“There are 3 main takeaways from the existing research on the rule. First, the compliance rates have been low. In March 2021, a random sample of 100 hospitals indicated that only 33% reported the negotiated commercial prices for some services. [..] In response to the low compliance, the CMS raised the penalty for noncompliant hospitals to $300 per day for small hospitals and up to $5500 per day for large hospitals beginning from January 1, 2022. Despite the steeper penalties, the compliance rate remains low. For example, Gul et al note that as of March 2022, only 29% to 56% … Read More
All posts in High-value Care
“Having analyzed health outcomes data from the independent National Committee for Quality Assurance, health plan member satisfaction surveys from J.D. Power, and internal data from our own organizations, we are confident that full implementation of five opportunities would improve clinical quality nationwide by 20%, increase access to care by 20%, and reduce health care spending by 15% to 20%. Reduce expensive and unnecessary trips to the ER – [..] Kaiser Permanente members in Virginia, Maryland, and Washington, DC [..] can access a 24/7 video health center that connects them with a doctor who can quickly assess the problem and offer … Read More
“The concept of value-based payment became widespread among U.S. health policymakers and analysts during the 2000s. It collectively refers to interventions that offer doctors and hospitals financial incentives that, in theory, induce them to improve both components of health-care value — cost and quality — without generating the hostility provoked by managed care insurance companies during the HMO [health maintenance organization] backlash of the late 1990s. [The Center for Medicare and Medicaid Innovation reviewed 54 models of value-based payment. Only four were certified to be expanded:] The Home Health Value-based Purchasing Model demonstration cut Medicare spending by 1% with mixed … Read More
“recent research demonstrates that hospital mortality rates can vary by a factor of 3 to 1 and health plans by 4 to 1, and publicly available quality ratings of health care plans and services do not correlate well with outcomes. What is more, lack of transparency among health plans and provider organizations prevents purchasers from making informed choices based on relative quality of provider organizations and health plan networks. Currently available outcomes data are limited to Medicare fee-for-service. [..] For at least five decades, the public health care conversation has focused primarily on rising costs, while the US has lagged … Read More
“US data from the period 1996–2016 are now available on health care spending by cause from the Disease Expenditure Project (DEX) and on DALYs [disability-adjusted life-years] by cause from the Global Burden of Disease (GBD) Study 2017. DALYs are the sum of years of life lost due to premature mortality, as well as years lived with disability among people living with a given cause. Intuitively, DALYs are a measure of burden, and therefore the goal of health systems is to avert DALYs. A decrease in DALYs is a measure of health gain referred to as DALYs averted. [..] We estimated … Read More
David H Jiang et al. published an article in Health Affairs last month arguing for a set of diabetes quality measures that are actually linked to optimal diabetes health. Composite measures that include “all-or-nothing” components will incentivize providers to focus on patients who are most likely to achieve the measure rather than those who would benefit the most clinically. This would also adversely affect patients with socioeconomic barriers to optimal health, as those patients are more likely to have multiple unmet measures or not meet a measure that is more difficult to achieve (e.g., smoking cessation). A more equitable approach … Read More
“While the medical risks of SMA [self-managed] may be few, the legal risks for people attempting SMA may be significant. Although only three states currently have laws explicitly criminalizing SMA, almost half of U.S. states have at least one law in place that could be used to prosecute people attempting or assisting with SMA. These policies include legislation explicitly banning SMA, criminalizing harm to the fetus, and criminalizing abortion. For those who have been targeted with criminalization for SMA, many came into contact with law enforcement following interactions with healthcare professionals. However, to date, legal experts are unaware of any … Read More
“As [health economist Jonathan] Kolstad explained, much of the insurance–industrial complex is built on the assumption that profit-seeking physicians will always consume excess resources unless barriers are put in their way. Formularies and prior authorizations, for example, create adversarial relationships between insurers and physicians, who may bristle at having nonphysicians dictate what’s best for their patients. Contributing to this tension is our dependence on randomized, controlled trials to tell us the “right” way to treat any one patient on the basis of average treatment effects in large study populations. The resultant technocratic approach to quality often fails to account for … Read More
Excerpt – The perception that practice variation signals quality deficiencies remains foundational to the pursuit of “high value” care. But if value is defined as quality divided by cost, measuring value faces all the same problems as measuring quality — flawed risk adjustment, metric gaming, omission of the many aspects of quality that defy measurement. So why do we continue to embrace these flawed constructs, particularly when it’s not clear that the current regulatory approach serves patients or clinicians? [president of the Commonwealth Fund David] Blumenthal offers international context: “The French, the Brits, the Swedes — they don’t torture their … Read More
“The diagnostic process begins with gathering data. Key elements involve ascertaining the person’s current concerns; reviewing the medical history; performing a physical examination; evaluating findings from laboratory, imaging, and pathology studies; and exploring the inferences and plans of previous clinicians. In the modern era, much of this data gathering takes place through a review of the electronic medical record. While that is a valuable and efficient tool, physicians must continue to learn the value of listening to a person’s descriptions and accounts of their symptoms and concerns firsthand. [..] After gathering data, the next step is to determine which pieces … Read More