- Assessing the Impact of Hospital Value-Based Purchasing on Clinical Quality and Patient Experience October 2014
Questions are arising about the impact of hospital value-based purchasing on clinical quality and patient experience. It is important for the medical community to understand the impact of this program.
- A decision exercise to engage cancer patients and families in Deliberation about Medicare Coverage for advanced Cancer Care July 2014
Concerns about unsustainable costs in the US Medicare program loom as the number of retirees increase and experience serious and costly illnesses like cancer. Engagement of stakeholders, particularly cancer patients and their families, in prioritizing insured services offers a valuable strategy for informing Medicare coverage policy. The researchers designed and evaluated a decision exercise that allowed cancer patients and family members to choose Medicare benefits for advanced cancer patients.
The growing cost of providing health benefits is prompting some large employers to modify the ways they offer coverage to their employees. Experts say these changes are part of a larger trend in which employers are replacing their defined health benefit (i.e. coverage through a specific health plan) with defined contributions that employees can use to purchase insurance products of their choice. A recent article in the Washington Post explores the strategies employers are considering for promoting choice and controlling costs in the context of health reform, including the use of private exchanges.
Public acceptance of a role for policy in reducing the use of low value care in the United States is tenuous but increasing with growing awareness of the burden that health care spending places on federal and state budgets and with patients’ increasing exposure to health care costs. In recent years, the American Board of Internal Medicine Foundation’s Choosing Wisely program, the U.S. Preventive Services Task Force, and the National Quality Forum have advanced the dialogue about low-value care by identifying services that deserve that label.
- The Impact of Tiered Physician Networks on Patient Choices September 2014
Several factors influence a patient’s choice of health care providers, including cost and quality. Increasingly, health plans, employers, and other payers are creating tiered provider networks to help guide patients’ decisions about care providers.
The American College of Rheumatology, through the Choosing Wisely initiative, identified measuring bone densitymore often than every 2 years as care “physicians and patients should question.” The researchers measured the prevalence and described the geographic variation of short-interval (repeated in under 2 years) dual-energy X-ray absorptiometry tests (DXAs) among Medicare beneficiaries and estimated the cost of this testing and its responsiveness to payment change.
- Assessing the Influence of Medical Group Practice Characteristics on Reducing Inappropriate Emergency Department and Avoidable Hospitalization Rates August 2014
Concern is growing over escalation in the improper and avoidable use of emergency departments by patients who did not receive appropriate care from their physicians. It is important to understand the costs of preventing these incidents at the medical group practice level.
- Physicians’ and Hospitals’ Varied Responses to Changes in Medicare Payment: Findings from HCFO Research August 2014
Efforts to address the nation's deficit and escalating health care costs require timely and policy-relevant research on the impact of changes to Medicare payment. Though not intended as a comprehensive list of all relevant HCFO-funded work, this synthesis provides a helpful guide for identifying policy-relevant research on the topic.
In 2011, the American Board of Internal Medicine Foundation created the Choosing Wisely initiative, which encourages physicians to be responsible stewards of finite healthcare resources. Using Medicare administrative data from 2006 to 2011, the researchers estimated the proportion of low-risk Medicare beneficiaries receiving non-invasive cardiac screening tests as well as the regional variation in and spending associated with these tests.
With the proliferation of narrow network plans on the new exchanges and more broadly in Medicare Advantage and commercial plans, consumers are being steered to health care coverage that offers lower prices, through reduced premiums, but limited choice. Anecdotal evidence to date suggests that the exchange networks are narrower than consumers anticipated, which may leave them vulnerable to the financial burden of out-of-network care for services not adequately covered within network...