Three separate pay-for-performance programs affect the amount of Medicare payment for inpatient services to about 3,400 US hospitals. These payments are based on hospital performance on specified measures of quality of care. A growing share of Medicare hospital payments (6 percent by 2017) are dependent upon how hospitals perform under the Hospital Readmissions Reduction Program, the Value-Based Purchasing Program, and the Hospital-Acquired Condition Reduction Program. In 2015 four of five hospitals subject to these programs will be penalized under one or more of them, and more than one in three major teaching hospitals will be penalized under all three. Interactions among these programs should be considered going forward, including overlap among measures and differences in scoring performance.
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http://dx.doi.org/10.1377/hlthaff.2015.0158 | DOI Listing |
JAMA Netw Open
January 2025
Fred Hutchinson Cancer Research Center, Hutchinson Institute for Cancer Outcomes Research and Biostatistics Program, Public Health Sciences Division, Seattle, Washington.
Importance: Several noninvasive tests for colorectal cancer screening are available, but their effectiveness in settings with low adherence to screening and follow-up colonoscopy is not well documented.
Objective: To assess the cost-effectiveness of and outcomes associated with noninvasive colorectal cancer screening strategies, including new blood-based tests, in a population with low adherence to screening and ongoing surveillance colonoscopy.
Design, Setting, And Participants: The validated microsimulation model used for the decision analytical modeling study projected screening outcomes from 2025 to 2124 for a simulated cohort of 10 million individuals aged 50 years in 2025 and representative of a predominantly Hispanic or Latino patient population served by a Federally Qualified Health Center in Southern California.
J Healthc Manag
January 2025
Division of Health Care Delivery Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, Florida.
Goal: While studies have examined quality and health outcomes related to the Centers for Medicare & Medicaid Services' (CMS's) Hospital Value-Based Purchasing (HVBP) Program, a significant gap exists in the literature regarding the relationship between pay-for-performance initiatives and hospital financial performance in the program's Efficiency and Cost Reduction domain. This study examined the association between hospitals' cost inefficiency and participation in the HVBP Program by estimating the probability and magnitude of improvement or achievement in the program's Efficiency and Cost Reduction domain.
Methods: The 2014-2019 Efficiency and Cost Reduction domain data were obtained from CMS and merged with the American Hospital Association's Annual Survey Database.
Innov Clin Neurosci
December 2024
Mr. Timberlake is with Berkshire Biomedical Corporation in Dallas, Texas.
Background: Methadone is commonly utilized to treat opioid use disorder (OUD). Requirements to visit an opioid treatment provider (OTP) clinic for methadone treatment limits access to treatment, impacts quality of life, and reduces OUD treatment program retention. The Computerized Oral Prescription Administration (COPA) system is a dual-biometric dispensing device for take-home dosing that could reduce the impacts of methadone administration on patients and clinic staff.
View Article and Find Full Text PDFHealth Aff (Millwood)
January 2025
Michael E. Chernew, Harvard University.
A core problem with the current risk-adjustment system in Medicare Advantage and accountable care organization (ACO) programs-the Hierarchical Condition Categories (HCC) model-is that the inputs (coded diagnoses) can be influenced for gain by risk-bearing plans or providers. Using existing survey data on health status (which provide less manipulable inputs), we found that the use of a hybrid risk score drawing from survey data and a scaled-back set of HCCs would, in addition to mitigating coding incentives, modestly lessen risk-selection incentives, strengthen payment incentives to deliver efficient care, allocate payment across ACOs more efficiently according to markers of population health that are not as affected by practice patterns or coding efforts, and redistribute payment in a manner that supports equity goals. Although sampling error and survey nonresponse present challenges, analyses suggest that these should not be prohibitive.
View Article and Find Full Text PDFAntimicrob Steward Healthc Epidemiol
December 2024
Department of Infectious Diseases, Henry Ford Hospital, Detroit, MI, USA.
Ambulatory antimicrobial stewardship can be challenging due to disparities in resource allocation across the care continuum, competing priorities for ambulatory prescribers, ineffective communication strategies, and lack of incentive to prioritize antimicrobial stewardship program (ASP) initiatives. Efforts to monitor and compare outpatient antibiotic usage metrics have been implemented through quality measures (QM). Healthcare Effectiveness Data and Information Set (HEDIS®) represent standardized measures that examine the quality of antibiotic prescribing by region and across insurance health plans.
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