Gregory Kruse

Impact of public reporting on unreported quality of care.

OBJECTIVE The impact of quality improvement incentives on nontargeted care is unknown and some have expressed concern that such incentives may be harmful to nontargeted areas of care. Our objective is to examine the effect of publicly reporting quality information on unreported quality of care. DATA SOURCES/STUDY SETTING The nursing home Minimum Data Set from 1999 to 2005 on all postacute care admissions. STUDY DESIGN We studied 13,683 skilled nursing facilities and examined how unreported aspects of clinical care changed in response to changes in reported care after public reporting was initiated by the Centers for Medicare and Medicaid Services on their website, Nursing Home Compare, in 2002. PRINCIPAL FINDINGS We find that overall both unreported and reported care improved following the launch of public reporting. Improvements in unreported care were particularly large among facilities with high scores or that significantly improved on reported measures, whereas low-scoring facilities experienced no change or worsening of their unreported quality of care. CONCLUSIONS Public reporting in the setting of postacute care had mixed effects on areas without public reporting, improving in high-ranking facilities, but worsening in low-ranking facilities. While the benefits of public reporting may extend beyond areas that are being directly measured, these initiatives may also widen the gap between high- and low-quality facilities.

Public-Private Networks as Sources of Knowledge and Upgrading Capabilities: A Parametric Stroll through Argentine Vineyards

This article uses a unique research design to statistically analyze how a firms public-private network can shape its upgrading capabilities. Such a network includes a firms ties to other firms as well as to associations, cooperatives, schools, and publicly supported institutions that aim to help firms innovate. We develop our argument through an examination of the transformation of the Argentine wine industry in two provinces that uses data from a unique field survey we designed and implemented in 2004-05 to statistically analyze the relative impact of firm level factors, inter-firm networks, and ties to non-firm organizations and institutions. While inter-firm networks are vital to upgrading, institutions bring value to firms in helping reconfigure socio-economic relationships. First, they can help firms improve process and product upgrading capabilities and graduate them to more sophisticated inter-firm networks. Second, linkages to institutions appear especially helpful to the extent they help the firm gain access to a variety of knowledge in different communities of producers. Governments can aid upgrading and competitiveness, especially in emerging markets, by building public-private institutions that not only offer supply-side resources to firms but also act as bridges across regions.

Is the System Really the Solution? Operating Costs in Hospital Systems

Hospital system formation has recently accelerated. Executives emphasize scale economies that lower operating costs, a claim unsupported in academic research. Do systems achieve lower costs than freestanding facilities, and, if so, which system types? We test hypotheses about the relationship of cost with membership in systems, larger systems, and centralized and local hub-and-spoke systems. We also test whether these relationships have changed over time. Examining 4,000 U.S. hospitals during 1998 to 2010, we find no evidence that system members exhibit lower costs. However, members of smaller systems are lower cost than larger systems, and hospitals in centralized systems are lower cost than everyone else. There is no evidence that the system’s spatial configuration is associated with cost, although national system hospitals exhibit higher costs. Finally, these results hold over time. We conclude that while systems in general may not be the solution to lower costs, some types of systems are.

Administration costs of intravenous chemotherapy in treating peripheral T-cell lymphoma

Abstract Objective: This retrospective cohort analysis was conducted to examine the cost components of administering IV chemotherapy to peripheral T-cell lymphoma (PTCL) patients in the US to inform decision makers. Methods: Patients diagnosed with PTCL (ICD-9 code 202.7X) between 1 October 2007 and 30 September 2012 were identified from a US administrative claims database. Costs for patients receiving at least one NCCN recommended IV chemotherapy were assessed using the allowed payment from claim line items, categorized into cost components (study drug costs, IV administration costs and other visit-related services). Results: The mean costs to the payer for IV cancer therapy administration in a PTCL patient population averaged about

Commentary on "Is the system really the solution? Operating costs in hospital systems": limits to system efficiency in centralized hospital systems: illustration from the University of Pennsylvania Health System.

5735 per visit and

Cardiovascular Disease and its Risk Factors in Patients with Familial Hypercholesterolemia: A Systematic Review

9356 per member per month (PMPM). Across all therapies, mean IV administration costs accounted for

PCN27 AN ANALYSIS OF COSTS ASSOCIATED WITH ADMINISTRATION OF TRASTUZUMAB-BASED COMBINATION IV THERAPIES IN METASTATIC BREAST CANCER PATIENTS IN A US POPULATION

127–

The impact of hospital pay-for-performance on hospital and Medicare costs.

794 per visit and

Analysis of Costs Associated With Administration of Intravenous Single-Drug Therapies in Metastatic Breast Cancer in a U.S. Population

594–

Variation in cardiac procedure use and racial disparity among Veterans Affairs Hospitals

1808 PMPM, contributing an additional 2–32% to the total costs of the drug alone. Mean other visit-related services costs for treating PTCL accounted for