Better patient care at high-quality hospitals may save medicare money and bolster episode-based payment models

Health Affairs

Volumn 35, Issue 9, 2016, Pages 1681-1689

  Tsai, Thomas C ^a,b,c   Greaves, Felix ^d   Zheng, Jie ^a   Orav, E John ^a   Zinner, Michael J ^e   Jha, Ashish K ^a,f  

^a HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

^b Department of Surgery at Brigham ^*  (United States)

^c BRIGHAM AND WOMEN S HOSPITAL   (United States)

^d IMPERIAL COLLEGE LONDON   (United Kingdom)

^e MIAMI CANCER INSTITUTE   (United States)

^f HARVARD UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

HOSPITAL READMISSION; HUMAN; MAJOR SURGERY; MEDICARE; MODEL; MONEY; PATIENT CARE; PATIENT SATISFACTION; SURGERY; SURGICAL MORTALITY; COST CONTROL; ECONOMIC MODEL; ECONOMICS; FACTUAL DATABASE; FEMALE; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HEALTH CARE QUALITY; HIGH VOLUME HOSPITAL; INSURANCE; MALE; MEDICAL FEE; RETROSPECTIVE STUDY; STATISTICS AND NUMERICAL DATA; UNITED STATES;

COST SAVINGS; DATABASES, FACTUAL; DELIVERY OF HEALTH CARE; EPISODE OF CARE; FEE-FOR-SERVICE PLANS; FEMALE; HEALTH POLICY; HOSPITALS, HIGH-VOLUME; HUMANS; INSURANCE CLAIM REVIEW; MALE; MEDICARE; MODELS, ECONOMIC; PATIENT CARE; QUALITY ASSURANCE, HEALTH CARE; RETROSPECTIVE STUDIES; UNITED STATES;

EID: 84988419020     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2016.0361     Document Type: Article

References (30)

1. Romley JA, Jena AB, O'Leary JF, Goldman DP. Spending and mortality in US acute care hospitals. Am J Manag Care. 2013;19(2):e46-54.
2. Kaestner R, Silber JH. Evidence on the efficacy of inpatient spending on Medicare patients. Milbank Q. 2010; 88(4):560-94.
3. Skinner J, Chandra A, Goodman D, Fisher ES. The elusive connection between health care spending and quality. Health Aff (Millwood). 2009;28(1):w119-23. DOI: 10.1377/ hlthaff.28.1.w119.
4. Zhang Y, Baik SH, Fendrick AM, Baicker K. Comparing local and regional variation in health care spending. N Engl J Med. 2012; 367(18):1724-31.
5. Burwell SM. Setting value-based payment goals-HHS efforts to improve U.S. health care. N Engl J Med. 2015;372(10):897-9.
6. CMS.gov. Bundled Payments for Care Improvement initiative: general information [Internet]. Baltimore (MD): Centers for Medicare and Medicaid Services; [last updated 2016 Jul 19; cited 2016 Jul 27]. Available from: http://innovation.cms.gov/initiatives/bundledpayments/
7. CMS.gov. Comprehensive Care for Joint Replacement model [Internet]. Baltimore (MD): Centers for Medicare and Medicaid Services; [last updated 2016 Jul 25; cited 2016 Jul 27]. Available from: https:// innovation.cms.gov/initiatives/cjr
8. Hospital Consumer Assessment of Healthcare Providers and Systems. CAHPS® Hospital Survey [home page on the Internet]. Baltimore (MD): Centers for Medicare and Medicaid Services; [cited 2016 Jul 27]. Available from: http://www.hcahpsonline.org/
9. American Hospital Associaton. AHA Annual Survey database. Chicago (IL): AHA; c 2014.
10. Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK. Variation in surgicalreadmission rates and quality of hospital care. N Engl J Med. 2013; 369(12):1134-42.
11. Miller DC, Gust C, Dimick JB, Birkmeyer N, Skinner J, Birkmeyer JD. Large variations in Medicare payments for surgery highlight savings potential from bundled payment programs. Health Aff (Millwood). 2011;30(11):2107-15.
12. Chandra A, Dalton MA, Holmes J. Large increases in spending on postacute care in Medicare point to the potential for cost savings in these settings. Health Aff (Millwood). 2013;32(5):864-72.
13. Jha AK, Li Z, Orav EJ, Epstein AM. Care in U.S. hospitals-the Hospital Quality Alliance program. N Engl J Med. 2005;353(3):265-74.
14. Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med. 2009;361(14):1368-75.
15. Tsai TC, Orav EJ, Jha AK. Patient satisfaction and quality of surgical care in US hospitals. Ann Surg. 2015;261(1):2-8.
16. Medicare Payment Advisory Commission. Report to the Congress: Medicare payment policy [Internet]. Washington (DC): MedPAC; 2015 Mar [cited 2016 Jul 27]. Available from: http://www.medpac.gov/ documents/reports/mar2015_ entirereport_revised.pdf
17. Isaac T, Zaslavsky AM, Cleary PD, Landon BE. The relationship between patients' perception of care and measures of hospital quality and safety. Health Serv Res. 2010;45(4): 1024-40.
18. Agency for Healthcare Research and Quality. Patient Safety Indicators overview [Internet]. Rockville (MD): AHRQ; [cited 2016 Jul 27]. Available from: http://qualityindicators.ahrq.gov/Modules/psi_resources.aspx
19. Pope GC, Kautter J, Ellis RP, Ash AS, Ayanian JZ, Lezzoni LI, et al. Risk adjustment of Medicare capitation payments using the CMS-HCC model. Health Care Financ Rev. 2004; 25(4):119-41.
20. Pouw ME, Peelen LM, Lingsma HF, Pieter D, Steyerberg E, Kalkman CJ, et al. Hospital standardized mortality ratio: consequences of adjusting hospital mortality with indirect standardization. PLoS One. 2013; 8(4):e59160.
21. To access the Appendix, click on the Appendix link in the box to the right of the article online.
22. Joynt KE, Gawande AA, Orav EJ, Jha AK. Contribution of preventable acute care spending to total spending for high-cost Medicare patients. JAMA. 2013;309(24):2572-8.
23. Li P, Kim MM, Doshi JA. Comparison of the performance of the CMS Hierarchical Condition Category (CMS-HCC) risk adjuster with the Charlson and Elixhauser comorbidity measures in predicting mortality. BMC Health Serv Res. 2010;10:245.
24. Ellis RP, Pope GC, Iezzoni L, Ayanian JZ, Bates DW, Burstin H, et al. Diagnosis-based risk adjustment for Medicare capitation payments. Health Care Financ Rev. 1996;17(3):101-28.
25. Suter LG, Wang C, Araas M, Joyce E, Vellanky S, Potteiger J, et al. Hospital-level 30-day all-cause mortality following coronary artery bypass graft surgery [Internet]. New Haven (CT): Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation; [revised 2014 Jun 6; cited 2016 Jul 27]. Available for download from: http://www.cms.gov/Medicare/ Quality-Initiatives-Patient-Assessment-Instruments/Hospital QualityInits/Downloads/Coronary-Artery-Bypass-Graft-CABGReadmission. zip
26. Newhouse JP, Garber AM. Geographic variation in Medicare services. N Engl J Med. 2013;368(16): 1465-8.
27. Institute of Medicine. Variation in health care spending: target decision making, not geography. Washington (DC): National Academies Press; 2013.
28. Tsai TC, Joynt KE, Wild RC, Orav EJ, Jha AK. Medicare's bundled payment initiative: most hospitals are focused on a few high-volume conditions. Health Aff (Millwood). 2015;34(3): 371-80.
29. Weeks WB, Rauh SS, Wadsworth EB, Weinstein JN. The unintended consequences of bundled payments. Ann Intern Med. 2013;158(1):62-4.
30. Tsai TC, Miller DC. Bundling payments for episodes of surgical care. JAMA Surg. 2015;150(9):905-6.