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Incorporating socioeconomic factors into payment adjustment – you get what...
When talking with practitioners at the sharp end of health care there is concern about the unintended results of policies that create penalties or rewards to encourage change. Take, for example, the...
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Payment policy bias against high Disproportionate Share Hospitals (DSH)
In its June 2013 report to Congress, MedPAC offered ways to refine the CMS Hospital Readmissions Reduction Program (HRRP). These included issues of stability (and efficiency) due to dealing with...
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Quality, Prices, and Health System Consolidation
The healthcare landscape is changing rapidly, but will we be happy with the outcome? The challenge of coordinated care, nascent accountable care organizations (ACO), and evolving integrated...
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Pediatric Readmissions and New Proposed NQF Measures
Since February 2014, the National Quality Forum has solicited comments on two proposed pediatric readmission measures, one pertaining to all pediatric conditions (#2393) and the other to lower...
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CMS, 2-Midnights, and linking payment with what you want to achieve
A recurring theme in our blog posts is the need for payment policy to reflect a clearly defined purpose. Start with what you want to achieve and work backwards to a policy that delivers it. The ongoing...
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Price Shopping and Narrow Networks
Making available hospital prices – amounts paid to hospitals – has historically been handled with a great deal of caution by policy makers. Fear that hospitals will use posted prices to coordinate...
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Risk Adjustment and Socioeconomic Status – The NQF Task Force Report
I was fortunate to serve on the NQF Task Force on Risk Adjustment for Socioeconomic Status or other Sociodemographic Factors (SDF)i. This report generated more comments than any other NQF Task Force...
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Selection in Health Insurance Exchanges – Risk or Risk-Adjustment?
The initial focus of media and industry scrutiny during the launch of health insurance exchanges was primarily the potential for adverse enrollee selection of insurance products. Healthier enrollees...
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We Need a New Way to Finance Hospital Externalities
Paying hospitals for beneficial mission-related costs has been a hit and miss affair. These costs fall under the general headings of providing indirect medical education, ensuring standby capacity for...
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Integrating Sociodemographic Factors into Risk Adjustment: Important...
Why is it necessary that risk adjustment incorporate sociodemographic factors for my diabetic schizophrenic patients who have unstable housing? Healthcare is fundamentally about people. That’s why, at...
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Putting Patients at the Center of Their Health Home
Much of what we seek to achieve in health reform centers upon improving the quality of patient care. We are strong advocates of outcomes quality, things that matter to patients, but in general the...
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Study Validates the Value and Utility of Risk-Adjustment for Stratifying...
Introduction by Norbert Goldfield, MD, and Richard Fuller Increasing value, or more precisely, improving outcomes from health care spending, a recurring theme of the C&ER blog, is intrinsically...
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Gaining Value from Post-Acute Care: Incentives, Structure or Management?
It is well known that a viable source of health dollar savings is the efficient use of post-acute care (PAC) services. MedPAC has identified widespread variation in post-acute care utilization, with...
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Designing Smarter Pay-for-Performance – Let’s Not Go down This Path
Aaron Mckethan, PhD, and Ashish K. Jha, MD, MPH, recently wrote an article for The Journal of the American Medical Association (JAMA) with an irresistible title: “Designing Smarter Pay-for-Performance...
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Refining the Definition of Health Service Units Will Help Control Prices and...
In recent years there has been a great deal of attention on the variation in service volume across providers and regions. Our suite of tools, collectively entitled Potentially Preventable Events (PPE),...
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Improving Outcomes by Focusing on Results: Readmissions, Complications and CMS
It’s been nearly a century since Dr. Ernest Codman championed an “end results system” to track and measure hospital outcomes to determine the effectiveness of treatment and improve patients’ lives....
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Budget Neutral Payment for Pharmaceuticals – Tying Value to Outcomes
We believe there are two core principles that should be adhered to when implementing payment reform initiatives. First, that measurement of performance change should be directly quantifiable in dollars...
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Incentives Empower Providers to Improve Care
For the last decade, we have been fortunate enough to work with many state Medicaid programs and commercial payers on reform efforts incorporating outcomes targets for health care providers. The...
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It’s Time to Redefine an Achievable Triple Aim
This blog offers further commentary on the excellent conversation that Paul Levy began in his column, “The Triple Aimers have Missed the Mark.” In his blog, he provides a succinct definition of the...
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Transparency of healthcare prices and quality of care: The caboose is at the...
…for the engine to pick up steam. In the past ten years, the train carrying healthcare pricing and quality information has been rolling but the caboose is still waiting at the station. Significant...
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