Health Policy

Another Readmission Failure Story from NEJM

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One after another, the “next new ideas” in healthcare seem to be failing.  This time it’s the potential to reduce readmissions that the New England Journal of Medicine takes to task. Despite CMS’s focus on incentivizing hospitals to reduce their readmission rates (by including them in bundled payment budgets) and penalizing those hospital

Pay-for-Performance Failure - Another Promising Idea Is Upended

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This week the New England Journal of Medicine published an article concluding that yet another Medicare experiment in cost or quality control was ineffective.  This article described the Medicare Premier Hospital Quality Incentive Demonstration, in which hospitals could receive an increase in their Medicare payments for meeting certain quality metrics.  The article did not describe the payments that were made to the participating hospitals, but presumably some hospitals scored well on the quality metr

The Effect Of Physicians’ Electronic Access To Tests

There has been a pretty interesting debate about the effect of EHRs on healthcare costs as a result of the initial Health Affairs article, which described a positive (not negative) correlation between EHR use and healthcare costs.  The most recent Health Affairs article replies to a posting by the National Coordinator for Health IT, who tried to debunk the major conclusions of the Health Affairs article.  I took note of the las

Preventing Readmissions - Conventional Wisdom vs. Research

Another interesting article about the causes of readmissions and their prevention is in this month’s New England Journal of Medicine.  This article (The Relationship between Hospital Admission Rates and Rehospitalizations) explores the causality for readmissions, and reports on the factors showing the highest correlation with the readmission rate.  The authors found that the primary driver of the readmission rate was the overall “all-cause admission rate”, meaning that hospitals having high admissio

Avoiding Readmissions - or Not?

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Avoiding readmissions is a critical component of every recent healthcare payment initiative. Current Medicare payment rules penalize hospitals with high readmission rates, the Bundled Payment Initiative requires contracting organizations to include related readmissions in the payment bundle, and ACOs will have incentives to reduce readmissions to create “shared savings”.

CMS Physician Group Practice Demonstration Results

The results of the Physician Group Practice (PGP) demonstration project have recently been released and are available from CMS here. Of interest in these results is the unevenness of the results. Of the 10 participating groups, one group received 52% of all shared savings payments, while three groups failed to achieve any shared savings.

ACO Antitrust Issues Underscore the Need for Data

A recent article in Becker's Hospital review linked to this article in the Corporate Counsel newsletter about the difficulties of complying with the ACO antitrust requirements, and the potential for disqualification from participation (with

Recommended Healthcare Reading

A recent poisting on the Better Health blog recommends four books to better understanding the US healthcare system:

Risk Adjustments for Individuals and Groups

A new report was recently released by CMS that measures the accuracy of the risk adjustment models that CMS utilizes for Medicare Advantage plans, the Physician Group Practice demonstration and others, and is expected to be used for Accountable Care Organizations (ACOs). This report provides some interesting insights into the effectiveness of risk adjusters.

The "Other" Medicare Pilot Program

Everyone involved in healthcare knows about ACOs.  Every healthcare publication contains at least one article about them.  Every seminar has a session describing them.  They're on every consultant's lips.  Google "ACO" and you'll find dozens of references to them (along with "ant colony optimization" and the American Cornhole Organization, which presumably have nothing to do with health reform). 
 

"Population Health" provides guidance for ACOs and others taking health risk

"Population Health -Creating a Culture of Wellness"  (http://www.amazon.com/Population-Health-Creating-Culture-Wellness/dp/076378043X/ref=sr_1_1?ie=UTF8&qid=1298394113&sr=8-1)  is a new book that provides a comprehensive overview of the issues involved in understanding and managing the health of large groups of people.  Coauthored by David Nash, Dean of Thomas Jefferson University's School of Population Health, the book is separated into section

New CBO Report on PPACA Budget Impact

CBO released an updated report on the budget effects of PPACAThe Congressional Budget Office released an interesting report on the effects of the health reform legislation that include two years (2010 and 2011) that were not included in the original CBO scoring as well some events that occurred subsequent to its passage.  Several points are interesting, including the following:

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