of the intervention on charges. The intervention significantly reduced rates of hospitalization (1.08 per patient-year in the control arm vs 0.65 per patient-year in the intervention arm, p = .007). The control arm had estimated hospitalization costs of $870,468 vs $390,489 in the intervention arm. Modeling demonstrated a 49% lower hospitalization charge risk in the intervention arm (RR 0.51, 95% CI 0.28-0.91; p = .022). From a payer or societal perspective, the net estimated cost savings, after accounting for intervention delivery costs, was $368,839, with a return on investment (ROI) of $4.30 for every $1 spent. These results demonstrate that a mHealth-enabled, pharmacist-led intervention significantly reduced hospitalization costs for payers over a 12-month period and has a positive ROI.
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Affiliation(s)
- David J Taber
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - James N Fleming
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Zemin Su
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Patrick Mauldin
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John W McGillicuddy
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Aurora Posadas
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Kuunibe N, Lohmann J, Hillebrecht M, Nguyen HT, Tougri G, De Allegri M. What happens when performance-based financing meets free healthcare? Evidence from an interrupted time-series analysis. Health Policy Plan 2021; 35:906-917. [PMID: 32601671 DOI: 10.1093/heapol/czaa062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 11/12/2022] Open
Abstract
In spite of the wide attention performance-based financing (PBF) has received over the past decade, no evidence is available on its impacts on quantity and mix of service provision nor on its interaction with parallel health financing interventions. Our study aimed to examine the PBF impact on quantity and mix of service provision in Burkina Faso, while accounting for the parallel introduction of a free healthcare policy. We used Health Management Information System data from 838 primary-level health facilities across 24 districts and relied on an interrupted time-series analysis with independent controls. We placed two interruptions, one to account for PBF and one to account for the free healthcare policy. In the period before the free healthcare policy, PBF produced significant but modest increases across a wide range of maternal and child services, but a significant decrease in child immunization coverage. In the period after the introduction of the free healthcare policy, PBF did not affect service provision in intervention compared with control facilities, possibly indicating a saturation effect. Our findings indicate that PBF can produce modest increases in service provision, without altering the overall service mix. Our findings, however, also indicate that the introduction of other health financing reforms can quickly crowd out the effects produced by PBF. Further qualitative research is required to understand what factors allow healthcare providers to increase the provision of some, but not all services and how they react to the joint implementation of PBF and free health care.
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Affiliation(s)
- Naasegnibe Kuunibe
- IHeidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 365, 69120 Heidelberg, Germany.,Department of Economics and Entrepreneurship Development, Faculty of Integrated development Studies, University for Development Studies, Wa Campus, Box 520, Wa, Upper West Region, Ghana
| | - Julia Lohmann
- IHeidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 365, 69120 Heidelberg, Germany.,Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Michael Hillebrecht
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Sectoral Department, Dag-Hammarskjöld-Weg 1-5, 65760 Eschborn, Germany
| | - Hoa Thi Nguyen
- IHeidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 365, 69120 Heidelberg, Germany
| | | | - Manuela De Allegri
- IHeidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 365, 69120 Heidelberg, Germany
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Mahdavi M, Doshmangir L, Jaafaripooyan E. Rethinking health services operations to embrace patient experience of healthcare journey. Int J Health Plann Manage 2021; 36:2020-2029. [PMID: 34288080 DOI: 10.1002/hpm.3288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 06/21/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
Patient experience is assumed pivotal for improving health services operations. The patient experience of healthcare services in Iran has been mostly assessed through the satisfaction and quality of single services or activities at individual providers, clinical departments, or health facilities. However, given the rise of chronic and multi-morbid conditions, health services for these conditions consist of several activities and interactions through a journey that patients take in the health system. To fill in this gap, we propose focusing on the assessment of patient experience on the patient journey through the health system. We advocate that there is much potential for improving the patient experience by rethinking the operations management of health services to embrace the patient experience of the healthcare journey. Rethinking health operations management may include an exhaustive list of interventions. Concisely, at the strategic level, policy-makers while understanding the need for shifting towards the patient experience, make sure that operational level management is experience oriented. This would be pursued through a strategic approach to patient experience, reconsidering qualifications for operational management, and benchmarking to identify and share best practices. Lessons learnt from previous quality improvement programmes are also considered as a capacity to establish the experience orientation.
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Affiliation(s)
- Mahdi Mahdavi
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Leila Doshmangir
- School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Hlávka JP, Yu JC, Goldman DP, Lakdawalla DN. The economics of alternative payment models for pharmaceuticals. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:559-569. [PMID: 33725260 PMCID: PMC8169601 DOI: 10.1007/s10198-021-01274-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/17/2021] [Indexed: 05/11/2023]
Abstract
Pharmaceuticals are priced uniformly by convention, but vary in their degree of effectiveness for different disease indications. As more high-cost therapies have launched, the demand for alternative payment models (APMs) has been increasing in many advanced markets, despite their well-documented limitations and challenges to implementation. Among policy justifications for such contracts is the maximization of value given scarce resources. We show that while uniform pricing rules can handle variable effectiveness in efficient markets, market inefficiencies of other kinds create a role for different value-based pricing structures. We first present a stylized theoretical model of efficient interaction among drug manufacturers, payers, and beneficiaries. In this stylized setting, uniform pricing works well, even when treatment effects are variable. We then use this framework to define market failures that result in obstacles to uniform pricing. The market failures we identify include: (1) uncertainty of patient distribution, (2) asymmetric beliefs, (3) agency imperfection by payer, (4) agency imperfection by provider, and (5) patient behavior and treatment adherence. We then apply our insights to real-world examples of alternative payment models, and highlight challenges related to contract implementation.
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Affiliation(s)
- Jakub P Hlávka
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA.
| | - Jeffrey C Yu
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
- USC School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Dana P Goldman
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
- USC School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Darius N Lakdawalla
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
- USC School of Pharmacy, University of Southern California, Los Angeles, CA, USA
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47
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Chen TT, Oldenburg B, Hsueh YS. Chronic care model in the diabetes pay-for-performance program in Taiwan: Benefits, challenges and future directions. World J Diabetes 2021; 12:578-589. [PMID: 33995846 PMCID: PMC8107979 DOI: 10.4239/wjd.v12.i5.578] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/08/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
In this review, we discuss the chronic care model (CCM) in relation to the diabetes pay-for-performance (P4P) program in Taiwan. We first introduce the 6 components of the CCM and provide a detailed description of each of the activities in the P4P program implemented in Taiwan, mapping them onto the 6 components of the CCM. For each CCM component, the following three topics are described: the definition of the CCM component, the general activities implemented related to this component, and practical and empirical practices based on hospital or local government cases. We then conclude by describing the possible successful features of this P4P program and its challenges and future directions. We conclude that the successful characteristics of this P4P program in Taiwan include its focus on extrinsic and intrinsic incentives (i.e., shared care network), physician-led P4P and the implementation of activities based on the CCM components. However, due to the low rate of P4P program coverage, approximately 50% of patients with diabetes cannot enjoy the benefits of CCM-related activities or receive necessary examinations. In addition, most of these CCM-related activities are not allotted an adequate amount of incentives, and these activities are mainly implemented in hospitals, which compared with primary care providers, are unable to execute these activities flexibly. All of these issues, as well as insufficient implementation of the e-CCM model, could hinder the advanced improvement of diabetes care in Taiwan.
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Affiliation(s)
- Tsung-Tai Chen
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan
| | - Brian Oldenburg
- Noncommunicable Disease Control Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia
| | - Ya-Seng Hsueh
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia
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48
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Marta GN, Ramiah D, Kaidar-Person O, Kirby A, Coles C, Jagsi R, Hijal T, Sancho G, Zissiadis Y, Pignol JP, Ho AY, Cheng SHC, Offersen BV, Meattini I, Poortmans P. The Financial Impact on Reimbursement of Moderately Hypofractionated Postoperative Radiation Therapy for Breast Cancer: An International Consortium Report. Clin Oncol (R Coll Radiol) 2021; 33:322-330. [PMID: 33358283 DOI: 10.1016/j.clon.2020.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/06/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022]
Abstract
AIMS Moderately hypofractionated breast irradiation has been evaluated in several prospective studies, resulting in wide acceptance of shorter treatment protocols for postoperative breast irradiation. Reimbursement for radiation therapy varies between private and public systems and between countries, impacting variably financial considerations in the use of hypofractionation. The aim of this study was to evaluate the financial impact of moderately hypofractionated breast irradiation by reimbursement system in different countries. MATERIALS AND METHODS The study was designed by an international group of radiation oncologists. A web-questionnaire was distributed to representatives from each country. The participants were asked to involve the financial consultant at their institution. RESULTS Data from 13 countries from all populated continents were collected (Europe: Denmark, France, Italy, the Netherlands, Spain, UK; North America: Canada, USA; South America: Brazil; Africa: South Africa; Oceania: Australia; Asia: Israel, Taiwan). Clinicians and/or departments in most of the countries surveyed (77%) receive remuneration based on the number of fractions delivered to the patient. The financial loss per patient estimated resulting from applying moderately hypofractionated breast irradiation instead of conventional fractionation ranged from 5-10% to 30-40%, depending on the healthcare provider. CONCLUSION Although a generalised adoption of moderately hypofractionated breast irradiation would allow for a considerable reduction in social and economic burden, the financial loss for the healthcare providers induced by fee-for-service remuneration may be a factor in the slow uptake of these regimens. Therefore, fee-for-service reimbursement may not be preferable for radiation oncology. We propose that an alternative system of remuneration, such as bundled payments based on stage and diagnosis, may provide more value for all stakeholders.
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Affiliation(s)
- G N Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil.
| | - D Ramiah
- Department of Radiation Oncology, Donald Gordon Medical Centre, Johannesburg, South Africa
| | - O Kaidar-Person
- Breast Cancer Radiation Unit, Radiation Oncology Institute, Sheba Medical Center, Ramat Gan, Israel
| | - A Kirby
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
| | - C Coles
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - R Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - T Hijal
- Division of Radiation Oncology, McGill University Health Centre, Montréal, Quebec, Canada
| | - G Sancho
- Department of Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Y Zissiadis
- Department of Radiation Oncology, Genesis Cancer Care, Wembley, WA, Australia
| | - J-P Pignol
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - A Y Ho
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - S H-C Cheng
- Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - B V Offersen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - I Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Department of Biomedical, Experimental, and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - P Poortmans
- Department of Radiation Oncology, Iridium Kankernetwerk, Wilrijk-Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium
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49
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Urick BY, Pathak S, Hughes TD, Ferreri SP. Design and effect of performance-based pharmacy payment models. J Manag Care Spec Pharm 2021; 27:306-315. [PMID: 33645246 PMCID: PMC10391031 DOI: 10.18553/jmcp.2021.27.3.306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Community pharmacy participation in performance-based payment models has increased in recent years. Despite this, there has been neither much research done to evaluate the effect of these models on health care quality and spending nor is there extensive literature on the design of these models. OBJECTIVES: To (a) describe the types of measures used in performance-based pharmacy payment models (PBPPMs); (b) describe the financial impact of PBPPMs on pharmacies; (3) explore pharmacy owners' perceptions of PBPPMs; and (4) describe any practice changes made in response to PBPPMs. METHODS: This is a cross-sectional study that surveyed independent community pharmacy owners between November 2019 and January 2020. The survey included 45 items split into 5 sections that covered respondent characteristics and the 4 domain objectives. Descriptive statistics were used for quantitative responses, and free-text responses were assessed for themes. RESULTS: Of the 68 individuals who responded to the survey, 42 were community pharmacy owners who met the study eligibility criteria, and 30 responded to most survey items. Owners expressed frustration at the design of PBPPMs, with 90% stating that they did not feel that the actions necessary to meet or exceed performance standards were within their control, and 90% also reported a loss of revenue because of these models. In addition, large numbers of respondents felt that they did not have enough information on how performance measures were computed (76.7%) or how cut-points were determined (86.7%). Despite negative feelings, most owners reported implementing changes in service offerings as a result of these models. CONCLUSIONS: PBPPMs appear to be commonplace and put substantial financial burden on community pharmacies. Study results suggest that greater education by payers could improve pharmacist engagement, as could involvement of pharmacies in the design and maintenance of PBPPMs. DISCLOSURES: This work was supported by a grant from the American Association of Colleges of Pharmacy, which was not involved in the collection, analysis, and interpretation of data; writing of the report; or the decision to submit this article for publication. Urick reports consulting fees from Pharmacy Quality Solutions. The other authors declare no conflicts of interest with respect to the research, authorship, and/or publication of this article.
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Affiliation(s)
- Benjamin Y Urick
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Shweta Pathak
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Tamera D Hughes
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
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50
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Fletcher DR, Grunwald GK, Battaglia C, Ho PM, Lindrooth RC, Peterson PN. Association Between Increased Hospital Reimbursement for Cardiac Rehabilitation and Utilization of Cardiac Rehabilitation by Medicare Beneficiaries: An Interrupted Time Series. Circ Cardiovasc Qual Outcomes 2021; 14:e006572. [PMID: 33677975 PMCID: PMC8035974 DOI: 10.1161/circoutcomes.120.006572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although cardiac rehabilitation (CR) is a Class I Guideline recommendation, and has been shown to be a cost-effective intervention after a cardiac event, it has been reimbursed at levels insufficient to cover hospital operating costs. In January 2011, Medicare increased payment for CR in hospital outpatient settings by ≈180%. We evaluated the association between this payment increase and participation in CR of eligible Medicare beneficiaries to better understand the relationship between reimbursement policy and CR utilization. METHODS From a 5% Medicare claims sample, we identified patients with acute myocardial infarction, coronary artery bypass surgery, percutaneous coronary intervention, or cardiac valve surgery between January 1, 2009 and September 30, 2012, alive 30 days after their event, with continuous enrollment in Medicare fee-for-service, Part A/B for 4 months. Trends and changes in CR participation were estimated using an interrupted time series approach with a hierarchical logistic model, hospital random intercepts, adjusted for patient, hospital, market, and seasonality factors. Estimates were expressed using average marginal effects on a percent scale. RESULTS Among 76 695 eligible patients, average annual CR participation was 19.5% overall. In the period before payment increase, adjusted annual participation grew by 1.1 percentage points (95% CI, 0.48-2.4). No immediate change occurred in CR participation when the new payment was implemented. In the period after payment increase, on average, 20% of patients participated in CR annually. The annual growth rate in CR participation slowed in the post-period by 1.3 percentage points (95% CI, -2.4 to -0.12) compared with the prior period. Results were somewhat sensitive to time window variations. CONCLUSIONS The 2011 increase in Medicare reimbursement for CR was not associated with an increase in participation. Future studies should evaluate whether payment did not reach a threshold to incentivize hospitals or if hospitals were not sensitive to reimbursement changes.
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Affiliation(s)
- Dana R Fletcher
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gary K Grunwald
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Catherine Battaglia
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - P Michael Ho
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Health Care System, Aurora, CO, USA
| | | | - Pamela N Peterson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Denver Health Medical Center, Denver, CO, USA
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