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Research Studies is a compilation of published research articles funded by 大象APPor authored by 大象APPresearchers.

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1 to 25 of 212 Research Studies Displayed
Mulcahy JF, Patel SY, Mehrotra A
Quantifying indirect billing within the Medicare physician fee schedule.
This cohort study鈥檚 goal was to quantify indirect billing within the Medicare physician fee schedule. Under certain circumstances advance practice clinicians (APCs) such as physician assistants and nurse practitioners can bill Medicare directly or indirectly. Indirect billing means the submitted claim states the care was provided by the physician, and the reimbursement is higher. The authors looked at Medicare fee-for-service and Medicare Advantage claims data to identify indirectly billed APC services. Office-based Medicare Part B claims were linked to Part D claims for prescription drug fills. The number of indirect billings for office encounters provided by an APC in 2022 was 38.9%. For all median physician visits in 2022, indirect billing on behalf of APCs represented 11.1% of all billed encounters. APC billing was most common among surgical specialists (29.7% of all encounters) and least common for primary care physicians (3.9%). The authors found that if all indirectly billed APC-provided care was billed directly by the APC, Medicare would have saved $270 million in 2022.
AHRQ-funded; HS028490.
Citation: Mulcahy JF, Patel SY, Mehrotra A . Quantifying indirect billing within the Medicare physician fee schedule. JAMA Health Forum 2025 Apr 4; 6(4):e250433. doi: 10.1001/jamahealthforum.2025.0433.
Keywords: Medicare, Payment
Ianni K, Chen A, Rodrigues D
Transporting difference-in-differences estimates to assess health equity impacts of payment and delivery models.
This simulation study鈥檚 objective was to transport the effects of the Comprehensive Primary Care Plus (CPC+) model to a target population of Black fee-for-service (FFS) Medicare beneficiaries living outside the original 18 CPC+ regions. Main outcome variable was total Medicare spending per beneficiary per year (pbpy). The authors simulated practice-level spending in 18 CPC+ regions and 32 non-CPC+ regions (1200 practices per region). They calibrated the parameters from the literature and then varied four key parameters to create 16 realistic simulation scenarios. Across the 16 simulation scenarios, transporting the treatment effect regions yielded median treatment effects that ranged from $15.5 pbpy smaller to $10 pbpy larger than in the sample. These differences turned out to be roughly the same magnitude as the estimated overall effect of $13 pbpy.
AHRQ-funded; HS028985.
Citation: Ianni K, Chen A, Rodrigues D . Transporting difference-in-differences estimates to assess health equity impacts of payment and delivery models. Health Serv Res 2025 Apr; 60(suppl 2):e14419. doi: 10.1111/1475-6773.14419.
Keywords: Primary Care, Payment, Medicare, Healthcare Costs, Simulation
Potluri VS, Reddy YNV, Tummalapalli SL
Early effects of the end-stage renal disease treatment choices model on kidney transplant waitlist additions.
This study examined the effect of End-Stage Renal Disease Treatment Choices (ETC) payment adjustments on U.S. kidney transplant waitlist additions. Researchers used data from the Organ Procurement and Transplantation Network registry to analyze waitlisting trends. The ETC Model was not found to be associated with significant changes in new waitlist additions.
AHRQ-funded; HS026372; HS028684.
Citation: Potluri VS, Reddy YNV, Tummalapalli SL . Early effects of the end-stage renal disease treatment choices model on kidney transplant waitlist additions. Clin J Am Soc Nephrol 2025 Jan; 20(1):124-35. doi: 10.2215/cjn.0000000000000571.
Keywords: Kidney Disease and Health, Transplantation, Payment
Gupta S, Zengul FD, Blackburn J
Hospital-based skilled nursing facility survival: organizational and market-level predictors.
This study examined the organizational and market-level factors associated with the survival of hospital-based skilled nursing facilities (HBSNFs) after implementation of the prospective payment system (PPS) reimbursement being applied in 1998, which disincentived hospitals from either purchasing an SNF or utilizing their excess capacity to establish one within a hospital. This reversed an incentive program from 1983. The authors examined American Hospital Association survey data to plot event histories of all U.S. acute care hospitals with an open HBSNF in 1998 and whether they closed its HBSNF during a 22-year period (1998-2020). Primary independent variables included hospital size, ownership, total margin, market competition, and Medicare Advantage penetration, with the variables lagging by 1 year. Results showed that HBSNFs located in large, not-for-profit hospitals and those operating in less competitive markets had greater odds of surviving.
AHRQ-funded; HS023345.
Citation: Gupta S, Zengul FD, Blackburn J . Hospital-based skilled nursing facility survival: organizational and market-level predictors. Health Care Manage Rev 2024 Oct-Dec; 49(4):254-62. doi: 10.1097/hmr.0000000000000411..
Keywords: Hospitals, Long-Term Care, Payment
Kilaru AS, Liao JM, Wang E
Association between mandatory bundled payments and changes in socioeconomic disparities for joint replacement outcomes.
This study鈥檚 objective was to determine whether mandatory participation by hospitals in bundled payments for lower extremity joint replacement (LEJR) was associated with changes in outcome disparities for patients dually eligible for Medicare and Medicaid. The authors used Medicare claims data for beneficiaries undergoing LEJR in the United States between 2011 and 2017. They conducted a retrospective observational study using a differences-in-differences method to compare changes in outcome disparities between dual-eligible and non-dual eligible beneficiaries after hospital participation in the Comprehensive Care for Joint Replacement (CJR) program, with the primary outcome LEJR complications. In adjusted analysis, CJR participation was associated with a reduced difference in complications between dual-eligible and non-dual-eligible beneficiaries (-0.9 percentage points). The reduction in disparities was observed among hospitals without prior experience in a voluntary LEJR bundled payment model, and there were no differential changes in 90-day readmissions or mortality.
AHRQ-funded; HS027595.
Citation: Kilaru AS, Liao JM, Wang E . Association between mandatory bundled payments and changes in socioeconomic disparities for joint replacement outcomes. Health Serv Res 2024 Oct; 59(5):e14369. doi: 10.1111/1475-6773.14369..
Keywords: Disparities, Orthopedics, Surgery, Payment, Outcomes, Social Determinants of Health
Kim N, Jacobson M
Outcomes by race and ethnicity following a Medicare bundled payment program for joint replacement.
The objective of this cohort study was to evaluate outcomes associated with the Comprehensive Care for Joint Replacement (CJR) model--a traditional Medicare bundled payment program for lower-extremity joint replacement--among Hispanic patients who were not enrolled in traditional Medicare. Three metropolitan statistical areas (MSAs) were randomly selected in California to participate in CJR. The results indicated that CJR program outcomes differed by race and ethnicity for patients outside traditional Medicare. The authors noted that these findings suggested the importance of considering differential outcomes of Medicare payment policies for racial and ethnic minority patient populations beyond the initially targeted groups.
AHRQ-funded; HS026488.
Citation: Kim N, Jacobson M . Outcomes by race and ethnicity following a Medicare bundled payment program for joint replacement. JAMA Netw Open 2024 Sep 3; 7(9):e2433962. doi: 10.1001/jamanetworkopen.2024.33962..
Keywords: Medicare, Payment, Surgery, Orthopedics, Racial and Ethnic Minorities
Lin SC, Funk RJ, Ryan AM
Bundled payments lead to quality improvements in hospitals' skilled nursing facility referral networks.
This study鈥檚 goal was to assess hospitals participating in Medicare's Bundled Payments for Care Improvement (BPCI) program for joint replacement who changed their referral patterns to favor higher-quality skilled nursing facilities (SNFs). This study used 2009-2015 inpatient and outpatient claims from a 20% sample of Medicare beneficiaries undergoing joint replacement in US hospitals (N = 146,074) linked with data from Medicare's BPCI program and Nursing Home Compare. Researchers found that BPCI participation was associated with a decrease in the number of SNF referrals and no significant change in the number of SNF partners or concentration of SNF partners. BPCI participation was associated with discharge to SNFs with a higher patient outcome rating by 0.04 stars. BPCI participation was not associated with improvements in discharge to SNFs with a higher facility survey rating, staffing rating, or registered nurse staffing rating.
AHRQ-funded; HS024525; HS024728; HS025875.
Citation: Lin SC, Funk RJ, Ryan AM . Bundled payments lead to quality improvements in hospitals' skilled nursing facility referral networks. Am J Manag Care 2024 Jun; 30(6):e184-e90. doi: 10.37765/ajmc.2024.89566.
Keywords: Medicare, Payment, Quality Improvement, Quality of Care
Regenbogen SE, Cocroft S, Krein SL
Hospital strategies in commercial episode-based reimbursement.
This study explores hospitals' strategies for reducing spending in commercial episode-based payment programs, aiming to inform the design of incentive structures. The research employed a qualitative approach as part of a larger mixed-methods study, conducting semistructured interviews with hospital leaders participating in a statewide quality improvement collaborative. This collaborative featured novel episode-based incentive payments introduced by the state's largest commercial payer. The study recruited 21 leaders from eight diverse hospitals, selected purposively to include both high and low performers. Interviews were conducted via video teleconference using a standardized protocol, covering four main domains: selection of clinical conditions for evaluation, strategies for reducing episode spending, best practices for earning incentives, and barriers to achievement. The researchers used rapid qualitative analysis with purposeful data reduction to identify key themes within the study domains. Results indicated that strategies were similar between high- and low-performing hospitals. When selecting conditions, some hospitals focused on areas of underperformance to target improvement opportunities, while others chose conditions where they were already achieving high efficiency. Many hospitals attempted to align their efforts with ongoing improvement initiatives and clinical areas with established leaders and champions. Key strategies included data-driven improvement, care standardization, and protocol dissemination. Best practices for success centered on readmission prevention and controlling postacute care spending.
AHRQ-funded; HS027830; HS028397.
Citation: Regenbogen SE, Cocroft S, Krein SL . Hospital strategies in commercial episode-based reimbursement. Am J Manag Care 2024 Jun; 30(6):276-84. doi: 10.37765/ajmc.2024.89561.
Keywords: Hospitals, Payment
Crowley AP, Neville S, Sun C
Differential hospital participation in bundled payments in communities with higher shares of marginalized populations.
This study鈥檚 objective was to examine whether communities with higher proportions of marginalized individuals were less likely to be served by a hospital participating in Bundled Payments for Care Improvement Advanced (BPCI-Advanced). Communities with higher shares of dual-eligible Medicare and Medicaid individuals were less likely to be served by a hospital participating in BPCI-Advanced than communities with the lowest quartile of dual-eligible individuals (Q4: -15.1 percentage points [pp] lower than Q1). There was no consistent significant relationship between community proportion of Black beneficiaries and likelihood of having a hospital participating in BPCI-Advanced, however communities with higher shares of Hispanic beneficiaries were more likely to have a hospital participating in BPCI-Advanced than those in the lowest quartile (Q4: 19.2 pp higher than Q1).
AHRQ-funded; HS027595.
Citation: Crowley AP, Neville S, Sun C . Differential hospital participation in bundled payments in communities with higher shares of marginalized populations. J Gen Intern Med 2024 May; 39(7):1180-87. doi: 10.1007/s11606-024-08655-4..
Keywords: Payment, Hospitals, Medicare
Lin SC, Adler-Milstein J, Hollingsworth JM
Alternative payment models and patient-reported quality of preparation for discharge: a retrospective longitudinal study.
This study鈥檚 objective was to assess patient-reported preparation for posthospital care was associated with reduced readmissions, and whether alternative payment model (APM) participation was associated with improved preparation for posthospital care. The authors used mixed-effects regression on observational data for 2685 US hospitals. They measured patient-reported preparation for posthospital care using the 3-Item Care Transition Measure and readmission using 30-day all-cause risk-adjusted readmissions from Hospital Compare. They obtained participation data in accountable care organizations (ACOs), Medical Homes, and Medicare's Bundled Payments for Care Improvement program from Medicare, the American Hospital Association's Annual Survey, and Leavitt Partner's ACO database. They found that APMs are not associated with improved preparation for posthospital care, even though it was associated with reduced readmissions (Marginal Effect: -0.012 percentage points).
AHRQ-funded; HS026908; HS025875.
Citation: Lin SC, Adler-Milstein J, Hollingsworth JM . Alternative payment models and patient-reported quality of preparation for discharge: a retrospective longitudinal study. J Patient Exp 2024 Mar 22; 11:23743735241240926. doi: 10.1177/23743735241240926..
Keywords: Payment, Hospital Discharge, Hospital Readmissions, Hospitals
Hider AM, Gomez-Rexrode AE, Agius J
Association of bundled payments with spending, utilization, and quality for surgical conditions: a scoping review.
This scoping review assessed the body of literature examining episode-based bundled payment models effect on health care spending, utilization, and quality of care for surgical conditions. Bundled payment models let hospitals receive financial incentives to reduce spending on care provided to patients during a predefined clinical episode. The review queried four databases from inception through September 27, 2021. A total of 879 unique articles were found, of which 28 met final inclusion criteria. Of these studies, 23 out of 28 evaluated the impact of voluntary bundled payments in orthopedic surgery and found that bundled payments are associated with reduced spending on total care episodes, attributed primarily to decreases in post-acute care spending. This reduced spending did not worsen clinical outcomes (e.g., readmissions, complications, and mortality). Evidence for non-orthopedic surgery bundled payments remains limited.
AHRQ-funded; HS028606.
Citation: Hider AM, Gomez-Rexrode AE, Agius J . Association of bundled payments with spending, utilization, and quality for surgical conditions: a scoping review. Am J Surg 2024 Mar; 229:83-91. doi: 10.1016/j.amjsurg.2023.12.009.
Keywords: Surgery, Payment, Healthcare Costs
Maganty A, Kaufman SR, Oerline MK
Value-based payment models and management of newly diagnosed prostate cancer.
This study鈥檚 goal was to examine the effect of urologist participation in value-based payment models on the initial management of men with newly diagnosed prostate cancer. The authors looked at data from Medicare beneficiaries with prostate cancer diagnosed between 2017 and 2019, with 1鈥墆ear of follow-up, who were assigned to their primary urologist, each of whom was then aligned to a value-based payment model (MIPS, accountable care organization, ACO without financial risk, and ACO with risk). Treatment did not vary by payment model, both overall (MIPS-67%, ACOs without risk-66%, ACOs with risk-66%). Similarly, treatment did not vary among men with very high risk of non-cancer mortality by payment model (MIPS-52%, ACOs without risk-52%, ACOs with risk-51%). Adjusted spending was similar across payment models (MIPS-$16,501, ACOs without risk-$16,140, ACOs with risk-$16,117).
AHRQ-funded; HS025707.
Citation: Maganty A, Kaufman SR, Oerline MK . Value-based payment models and management of newly diagnosed prostate cancer. Cancer Med 2024 Jan; 13(1):e6810. doi: 10.1002/cam4.6810..
Keywords: Payment, Cancer: Prostate Cancer, Cancer
Lopez JM, Wing H, Ackerman SL
Community health center staff perspectives on financial payments for social care.
The purpose of this study was to examine how community health center (CHC) staff perceive the current and potential influence of fee-for-service payments on clinical teams' engagement in these activities. The researchers interviewed 42 clinicians, frontline staff, and administrative leaders employed by12 Oregon CHC clinical sites about their social care initiatives. The study grouped the findings into three categories: 1. participants' awareness of existing or anticipated financial incentives, 2. uses for incentive dollars, and 3. perceived impact of financial incentives on social care activities in clinical practices. Current or anticipated important uses for incentive dollars included paying for social care staff, providing social services, and supporting additional fundraising efforts. Frontline staff reported that the strongest influence on clinic social care practices was the ability to provide responsive social services. Clinic leaders reported that for financial incentives to significantly change CHC practices would necessitate payments large enough to expand the social care workforce as well.
AHRQ-funded; HS026435.
Citation: Lopez JM, Wing H, Ackerman SL . Community health center staff perspectives on financial payments for social care. Milbank Q 2023 Dec; 101(4):1304-26. doi: 10.1111/1468-0009.12667..
Keywords: Community-Based Practice, Payment, Healthcare Delivery
Scott JW, Neiman PU, Scott KW
High deductibles are associated with severe disease, catastrophic out-of-pocket payments for emergency surgical conditions.
This retrospective analysis of claims data examined the association of a high-deductible health insurance plan (HDHP) with severe disease and catastrophic out-of-pocket payments for emergency surgical conditions (e.g., appendicitis, cholecystitis, diverticulitis, and intestinal obstruction). Primary outcome was disease severity at presentation-determined using ICD-10-CM diagnoses codes and based on validated measures of anatomic severity (e.g., perforation, abscess, diffuse peritonitis). The secondary outcome was catastrophic out-of-pocket spending, defined by the World Health Organization as out-of-pocket spending >10% of annual income. Among 43,516 patients [mean age 48.4 years; 51% female], 41% were enrolled in HDHPs. Despite being younger, healthier, wealthier, and more educated, HDHP enrollees were more likely to present with more severe disease (28.5% vs 21.3%); even after adjusting for relevant demographics. HDHP enrollees were also more likely to incur 30-day out-of-pocket spending that exceeded 10% of annual income (20.8% vs 6.4%).
AHRQ-funded; HS027788; HS028672.
Citation: Scott JW, Neiman PU, Scott KW . High deductibles are associated with severe disease, catastrophic out-of-pocket payments for emergency surgical conditions. Ann Surg 2023 Oct 1; 278(4):e667-e74. doi: 10.1097/sla.0000000000005819..
Keywords: Health Insurance, Healthcare Costs, Payment, Surgery
Kwon Y, Perraillon MC, Drake C
Comparison of primary payer in cancer registry and discharge data.
The purpose of this cross-sectional study was to ascertain agreement between variables capturing the primary payer at cancer diagnosis across the Pennsylvania Cancer Registry (PCR) and statewide facility discharge records (Pennsylvania Health Care Cost Containment Council [PHC4]) for adults under 65 years, and to examine variables related with misclassification of Medicaid status in the registry given the role of managed care. The researchers evaluated agreement of payer at diagnosis across data sources. The study found that agreement of payers was high for private insurance, but there was misclassification and/or underreporting of Medicaid in the registry. Among cases with "other" and "unknown" insurance, 73.8% and 62.1%, respectively, had private insurance. Medicaid managed care was related with a statistically significant increase of 12.6 percentage points in the probability of misclassifying Medicaid enrollment as private insurance in the registry.
AHRQ-funded; HS027396.
Citation: Kwon Y, Perraillon MC, Drake C . Comparison of primary payer in cancer registry and discharge data. Am J Manag Care 2023 Sep; 29(9):455-62. doi: 10.37765/ajmc.2023.89425..
Keywords: Cancer, Payment
Waltman A, Konetzka RT, Chia S
Effectiveness of a bundled payments for care improvement program for chronic obstructive pulmonary disease.
This single-site retrospective observational study evaluated the impact of an evidence-based transitions of care program on episode costs and readmission rates, comparing patients hospitalized for COPD exacerbations who received versus those who did not receive the intervention. Between October 2015 and September 2018, 132 received and 161 did not receive the program. Below target mean episode costs were found for six out of eleven quarters for the intervention group, as opposed to only one out of twelve quarters for the control group. Overall, there were non-significant mean savings of $2551 in episode costs relative to target costs for the intervention group, though results varied by index admission diagnosis-related group (DRG). There were additional costs of $4184 per episode for the least-complicated cohort (DRG 192), but savings of $1897 and $1753 for the most complicated index admissions (DRGs 191 and 190, respectively). A significant mean decrease of 0.24 readmissions per episode for intervention was observed in 90-day readmission rates relative to control. Skilled nursing facility readmissions and hospital discharges were factors of higher costs (mean increases of $9098 and $17,095 per episode respectively).
AHRQ-funded; HS027804.
Citation: Waltman A, Konetzka RT, Chia S . Effectiveness of a bundled payments for care improvement program for chronic obstructive pulmonary disease. J Gen Intern Med 2023 Sep; 38(12):2662-70. doi: 10.1007/s11606-023-08249-6..
Keywords: Respiratory Conditions, Chronic Conditions, Payment, Quality Improvement, Quality of Care
Anderson KE, DiStefano MJ, Liu A
Incorporating added therapeutic benefit and domestic reference pricing into Medicare payment for expensive part B drugs.
The objective of this retrospective analysis was to identify expensive Part B drugs and to consider the evidence for each drug's added benefit in order to model a reimbursement policy for Medicare that integrates added benefit assessment and domestic reference pricing. Data were taken from a nationally representative sample of traditional Medicare Part B claims. The analysis showed that more than one-third of the expensive Part B drugs prescribed in 2019 offered low added benefit. The authors concluded that reference pricing based on added benefit assessment could be used to address the launch prices for expensive Part B drugs with low added benefit.
AHRQ-funded; HS000029.
Citation: Anderson KE, DiStefano MJ, Liu A . Incorporating added therapeutic benefit and domestic reference pricing into Medicare payment for expensive part B drugs. Value Health 2023 Sep; 26(9):1381-88. doi: 10.1016/j.jval.2023.05.018..
Keywords: Medicare, Payment, Medication, Healthcare Costs
Lewis A, Howland RE, Horwitz LI
Medicaid value-based payments and health care use for patients with mental illness.
This retrospective cohort study鈥檚 objective was to investigate if New York State's Medicaid value-based payment reform was associated with improved utilization patterns for patients with mental illness (major depression disorder, bipolar disorder, and/or schizophrenia). The cohort included Medicaid 306,290 individuals with depression (67.4% female; mean age, 38.6 years), 85,105 patients with bipolar disorder (59.6% female; mean age, 38.0 years), and 71,299 patients with schizophrenia (45.1% female mean age, 40.3 years). After adjustment, the analysis estimated a statistically significant, positive association between value-based payments and behavioral health visits for patients with depression (0.91 visits) and bipolar disorder (1.01 visits). There were no statistically significant changes to primary care visits for patients with depression and bipolar disorder, but value-based payments were associated with reductions in primary care visits for patients with schizophrenia (-1.31 visits). In every diagnostic population, value-based payment was associated with significant reductions in mental health emergency department visits (population with depression: -0.01 visits; population with bipolar disorder: -0.02 visits; population with schizophrenia: -0.04 visits).
AHRQ-funded; HS026980; HS026120.
Citation: Lewis A, Howland RE, Horwitz LI . Medicaid value-based payments and health care use for patients with mental illness. JAMA Health Forum 2023 Sep; 4(9):e233197. doi: 10.1001/jamahealthforum.2023.3197..
Keywords: Medicaid, Behavioral Health, Payment, Depression
Landon BE, Lam MB, Landrum MB
Opportunities for savings in risk arrangements for oncologic care.
High spending for cancer care is a target for savings as the United States hastens adoption of alternative payment through global payment models such as Accountable Care Organizations (ACOs) or Medicare Advantage (MA). The purpose of this study was to quantify the level at which Accountable Care Organizations ACOs and other risk-bearing organizations operating in a specific geographic area could realize savings by directing patients to efficient medical oncology practices. The incident cohort included 1,309,825 patients Options for directing differed across markets; the top quartile market had 10 or more oncology practices, but the bottom quartile had 3 or fewer oncology practices. Total spending (including Medicare Part D) in the incident cohort increased from a mean of $57,314 in 2009 to 2010 to $66,028 in 2016 to 2017. Within markets, total spending for practices in the highest spending quartile was 19% greater than in the lowest quartile. Hospital spending was the single largest component of spending in both time periods followed by Part B (infused) chemotherapy. Correlations in practice-level spending between the first-year (2009) and second-year (2010) spending were high.
Citation: Landon BE, Lam MB, Landrum MB . Opportunities for savings in risk arrangements for oncologic care. JAMA Health Forum 2023 Sep; 4(9):e233124. doi: 10.1001/jamahealthforum.2023.3124..
Keywords: Cancer, Medicare, Healthcare Costs, Payment
Tummalapalli SL, Struthers SA, White D
Optimal care for kidney health: development of a Merit-based Incentive Payment System (MIPS) value pathway.
This article detailed the iterative consensus-building process used by the American Society of Nephrology Quality Committee to develop the Optimal Care for Kidney Health Merit-based Incentive Payment System (MIPS) Value Pathway (MVP). The Optimal Care for Kidney Health MVP, published in the 2023 Medicare Physician Fee Schedule Final Rule, included measures related to angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use, hypertension control, readmissions, acute kidney injury requiring dialysis, and advance care planning. The MVP nephrology鈥檚 goal was to streamline measure selection in MIPS and served as a case study of collaborative policymaking between one professional organization and national regulatory agencies.
AHRQ-funded; HS028684.
Citation: Tummalapalli SL, Struthers SA, White D . Optimal care for kidney health: development of a Merit-based Incentive Payment System (MIPS) value pathway. J Am Soc Nephrol 2023 Aug; 34(8):1315-28. doi: 10.1681/asn.0000000000000163..
Keywords: Kidney Disease and Health, Payment, Healthcare Costs, Medicare
Loomer L, Rahman M, Mroz TM
Impact of higher payments for rural home health episodes on rehospitalizations.
This article evaluated the impact of higher Medicare payments for rural home health care on rehospitalizations. In 2010, Medicare began paying home health (HH) providers 3% more to serve rural beneficiaries. The authors used Medicare data on postacute HH episodes from 2007 to 2014 to estimate the impact of higher payments on beneficiaries outcomes using difference-in-differences analysis, comparing rehospitalizations between rural and urban postacute HH episodes before and after 2010. Their sample included 5.6 million post acute HH episodes (18% rural). After 2010 30- and 60-day rehospitalization rates declined by 10.08% and 16.49% for urban HH episodes and 9.87% and 16.08% for rural HH episodes, respectively. The difference-in-difference estimate was 0.29 percentage points and 0.57 percentage points for 30- and 60-day rehospitalization, respectively.
AHRQ-funded; HS027054.
Citation: Loomer L, Rahman M, Mroz TM . Impact of higher payments for rural home health episodes on rehospitalizations. J Rural Health 2023 Jun; 39(3):604-10. doi: 10.1111/jrh.12725..
Keywords: Payment, Rural Health, Rural/Inner-City Residents, Hospital Readmissions, Hospitalization
Maclean JC, McClellan C, Pesko MF
大象APPAuthor: McClellan C
Medicaid reimbursement rates for primary care services and behavioral health outcomes.
This AHRQ-authored research studied the effects of changing Medicaid reimbursement rates for primary care services on behavioral health outcomes-defined here as mental illness and substance use disorders. The authors applied two-way fixed-effects regressions to survey data specifically designed to measure behavioral health outcomes over the period 2010-2016. They found that higher primary care reimbursement rates reduce mental illness and substance use disorders among non-elderly adult Medicaid enrollees, although they interpreted findings for substance use disorders with some caution as they may be vulnerable to differential pre-trends. Overall, their findings suggest positive spillovers from a policy designed to target primary care services to behavioral health outcomes.
AHRQ-authored.
Citation: Maclean JC, McClellan C, Pesko MF . Medicaid reimbursement rates for primary care services and behavioral health outcomes. Health Econ 2023 Jan 6;32(4):873-909. doi: 10.1002/hec.4646.
Keywords: Medicaid, Payment, Primary Care, Behavioral Health, Outcomes, Access to Care, Substance Abuse, Health Insurance
Ko H, Martin BI, Nelson RE
How does the effect of the comprehensive Care for Joint Replacement model vary based on surgical volume and costs of care?
This article described differences in costs, quality, and patient selection between hospitals that continued to participate in the comprehensive Care for Joint Replacement (CJR) program after the CMS policy revision and those that withdrew from CJR before and after the implementation of CJR. Study subjects were Medicare beneficiaries who had undergone elective lower extremity joint replacement from 2013 to 2017. The results indicated that hospitals that continued to participate in CJR achieved a greater cost reduction. The authors noted that these the cost reductions were partly attributable to the avoidance of potential higher-cost patients.
AHRQ-funded; HS024714.
Citation: Ko H, Martin BI, Nelson RE . How does the effect of the comprehensive Care for Joint Replacement model vary based on surgical volume and costs of care? Med Care 2023 Jan;61(1):20-26. doi: 10.1097/mlr.0000000000001785..
Keywords: Orthopedics, Surgery, Healthcare Costs, Medicare, Payment
Auty SG, Daw JR, Wallace J
State-level variation in supplemental maternity kick payments in Medicaid managed care.
The purpose of the cross-sectional study described in this research letter was to assesses the prevalence and magnitude of state-level delivery event鈥搕riggered kick payments to Medicaid managed care (MMC) plans for covering pregnant patients and the association of such payments with delivery costs. MMC kick payment rates were compared with average state Medicaid fee-for-service (FFS) payments for delivery hospitalizations and state kick payment rates compared with the Medicaid-Medicare fee index. The authors found 鈥渟ubstantial and potentially unwarranted鈥 state variation in delivery kick payment rates within MMC. They noted that if kick payment rates are set too low, plans may attempt to avoid pregnant enrollees by limiting coverage of certain services or restricting maternity care clinicians in their networks, with consequences for Black and Indigenous maternity patients.
AHRQ-funded; HS028754.
Citation: Auty SG, Daw JR, Wallace J . State-level variation in supplemental maternity kick payments in Medicaid managed care. JAMA Intern Med 2023 Jan; 183(1):80-82. doi: 10.1001/jamainternmed.2022.5146..
Keywords: Care Management, Health Insurance, Access to Care, Payment, Maternal Health
Liao JM, Wang E, Isidro U
The association between bundled payment participation and changes in medical episode outcomes among high-risk patients.
This research evaluated whether the association between participation in bundled payments for medical conditions and episode outcomes differed for clinically high-risk versus other patients in regard to length of stay (LOS) at skilled nursing facilities (SNFs). Participants included 471,421 Medicare patients hospitalized at bundled payment and propensity-matched non-participating hospitals. Primary outcomes were SNF LOS and 90-day unplanned readmissions. SNF length of stay was differentially lower among frail patients, patients with advanced age (>85 years), and those with prior institutional post-acute care provider utilization compared to non-frail, younger, and patients without prior utilization, respectively. Bundled payment participation was also associated with differentially greater SNF LOS among disabled patients. It was not associated with differential changes in readmissions in any high-risk group but was associated with changes in quality, utilization, and spending measures for some groups.
AHRQ-funded; HS027595.
Citation: Liao JM, Wang E, Isidro U . The association between bundled payment participation and changes in medical episode outcomes among high-risk patients. Healthcare 2022 Dec 12; 10(12). doi: 10.3390/healthcare10122510..
Keywords: Payment, Quality Improvement, Quality of Care, Risk, Policy

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