“Like people of Middle Eastern and North African origins, millions of other Americans have been funneled into one side of our country’s enduring binary of whiteness or the other. According to today’s census forms, Greeks, Irish, Italians, Slavs (who were systematically excluded for a century), and Jews—who are still the target of white-supremacist violence—are indistinct from people with Mayflower backgrounds. Being an unspecified “white” person has allowed many of us to blend in, when the most unifying thing we might do in this era of identity-driven polarization is acknowledge all the ways we are different. Today’s nationalist identity politics are … Read More
All posts in Measurement
From the article abstract: “[Objective] [..] We developed machine-learning models to detect CKD [chronic kidney disease] without blood collection, predicting an eGFR [estimated glomerular filtration rate in ml/min/1.73 m2] less than 60 (eGFR60 model) or 45 (eGFR45 model) using a urine dipstick test. [Materials and Methods] The electronic health record data (n = 220 018) obtained from university hospitals were used for XGBoost-derived model construction. The model variables were age, sex, and 10 measurements from the urine dipstick test. The models were validated using health checkup center data (n = 74 380) and nationwide public data (KNHANES data, n = 62 945) for the general population in Korea. [Results] The … Read More
“Primary care is where most people have relationships with a health professional, where more than one-third of all health care visits happen, and the only part of the health system that demonstrably produces longer lives and more equity. However, primary care is experiencing widespread and longstanding shortages and skyrocketing rates of burnout and moral injury. Primary care physician turnover, often associated with burnout, is estimated to cost CMS nearly one billion dollars annually. Before the COVID-19 pandemic, more than one-third of family physicians reported frequent burnout. Since the pandemic, primary care physicians are stepping up to meet patient needs even … Read More
“we believe the quality bonus program (QBP), which offers incentives for providing high-quality care in Medicare Advantage, needs critical review and strengthening to improve accountability — steps that will be particularly important to support enrollees with serious illness. The foundation of the QBP is a five-star rating system in which plans are scored on the basis of claims-based performance measures and patient surveys. [..] A decade after the QBP’s implementation in 2012, however, concerns about its accuracy in measuring quality and its ability to drive quality improvement have been persistently documented in academic research and MedPAC reports. The inaccurate reflection … Read More
“The effects of social determinants of health (SDOH) on health outcomes have been extensively evaluated and described. Efforts to elucidate the impact of specific unmet health-related social needs (HRSN), such as food insecurity and lack of transportation, on specific outcome measures can help pinpoint necessary interventions and policy changes. [..] In recent years, the Centers for Medicare &Medicaid Services (CMS) have placed higher priority on addressing health equity, including directly addressing unmet HRSN and accounting for social risk in Medicare payments. For payments, a growing body of literature has demonstrated that health care systems caring for patients with higher social … Read More
“The PHQ-9 became a means for time-crunched primary care doctors, under pressure to see more and more patients in shorter appointments, to dole out prescriptions with barely a conversation. Despite its prevalence, data suggesting that PHQ-9 has actually improved outcomes is ambiguous at best. Meanwhile, mental health outcomes for patients are dismal and only getting worse, with depressive symptoms and suicide climbing ever higher. A combination of good intentions and straightforward business savvy lies behind the PHQ-9. Pfizer invested hundreds of thousands of dollars in its development [..]. The company naturally hoped its investment would pay off with increased Zoloft … Read More
“Screening colonoscopy has been shown to reduce colorectal cancer (CRC) incidence and mortality by enabling detection and removal of precancerous lesions. However, the available evidence about the optimal screening interval is limited. [..] More targeted screening offers would potentially reduce the burden of testing and demand of capacities and costs associated with colonoscopy, thereby also counteracting the frequently reported overuse and underuse of screening examinations in considerable proportions of the population. [..] Anonymized registration of screening colonoscopy findings and the use of the anonymized data for program evaluation by the Central Research Institute of Ambulatory Health Care in Germany is … Read More
“[Introduction] [..] population-based payment models, as in the Medicare Shared Savings Program or Medicare Advantage (MA) program, can facilitate the resource reallocations necessary to address health care disparities. Risk adjustment is the mechanism by which payment is allocated in these models. Traditionally, risk adjustment has been conceived and executed purely as a predictive exercise. Regression is used to predict total annual per person spending as a function of demographic and clinical characteristics. A person’s predicted spending is converted to a risk score, which is applied to a base regional rate to determine the prospective payment or benchmark for that person. … 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