Debate Heightens Over Measuring Health-Care Quality – WSJ

January 31, 2015

“Measurement fatigue is a real problem in hospitals,” said Scott Wallace, a visiting professor at Dartmouth’s Geisel School of Medicine. “But, to me, the only metric that matters is, did you get better?”

As of last year, 33 federal programs asked providers to submit data on 1,675 quality measures, according to a government count. State, local and private health plans use hundreds more.

This year, many of the federal pay-for-performance programs carry financial penalties. Hospitals and doctors stand to lose millions in Medicare payments for missing filing deadlines or improvement benchmarks in programs that track hospital-acquired infections, readmissions and electronic-record use.

In all, about 80% of traditional Medicare spending is already tied to such pay-for-performance programs. HHS Secretary Sylvia Burwell said Monday the agency wants that to increase to 90% by 2018. She also set a goal of having 50% of Medicare spending in alternative payment models, in which providers are accountable for quality and the cost of care for groups of patients.

via Debate Heightens Over Measuring Health-Care Quality – WSJ.

Medicare Advantage improves patient outcomes | TheHill

January 15, 2015

Surprisingly, despite the Medicare Advantage program’s widespread popularity and measurable success for both patients and taxpayers, Congress has repeatedly gone after this vital program with cuts that threaten its integrity and long term sustainability. Ultimately, bolstering Medicare Advantage in order to support innovative care coordination, quality patient outcomes and lower healthcare costs is a vital step for patients everywhere.

via Medicare Advantage improves patient outcomes | TheHill.

Health Insurers Map Patient Database | Industries News Press

August 5, 2014

Health-information exchanges — not to be confused with health-insurance exchanges for purchasing coverage — are networks that allow patients’ records to be shared digitally among the providers caring for them. Through an HIE, emergency physicians could quickly access the medical history of a comatose accident victim, for example, or a specialist could review past test results and avoid ordering duplicates.

In 2009, the federal government allocated nearly $550 million in fiscal-stimulus funds to spur the development of HIEs in every state. More than 300 are in operation, including some run by state governments, some formed by hospital systems that share data only among their own affiliates and some public-private hybrids.

But dozens of HIEs have closed or consolidated amid funding and logistical woes, and experts say many more could struggle when federal funding ends this year. Previous efforts to create a statewide health-data network for California have foundered, though the state has some regional and local exchanges.

via Health Insurers Map Patient Database | Industries News Press.

Public Health Insurance Expansions and Hospital Technology Adoption

July 2, 2014

This paper explores the effects of public health insurance expansions on hospitals’ decisions to adopt medical technology. Specifically, we test whether the expansion of Medicaid eligibility for pregnant women during the 1980s and 1990s affects hospitals’ decisions to adopt neonatal intensive care units NICUs. While the Medicaid expansion provided new insurance to a substantial number of pregnant women, prior literature also finds that some newly insured women would otherwise have been covered by more generously reimbursed private sources. This leads to a theoretically ambiguous net effect of Medicaid expansion on a hospital’s incentive to invest in technology. Using American Hospital Association data, we find that on average, Medicaid expansion has no statistically significant effect on NICU adoption. However, we find that in geographic areas where more of the newly Medicaid-insured may have come from the privately insured population, Medicaid expansion slows NICU adoption. This holds true particularly when Medicaid payment rates are very low relative to private payment rates. This finding is consistent with prior evidence on reduced NICU adoption from increased managed-care penetration. We conclude by providing suggestive evidence on the health impacts of this deceleration of NICU diffusion, and by discussing the policy implications of our work for insurance expansions associated with the Affordable Care Act.

via Public Health Insurance Expansions and Hospital Technology Adoption.

The Effect of Health Insurance on Near-Elderly Health and Mortality by Bernard S. Black, José-Antonio Espín-Sánchez, Eric French, Kate Litvak :: SSRN

May 13, 2014

We use the best available longitudinal dataset, the Health and Retirement Survey, and a battery of causal inference methods to provide both central estimates and bounds on the effect of health insurance on health and mortality among the near elderly initial age 50-61 over an 18-year period. Those uninsured in 1992 consume fewer healthcare services, but are not less healthy and, in our central estimates, do not die sooner than their insured counterparts. We discuss why a zero average effect of uninsurance on mortality and health is plausible, some selection effects that might explain our full results, and methodological concerns with prior studies.

via The Effect of Health Insurance on Near-Elderly Health and Mortality by Bernard S. Black, José-Antonio Espín-Sánchez, Eric French, Kate Litvak :: SSRN.

Romneycare Improved Health Outcomes, Thanks To Private-Sector Coverage

May 7, 2014

The Annals of Internal Medicine study, using a rigorous methodology, tells us something that actually isn’t very surprising: that expanding coverage using private-sector health insurance improves health outcomes. The very same medical literature that overwhelmingly highlights Medicaid’s poor outcomes also highlights the substantial benefits of private health insurance.

via Romneycare Improved Health Outcomes, Thanks To Private-Sector Coverage.

An Obamacare Fine on Overweight Americans: Discriminatory and Ineffective | The Health Care Blog

March 25, 2014

This is cause for serious concern. Not only does the change lend credence to a discredited approach to fighting obesity, but it in effect allows companies to punish their employees for pre-existing conditions, something that Obamacare was designed to avoid.

Worse that being simply ineffective, financial penalties for obesity have significant negative effects. They erode trust between employers and employees, prompting some workers to quit or suffer the genuine fear that the release of private health data will endanger their future employability.

These penalties also discriminate against the poor — many of whom live in neighborhoods with limited access to nutritional foods but plenty of cheap junk food available – and against people with mobility problems who are more likely to be obese. Large controlled studies show that increasing health care charges actually steers people away from essential medical care, exacerbating high blood pressure, worsening vision, and increasing mortality by 10% among low income people with chronic diseases.

via An Obamacare Fine on Overweight Americans: Discriminatory and Ineffective | The Health Care Blog.


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