Posts Tagged “Hospital”
ShowHide 3rd Party PapersNew England Journal of Medicine: The Emerging Importance of Patient Amenities in Hospital Care
HealthLeaders Media: Leading hospital systems that have seen the value of growth from mergers and acquisitions share insights and lessons learned
Urban Institute: How will hospitals be affected by health care reform?
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.
CA Health Care Almanac: California Hospital Facts and Figures
ShowHide Commentary
2012 Potpourri V
by Kevin Roche on Friday, February 3, 2012
Another Potpourri brimming with doses of useful information that you eagerly await each week, including Medicare special needs plans and patients with diabetes, health information technology venture capital funding and M & A, identifying overuse in health care, what makes a better medical group, does merging weak hospitals help them and interventions that appear to work to prevent development of diabetes.
Tags: Care Management, Chronic Disease, Financings, Health Care Costs, Hospital, M&A, Medicare, Physicians
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
AHA Guidelines on Hospital Ownership Changes
by Kevin Roche on Wednesday, January 25, 2012
The American Hospital Association releases its Principles and Guidelines for Changes in Hospital Ownership, which recognize and attempt to ameliorate the public concerns about the effects of hospital consolidation or for-profit conversions of hospitals.
Tags: Health Care Costs, Hospital
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
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
Hospital Cost Components
by Kevin Roche on Wednesday, December 14, 2011
Inpatient hospital costs are the largest single category of health care costs and account for much of the last decade’s rapid annual rise in health care spending. A statistical brief from the HCUP project examines components of hospital costs to ascertain sources of growth. Cost per stay is the largest single cause of rising hospital inpatient costs.
Tags: Health Care Costs, Hospital
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
Hospital in the Home Analysis
by Kevin Roche on Thursday, December 8, 2011
An intriguing concept is explored in a paper from Deloitte: would it be possible to move some services typically delivered in a hospital to the patient’s home. Based on pilot’s in Australia, the paper suggests that savings can be achieved, with no apparent threat to quality or patient safety.
Tags: Health Care Costs, HomeCare, Hospital
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
Hospital Transition Care
by Kevin Roche on Thursday, November 10, 2011
It stands to reason that a care transition program will improve outcomes in regard to hospitalized stroke and heart attack patients, but an AHRQ research review finds little solid evidence that this is the case for most types of care transition interventions.
Tags: Care Management, Disease Management, HomeCare, Hospital
2011 Potpourri XXXXIII
by Kevin Roche on Friday, November 4, 2011
Winter nears but our Potpourri will distract you from the cold breezes, providing compelling nuggets on prostate screening recommendations, consumer use of technology for health, insurer medical cost trends, what to do about Medicare’s physician payments, heart failure hospitalization and mortality rates and rates of non-filling of new prescriptions.
Tags: Chronic Disease, Disease Management, Drugs, Health Care Costs, Health Insurance, HIT, Hospital, Medicare, Physicians, Telemedicine, Wellness and Prevention
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
Predicting Readmissions
by Kevin Roche on Monday, October 31, 2011
Hospital readmissions are targeted as a quality metric and a reimbursement adjustment. The program used by CMS in particular appears flawed, and a recent study examining readmission-risk models supports that conclusion.
Tags: Hospital, Medicare, Readmisssions
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
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
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.
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
Maryland’s Hospital Payment System
by Kevin Roche on Monday, September 26, 2011
Maryland is unique among the states in having an all-payer hospital rate regulation system. The most recent report on the system’s performance shows that it is continuing to constrain the grow of hospital spending. Payers, hospitals and patients seem happy with the system.
Tags: Health Care Costs, Hospital, Regulation
2011 Potpourri XXXVII
by Kevin Roche on Friday, September 23, 2011
Another wonderful collection of health care research summaries, including a GAO report on likely effects of the MLR rule, physician work intensity, reducing hospital-acquired infections, discharge followup and hospital readmissions, the effect of pay-for-performance on cardiac care and use of EHRs and health history recording.
Tags: EHRs, HAI, Health Care Reform, HIT, Hospital, MLR, Pay For Performance, Physicians, Readmissions
Hospital Readmissions
by Kevin Roche on Wednesday, September 21, 2011
A paper prepared by Mathematica for the New York State Health Foundation discussions readmissions in the state and evaluates proposed methods of reducing those readmissions. Just in New York, billions of dollars could potentially be saved by effective interventions.
Tags: Health Care Costs, Hospital, Readmissions
Health Plan and Hospital Market Concentration
by Kevin Roche on Tuesday, September 20, 2011
Hospitals and other providers have expressed concern that health plan consolidation jeopardizes the adequacy of reimbursement to providers but a new piece of research indicates that hospital consolidation is a much greater threat to attempts to control health spending.
Tags: Health Care Costs, Hospital
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
2011 Potpourri XXXV
by Kevin Roche on Friday, September 9, 2011
Fall looms and brings the football season. Our Potpourri scores with nutritious bites of health information, including getting more genetic data into medical records, giving doctors price lists, the value of HIEs, reducing hospital costs, medication continuation after hospitalization and use of episode-based payments.
Tags: Genomics, Health Care Costs, HIT, Hospital, Personalized Medicine, Physicians, Reimbursement
2011 Potpourri XXXIV
by Kevin Roche on Friday, September 2, 2011
A dazzling review of recent research and other health related nuggets is presented in this latest Potpourri, including potential problems with evidence-based medicine, physician dilemmas in controlling cost, workers’ compensation medical costs, reducing hospital infections, improving heart attack care and the growth of CDHPs.
Tags: Comparative Effectiveness, Consumers, Health Insurance, Hospital, Medical Care, Physicians, Workplace
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
Hospital Employment of Physicians
by Kevin Roche on Wednesday, August 24, 2011
An issue brief from the Center for Studying Health System Change reviews the potential effects of increasing employment of physicians by hospitals. While there may be benefits in terms of greater care integration, the trend also will likely drive up spending.
Tags: Health Care Costs, Hospital, Physicians
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
Hospital Pricing Behavior and Market Characteristics
by Kevin Roche on Monday, August 8, 2011
Further evidence that hospitals with market power raise prices almost at will and disregard opportunities to cut costs is provided by research reported in Health Affairs. Hospitals in concentrated markets have enormous margins on their private insurers payments.
Tags: Health Care Costs, Health Insurance, Hospital, Medicare
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
2012 Medicare Payment Rules
by Kevin Roche on Thursday, July 28, 2011
Each year CMS issues proposed, and ultimately final, rules relating to reimbursement for various categories of providers in the next year. The 2012 rules have a wealth of background and other information in them, including significant detail on the increasingly important quality measurement programs.
Tags: Hospital, Medicare, 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
Savings from Home Health Use
by Kevin Roche on Wednesday, July 6, 2011
A study finds that using home health care after a hospital admission for Medicare beneficiaries with certain chronic illnesses reduces Medicare Part A spending and readmissions compared to a beneficiary group that used other post-discharge services.
Tags: Elder Care, Health Care Costs, HomeCare, Hospital, Medicare
2011 Potpourri XXVI
by Kevin Roche on Friday, July 1, 2011
Fireworks galore for the Fourth of July Potpourri, including dynamite excerpts on the effects of parent caregiving on caregivers’ financial status; health insurance exchanges; physician compensation; provider performance data gathering and use; hospital market concentration; use of HIT in nursing homes and teen use of health websites.
Tags: Consumers, Elder Care, Health Care Costs, Health Care Reform, Health Insurance, HIT, Hospital, Meaningful Use, Pay For Performance, Physicians, Telemedicine
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
2011 Potpourri XXIII
by Kevin Roche on Friday, June 10, 2011
Another scintillating menu of health care tidbits, including provider reaction to the proposed Accountable Care Organization rule; end-of-life care in the US and Canada; hospital volume and outcomes for difficult surgeries; hospital marketing of robotic surgery; and cutting lab test costs.
Tags: ACO, Elder Care, End-of-Life Care, Health Care Costs, Hospital
Massachusetts Provider Price Variation
by Kevin Roche on Wednesday, June 8, 2011
A new report on prices paid by commercial insurers in Massachusetts shows great variation, which appears unrelated to providers’ costs or to the quality of care delivered. While the specific causes of the variation aren’t analyzed, a large opportunity to limit spending by reducing high-end payments is apparent.
Tags: Health Care Costs, Health Insurance, Hospital, Physicians
2011 Potpourri XXI
by Kevin Roche on Friday, May 20, 2011
Once more into the world of health care to find nuggets of useful information, this week including the legality of wellness programs, the switch to ICD-10, pragmatic trials, the status of the workers’ comp industry, consumer health care sentiment, and hospital ER strategies.
Tags: Comparative Effectiveness, Consumers, Health Care Costs, HIT, Hospital, Wellness and Prevention, Workplace
Milliman’s Annual Health Care Cost Report
by Kevin Roche on Monday, May 16, 2011
The 2011 Milliman Medical Index was released, showing a 7.3% increase for a family of four covered by an employer sponsored PPO plan. Premium share and other out-of-pocket payments continue to rise faster than overall cost and unit prices, especially for hospital services, are the main source of the continued higher spending.
CMS Hospital Payment for 2012
by Kevin Roche on Wednesday, May 11, 2011
CMS’ proposed rule and explanations for hospital payments for 2012 are lengthy but as usual give a great background on the issues that go into the payment elements. Hospital payments are slated for at best a very modest increase.
Tags: Health Care Costs, Hospital, Medicare
Hospital Spending
by Kevin Roche on Monday, May 9, 2011
A brief from the Agency for Healthcare Research and Quality looks at hospital charges in the United States, which accounted for 31% of total health care expenditures. Spending by payer and condition are detailed.
Tags: Health Care Costs, Hospital
Hip Replacements
by Kevin Roche on Thursday, April 28, 2011
Hip replacement is one of the most pervasive orthopedic procedures, particularly among older Americans. Research among Medicare beneficiaries reveals trends over 18 years, finding lower mortality, but potential issues on site of discharge and readmissions.
Tags: Care Management, Elder Care, Hospital, Medicare
Outpatient Services
by Kevin Roche on Wednesday, April 27, 2011
The Agency for Healthcare Research & Quality released a Statistical Brief looking at physician visits, finding variance in cost and out-of-pocket expense, depending on the setting.
Tags: Health Care Costs, Hospital, Physicians
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
2011 Potpourri XVI
by Kevin Roche on Friday, April 15, 2011
Happy Easter and welcome to our spring kickoff potpourri, complete with a survey on technology use by consumers; brand drug pricing; how to get individuals to purchase health coverage; views of the Massachusetts reforms; hospital pay-for-performance and use of PHRs.
Tags: Consumers, Drugs, Health Care Reform, Health Insurance, HIT, Hospital, Pay For Performance
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
Hospital-Employed Physicians
by Kevin Roche on Thursday, April 7, 2011
A NEJM article notes the increasing employment of doctors by hospitals, even though the hospitals usually lose money on the practice in the short-term. The effects of this trend on the costs and quality of care are explored.
Tags: Health Care Costs, Hospital, Physicians
2011 Potpourri XIII
by Kevin Roche on Friday, March 25, 2011
Another edition of the Potpourri, featuring results on the Guided Care program, bundled payment experience, academic physician compensation, end-of-life care, hospital prices and costs, and geographic variation in Medicare spending.
Tags: Care Management, Chronic Disease, Disease Management, Elder Care, Health Care Costs, Hospital, Physicians
MedPAC Comments on Hospital Value Based Purchasing Rule
by Kevin Roche on Monday, March 21, 2011
The Medicare Payment Advisory Commission commented on the Medicare program’s proposed rule for a hospital value-based purchasing initiative, generally agreeing with CMS’ recommendations.
Tags: Hospital, Medicare, Pay For Performance
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
Price Transparency’s Consequences
by Kevin Roche on Wednesday, March 16, 2011
Is it always better for providers of health care to have to fully disclose their actual charges to various payers? A NEJM Perspective suggests that it may not be and that other forms of disclosure may be more useful.
Tags: Consumers, Health Care Costs, Hospital
2011 Potpourri X
by Kevin Roche on Friday, March 4, 2011
Hopefully winter nears its end; it has been brutal where we are. This week’s Potpourri may offer a little diversion, covering defensive medicine, a pediatric tele-consultation service, home stroke rehabilitation, consumers’ ability to afford care, patient satisfaction and hospital readmission rates and a mobile phone app to improve medication adherence.
Tags: Care Management, Drugs, Health Care Costs, HomeCare, Hospital, Telehealth
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
2011 Potpourri IV
by Kevin Roche on Friday, January 21, 2011
On we go into the New Year, already on our fourth Potpourri, this one rich with information on state Medicaid program issues; what makes for a successful wellness program; what makes for a well-run hospital; pushing back on too much medical care; the value of colonoscopy and walking faster to live longer.
Tags: Elder Care, Hospital, Medicaid, Physicians, Wellness and Prevention
Hospitalizations for Seniors
by Kevin Roche on Tuesday, January 4, 2011
The Agency for HealthCare Research & Quality released a brief on hospitalizations among the elderly. This category of service accounts for a significant and growing portion of national health spending and warrants attention if Medicare costs are to be contained at an affordable level.
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
More on Hospital Pricing
by Kevin Roche on Thursday, December 30, 2010
America’s Health Insurance Plans piles on hospitals in regard to their pricing, using data from Oregon and California. The analysis might be more persuasive if it weren’t coming from a trade association, but it is further evidence of a major source of health care cost increases.
Christmas Potpourri
by Kevin Roche on Friday, December 24, 2010
A very happy and relaxing Christmas Eve and Day to all our readers. To aid in the pursuit of that happiness and relaxation we offer up our scraps of enlightenment, this week covering EHR impact on productivity, e-prescribing systems, health insurance rate reviews, not-for-profit hospital executive compensation, Oregon’s state health plan and use of placebos to improve health.
Tags: Consumers, Drugs, Health Care Costs, Health Insurance, HIT, Hospital, Meaningful Use, Medicaid, Physicians
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
2010 Potpourri XLIII
by Kevin Roche on Saturday, December 11, 2010
The snow is raging here in Minneapolis, but nothing stops the delivery of our Potpourri, which includes discussion of paybacks on EHRs, the fate of dialysis patients, use of telecommunciations to aid drug adherence, cost savings from select pharmacy networks and hospital readmissions.
Tags: Chronic Disease, HIT, Hospital, Medicare, Pharmaceutical, Telemedicine
TeleCare in the ICU
by Kevin Roche on Monday, December 6, 2010
New research from the New England Healthcare Institute examines use of telemonitoring of ICU patients and finds that it produces good outcomes and could create substantial cost savings in the state of Massachusetts alone.
Tags: Care Management, Hospital, Telemedicine
Cancer Care Variation
by Kevin Roche on Wednesday, November 24, 2010
The Dartmouth Atlas project has issued numerous reports on variation in health spending across the United States. The most recent report focuses on cancer care for terminal patients and once again finds substantial difference in resource use both across and within geographic regions.
Tags: Hospital, Medical Care, Physicians
GAO on Integrated Delivery Systems
by Kevin Roche on Tuesday, November 23, 2010
The Government Accounting Office interviewed representatives of a number of integrated provider systems to ascertain features, purported benefits in assisting underserved populations and challenges to the success of the organizations.
Tags: Care Management, Hospital, Physicians
More on Hospital Pricing Power
by Kevin Roche on Saturday, November 20, 2010
Another study, this time from the Center for Studying Health System Change, suggests that hospital market power plays a substantial role in health care cost increases and discusses some possible options to address the problem.
Tags: Health Care Costs, Hospital
The Most Costly Hospital Stays
by Kevin Roche on Monday, November 1, 2010
AHRQ released a report on high-cost hospitalizations, demonstrating the concentration of spending on a relatively few cases. The diagnoses are what would be expected and it is unclear how these hospitalizations might be avoided.
Tags: Health Care Costs, Hospital
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
2010 Potpourri XXXVIII
by Kevin Roche on Saturday, October 16, 2010
More health care tidbits in this week’s potpourri, including medication adherence; the benefits of workplace wellness programs; the costs to employers of obesity; hospital prices in Oregon; reimbursement methods for drugs and potential savings from health IT.
Tags: Drugs, Health Care Costs, HIT, Hospital, Providers, Wellness and Prevention
More Group Purchasing Organization News
by Kevin Roche on Thursday, October 14, 2010
A medical device manufacturers’ trade association publishes sponsored research on the effect of GPOs on costs, concluding that hospitals would be better off to buy directly from the manufacturers or to restructure how GPOs are paid.
Tags: Health Care Costs, Hospital
Watch Out for those HIT Systems
by Kevin Roche on Friday, October 8, 2010
Spurred by government funds and regulations, the medical world is rushing to implement electronic records and other functionality. The consequences may not always be great, as a recent study suggests.
Tags: HIT, Hospital, Malpractice
GAO Group Purchasing Organization Report
by Kevin Roche on Monday, October 4, 2010
Hospitals and other providers often use group purchasing organizations to facilitate obtaining goods and services at better prices and other terms. A GAO report looks at some of the business practices of these organizations.
Tags: Health Care Costs, Hospital, Regulation
2010 Potpourri XXXVI
by Kevin Roche on Saturday, October 2, 2010
The days shorten but the potpourri stays strong, this week including information on the safety of FDA-cleared devices; medication adherence; genetic tests; the FDA and CMS working together to review products; state all-payer databases and the increasing control of physician practices by hospital systems.
Tags: Care Management, Devices, Drugs, Health Care Costs, HIT, Hospital, Medicare, Personalized Medicine, Physicians, Regulation
Accessing Acute Care and Avoiding the ER
by Kevin Roche on Friday, September 17, 2010
Health Affairs publishes several studies addressing inappropriate use of the emergency room, finding that many visits could be dealt with in other settings, but that higher copays may not deter inappropriate use.
Tags: Access, Consumers, Health Care Costs, Hospital
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
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
Virtual Hospital Wards
by Kevin Roche on Friday, September 3, 2010
A Commonwealth Foundation Brief describes a “virtual ward” model developed in Great Britain to minimize hospitalizations for chronic disease patients. Early results are encouraging and similar models are being tried in the United States.
Tags: Chronic Disease, Hospital, Medical Care, Telemedicine
2010 Potpourri XXXI
by Kevin Roche on Saturday, August 28, 2010
Summer nears an end, but not our Potpourris. This one includes the costs of malpractice, an innovative provider error disclosure program, employer wellness paybacks, blood pressure medication issues, the cost of new technologies, provider pricing power and the mental health of Californians.
Tags: Care Management, Health Care Costs, Hospital, Malpractice, Personalized Medicine, Wellness and Prevention
Emergency Room Use
by Kevin Roche on Tuesday, August 24, 2010
A study discusses trends in the use of emergency rooms. Medicaid beneficiaries are the vast majority of the increase in utilization, which may reflect poor access to primary care or inappropriate health care seeking behavior.
Tags: Health Care Costs, Hospital, Medicaid, Medical Care
More on EHR Benefits
by Kevin Roche on Monday, August 23, 2010
New research adds more caution to the promotion of great benefits from electronic medical records. The researchers found that in hospitals, costs actually increased and quality worsened by some measures, although improving by others.
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
Massachusetts Reports
by Kevin Roche on Tuesday, August 3, 2010
Although its reform effort appears to have gone amok, largely for cost reasons, the state of Massachusetts is producing a lot of useful data and research on medical service delivery, including three recent ones on avoidable emergency room and hospital use and the state of primary care services.
Tags: Health Care Costs, Health Care Reform, Hospital, Physicians
2010 Potpourri XXV
by Kevin Roche on Saturday, July 17, 2010
Another week, another potpourri, this time with items on workers’ compensation drug spending, benefit consulting firm mergers, hospital readmissions, geographic variation in spending and use of mobile vans to deliver health care.
Tags: Drugs, Health Care Costs, Hospital, M&A, Medical Care, Workers Compensation
2010 Potpourri XXIV
by Kevin Roche on Saturday, July 10, 2010
Sitting indoors seeking relief from the summer heat? Here’s a montage of cool and refreshing health care items, including CPOE systems, accountable care organizations, Massachusetts’ reform experience, reducing imaging, and medical management trends.
Tags: Care Management, Government, Health Care Reform, HIT, Hospital, Medical Care
Hospital Pay-for-Performance Programs
by Kevin Roche on Tuesday, July 6, 2010
Medicare has an impending value-based purchasing program for hospitals. Payments would be based on performance against quality standards. Some hospitals ability to improve performance may be limited by the economic and workforce characteristics of their location, according to new research.
Tags: Hospital, Medicare, Pay For Performance
Services With Increasing Costs
by Kevin Roche on Wednesday, June 30, 2010
Where does all that health spending go and what areas are incurring some of the largest increases? An AHRQ statistical brief looks at hospital costs from 2001 and 2007 and identifies the ten fastest growing diagnoses by cost in that period.
Better Followup May Not Prevent Hospital Readmissions
by Kevin Roche on Tuesday, June 29, 2010
A common perception is that there are too many hospital readmissions which could be prevented with better discharge planning. A new study indicates that scheduling follow-up visits may not help prevent readmissions, most of which are unrelated to the original admisssion in any event.
Tags: Care Management, Hospital
2010 Potpourri XXIII
by Kevin Roche on Saturday, June 26, 2010
Once more into the breach with the Saturday health care roundup, including medication adherence, monitoring patients’ health status in their homes, Massachusetts’ reform update and insurance costs, hospitals’ economic contribution, hospital cost shifting and consumers’ views on use of health IT.
Tags: Drugs, Health Care Costs, Health Care Reform, Health Insurance, HIT, HomeCare, Hospital, Monitoring, Telemedicine
Physician Compensation
by Kevin Roche on Friday, June 11, 2010
An MGMA survey and an article based on the survey provide a look at where physician employment and compensation is headed. Hospitals look to be extending their power and leverage.
Tags: Hospital, Physicians
Heart Failure Hospitalizations
by Kevin Roche on Friday, June 4, 2010
Research reported in JAMA suggests that while lengths of stay and in-hospital deaths for heart failure patients covered by Medicare have fallen, readmissions and out-of-hospital deaths are up. While the authors suggest some cause and effect, that is not likely the case.
Tags: Hospital, Medical Care
Hospital Readmissions
by Kevin Roche on Monday, May 24, 2010
Hospital readmissions are one area of health spending being studied intensively to identify causes and possible solutions to inappropriate or avoidable rehospitalizations. A California agency issued a report on readmissions in that state.
Tags: Health Care Costs, Hospital
Using Technology to Limit Medication Mistakes
by Kevin Roche on Tuesday, May 11, 2010
Errors in medication are far more common than might be imagined and cause serious adverse events. A NEJM article reports on efforts to use technology to limit such errors in hospitals.
Hospital Charges to the Uninsured
by Kevin Roche on Monday, May 10, 2010
The plight of the uninsured was used as one justification for reform. AHRQ has put out a report on trends in hospitalizations for the uninsured over the last ten years, which highlights some interesting facts.
Tags: Health Insurance, Hospital
Hospital Readmissions
by Kevin Roche on Thursday, May 6, 2010
A study in JAMA explores hospital readmissions for Medicare beneficiaries, finding that there is significant variation in discharge planning and follow-up, and that early attention to care after discharge leads to lower readmissions.
Tags: Hospital, Medical Care
2010 Potpourri XV
by Kevin Roche on Saturday, May 1, 2010
The latest in our weekend selection of health news and research developments, including any willing provider laws, emergency room visits, the link between insurance and health outcomes, hospital rankings and rising insurance premiums.
Tags: Health Insurance, Hospital, Medical Care, Providers
Hospital Value
by Kevin Roche on Thursday, April 29, 2010
Milliman, Inc. is a very prominent and capable actuarial firm which does excellent research on health care issues. The firm released a report on high, and low, value hospital regions, focusing on spending as the indicia of value.
Tags: Health Care Costs, Hospital
High Performance Health Systems
by Kevin Roche on Wednesday, April 28, 2010
The Commonwealth Fund, the Health Research & Educational Trust and the American Hospital Association issued an analysis of what contributes to a high performance hospital system in terms of patient safety and outcomes. Culture is paramount.
Tags: Hospital, Medical Care
2010 Potpourri XIV
by Kevin Roche on Saturday, April 24, 2010
Another thrilling collection of health care tidbits; including patient safety, malpractice claims, physician discipline, hospital costs and charges, venture financings, employer health costs and who makes good liars.
Tags: Financings, Health Insurance, Hospital, Malpractice, Physicians
2010 Potpourri XII
by Kevin Roche on Saturday, April 10, 2010
The latest collection of health care tidbits, including telemedicine, physician attitudes, medication adherence, retail clinics, physician value to hospitals and CDHPs.
Tags: Consumer Directed Health, Drugs, Health Insurance, Hospital, Physicians, Telemedicine
Volume and Quality in Hospital Procedures
by Kevin Roche on Monday, April 5, 2010
For some years researchers have examined the link, if any, between the volume of a certain type of procedure or service at a hospital and outcomes. A new study published in NEJM extends that research, finding that at a certain level volume is associated with lower mortality.
Tags: Health Care Reform, Hospital
2010 Potpourri XI
by Kevin Roche on Saturday, April 3, 2010
This week’s collection includes obesity, clinical trials results, how hospitals make money from physicians, strategic implications of reform, what reform is likely to do to young people’s insurance premiums and patents on genes. Enjoy!
Tags: Consumers, Health Care Reform, Health Insurance, Hospital, Physicians
The Massachusetts Debacle
by Kevin Roche on Tuesday, March 30, 2010
The Massachusetts Attorney General’s final report on what is driving health care cost increases in Massachusetts confirms the preliminary version’s finding that most of the spending rise is due to nothing more than application of raw provider market power to extract high prices from private payers. Another report also examines hospitals’ pricing practices.
Tags: Health Care Costs, Health Care Reform, Hospital, Physicians
More on Hospital Costs and Pricing
by Kevin Roche on Monday, March 29, 2010
Health Affairs publishes a study with a creative approach to understanding hospital costs, hospital pricing, Medicare payments and market power. The authors’ conclusion is that profitable hospitals have higher expenses because they have more money to spend, and those higher expenses may make them look unprofitable in regard to Medicare payments.
Tags: Health Care Costs, Hospital
Hospital Trends
by Kevin Roche on Thursday, March 25, 2010
Hospitals have increasingly become the hub for medical services in many communities. Trends relating to hospitals are therefore of significant interest. A recent article gives a perspective on some of those trends.
Tags: Hospital
2010 Potpourri X
by Kevin Roche on Saturday, March 20, 2010
More weekend reading, in case spring hasn’t arrived where you are, covering personalized medicine, the OIG’s unheeded recommendations, robot surgery, hospital costs, venture funding and telemedicine.
Tags: Financings, fraud and abuse, Hospital, Personalized Medicine, Telemedicine
2010 Potpourri IX
by Kevin Roche on Saturday, March 13, 2010
One more sampling of health care news, covering provider reaction to the EHR meaningful use rule, telemedicine, people’s perceptions of their health status and insurance coverage and hospital costs and prices.
Tags: Health Care Costs, Health Insurance, HIT, Hospital
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.
Competition Leads to Lower Hospital Costs
by Kevin Roche on Friday, February 26, 2010
Research indicates that commercial health insurance, while it has geographic variation in spending, does not vary in the same way as Medicare. A primary factor explaining private health plan geographic spending variation appears to be the state of competition for hospital services in different locales.
Tags: Health Care Costs, Health Insurance, Hospital, Medicare
Massachusetts Report on Provider Pricing Impact
by Kevin Roche on Monday, February 1, 2010
The Massachusetts Attorney General investigates and discovers that hospitals and some physicians have market power and consequently are able to demand high payments and those payments are the main cause of increases in the cost of health insurance, not utilization increases.
Tags: Health Care Costs, Hospital, Physicians
Variations in Hospital Payments in One State
by Kevin Roche on Friday, January 29, 2010
Rhode Island released a report on payments to hospitals from various sources and looked at factors accounting for significant differences in payment levels. The variation is likely entirely due to hospital bargaining power by large systems, which in turn is driving health insurance premium increases.
Tags: Health Care Costs, Hospital
Hospital Quality Improvement
by Kevin Roche on Tuesday, January 19, 2010
The Joint Commissions issued a report showing improvement in American hospitals’ quality scores. A large percent of all hospitals submitted information on several care areas, most demonstrating greater compliance with evidence-based standards. It is not clear how connected this performance is with actual health outcomes.
Tags: Hospital
AHA Information On Underpayments and Uncompensated Care
by Kevin Roche on Wednesday, December 16, 2009
The American Hospital Association has released updated information on the amount of uncompensated care delivered by community hospitals and on the degree of underpayment of costs by Medicare and Medicaid.
Tags: Hospital
Report Cards Get a Failing Grade
by Kevin Roche on Wednesday, December 9, 2009
A study suggests that hospital report cards on cardiac care in Canada did not result in significant performance improvement. Even less clear is whether they lead to better health outcomes.
Tags: Hospital, Pay For Performance
Study Says Hospital EMRs Don’t Save Money
by Kevin Roche on Wednesday, November 25, 2009
Researchers from Harvard University find that hospitals with more extensive use of electronic records have neither lower costs or better quality, but caution should be used as these researchers have a specific reform viewpoint.
Hospitals Are Surviving the Recession
by Kevin Roche on Monday, November 16, 2009
Thomson Reuters and the AHA release updated reports on hospitals, Thomson showing that their revenues and profits are improving, as are credit availability and investment portfolios, while the AHA continues to paint a fairly dire picture.
Tags: Hospital
More Variation in Spending Research
by Kevin Roche on Monday, October 19, 2009
A study reported in Circulation indicates that California teaching hospitals that utilize more resources in treating heart failure had lower rates of mortality. The study results call into question the methods and findings of some Dartmouth Atlas research. Another report looks at supply and variation in MRI usage.
Tags: Care Management, Health Care Costs, Hospital, Medical Care, Providers
The Advantage of Medicare Advantage
by Kevin Roche on Friday, September 25, 2009
AHIP presents evidence on the value of Medicare Advantage plans in delivering more efficient and effective care.
Tags: Government, Health Care Costs, Health Care Reform, Health Insurance, Hospital
Maryland’s Approach to Hospital Pricing
by Kevin Roche on Friday, September 18, 2009
A WSJ articles reports on Maryland’s experience with hospital price controls.
Looking at Hospital Input Costs
by Kevin Roche on Friday, August 14, 2009
One relatively unexplored method for reducing health spending is lowering providers’ input costs. A New York Times article examines one category of hospital costs.
Tags: Health Care Costs, Hospital, Providers
Hospital Trade Association Survey Results
by Kevin Roche on Friday, July 24, 2009
HFMA has released its latest Financila Pulse, describing hospitals’ expectations regarding revenue and other financial results.
Tags: Hospital, Medical Care
Room for Improvement in Preventing Hospital Admissions
by Kevin Roche on Friday, May 29, 2009
The Agency for Healthcare Research and Quality’s (“AHRQ”) Healthcare Cost and Utilization Project released a report in April 2009 outlining hospitalizations that might have been preventable had the patients been receiving appropriate ambulatory care.
Tags: Health Care Costs, Hospital, Medical Care
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
An Opportunity for Birthing Quality and Cost Improvement
by Kevin Roche on Thursday, May 21, 2009
The Los Angeles Times ran an article on May 17, 2009, regarding Cesarean births. Birth services are a microcosm of the problems in the broader health system.
Tags: Government, Health Care Costs, Hospital
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For many patients, a visit to the hospital is beginning to look a lot like a stay in a luxury hotel