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
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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