Posts Tagged “Health Care Quality”
ShowHide 3rd Party PapersCommonwealth Fund: Based on analysis of OECD health data from 2008, the United States continues to differ markedly from other countries on a number of health system measures.
Archives of Internal Medicine: Improving follow-up appointments is often considered one of the key strategies for reducing costly hospital readmissions, but a new study suggests that better discharge processes don’t reduce 30-day readmission rates at all.
The Joint Commission: Improving America’s Hospitals: The Joint Commission’s Report on Quality and Safety 2009, provides scientific evidence of improving patient care
USPSTF: Screening for Breast Cancer: Recommendation Statement
ShowHide Commentary
Rand Research on the Benefits of Integrated Care.
by Kevin Roche on Tuesday, May 14, 2013
A new paper from Rand looks at the effect of integrated care on a variety of outcomes, including provider and patient satisfaction, quality and costs.
Tags: Care Management, Health Care Costs, Health Care Quality, Physicians
The Oregon Medicaid Lottery
by Kevin Roche on Monday, May 6, 2013
Proponents of health care coverage for years have suggested that people literally died without it. New research in regard to the Oregon Medicaid lottery suggests that is highly unlikely to be true and that insurance coverage has little to do with real health outcomes.
Tags: Health Care Costs, Health Care Quality, Health Insurance, Medicaid
Hospital Quality Reporting
by Kevin Roche on Friday, May 3, 2013
A new brief from the National Institute for Health Care Reform explores the status of hospital quality reporting efforts and makes recommendations for improvement.
Tags: Health Care Quality, Hospital
Diabetes Care Improvement
by Kevin Roche on Friday, April 26, 2013
Even after all the emphasis on guidelines and pay-for-performance the quality of care for diabetes patients has shown only very moderate improvement in the last ten years.
Hospital Stay Complications and Financial Consequences
by Kevin Roche on Wednesday, April 24, 2013
A study published in the Journal of the American Medical Association finds that some hospitals profit from complications, receiving more revenue, even though in at least some cases the complications were likely the responsibility of the hospital.
Tags: Health Care Quality, Hospital
2013 MedPAC Report to Congress, Part I
by Kevin Roche on Tuesday, April 16, 2013
This is the first of several posts on the Medicare Payment Advisory Commissions 2013 Annual Report to Congress, which covers a variety of provider types and other issues. In this post we cover the introduction and some of the specific provider payment recommendations in regard to hospitals.
Universal Considerations for Lowering Health Care Spending
by Kevin Roche on Wednesday, April 10, 2013
An article in the current Health Affairs discusses the worldwide issue of how to limit health spending while at the same time improving people’s health and the health care they receive. Seems difficult, but the authors suggest the key is lowering labor costs.
Pay for Performance in Lower Income Countries
by Kevin Roche on Tuesday, April 9, 2013
While we often focus our attention on the health care problems of the developed world, lower income countries have bigger issues, many of which are being addressed with the same “innovations” used in the richer nations. An NBER paper looks at the use of pay-for-performance in these countries.
Provider/Patient Relationships and Quality of Care
by Kevin Roche on Monday, April 8, 2013
A report from the Health Foundation and Rand Europe examines how efforts to change the relationship between providers and patients may affect the quality of health care.
Tags: Consumers, Health Care Quality
Life Expectancy in the United States
by Kevin Roche on Tuesday, March 26, 2013
One of the arguments critics of the United States’ Health System love to use is our lower life expectancy than other developed countries. As research published in Health Affairs demonstrates, this has little to do with the quality of our health care.
Tags: Health Care Quality
Effect of Wellness Programs
by Kevin Roche on Thursday, March 21, 2013
The most recent issue of Health Affairs focuses on health and wellness. One of the programs reported found that in a health system’s employee population, hospitalizations were reduced but not overall costs.
Tags: Consumers, Health Care Costs, Health Care Quality, Wellness and Prevention
Use of Non-Physician Care Providers
by Kevin Roche on Monday, March 11, 2013
Physicians have battled for decades to keep other types of licensed providers from having an expanded scope of practice. With the advent of health reform and concerns about access and cost, these restrictions are harder to justify. They are explored in a new report from the National Institute for Health Care Reform.
Consumer Engagement in Health
by Kevin Roche on Tuesday, March 5, 2013
Consumer engagement in health is one of the themes of the current issue of Health Affairs. Two of the articles summarize findings regarding the effects of more engaged consumers on spending and health.
Health Spending and Mortality
by Kevin Roche on Friday, March 1, 2013
More spending, higher quality? More spending, lower quality? Less spending, higher quality? Less spending, lower quality? Theories and research abound, the latest a study of acute care hospitals in The American Journal of Managed Care.
Robot Assisted Surgery and Wasting Money
by Kevin Roche on Thursday, February 28, 2013
Can technology be a significant driver of health spending? You betya, look at robotically-assisted surgery. A new study in the Journal of the American Medical Association indicates that in the case of hysterectomy, robotic surgery has increased greatly, with no improvement in health outcomes and higher spending.
Tags: Health Care Costs, Health Care Quality, Medical Devices
Economic Impact of HIT
by Kevin Roche on Wednesday, February 27, 2013
There is substantial controversy about the benefits of health information technology and whether those benefits outweigh the costs. A meta-study in the Journal of the American Medical Informatics Association takes a fresh look at this question.
Tags: Health Care Costs, Health Care Quality, HIT, HITECH
Illness Adjustment Issues
by Kevin Roche on Monday, February 25, 2013
Several methods are commonly used to adjust health data for the illness burden of the patients’ information that is being used. A new study in the British Medical Journal suggests these are seriously flawed by not recognizing differences caused by variation in the use of health care services by the patients.
Tags: Health Care Costs, Health Care Quality, Research Methods
More on Hospital Readmissions
by Kevin Roche on Tuesday, February 19, 2013
Yet another piece of research, this one in the Journal of the American Medical Association, finds finds at best a very weak relationship between readmission rates and mortality.
End-of-Life Care and Place of Death
by Kevin Roche on Tuesday, February 12, 2013
Most people want to die at home, but few do. A study published in the Journal of the American Medical Association examines changes in place of death and use of hospice care over the last decade for Medicare beneficiaries.
Tags: End-of-Life Care, Health Care Costs, Health Care Quality, Medicare
Medicare Advantage Disenrollees
by Kevin Roche on Thursday, February 7, 2013
A study from the Centers for Medicare and Medicaid Services Office of the Actuary looks at characteristics of Medicare beneficiaries who disenroll from Medicare Advantage and their spending patterns following disenrollment.
Hospital Readmissions
by Kevin Roche on Wednesday, February 6, 2013
The Journal of the American Medical Association published an issue largely devoted to studies of hospital readmissions, looking both at patterns and potential causes and programs that might help reduce preventable readmissions.
New Paper on Regional Health Spending Variations
by Kevin Roche on Sunday, February 3, 2013
A draft working paper from the Federal Reserve Staff is the latest salvo in the ongoing exploration of any link between more health spending and better quality or vice versa. The paper suggests that geographic variation in spending is not likely highly correlated with quality.
Tags: Geographic Variation, Health Care Costs, Health Care Quality
Star Ratings and Medicare Enrollment
by Kevin Roche on Thursday, January 31, 2013
One primary purpose of quality reporting is to help consumers make informed decisions about where they get their care from or where they purchase insurance. Research in JAMA indicates there is a positive connection between CMS’ star ratings and beneficiary enrollment in Medicare Advantage plans.
Tags: Health Care Quality, Medicare
The Relationship Between Cost and Quality
by Kevin Roche on Monday, January 28, 2013
The relationship between cost and quality is tricky in health care, as it is with many services and products. A new study published in the Annals of Internal Medicine conducts a meta-review of the research on the issue, finding very mixed and inconclusive results.
A Review of the Benefits of Wellness Programs
by Kevin Roche on Friday, January 25, 2013
Do wellness programs improve quality and cost outcomes? Despite their popularity, from a research perspective the answer remains unclear, but a new review published in the Journal of Occupational and Environmental Medicine takes a fresh look, which concludes that the evidence remains inconclusive.
Tags: Health Care Costs, Health Care Quality, Wellness and Prevention
EHRs Not Doing the Job Yet
by Kevin Roche on Wednesday, January 23, 2013
An article by Rand Corp researchers published in Health Affairs indicates that electronic health records and other aspects of health information technology are not fulfilling their promise, whatever that was. The authors give reasons for the disappointing performance and suggest remedies.
Tags: EHRs, Health Care Costs, Health Care Quality, HIT
AHRQ Summary of Quality Improvement Method Reviews
by Kevin Roche on Friday, January 11, 2013
In the past few years the Agency for Healthcare Research and Quality has published several reviews on the evidence for effectiveness of various forms of quality improvement initiatives. Now the Agency releases a summary of these reviews, which show minimal evidence to data for most of them.
Tags: Health Care Quality
Readmissions and Safety Net Hospitals
by Kevin Roche on Thursday, January 3, 2013
One of the biggest problems with the Center for Medicare and Medicaid Services’ hospital readmissions program is that it likely unfairly and disproportionately hurts hospitals which treat larger numbers of poor patients. A brief from the Commonwealth Fund explores this issue and potential solutions.
Tags: Health Care Costs, Health Care Quality, Hospital, Hospital Readmissions
2012 Potpourri XL
by Kevin Roche on Friday, December 28, 2012
Our last Potpourri for 2012 is the ultimate in health information, containing not lumps of coal but tasty nuggets of holiday goodies, including transition care from hospital to primary care, how to control health spending growth, use of market incentives to improve the health system, building a good health insurance exchange and Massachusetts’ experience with the uninsured after reform.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Health Insurance Exchange, Hospital Readmissions, Transitional Care
Review of Medical Home Evidence
by Kevin Roche on Thursday, December 27, 2012
Patient-centered medical homes, accountable care organizations, who can keep all the delivery innovations straight! Research summarized in an Annals of Internal Medicine article reviews the state of the evidence on the use of medical homes. So far, not great, small gains in quality and no showing of overall cost savings.
Tags: Care Management, Health Care Costs, Health Care Quality, Medical Homes, Physicians
Health Care Associated Infections
by Kevin Roche on Wednesday, December 19, 2012
We would all like to think that receiving health care services isn’t going to make us sicker, but occasionally untoward things happen. A new report from the Agency for Healthcare Research and Quality looks at efforts to prevent one such harm, health care associated infections.
Tags: Health Care Quality, Providers
Medication Adherence Interventions
by Kevin Roche on Tuesday, December 11, 2012
Medication adherence is a serious quality of care issue, although its cost implications are often exaggerated. Research continues apace to understand why people don’t take their drugs and what interventions may work to improve adherence. An Annals of Internal Medicine article summarizes the state of the art.
Tags: Care Management, Drugs, Health Care Quality
The Cost of Medication Non-Adherence
by Kevin Roche on Thursday, December 6, 2012
Medication non-adherence has many causes and is likely a serious quality issue. Capgemini, the consulting group, has released a report claiming that such non-adherence adds hundreds of billions of dollars to our health care spending, and costs drug companies a similarly large amount of revenue.
Tags: Care Management, Consumers, Drugs, Health Care Costs, Health Care Quality
Oliver Wyman on ACOs
by Kevin Roche on Wednesday, December 5, 2012
Actuarial firm Oliver Wyman issues a report on Accountable Care Organizations, using questionable math to create the headline-grabbing number of 10% of Americans being covered by ACOs. The report basically continues the unwarranted hype surrounding ACOs as a savior for our health spending issues.
Tags: ACO, Health Care Quality, Medicaid
NCQA Annual Health Report
by Kevin Roche on Tuesday, December 4, 2012
The National Committee for Quality Assurance releases its annual report on the state of health care quality in America, based on its collection of various quality measures from health plans. One striking finding is the improvement in and level of quality in Medicare Advantage plans.
2012 Potpourri XXXVI
by Kevin Roche on Friday, November 30, 2012
Another in our series of Potpourris, tasty, succulent morsels of health data food, including this week the effect of mammography screening, improving health and health costs, state costs to run health insurance exchanges, family caregiving and the costs of fixing Medicare’s physician reimbursement.
Tags: Elder Care, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance Exchange, Medicare, Wellness and Prevention, Workplace
2012 Potpourri XXXV
by Kevin Roche on Friday, November 16, 2012
Thanks be given for our last Potpourri before Thanksgiving, a table spread with delectable bites of information on hospital readmissions and quality measure performance, health plan enrollment growth, health price rises, use of deductibles in employer-based health insurance and trends in employment of physicians.
Tags: Consumers, Health Care Costs, Health Care Quality, Health Insurance, Hospital Readmissions, Medicare, Pay For Performance, Physicians
More on End-of-Life Care
by Kevin Roche on Wednesday, November 14, 2012
A substantial amount of Medicare and overall health spending is incurred in the last few months of patients’ lives. Much of this spending is due to intensive care that obviously is rather superfluous at that point. A new article in the Journal of Clinical Oncology reports on research regarding end-of-life discussions and resulting care.
Tags: Care Management, End-of-Life Care, Health Care Costs, Health Care Quality
Limits on Use of Nurse Practitioners
by Kevin Roche on Tuesday, November 13, 2012
Everyone is concerned about health spending growth, the primary cause of which is unit price increases. So why are obvious methods to reduce unit price of services, like substituting less-expensive providers, ignored? An article in Health Affairs looks at limitations of use of nurse practitioners.
Tags: Health Care Costs, Health Care Quality, Physicians, Regulation
A Pay-for-Performance Program That May Have Worked
by Kevin Roche on Monday, November 12, 2012
Research reported in the New England Journal of Medicine suggests that a hospital pay-for-performance program in part of England may have led to reduced mortality for three conditions, with pneumonia showing a statistically significant decrease.
2012 Potpourri XXXIV
by Kevin Roche on Friday, November 9, 2012
Thank God the election is finally over, but our Potpourri is never-ending, this week bringing you the latest on why comparative effectiveness research results don’t translate to practice, innovations to reduce health spending, the value of medication adherence, factors related to end-of-life quality and MedPAC on new quality measures for avoidable hospital and ER use.
Tags: Comparative Effectiveness, Drugs, End-of-Life Care, Health Care Costs, Health Care Quality, Hospital, Medicare
2012 Potpourri XXXII
by Kevin Roche on Friday, October 26, 2012
The light fades but not our evanescent Potpourri, this week featuring stories on computerized point of entry ordering, the presence of large treatment effects in research, characteristics of patients with readmissions, a survey on Medicare physician reimbursement and a study on family caregivers.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Research, HIT, Hospital Readmissions, Medicare, Physicians
And One More Thing About Pay-for-Performance
by Kevin Roche on Thursday, October 25, 2012
In yet another piece evaluating the effectiveness to-date of pay-for-performance programs, Health Affairs carries a review of research on the topic, finding that results are mixed. Some seem to have improved quality, but others did not and providers caring for poorer and sicker patients may be disadvantaged.
Tags: Health Care Costs, Health Care Quality, Pay For Performance
Public Reporting of Outcomes Also Has Problems
by Kevin Roche on Tuesday, October 23, 2012
More research, this time from the Journal of the American Medical Association, to suggest that another quality improvement technique, this time public reporting of outcomes, does not achieve the intended goals. In regard to heart attack patients receiving PCI, public reporting seems to lead to lower rates of the procedure and no change in mortality outcomes.
Pay for Performance Has Problems
by Kevin Roche on Monday, October 22, 2012
Research reported in the New England Journal of Medicine reveals that the Centers for Medicare and Medicaid Services program of not paying for certain hospital acquired infections is not working, to put it mildly. The program seems to have had absolutely no impact on the targeted infection rates.
Tags: Health Care Quality, Hospital, Medicare, Pay For Performance
2012 Potpourri XXXI
by Kevin Roche on Friday, October 19, 2012
It is cooling down across most of the country, but our Potpourri remains red-hot, with nuggets on the moderation in health spending over the last few years, how to change automatic health behaviors, EHRs and diabetes care, a medical home pilot in Colorado and an ACO demonstration in Maine.
Tags: ACO, Care Management, EHRs, Health Care Costs, Health Care Quality, medical home, Wellness and Prevention
The Effect of Patients Reading Their Doctor’s Notes
by Kevin Roche on Tuesday, October 16, 2012
Research published in the Annals of Internal Medicine examines the effects of allowing patients to read the notes written by physicians about their health and care. Patients generally seem to regard the practice very positively and it appears to have little negative impact on physician work processes.
Tags: Consumers, Health Care Quality, HIT, Physicians
Accuracy of Data in Quality Measurements
by Kevin Roche on Monday, October 15, 2012
An article and accompanying editorial in the Annals of Internal Medicine discuss the effect of non-payment for hospital-acquired catheter-linked urinary tract infections, finding that the underlying data is likely so inaccurate that the policy cannot work as intended.
Tags: Health Care Quality, HIT
2012 Potpourri XXX
by Kevin Roche on Friday, October 12, 2012
Another luminescent Potpourri, focusing on the ACA’s high-risk pool plan; controlling health spending in Massachusetts; what components of EHRs and HIEs may control costs; another survey of employers and dealing with hospital pricing power.
Tags: EHRs, Employers, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, HIT, Hospital
AHRQ on Quality Reporting
by Kevin Roche on Thursday, October 11, 2012
An Agency for Healthcare Research & Quality report looks at the evidence for the effectiveness of public reporting of providers’ performance on various quality measures in actually creating quality improvements at those providers.
Tags: Health Care Quality, Providers
Medication Adherence Interventions
by Kevin Roche on Monday, October 8, 2012
Medication adherence is a widespread problem in health care, ranging from failure to even pick up a prescription to failure to follow instructions on when and how to use the drug. A number of interventions have been tried to improve adherence and an Agency for Healthcare Research and Quality review seeks to ascertain what evidence there is for effectiveness for these interventions.
Tags: Care Management, Drugs, Health Care Quality
2012 Potpourri XXIX
by Kevin Roche on Friday, October 5, 2012
Our first Potpourri in a while is as diverse and flamboyant as the fall colors, including items on the effectiveness of telemonitoring, the history of health “reform” in the United States, mortality and Medicaid eligibility expansions, continued issues with cost affecting access in Massachusetts and methods to help control imaging use.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Reform, Medicaid, Medicare, Telemedicine
CMS’ Physician Group Practice Demo Results
by Kevin Roche on Wednesday, October 3, 2012
The Physician Group Practice Demonstration conducted by Medicare has largely wrapped up , to be supplanted by the accountable care organization programs. The PGP demo appears to have led to slightly improved quality and has led to slightly lower cost savings over traditional fee-for-service Medicare.
Tags: Care Management, Disease Management, Health Care Costs, Health Care Quality, Medicare, Physicians
AHRQ on Bundled Payments
by Kevin Roche on Thursday, September 27, 2012
Bundled payments are designed to change the incentives for providers so that they manage patient care in a more cost-effective manner, hopefully without negatively affecting quality. A report from the Agency for Healthcare Research and Quality examines the research evidence to date on the effect of bundled payment approaches, finding that spending and utilization are probably lower, with an uncertain effect on quality.
Tags: Bundled Payments, Health Care Costs, Health Care Quality, Providers
MedPAC on Readmissions
by Kevin Roche on Wednesday, September 19, 2012
We, among many others, have been harsh critics of Medicare’s misguided hospital readmissions penalty program, which begins this year. MedPAC has weighed in with its views on how to “refine” the program, but its recommendations will only exacerbate the flaws in the current regulations.
Tags: Health Care Costs, Health Care Quality, Hospital Readmissions, Medicare
Variation in Episode Cost in a Commercial Health Plan
by Kevin Roche on Thursday, September 13, 2012
Research based on data from UnitedHealth Group’s commercial health plans finds wide variation in episode of care costs across both selected procedures and chronic diseases. The research also showed that for care provided by physicians meeting certain quality and efficiency benchmarks, episode of care costs were generally lower than for care provided by other physicians.
Tags: Health Care Costs, Health Care Quality, Health Insurance, Providers
Institute of Medicine Report
by Kevin Roche on Monday, September 10, 2012
The Institute of Medicine released a report regarding supposed unnecessary spending on health care in the United States and potential ways to remedy that problem, largely through use of health information technology.
Tags: Health Care Costs, Health Care Quality, Health Care Reform
Financial Incentives for Providers
by Kevin Roche on Wednesday, August 29, 2012
Are financial incentives for providers a good thing? A review in the British Medical Journal examines when financial incentives can be helpful in improving care and when they might actually lead to worse outcomes. The authors created a checklist designed to provide easy guidance on design and implementation of pay for performance type programs.
2012 Potpourri XXVII
by Kevin Roche on Friday, August 24, 2012
Yet another brilliant collection of health care data points, including use of gene profiling tests to guide breast cancer care, 30-day mortality models for stroke performance, hospital medication administration errors, the costs of the Medicare physician payment fix and patient-sharing networks among physicians.
Tags: Drugs, Genomics, Health Care Costs, Health Care Quality, Hospital, Medicare, Physicians
Early Hospital Readmission Experience
by Kevin Roche on Thursday, August 23, 2012
The first year of experience with Medicare’s readmission program is in and Kaiser has done an initial analysis of the results. A large number of hospitals will be penalized, mostly those who can least afford it, and the program continues to show how poorly designed it is and what severe unintended consequences will ensue from its implementation.
Tags: Health Care Quality, Hospital, Medicare, Readmissions
Designing Internet Health Applications
by Kevin Roche on Wednesday, August 22, 2012
Research published in the Journal of Medical Internet Research focuses on whether and why the use of online health applications improves patient empowerment and knowledge and if such improvement leads to better health outcomes.
Tags: Consumers, Health Care Quality, HIT
Retail Clinic Growth
by Kevin Roche on Monday, August 20, 2012
An article from Rand Corporation researchers published in Health Affairs details the continued growth and use of retail clinics. These facilities offer a convenient and inexpensive method for consumers to access health care and offer an increasing menu of services.
Tags: Consumers, Health Care Costs, Health Care Quality, Retail Clinics
Physician Participation in Government Health Plans
by Kevin Roche on Thursday, August 16, 2012
Health Affairs contains a survey regarding physicians’ acceptance of new Medicaid patients, which reveals that a significant fraction won’t accept new ones, largely because of low fees. The reform act attempts to ameliorate the issue, but likely will exacerbate it in the longer term.
Tags: Health Care Costs, Health Care Quality, Medicaid, Physicians
PWC on Health Care Customers’ Experience
by Kevin Roche on Tuesday, August 14, 2012
The “consumer” is all the rage in health care and a new report form PWC examines the customer experience and how to improve it, based on expectations in other industries and surveys of health care patients. Simple things like friendliness, speed and convenience may be keys to building loyalty and managing retention.
Tags: Consumers, Health Care Quality
2012 Potpourri XXV
by Kevin Roche on Friday, August 10, 2012
Another wonderful Potpourri, as lovely as a summer day, with information on small physician practices, medication adherence in Medicaid, access to care in Massachusetts, plan loyalty and PHRs, a survey regarding onsite health centers and hospital productivity in Massachusetts after reform.
Tags: Consumers, Drugs, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, HIT, Medicaid, Physicians
2012 Potpourri XXIII
by Kevin Roche on Friday, July 27, 2012
At the height of the summer, with dryness across the land, there is no drought of information in our Potpourri, this week including use of an interactive health record to increase preventive care, Medicare and Medicaid geographical variation, shared decision-making, readmissions for heart attacks and Japan’s all-payer rate setting system.
Tags: Consumers, Health Care Costs, Health Care Quality, HIT, Hospital, Hospital Readmissions, Medicaid, Medicare, Physicians, Wellness and Prevention
Patient Satisfaction
by Kevin Roche on Thursday, July 26, 2012
Patient satisfaction and patient-centered care are two health care movements which are being incented and rewarded by various government and private payer programs, but a Perspective in the Journal of the American Medical Association points out that these concepts may not lead to the most desirable outcomes.
Federally Qualified Health Centers
by Kevin Roche on Wednesday, July 25, 2012
Federally qualified community health centers are a lynchpin to providing accessible health care for lower income Americans. Two recent reports discuss quality and cost issues at these centers and indicate that they are a very good option for care.
Tags: Access, Health Care Quality, Health Care Reform, Physicians
Reducing Medication Errors at Hospital Discharge
by Kevin Roche on Tuesday, July 24, 2012
Medication errors figure prominently in health care spending, and errors after hospital discharge are a cause of readmissions. Recently reported research examined whether an intervention by clinical pharmacists could reduce such errors.
Tags: Drugs, Health Care Quality, Hospital
Hospital Executive Compensation
by Kevin Roche on Monday, July 23, 2012
Hospital costs are the major contributor to national health spending growth. A report from the New Hampshire Center for Public Policy examines executive compensation at the state’s non-profit hospitals, which is quite substantial and bears no relation to quality.
2012 Potpourri XXII
by Kevin Roche on Friday, July 20, 2012
Our Potpourri finally returns, including items on duplicate payments in federal health programs, EHR use and malpractice claims, venture capital statistics, consumer use of online self-service applications, and a new statistical method for predictive modeling.
Tags: Consumers, Financings, Government, Health Care Costs, Health Care Quality, Malpractice
Rand on CDHP
by Kevin Roche on Wednesday, July 18, 2012
No matter how controversial they may be, consumer-directed health plans with their higher cost-sharing continue to spread rapidly. A Rand Corporation brief examines the evidence on the effect of these plans on the cost and use of health care.
Tags: Consumer Directed Health, Health Care Costs, Health Care Quality, Health Insurance
Deloitte Consumer Survey
by Kevin Roche on Friday, July 13, 2012
Deloitte publishes its fifth annual survey of consumers on the performance of the American health system and the effects of health reform. The health reform law isn’t positively viewed, but people seem satisfied with their own care.
Tags: Consumers, Health Care Costs, Health Care Quality, Health Care Reform
Medicaid ER Usage
by Kevin Roche on Wednesday, July 11, 2012
Emergency room use tends to be expensive, and may reflect difficulty accessing other sources of primary care. Medicaid recipients are often identified as frequent inappropriate users of emergency rooms, but a new report from the Center for Studying Health System Change attempts to rebut that notion.
Patient-Centered Health IT
by Kevin Roche on Friday, July 6, 2012
Another excellent Agency for Healthcare Research and Quality has been released, this one examining the state of health information technology that enables patient-centered care. The report summarizes evidence on the utility of HIT for improving care quality and barriers to its further spread.
Tags: Consumers, Health Care Quality, HIT
Oregon’s Early Experience With Insuring the Uninsured
by Kevin Roche on Friday, June 29, 2012
The alleged primary spur for passage of the federal reform law was providing insurance for the uninsured, which supposedly would save money in the long run. An Oregon initiative has created an opportunity to see results from a similar effort and a report gives first year outcomes.
Tags: Health Care Costs, Health Care Quality, Health Care Reform, Medicaid
AHRQ on Improving Health Care Decision-Making
by Kevin Roche on Wednesday, June 27, 2012
The Agency for Healthcare Research and Quality has issued a report looking at use of clinical decision support and knowledge management systems, finding some evidence for positive health and cost outcomes, but also large gaps in our understanding of how to maximize the value of these technologies.
Tags: Care Management, Health Care Quality, HIT
ER Crowding
by Kevin Roche on Monday, June 25, 2012
Use of emergency rooms is monitored as a potential indicator of access and quality problems. A recent study from the American College of Emergency Room Physicians analyses trends in both emergency room use and crowding.
2012 Potpourri XX
by Kevin Roche on Friday, June 15, 2012
Our Potpourri resumes, with information on consumer trust of insurers and providers, consumer use of online health information, price transparency in health care, imaging rates in integrated health care systems and effectiveness of telephonic depression therapy.
Tags: Care Management, Consumers, Health Care Costs, Health Care Quality, HIT, Physicians, Telemedicine
Wellness Lessons From Germany
by Kevin Roche on Wednesday, June 13, 2012
Germany has encouraged wellness programs in a manner similar to the US. A new report from the Commonwealth Fund discusses results from the country’s efforts and draws lessons that may be applicable to the United States.
Tags: Health Care Costs, Health Care Quality, Wellness and Prevention
2012 Potpourri XIX
by Kevin Roche on Friday, June 1, 2012
Summer is heating up and our Potpourri is smoking too, with nuggets on a silly provision in the final MLR rule; research on causes of readmissions, some within hospital control, some not; why are some hospitals more costly in treating heart failure than others and an unintended consequence of a change in dialysis drug reimbursement.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Hospital, Medicare, Physicians, Readmissions, Reimbursement
Care Management Kills?
by Kevin Roche on Wednesday, May 30, 2012
Research reported in the Annals of Internal Medicine finds that a comprehensive care management program for chronic obstructive pulmonary disease had excess mortality, to the point that the trial was stopped early. It seems unlikely that this was actually due to the trial.
2012 Potpourri XVII
by Kevin Roche on Friday, May 11, 2012
This week’s Potpourri contains tasty morsels of health care nutrition, including geographic variation in cardiac procedures, barriers to shared decision-making, issues in the credibility of survey-based research, the value of a diabetes disease management program, and differences in hospital costs.
Tags: Disease Management, Health Care Costs, Health Care Quality, Hospital
Differences in Health Care Spending and Status Across Countries
by Kevin Roche on Thursday, May 10, 2012
The Commonwealth Fund puts out yet another report decrying the sorry American health system, which has by far the highest per capita costs and supposedly no better outcomes. It is unclear, however, that Americans don’t actually by and large get more total value for their dollars and the higher spending is largely due to unit prices.
Tags: Health Care Costs, Health Care Quality, international health systems
Clinical Decision Support Systems
by Kevin Roche on Tuesday, May 1, 2012
The only way to know if something really works is to have credible experimental research. A review of clinical decision support research suggests that they can improve health care processes but that the effect on ultimate outcomes is unknown.
Tags: Health Care Quality, HIT
Hospital Spending and Quality
by Kevin Roche on Tuesday, April 17, 2012
All the focus on quality and the effect of spending on quality of care has led to some creative research approaches to understanding what that relationship may be. A new paper from the National Bureau of Economic Research looks at ambulance to hospital patterns to see what can be gleaned there.
2012 Potpourri XIII
by Kevin Roche on Friday, April 13, 2012
Our latest Potpourri features the comparative cost of cancer care in the US and elsewhere, the effect of genomics on spending, international practice guidelines, state Medicaid waivers, unintended consequences from patient satisfaction efforts and county health rankings.
Tags: Comparative Effectiveness, Consumers, Health Care Costs, Health Care Quality, Medicaid, Medical Care, Pay For Performance
Coding and Outcomes Measurements
by Kevin Roche on Wednesday, April 11, 2012
In an era of multiple programs measuring outcomes and costs by provider and by disease or condition, the importance of consistent coding in the data used to do the measurement cannot be overstated, yet it appears that coding, and coding changes may have a substantial influence in results, according to a new JAMA study.
Tags: Health Care Costs, Health Care Quality, Pay For Performance
2012 Potpourri XII
by Kevin Roche on Friday, April 6, 2012
An early spring for much of the country and our latest Potpourri is in full bloom, with nuggets on health information exchanges, genetic testing guidelines, an employer survey on reform, EMRs and lab test ordering and the relationship between clinical quality and patient satisfaction.
Tags: Genomics, Health Care Quality, Health Insurance, HIT, HITECH, Patient Satisfaction, Workplace
Another Pay-for-Performance Bust
by Kevin Roche on Monday, April 2, 2012
Makes sense that paying for better delivery of quality care would improve outcomes, but the research so far doesn’t support that notion. The latest evidence is a study in the New England Journal of Medicine on the patient outcomes effects of the Medicare Hospital Quality Incentive Demonstration.
2012 Potpourri XI
by Kevin Roche on Friday, March 30, 2012
Welcome to another Potpourri of health information, focusing on workers’ comp medical prices, cost-sharing on asthma meds, the Medicare Advantage program, doctors’ experience of quality improvement programs, a review of the last 60 years in health economics and the value of teledermatology.
Tags: Care Management, Consumers, Drugs, Health Care Costs, Health Care Quality, Medicare, Physicians, Telemedicine, Workplace
Massachusetts’ Experience with Universal Coverage and Health
by Kevin Roche on Tuesday, March 27, 2012
As ObamaCare meets judgment at the Supreme Court, evidence about the effect of its predecessor in Massachusetts continues to be amassed. A new paper from the National Bureau of Economic Research examines the effect of near universal coverage on various markers of health in the state.
Local Health System Performance Report
by Kevin Roche on Monday, March 26, 2012
A new report from the Commonwealth Fund tracks performance of local health care systems across the United States, finding as much as a two to three times variation across the 306 regions, as measured on several dimensions of access and quality.
2012 Potpourri X
by Kevin Roche on Sunday, March 25, 2012
Spring is in the air but take a few minutes to refresh with our latest Potpourri, which includes the Congressional Budget Office’s latest health reform projections, ER use by those with Medicaid or private insurance coverage, the effect of selective outcomes reporting in research, an AonHewitt survey of employers on exchange use, another CBO report on employer incentives for use of TriCare and physician costs to comply with quality mandates.
Tags: Care Management, Comparative Effectiveness, Consumers, Employers, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance Exchanges, Medicaid, Physicians
Medical Home Research
by Kevin Roche on Thursday, March 22, 2012
A review article in the American Journal of Managed Care summarizes the evidence to date on medical homes. The results look modestly promising, with evidence of improving quality of care, some signs of cost control, but other evidence that suggests net cost increases.
Tags: Care Management, Health Care Costs, Health Care Quality, Medical Homes
Spending and Quality
by Kevin Roche on Tuesday, March 20, 2012
We would all like to believe that spending more on health care means we would have better outcomes and healthier people. Most research on the topic to date has suggested that this is not true, but a new study from Canada indicates that perhaps spending more is associated with better treatment outcomes.
Useful Consumer Health Reporting
by Kevin Roche on Monday, March 19, 2012
Can all the public reporting on provider quality and cost performance actually be used by consumers to make good choices for their health care services? That is the question explored in a Health Affairs study and the research gives a positive answer.
Tags: Consumers, Health Care Quality, Providers
Personalized Medicine
by Kevin Roche on Wednesday, March 14, 2012
Years after it was initially predicted to do so, medical care based on individual genetic findings is becoming more pervasive. A new report from UnitedHealth Group examines trends and impacts over the next few years from this more personalized version of medicine.
Tags: Disease Management, Genomics, Health Care Costs, Health Care Quality
2012 Potpourri VIII
by Kevin Roche on Friday, March 2, 2012
Its March and spring nears; our Potpourri blooms with nuggets of health care information, including comparative regulation of medical devices in the US and Europe, do physicians always truthful with patients, CMS’ oversight of home health care agencies, the validity of a CMS’ measure of ER scanning, and patient-centered care.
Tags: Consumers, Devices, FDA, Health Care Quality, HomeCare, Medicare, Pay For Performance, Physicians
Managed Care Medicare Plan Hospital Readmission Rates
by Kevin Roche on Thursday, March 1, 2012
The CMS program to reduce, or at least penalize hospitals for, unnecessary readmissions is in full swing this year. A new study looks at how Medicare Advantage plans do in regard to readmissions for their beneficiaries and compares this performance to that for fee-for-service beneficiaries.
Tags: Health Care Costs, Health Care Quality, Hospital, Hospital Readmissions, Medicare
Practice Characteristics and Outcomes
by Kevin Roche on Monday, February 27, 2012
One of the hot new concepts is use of “medical home” physician practices to improve quality and lower costs. A study from Health Affairs suggests that practices having medical home characteristics don’t necessarily do better in producing good outcomes for outpatients.
High Deductible Health Plans and Care Receipt
by Kevin Roche on Tuesday, February 21, 2012
A survey of high-deductible health plan users finds that care is more likely to be deferred by enrollees in such plans as opposed to traditional ones, particularly low-income persons, but not for patients with chronic conditions. The survey has weaknesses, including the fact that it does not explore outcomes.
Tags: Consumer Directed Health, Health Care Quality, Health Insurance
Patient Perceptions and Illness
by Kevin Roche on Monday, February 20, 2012
Placebo and nocebo effects are just part of the broader topic of how patient perceptions about their health, illnesses and treatments may affect outcomes. An article in Current Directions in Psychological Science summarizes research on patient perception of illness.
Patient Satisfaction and Quality
by Kevin Roche on Wednesday, February 15, 2012
Patient satisfaction surveys and scores are a large component in most pay-for-reporting, pay-for-performance and value-based purchasing programs, on the theory that patient satisfaction is linked to quality. A new study published in the Archives of Internal Medicine undercuts this theory.
Tags: Health Care Quality, Patient Satisfaction, Pay For Performance
2012 Potpourri VI
by Kevin Roche on Friday, February 10, 2012
This week’s Potpourri focuses on the cost of robotic surgery, the benefits of aspirin compared to more expensive drugs, the benefits of fitness club use, what states and specialties are responsible for the SGR overrun, and the performance of safety-net hospitals on ER quality measures.
Tags: Devices, Drugs, Health Care Costs, Health Care Quality, Hospital, Physicians
Massachusetts Update
by Kevin Roche on Wednesday, February 8, 2012
The Massachusetts reform rolls on, with the state’s residents generally still okay with the changes, although cost continues to be a problem. An article in Health Affairs sums up the current state of affairs.
Tags: Health Care Costs, Health Care Quality, Health Care Reform
CBO on Medicare’s Value-Based Payment Demos
by Kevin Roche on Thursday, February 2, 2012
Another excellent paper from the Congressional Budget Office is issued, this one on Medicare’s demonstration projects on value-based payments to providers. Once again, the demonstrations had very mixed results, with only one demonstration generating savings for the Medicare program.
Tags: Bundled Payments, Health Care Costs, Health Care Quality, Pay For Performance, Providers
2012 Potpourri IV
by Kevin Roche on Friday, January 27, 2012
Another zinger of a Potpourri, with nuggets on a GAO audit of NQF work, use of web tools for diabetes management, the Healthways well-being index, the problem with federal health spending, hospital job losses from reimbursement cuts, and reducing unnecessary testing.
Tags: Care Management, Health Care Costs, Health Care Quality, HIT, Hospital, Physicians, Wellness and Prevention
CBO on Medicare’s Care Management Demos
by Kevin Roche on Tuesday, January 24, 2012
The Centers for Medicare and Medicaid Services has engaged in a number of care management demonstrations over the years. The Congressional Budget Office adds its assessment to the body of research examining the outcomes of those demostrations.
Tags: Care Management, Chronic Disease, Disease Management, Health Care Costs, Health Care Quality, Medicare
2012 Potpourri III
by Kevin Roche on Friday, January 20, 2012
Winter is getting long and tedious by now, but our Potpourri offers a welcome respite, with refreshing tidbits on hospital uncompensated care, teledermatology, Medicaid controls of antipsychotic use, Medicare cuts to osteoporosis testing payments, the relationship between primary care access and mortality risk, and where the United States will find cost-savings.
Tags: Drugs, Health Care Costs, Health Care Quality, Hospital, Medicaid, Medicare, Telemedicine
Hospital Readmissions
by Kevin Roche on Thursday, January 19, 2012
Researchers have published a study in the Journal of the American Medical Association which examines hospital readmission rates for heart attack patients in multiple countries. The United States has higher absolute rates of readmissions, but the lowest lengths of stay and the two circumstances appear to be linked.
Tags: Health Care Costs, Health Care Quality, Hospital, Readmissions
Calculating Hospital Mortality Rates
by Kevin Roche on Tuesday, January 17, 2012
When money starts getting attached to calculations, the nitty-gritty of how the data for the calculations is collected and how the calculation is defined become very important. An article in the Annals of Internal Medicine examines methods for determining hospital mortality rates, finding differences across methods that could have important financial consequences.
2012 Potpourri I
by Kevin Roche on Friday, January 6, 2012
Welcome to 2012, when you can once again expect a series of high-quality Potpourris from our immense data bank! Our initial foray includes the Independence at Home CMS demo, discharge summaries and hospital readmissions, CMS’ quality measures for Medicaid patients, private equity fundraising, medical homes and cost savings for Medicaid patients and the effect of poor discharge summaries on nursing home patients.
Tags: Care Management, Financings, Health Care Quality, HomeCare, Hospital, Medicaid, medical home, Medicare, Readmissions
Public Reporting of Performance Measures
by Kevin Roche on Thursday, January 5, 2012
The Agency for Healthcare Research and Quality examines the supposed mechanisms by which public reporting of provider performance on quality measures will improve outcomes and details the evidence which supports or fails to support that theory.
End-of-Life Care
by Kevin Roche on Tuesday, January 3, 2012
A draft evidence report from AHRQ looks at end-of-life and hospice care. End-of-life care is often fingered as one of the causes of increasing health spending. The report finds moderate evidence supporting beneficial effects from many of the studied interventions.
Tags: End-of-Life Care, Health Care Costs, Health Care Quality, Medicare
Medical Homes
by Kevin Roche on Wednesday, December 28, 2011
Another one of the concepts being counted on to help improve health care quality and lower costs in the wake of reform is the “medical home.” An AHRQ draft review finds little evidence on quality effects or cost savings, but also suggests there is promise in the approach.
Tags: Health Care Costs, Health Care Quality, Medical Care, medical home, Physicians
Physician Views of Health Care
by Kevin Roche on Wednesday, December 21, 2011
Physicians have felt under assault for decades, with managed care restrictions, low reimbursement and malpractice concerns leading the charge. A new survey from Deloitte’s Center for Health Solutions give doctors’ perspectives on health care reform and their profession.
Tags: Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Physicians
More on Hospital Readmissions
by Kevin Roche on Monday, December 19, 2011
The latest research on hospital readmissions, published in the NEJM, finds that the largest single factor associated with readmission rates for heart failure and pneumonia is the underlying rate of overall hospitalizations, suggesting that to reduce readmissions, you need to reduce the general predeliction to hospitalize.
Tags: Health Care Costs, Health Care Quality, Hospital, Hospital Readmissions
2011 Potpourri XXXXVIII
by Kevin Roche on Friday, December 16, 2011
The holiday season is in full swing, as is the time for bad weather, but nothing can deter the delivery of our Potpourri of health stories, including this week the nocebo effect, use of imaging when a financial interest in the equipment is present, broker commissions and the MLR, present-on-admission indicators, selecting patients for use in performance measuring, and physicians views of health insurers.
Tags: Health Care Costs, Health Care Quality, Health Insurance, Hospital, Medical Care, Pay For Performance, Physicians
Performance Measures
by Kevin Roche on Thursday, December 15, 2011
Health care is now full of all kinds of performance measures, and the results are increasingly used for payment-related purposes, raising their potential impact significantly. A new Rand report sponsored by the National Quality Forum examines the use of performance measures and evaluates their impact.
Bundled Payments
by Kevin Roche on Tuesday, December 13, 2011
Another excellent draft report from the Agency for Healthcare Research and Quality reviews the evidence related to the effects of bundled payments to providers on quality and costs. The evidence, while weak, suggests that utilization and costs decline and quality is not notably affected in either direction.
Tags: Bundled Payments, Comparative Effectiveness, Health Care Costs, Health Care Quality
Disease Registries
by Kevin Roche on Monday, December 12, 2011
Disease registries are used to track a number of patients with a common condition to determine factors which affect their outcomes and to help guide their treatment. An article in Health Affairs reviews a number of disease registries in several countries, finding that they have a high potential to improve overall quality.
Tags: Care Management, Chronic Disease, Health Care Costs, Health Care Quality
2011 Potpourri XXXXVII
by Kevin Roche on Friday, December 9, 2011
Another scintillating Potpourri, focused on the effect of copayments on prescription adherence, use of PHRs in the FEHBP plans, doctors use of cancer drugs after a Medicare reimbursement change, visiting physicians after a hospital discharge, consumers expectations regarding health insurance and early experience with bundled payments.
Tags: Consumers, Health Care Costs, Health Care Quality, Health Insurance, HIT, Hospital, Physicians, Readmissions
What Works in Financial Incentives
by Kevin Roche on Monday, December 5, 2011
Both providers and consumers are increasingly subjected to positive and negative inducements to behave in certain ways. An article in the International Journal of Behavioral Medicine explores some possible behavioral and ethical rules for the design of patient-oriented incentive programs.
Tags: Consumers, Health Care Costs, Health Care Quality, Incentives
2011 Potpourri XXXXVI
by Kevin Roche on Friday, December 2, 2011
The holiday shopping season is in full swing but our Potpourri is free, filled with useful data on high-deductible health plans and utilization, Medicare Advantage plan Stars bonuses, drug complications and hospitalizations, physician office visit trends, premium increases, and patient expectations.
Tags: Consumer Directed Health, Drugs, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Medicare, Patient Satisfaction, Physicians
Trends in Patient Satisfaction
by Kevin Roche on Wednesday, November 30, 2011
A Press Ganey report describes trends in patient satisfaction for hospitals, outpatient departments, emergency rooms, physicians and home care and lists top priorities for patients in improving their experience of care.
Tags: Consumers, Health Care Quality, Patient Satisfaction, Providers
Retail Clinic Trends
by Kevin Roche on Monday, November 28, 2011
A new report by Rand Corp. researchers published in the American Journal of Managed Care finds rapid growth in the use of retail clinics and identifies some of the factors associated with their use.
The Efficacy of Rehospitalization Interventions
by Kevin Roche on Monday, November 21, 2011
The Annals of Internal Medicine carries a study on the effectiveness of interventions to reduce the 30-day readmissions rate. This meta-review found little consistent evidence to support the value of any particular intervention, which should give further pause to the notion that most readmissions could be avoided or that hospitals should be penalized when they can’t be told how to reliably reduce readmissions.
Tags: Health Care Costs, Health Care Quality, Hospital, Readmisssions
2011 Potpourri XXXXV
by Kevin Roche on Friday, November 18, 2011
No Potpourri next week due to the holiday, so enjoy this festive collection of health care nuggets, including pay-for-performance in large physician groups, employer views on the effect of the reform law, the effect of physician financial interest in cardiac testing, experience with high deductible plans, medical homes and quality improvement and for-profit and non-for-profit hospital treatment of the uninsured.
Tags: ACO, Care Management, Consumer Directed Health, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Hospital, medical home, Pay For Performance, Physicians
Medicare Disease Management Pilots
by Kevin Roche on Wednesday, November 16, 2011
A final summary of Medicare’s disease management pilots gives a bleak picture of the value of the efforts. While there are design and methodological critiques of the Medicare program that may make the results not generalizable, the outcomes do suggest that if disease management is to show value, design and execution need to be improved.
Tags: Disease Management, Health Care Costs, Health Care Quality, Medicare
Cost-Shifting and Care
by Kevin Roche on Tuesday, November 8, 2011
Research reported in Health Affairs examines the Mayo Clinic’s experience after increasing cost-sharing for its employees. Reductions in the use of many discretionary services seem to have been sustained over a multi-year period, leading to overall spending restraint.
Tags: Consumer Directed Health, Consumers, Health Care Costs, Health Care Quality, Health Insurance
AHRQ on Provider Performance Reporting
by Kevin Roche on Thursday, November 3, 2011
The world’s aflame with reporting on provider quality and cost performance. Making sure the information is complete, accurate and credible is no simple task, as a recent Agency for Healthcare Research and Quality report demonstrates.
Tags: Health Care Quality, Hospital, Pay For Performance, Physicians
More Trashing of the US Health System
by Kevin Roche on Wednesday, November 2, 2011
From the Commonwealth Fund comes another in a series of reports bemoaning the woeful inadequacy of the American health system, especially compared to those in other developed countries. Whatever our faults, this type of analysis is filled with its own flaws and provides little useful guidance for addressing our issues.
Tags: Health Care Costs, Health Care Quality, Health Care Reform
Specialty Pharmacy
by Kevin Roche on Tuesday, November 1, 2011
Specialty drugs have gotten the attention of all payers, with multiple efforts underway to manage the exploding costs associated with this category. A new paper from URAC summarizes the issues and sets out the value of using an accredited specialty pharmacy.
AHA Report on Hospital Readmissions
by Kevin Roche on Wednesday, October 19, 2011
The American Hospital Association weighs in on the hospital readmission reduction incentive program with a well-thought out program that identifies the complexities involved in identifying inappropriate readmissions and designing initiatives to reduce those readmissions.
Tags: Health Care Costs, Health Care Quality, Hospital, Readmissions
Off-Label Use of Atypical AntiPsychotics
by Kevin Roche on Tuesday, October 18, 2011
A Journal of the American Medical Association article, based on work sponsored by AHRQ, reviews the off-label use of atypical antipsychotics, which are usually very expensive and have significant side effects. While there are occasional benefits to such use, adverse events are common, particularly in the elderly.
Tags: Drugs, Elder Care, FDA, Health Care Quality
2011 Potpourri XXXX
by Kevin Roche on Friday, October 14, 2011
The leaves fall but not the quality of our Potpourri, this week covering beneficiaries’ use of Medicare Star ratings, quality of care guidelines and older patients, compassionate care, asthma care guidelines and outcomes, infection control in hospitals and informal caregivers in California.
Tags: Consumer Directed Health, Elder Care, evidence based medicine, Health Care Costs, Health Care Quality, Hospital, Medicare, Pay For Performance
Advance Directives and End-of-Life Spending
by Kevin Roche on Wednesday, October 12, 2011
End-of-life care is a significant contributor to overall health expenditures. New research in the Journal of the American Medical Association probes the effect of advance directives on end-of-life spending, with a particular focus on geographic variations both in the use of directives and care.
Tags: Elder Care, End-of-Life Care, Health Care Costs, Health Care Quality, Medicare
Hospital Quality and Community Demographics
by Kevin Roche on Tuesday, October 11, 2011
Increasingly hospitals are being judged on their “quality” based on process and outcome measures and on their cost. New research examines the characteristics of hospitals which fall in various quartiles based on quality and costs, finding that many hospitals serving poorer patients are judged low quality and high cost, but whether those hospitals are being fairly evaluated is an open question.
Shared Decision Making
by Kevin Roche on Monday, October 10, 2011
A new paper discusses the state of shared decision-making, illuminating progress and barriers to use by patients and providers. This approach results in higher-quality care, because it is consistent with patient values and with truly informed patient consent and it may also help reduce spending.
Tags: Comparative Effectiveness, Consumers, Health Care Costs, Health Care Quality, Physicians, shared decision-making
Dartmouth Atlas on Hospital Readmissions
by Kevin Roche on Thursday, October 6, 2011
In another piece of research related to hospital readmissions, the Dartmouth Atlas project released a report on variations in readmission patterns across the country and among academic medical centers. Possible reasons for the variation are explored as is the longitudinal trend, which shows no improvement.
Tags: Health Care Costs, Health Care Quality, Hospital, Hospital Readmissions
Consumerism and Employer-Provided Health Care
by Kevin Roche on Thursday, September 29, 2011
A new Rand report explores the use of health information technology to assist consumers in managing their health and making decisions about health care coverage. As health care coverage changes, these tools are more important, but their utility is unproven.
Tags: Consumers, Health Care Costs, Health Care Quality, HIT
EHRs and Diabetes Care
by Kevin Roche on Monday, September 19, 2011
New research provides stronger evidence that using electronic health records may improve quality of care according to some measures more than continuing to use paper medical records, at least for diabetes patients.
Tags: EHRs, Health Care Quality, HIT
2011 Potpourri XXXVI
by Kevin Roche on Friday, September 16, 2011
The leaves begin to fall but not the quality of our Potpourri, this week including useful data on hospital readmissions in the VA system, what makes top hospitals successful, the accuracy of mortality ratings for children’s hospitals, the use of mortality rankings to identify the best hospitals, advertising by health care providers and the quality effects of the annual changeover of trainees in hospitals.
Tags: Health Care Costs, Health Care Quality, Hospital, Physicians, Readmissions
Review of Physician Financial Incentive Programs
by Kevin Roche on Wednesday, September 14, 2011
A new Cochrane Review finds very minimal evidence to suggest that efforts aimed at improving quality of care by creating financial rewards or penalties for primary care physicians are having the desired impact, suggesting caution in implementing the programs until there is further and better quality research.
Physician Pay-for-Performance Programs
by Kevin Roche on Tuesday, August 30, 2011
A paper from the National Bureau of Economic Research examines the effect of a physician pay-for-performance program in Canada. The study found very limited effects of the incentives in spurring greater delivery of the care which was incented.
Are Readmissions Really an Indicator of Poor Quality?
by Kevin Roche on Monday, August 29, 2011
CMS currently intends to implement its readmissions penalty/incentive program in a manner that may not truly distinguish between good and poor quality at hospitals, according to recent research in Canada which finds no correlation between overall readmission rates and inappropriate readmissions.
Tags: Health Care Quality, Hospital, Medicare
2011 Potpourri XXXII
by Kevin Roche on Friday, August 19, 2011
Our thirty-second Potpourri of the year brings fascinating health items such as how to design wellness incentives, how Medicare could save money, the complexities of improving care, the use of community health centers to save money, designing subjective survey questions and an intervention to reduce hospital readmissions.
Tags: Care Management, Health Care Costs, Health Care Quality, Hospital, Malpractice, Medicare, Wellness and Prevention
2011 Potpourri XXX
by Kevin Roche on Friday, August 5, 2011
This week’s Potpourri features dropped malpractice claims, the quality benefits of EHRs, improper Medicare payments, health insurer customer satisfaction, the utilization and cost effects of using hospitalists, and determining if a patient has decision-making capacity.
Tags: Consumers, EHRs, Health Care Costs, Health Care Quality, Health Insurance, HITECH, Hospital, Malpractice, Medicare, Physicians
GAO on the Value of Health Spending
by Kevin Roche on Wednesday, August 3, 2011
The Government Accounting Office examined various interventions designed to improve the quality of health care and/or lower costs and analyzed the strength of the evidence supporting the effect of the intervention. In general, not many interventions have high-quality research results to support efficacy.
Tags: Care Management, Health Care Costs, Health Care Quality
Early Massachusetts Experience With Global Payment
by Kevin Roche on Tuesday, July 26, 2011
Research published in the New England Journal of Medicine examines early results from the Massachusetts Blue Cross plan’s global budgeting program, finding very modest health spending reductions and small changes in quality.
Tags: ACO, Health Care Costs, Health Care Quality, Health Insurance, Physicians
Hospital-Acquired Conditions
by Kevin Roche on Monday, July 18, 2011
AHRQ releases a Statistical Brief on Hospital-Acquired Conditions, which are a focus of quality improvement, including unreimbursed never events. The Brief details types of conditions across several payers, including Medicare.
Tags: Health Care Quality, Hospital
2011 Potpourri XXVII
by Kevin Roche on Friday, July 15, 2011
A mid-summer’s evening (or weekend) Potpourri, but no heated discussion here, just soothing nuggets of knowledge, including use and misuse of PCI, how to measure blood pressure, CMS and telemedicine, preventing falls, copying and pasting EHR notes, and physicians attitude to work and compensation.
Tags: EHRs, Health Care Costs, Health Care Quality, Medical Care, Medicare, Physicians, Telemedicine
2011 Potpourri XXVI
by Kevin Roche on Friday, July 8, 2011
Our current Potpourri features Google’s dropping of its PHR, the AMA’s report on insurer claims paying, the role of health advocacy groups, employer’s intentions in regard to offering health coverage, drug approval in the US versus Europe and the use of a checklist to improve quality in the ICU.
Tags: Drugs, FDA, Health Care Costs, Health Care Quality, Health Insurance, HIT, Physicians
Deloitte Consumer Surveys
by Kevin Roche on Tuesday, July 5, 2011
Deloitte issues the results of a global and a United States consumer survey on perceptions of health and health care system. Most Americans have a gloomy outlook, but so do the citizens of most of the surveyed countries.
Tags: Consumers, Government, Health Care Costs, Health Care Quality
How England’s NICE Works
by Kevin Roche on Wednesday, June 29, 2011
Two articles describe in detail how Britain’s NICE operates in creating guidelines and conducting cost-effectiveness reviews. The process is highly transparent and professional, and while the institution has taken criticism for some of its decisions, its role is extremely important.
Tags: Comparative Effectiveness, Health Care Costs, Health Care Quality
Health Literacy
by Kevin Roche on Wednesday, June 22, 2011
Health literacy is the degree to which a patient can understand and use health-related information to help make decisions about his or her care. A report from AHRQ reviews the research on the effect of health literacy on outcomes and health.
Tags: Consumers, Health Care Quality
Accurate Provider Performance Reporting
by Kevin Roche on Monday, June 20, 2011
Provider performance reporting is spreading rapidly and increasingly has payment consequences attached to it. New research published in JAMA gives further reason to be cautious in designing and implementing these programs.
The Effect of Competition on Health Care in England
by Kevin Roche on Tuesday, June 14, 2011
A working paper at the National Bureau of Economics reports on an analysis of the effects of England’s attempt to increase competition between hospitals on quality, finding that hospitals in more competitive markets had higher quality outcomes than those in more concentrated markets, without increasing the cost of care.
Tags: Consumers, Health Care Quality, Health Insurance, Hospital
More Data Available from CMS
by Kevin Roche on Thursday, June 9, 2011
CMS has proposed a rule to implement a PPACA provision allowing access to extracts of provider-level Medicare data to evaluate performance, primarily on quality measures. This is a good first step, but just a first step in being able to completely profile physician practice patterns.
Tags: Comparative Effectiveness, Health Care Costs, Health Care Quality, Medicaid, Medicare, Providers
Telehealth in the ICU
by Kevin Roche on Monday, May 23, 2011
An article in JAMA discusses research on the use of remote monitoring teams in intensive care units, finding significant benefits in consistency and quality of care and likely lower costs.
Guidelines and Good Care
by Kevin Roche on Thursday, May 5, 2011
New research examines the need to use care guidelines carefully, showing the danger of using generalized rules for all patients, and the benefit of tailoring those rules for individual circumstances.
Health Literacy and Outcomes
by Kevin Roche on Tuesday, May 3, 2011
Research published in JAMA examines the extent to which patients’ health literacy is associated with heart failure outcomes, finding a connection in the case of all-cause mortality, but not with hospitalizations.
Off-Label Drug Use
by Kevin Roche on Monday, April 25, 2011
Two pieces of research discuss an example of extensive off-label use of a drug, finding that costs are being raised with little likelihood of an increase in quality of care.
2011 Potpourri XVII
by Kevin Roche on Friday, April 22, 2011
Happy Easter and welcome to our latest Potpourri, which will raise you up with information on workplace wellness, hospital pricing, clinical decision support systems, using HIT to save on drug development costs, CMS’ quality improvement programs and health care M&A activity.
Tags: Care Management, Drugs, Health Care Quality, HIT, Hospital, M&A, Pay For Performance, Workplace
The VHA and Chronic Disease Care
by Kevin Roche on Thursday, April 21, 2011
A study of the VHA’s care for chronic disease patients finds generally good compliance with treatment recommendations, but not necessarily the best patient outcomes, reflecting the complexity of improving quality.
Tags: Care Management, Chronic Disease, Disease Management, Government, Health Care Quality
Ensuring the Utility of Performance Measures
by Kevin Roche on Tuesday, April 19, 2011
Researchers examine what can be done to improve the science of performance measurement in a new Health Affairs article, making valuable suggestions to increase the credibility of an increasingly important aspect of our health system.
GAO Reports on CHIPs Programs
by Kevin Roche on Thursday, April 14, 2011
Medicaid and the Childrens Health Insurance Programs provide coverage for a very substantial portion of the nation’s children. The GAO issues a report on the adequacy of some aspects of the care they receive.
Tags: Care Management, Government, Health Care Costs, Health Care Quality, Medicaid
Hospital Error Numbers
by Kevin Roche on Wednesday, April 13, 2011
Health Affairs publishes a study suggesting that the systems which have been used to identify patient safety issues in hospitals miss most problems. A new tool does a better job but also indicates that safety is still a serious problem.
Tags: Health Care Quality, Hospital
Nursing Home Quality and Malpractice Claims
by Kevin Roche on Tuesday, April 12, 2011
Research published in the New England Journal of Medicine examines the relationship between nursing home quality metrics and the number of malpractice claims they have, finding a weak relationship at best.
Tags: Elder Care, Health Care Quality, Malpractice
2011 Potpourri XV
by Kevin Roche on Friday, April 8, 2011
Our Masters week Potpourri masterfully covers such items as EHR satisfaction, ICU telemedicine, effects of concierge care on Medicare, failure to fill prescriptions, percent of household spending on health care by seniors, and drug rep visits to physicians.
Tags: Drugs, EHRs, Health Care Costs, Health Care Quality, HIT, Medicare, Physicians, Telemedicine
2011 Potpourri XII
by Kevin Roche on Friday, March 18, 2011
Our Ides of March Potpourri, featuring two studies of the impact of wellness programs; the link between hospital spending and mortality outcomes; HHS waiving the MLR requirement for Maine; bills to have CMS disclose physician practice patterns; and research on smoking cessation techniques.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Hospital, Medicare, Wellness and Prevention, Wireless
New End-of-life Studies
by Kevin Roche on Thursday, March 17, 2011
Feeling blue, don’t read this post. It is collection of research reports related to death and end-of-life care. Mostly positive trends, not that it helps those who make up the statistics.
2011 Potpourri XI
by Kevin Roche on Friday, March 11, 2011
Another in our weekly series of health care nuggets, with this week’s Potpourri featuring Medicare beneficiaries and physician supply, the FDA’s position on certain device software, a wellness survey, the AMA’s stance on genetic testing, marketing of drugs, and an integrated disability and health care program.
Tags: Consumers, Drugs, FDA, Genomics, Health Care Quality, Medicare, Mobile, Physicians, Wellness and Prevention
Socioeconomic Status and Health
by Kevin Roche on Wednesday, March 9, 2011
A study comparing French and British populations examines the link between socioeconomic status and mortality, finding that cultural differences may result in a different causative relationship in different countries.
Tags: Consumers, Health Care Quality
The Effects of HSAs
by Kevin Roche on Tuesday, March 8, 2011
High-deductible plans often have health savings accounts associated with them. New research looks at the effect of HSA-linked plans on utilization and spending, finding significant reductions, but concerns about use of preventive services.
Tags: Consumer Directed Health, Health Care Costs, Health Care Quality, Health Insurance
Latest Dartmouth Atlas Work
by Kevin Roche on Thursday, March 3, 2011
The latest Dartmouth Atlas work looks at variation in elective surgery rates in the context of patient involvement in decision-making. The report highlights differences in treatment for a number of common conditions and provides good advice for patients.
Tags: Consumers, Health Care Costs, Health Care Quality, Medicare, Physicians
Medicare Advantage Stars Program
by Kevin Roche on Monday, February 28, 2011
The Medicare Advantage Stars program is reviewed in a Kaiser Family Foundation brief which discusses coming changes in the calculations and the current ratings and characteristics of a number of plans
Tags: Health Care Quality, Medicare
2011 Potpourri IX
by Kevin Roche on Friday, February 25, 2011
A positively presidential set of health care data points for your edification in today’s Potpourri, including examining correlations between hospital volume, quality and costs, improving quality program adherence, creating good insurance markets, the physician gender pay gap, the effects of the health reform law, and potential inconsistencies in HHS’ HIT incentive programs.
Tags: EHRs, Government, Health Care Quality, Health Care Reform, Health Insurance, HIT, HITECH, Hospital, Physicians
2011 Potpourri VIII
by Kevin Roche on Friday, February 18, 2011
The year wears on, winter hopefully draws to a close, and our Potpourri provides nutritious sustenance, this week featuring comparative effectiveness research and personalized medicine, two surveys on hospital progress in implementing EHRs, a patient-centered vision of HIT, the validity of care guidelines, and the use of clinical decision support to control inappropriate imaging.
Tags: Comparative Effectiveness, Consumers, Health Care Quality, HIT, Hospital, Medical Care, Personalized Medicine
PWC on Medical Device Development
by Kevin Roche on Wednesday, February 9, 2011
PWC issued a report assessing the status of innovation in medical devices, finding that the United States no longer has the lead in this area and that the types of devices currently being deemed “innovative” has changed.
Evaluating the Benefits of EHRs
by Kevin Roche on Tuesday, February 8, 2011
An extensive review published in the Public Library of Science evaluates the evidence for health care safety and quality benefits from electronic health records, finding that there is a significant gap between what is claimed and what has been demonstrated.
Tags: EHRs, Health Care Quality, HIT
Spreading Medical Knowledge
by Kevin Roche on Thursday, January 27, 2011
An article in Health Affairs discusses the important topic of disseminating new medical and health care knowledge to physicians and other providers, in this case specifically in regard to comparative effectiveness. Many barriers exist to widespread use of new knowledge and additional techniques are needed to maximize such use.
Tags: Comparative Effectiveness, Health Care Quality, Medical Care, Physicians
AHRQ Quality Study
by Kevin Roche on Tuesday, January 25, 2011
An unfortunate contributor to medical costs, as well as an obvious source of quality problems, are patient care errors. AHRQ releases the first results from a survey of medical offices on patient safety culture, with the goal of helping those offices reduce those patient care errors.
Tags: Health Care Quality, Physicians
One Perspective on Health Care’s Future
by Kevin Roche on Wednesday, January 19, 2011
CSC put out a report giving its vision of the future of health care, with a particular focus on how emerging technologies may reshape wellness, prevention, early disease detection, treatment and how care is delivered.
Tags: Care Management, Health Care Costs, Health Care Quality, HIT, Medical Care, Wellness and Prevention
Medication Adherence Methods
by Kevin Roche on Thursday, January 6, 2011
The high prevalence of medications as the primary method of treatment especially for chronic diseases has led to focus on ensuring that patients take the drugs that are prescribed for them. A review article examines the outcome of research on various intervention programs to encourage adherence.
Tags: Consumers, Drugs, Health Care Costs, Health Care Quality
EMRs to the Rescue–or Not?
by Kevin Roche on Monday, January 3, 2011
The expansion in government encouraged HIT, particularly EMRs, has researchers busy trying to identify cost and quality effects. Another recent study suggests that the effect of EMRs on quality is complex and not necessarily always beneficial.
Tags: Health Care Quality, HIT, Hospital
New Year Potpourri or 20ll Potpourri I
by Kevin Roche on Friday, December 31, 2010
Happy New Year and a prosperous 2011 to all of you, a prosperity which undoubtedly will be aided by the insights from our Potpourris, which this week include physicians’ use of patient satisfaction data, drugs for children, Medicaid quality measures, health reform provisions taking effect in 2011 and the FDA’s rate of drug approval in 2010.
Tags: Drugs, FDA, Health Care Quality, Health Care Reform, HIT, Medicaid, Medicare, Physicians
Disease Management Lessons from Germany
by Kevin Roche on Thursday, December 23, 2010
Attention to management of chronic diseases is a common feature of health systems around the world. Germany has implemented an approach which is focused through primary care physicians and has shown both quality improvement and cost savings.
Tags: Disease Management, Health Care Costs, Health Care Quality
Hospital Quality Performance Measures
by Kevin Roche on Wednesday, December 22, 2010
A new study reported in the New England Journal of Medicine looked at common methods of calculating hospital mortality rates and found significant variation in the results, which has significant implications for the usability of this frequently used quality metric.
Tags: Health Care Quality, Hospital
Use and Misuse of Imaging
by Kevin Roche on Tuesday, December 21, 2010
Health Affairs carries several articles analyzing imaging use, particularly in regard to physician interests in imaging equipment. The findings support the idea that physicians are often driven by their own economic advantage when making decisions about patient treatment.
Tags: Care Management, Health Care Costs, Health Care Quality, Physicians
2010 Potpourri XLIV
by Kevin Roche on Saturday, December 18, 2010
Another week, another Potpourri, this one detailing items including high deductible insurance and delay of care; another study looking at HDHP and well-child care; a quality comparison of Medicare Advantage and fee-for-service; video games to improve health and CMS’ report on several quality demonstrations.
Tags: Care Management, Consumers, Health Care Quality, HIT, Medicare
Abandoned Prescriptions
by Kevin Roche on Wednesday, December 8, 2010
Prescriptions written by doctors and transmitted to pharmacies are not always picked up by patients. New research examines the factors that appear to be linked to, if not causative of, such prescription abandonment.
Tags: Consumers, Drugs, Health Care Costs, Health Care Quality
Home Is Where the Care Is
by Kevin Roche on Thursday, October 28, 2010
The complexity and rate of change in health care sometimes makes spotting major trends difficult. One appears to be growth of home-based diagnostic and therapeutic care. An article in the New England Journal of Medicine discusses drivers for this trend.
Tags: Care Management, Consumers, Health Care Costs, Health Care Quality, HomeCare, Telemedicine
Process of Care and Health Outcomes
by Kevin Roche on Wednesday, October 20, 2010
As the use of pay-for-reporting and pay-for-performance grows, there is more research into whether care processes being measured are really related to ultimate health outcomes. A new article says not necessarily.
Tags: Care Management, Health Care Quality, Hospital, Medicare, Pay For Performance
IOM’s Report on Nursing
by Kevin Roche on Monday, October 18, 2010
The Institute of Medicine’s report on The Future of Nursing discusses many issues, but one that catches the eye relates to the role of restrictions on nurse scope of practice in impeding better access and lower costs.
Tags: Health Care Costs, Health Care Quality, Physicians, Providers
Why Do We Have Worse Survival Rates?
by Kevin Roche on Wednesday, October 13, 2010
Health spending is high in the United States compared to other industrial countries. Quality, based on health outcomes such as survival or mortality, appears to be worse. A new article probes the reasons why, but may have some flaws.
2010 Potpourri XXXVII
by Kevin Roche on Saturday, October 9, 2010
The regular weekend lineup of health care news, including doctors trying to limit nurse anesthetists’ practices; text messaging for teenager dermatitis patients; Hewitt’s cost projections for 2011; physicians and the internet; how to calculate MLRs and use of incentive pay for physicians.
Tags: Health Care Quality, Health Insurance, Physicians, Regulation, Telemedicine
Quality of Care and Patient Satisfaction
by Kevin Roche on Thursday, October 7, 2010
There has been a major push to expand measurement of provider quality, as defined by process of care and outcomes. A study suggests that having good quality doesn’t necessarily mean patients will be more satisfied.
Tags: Consumers, Health Care Quality, Providers
New Papers on the Medical Home
by Kevin Roche on Thursday, September 30, 2010
Two recent publications explore the potential of widespread use of the medical home concept to create better primary care and coordination of overall care for patients, and examine barriers and challenges for adoption.
Primary Care Cost and Quality
by Kevin Roche on Monday, September 27, 2010
The Dartmouth Atlas researches whether more primary care necessarily leads to better quality of care. The answer appears to be usually not, but the explanation for this result is complex and it may not be as simple as cause and effect.
Tags: Consumers, Health Care Quality, Medicare, Physicians
Medicare Advantage Quality Ratings
by Kevin Roche on Friday, September 24, 2010
CMS is very enamored of quality ratings for providers of all types, including the Medicare Advantage plans, which are rated on a five-star basis. A new brief examines changes to this rating program.
Tags: Health Care Quality, Medicare, Regulation
2010 Potpourri XXXIII
by Kevin Roche on Saturday, September 11, 2010
Fall is a lovely time of year and what could be better than relaxing with a Potpourri, featuring health insurance increases, the true costs of EHRs, hospital pay-for-performance programs and quality, the impact of social networks on health behavior, and unenrolled Medicaid-eligible children.
Tags: Consumers, Government, Health Care Costs, Health Care Quality, HIT, Hospital, Medicaid, Pay For Performance, Workplace
CDHP Study by GAO
by Kevin Roche on Thursday, September 9, 2010
Fears have been expressed that increasing CDHP enrollment puts people at risk for skipping necessary health services. The GAO looked at this population and found healthier people enrolled and they spent less after enrollment than non-CDHP members.
Tags: Consumer Directed Health, Health Care Costs, Health Care Quality, Health Insurance
Using Nurses Instead of Doctors
by Kevin Roche on Wednesday, September 8, 2010
Research shows that allowing nurse anesthetists to do their jobs without physician supervision does not pose additional risk to patients. Regulations and laws which limit this ability should therefore be eliminated.
Tags: Health Care Costs, Health Care Quality, Medical Care, Regulation
Hospital Process of Care Measures and Outcomes
by Kevin Roche on Tuesday, September 7, 2010
A new study of the association between process of care measures and health outcomes for certain hospital episodes has encouraging results for pay for reporting and pay for performance programs.
2010 Potpourri XXXII
by Kevin Roche on Saturday, September 4, 2010
We have certainly labored over the Labor Day weekend version of the Potpourri, featuring relative performance of US and foreign medical school graduates, California health insurance hikes, non-for-profit hospital CEO pay, performance measures and outcome variation at hospitals related to cost, new reimbursement methods and physician cost profiling.
Tags: Health Care Costs, Health Care Quality, HIT, Hospital, Physicians
More On Palliative Care
by Kevin Roche on Wednesday, August 25, 2010
Palliative care has been extensively researched and the results indicate greater quality of life and patient satisfaction for persons with terminal illness. New research suggests it also extends survival.
2010 Potpourri XXX
by Kevin Roche on Saturday, August 21, 2010
Another selection of medical delights, including a telemedicine study that didn’t show improved outcomes, a telemedicine study that demonstrated the value of teleaudiology, end-of-life care, physician quality measurement, hospital quality measurement, and telemedicine for CHF patients.
Tags: Health Care Quality, Hospital, Medical Care, Physicians, Telemedicine
End-of-Life Care
by Kevin Roche on Wednesday, August 4, 2010
The New Yorker carries an exceptional article by Atul Gawande on end-of-life care, highlighting irrational reimbursement policies and the difficult decisions that both patients and providers must make.
Tags: Health Care Costs, Health Care Quality, Medical Care, Physicians
Process Measures and Quality Improvement
by Kevin Roche on Wednesday, July 28, 2010
A study in JAMA suggests that process-of-care quality measures, which are frequently used for bonus or penalty reimbursement programs, may have little real relationship to ultimate health outcomes.
Tags: Health Care Quality, Medical Care
The US Health System Stinks…Or Does It?
by Kevin Roche on Thursday, July 1, 2010
The Commonwealth Fund issues one of its regular reports designed to demonstrate how bad the US health system is compared to those of other developed countries. Unfortunately, the report is based almost exclusively on subjective survey data and fails to provide any adjustments to create a truer picture of the status of our system vis-a-vis others.
Tags: Government, Health Care Costs, Health Care Quality, Health Care Reform
2010 Potpourri XIX
by Kevin Roche on Saturday, May 29, 2010
Summer is starting and you are just laying around at the beach or the lake, eager to get a few missed health care tidbits. Here they are! Telemedicine, health reform, employer provided health insurance, computers providing health care and a nice merger.
Tags: aquisitions, Health Care Quality, Health Care Reform, Health Insurance, HIT, Telemedicine
2010 Potpourri XIII
by Kevin Roche on Saturday, April 17, 2010
More exotic gleamings from the world of health care, including self-directed care, telemedicine, point-of-care diagnostics, HCA, doctor-patient interactions and socio-economic factors in health outcomes.
Tags: Care Management, Consumers, Diagnostics, Health Care Quality, Physicians, Telemedicine
Hospital Costs and Quality
by Kevin Roche on Wednesday, March 10, 2010
Following up on similar research, an article delves into the relationship between hospital costs and quality, finding inconsistent associations between high cost and better quality. It does not appear that low-cost hospitals have higher readmission rates and greater downstream costs.
CDC Health Status Report
by Kevin Roche on Tuesday, March 2, 2010
The Centers for Disease Control issues a massive compendium of health facts and information called Health United States 2009. In addition to basic information regarding health care, it has some description and analysis of particular issues such as use of medical technology.
Tags: Devices, Government, Health Care Costs, Health Care Quality
More Breast Cancer Screening Controversy
by Kevin Roche on Thursday, January 28, 2010
The recommended schedule for mammography screenings to detect breast cancer is examined in a Cochrane report, which finds that the current recommendation probably leads to overdiagnosis and treatment and the women are not being properly presented with the overall risks and benefits.
Tags: Comparative Effectiveness, Health Care Costs, Health Care Quality, Wellness and Prevention
EHRs and Quality
by Kevin Roche on Friday, October 23, 2009
A study finds a modest link between fully functional EHRs and performance on HEDIS quality measures by Massachusetts physicians.
Tags: Health Care Quality, HIT, Medical Care
Shared Decision Making
by Kevin Roche on Tuesday, June 23, 2009
Shared decision-making for preference-sensitive conditions has the potential to improve quality and control spending. States are exploring required use of the technique and it should be considered in federal reform efforts.
Tags: Care Management, Consumers, Health Care Costs, Health Care Quality, Health Insurance
Cost/Quality Relationship Unclear
by Kevin Roche on Wednesday, May 27, 2009
A study reported in Health Affairs, vol. 28, page 897 (May/June 2009), provides a further input to the question of the relationship, if any, between costs and quality in health care.
Tags: Health Care Costs, Health Care Quality, Hospital, Medical Care, Medicare
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