[From the article’s Abstract] “Clinicians and policy experts have raised concerns that the 30-day readmission measure used in this program [Hospital Readmissions Reduction Program] provides an incomplete picture of performance because it does not capture all hospital encounters that may occur after discharge. In contrast, the excess days in acute care (EDAC) measure, which currently is not used in the HRRP, captures the full spectrum of hospital encounters (emergency department, observation stay, inpatient readmission) and their associated lengths of stay within 30 days of discharge. [..] Overall, only moderate agreement was found on hospital performance rankings by using the readmission … Read More
All posts by Anupam
“Federal law eliminates consumer cost sharing for multiple methods of colorectal cancer screening, including colonoscopy when done by an in-network provider. However, some patients having screening incur considerable out-of-pocket costs because out-of-network bills are not included in federal mandates. [..] A claims database from a large national insurer was queried for commercially insured patients aged 18 to 64 years who had a colonoscopy between 2012 and 2017. Cases coded as elective with a stay of 1 day or shorter were included. The analysis was restricted to cases in which both the facility and the endoscopist were in-network. [..] The typical … Read More
“Because ESKD [end-stage kidney disease] is operationally defined as receiving long-term dialysis or a kidney transplant, we hypothesized that the number of patients with incident ESKD can vary considerably depending on decisions between patients and physicians about the choice and timing of kidney replacement therapy, and particularly of initiating dialysis. Consistent with this, after publication of the Initiating Dialysis Early and Late (IDEAL) trial—a randomized clinical trial showing no significant difference in death or other outcomes with earlier (eGFR of 9.0 mL/min/1.73 m2) vs later (eGFR of 7.2 mL/min/1.73 m2) initiation of dialysis—a rapid drop in early dialysis initiation was … Read More
“The Medicare Advantage (MA) quality bonus program (QBP), which rewards MA plans on a quality star rating scale, is flawed and inconsistent with the Commission’s principles for quality measurement. First, the QBP includes almost 50 quality measures, including process and administrative measures, instead of focusing on a small set of population-based outcome and patient experience measures. Second, organizations are rated at the MA contract level. Contracts cover very wide areas—including noncontiguous states—and therefore a contract-level rating may not be a useful indicator of the quality of care provided in a beneficiary’s local area. Third, the QBP uses a “tournament model,” … Read More
“Initially, eligibility was limited to individuals with diabetes, LDL-C level greater than 130 mg/dL (to convert LDL-C to mmol/L, multiply by 0.0259), and an annual statin medication possession ratio in pharmacy records of less than 80%. We subsequently broadened eligibility criteria to include individuals with a statin prescription who self-reported nonadherence and had either (1) LDL-C level greater than 100 mg/dL and a diagnosis of ASCVD or an American College of Cardiology/American Heart Association Task Force 10-year cardiovascular disease risk score of at least 7.5%, or (2) LDL-C level greater than 190 mg/dL with no other risk factors, or (3) … Read More
This week’s refresh of the excess mortality count from the CDC (last updated October 7 [I think]). The federal agency identified over 272,000 excess deaths across the country since the start of this year (about 9,000 more than last week’s estimate). The overall excess mortality rate increased slightly from 11.1% last week to 11.2% this week. Data from the CDC’s National Center for Health Statistics, updated October 7, 2020
“Given the wide variation in both pricing and collection practices by hospitals, measures of billing practices are needed. Billing quality is a type of medical quality. In the same way that medical complication rates are collected for improvement purposes and some are available to the public, metrics of billing quality could be used to create public accountability for US hospitals. [..] The first proposed metric is whether patients are routinely provided with an itemized bill of services in plain English. Most bills have historically listed medical codes and terms. However, describing services in a way that is understandable to patients … Read More
“The program [Medicare Part D] itself does not negotiate drug prices with pharmaceutical companies. Instead, the government partners with pharmacy benefit managers (PBMs) to leverage its market power and reduce drug prices for seniors in Part D. Insurance companies, unions, large employers, and state governments also engage PBMs in similar arrangements. By representing such a wide swath of the purchasers of prescription drugs, PBMs can use their purchasing power to negotiate lower prices from pharmaceutical companies. [..] the Department of Health and Human Services has issued a rule that would limit their ability to pass back the rebates they negotiate … Read More
“Covid-19 is an overwhelming challenge, and many factors contribute to its severity. But the one we can control is how we behave. And in the United States we have consistently behaved poorly. [..] Why has the United States handled this pandemic so badly? We have failed at almost every step. We had ample warning, but when the disease first arrived, we were incapable of testing effectively and couldn’t provide even the most basic personal protective equipment to health care workers and the general public. [..] While the absolute numbers of tests have increased substantially, the more useful metric is the … Read More
“Competition in health care fails for several fundamental reasons. First, patients often lack the information needed to assess both their care needs and the quality of their care. Second, illness and health care needs are inherently difficult to predict, exposing people to financial risks that they must insure against. This risk gives rise to an insurance system that shields patients from the price of care, dampening their incentive to use care judiciously and to seek care from providers offering high-quality care at affordable prices. The information problem, amplified by insurance, reduces the ability and incentives for patients to seek low-price, … Read More