Mei Zhao

Variations in inpatient mortality among hospitals in different system types, 1995 to 2000.

Background:Relatively few studies focused on the impact of system formation and hospital merger on quality, and these studies reported typically little or no quality effect. Objective:To study associations among 5 main types of health systems–centralized, centralized physician/insurance, moderately centralized, decentralized, and independent–and inpatient mortality from acute myocardial infarction (AMI), congestive heart failure, stroke, and pneumonia. Data and Methods:Panel data (1995–2000) were assembled from 11 states and multiple sources: Agency for Healthcare Research and Quality State Inpatient Database, American Hospital Association Annual Surveys, Area Resource File, HMO InterStudy, and the Centers for Medicare and Medicaid Services. We applied a panel study design with fixed effects models using information on variation within hospitals. Results:We found that centralized health systems are associated with lower AMI, congestive heart failure, and pneumonia mortality. Independent hospital systems had better AMI quality outcomes than centralized physician/insurance and moderately centralized health systems. We found no difference in inpatient mortality among system types for the stroke outcome. Thus, for certain types of clinical service lines and patients, hospital system type matters. Research that focuses only on system membership may mask the impact of system type on the quality of care.

Nursing Home Price and Quality Responses to Publicly Reported Quality Information

OBJECTIVE To assess whether the release of Nursing Home Compare (NHC) data affected self-pay per diem prices and quality of care. DATA SOURCES Primary data sources are the Annual Survey of Wisconsin Nursing Homes for 2001-2003, Online Survey and Certification Reporting System, NHC, and Area Resource File. STUDY DESIGN We estimated fixed effects models with robust standard errors of per diem self-pay charge and quality before and after NHC. PRINCIPAL FINDINGS After NHC, low-quality nursing homes raised their prices by a small but significant amount and decreased their use of restraints but did not reduce pressure sores. Mid-level and high-quality nursing homes did not significantly increase self-pay prices after NHC nor consistently change quality. CONCLUSIONS Our findings suggest that the release of quality information affected nursing home behavior, especially pricing and quality decisions among low-quality facilities. Policy makers should continue to monitor quality and prices for self-pay residents and scrutinize low-quality homes over time to see whether they are on a pathway to improve quality. In addition, policy makers should not expect public reporting to result in quick fixes to nursing home quality problems.

Value-based purchasing and hospital acquired conditions: Are we seeing improvement?

OBJECTIVE To determine if the Value-Based Purchasing Performance Scoring system correlates with hospital acquired condition quality indicators. DATA SOURCES/STUDY SETTING This study utilizes the following secondary data sources: the American Hospital Association (AHA) annual survey and the Centers for Medicare and Medicaid (CMS) Value-Based Purchasing and Hospital Acquired Conditions databases. STUDY DESIGN Zero-inflated negative binomial regression was used to examine the effect of CMS total performance score on counts of hospital acquired conditions. Hospital structure variables including size, ownership, teaching status, payer mix, case mix, and location were utilized as control variables. DATA COLLECTION The secondary data sources were merged into a single database using Stata 10. PRINCIPAL FINDINGS Total performance scores, which are used to determine if hospitals should receive incentive money, do not correlate well with quality outcome in the form of hospital acquired conditions. CONCLUSIONS Value-based purchasing does not appear to correlate with improved quality and patient safety as indicated by Hospital Acquired Condition (HAC) scores. This leads us to believe that either the total performance score does not measure what it should, or the quality outcome measurements do not reflect the quality of the total performance scores measure.

Value-based purchasing, efficiency, and hospital performance.

The Medicare hospital value-based purchasing (HVBP) program that links Medicare payments to quality of care became effective in 2013 in the United States. Hospital efficiency will be added to the HVBP in 2015. It is unclear whether hospital efficiency–specific hospital characteristics are associated with HVBP performance scores and the subsequent incentive payments. Using data from the American Hospital Association Annual Survey the Medicare Hospital Compare, this article examines the association of hospital efficiency hospital characteristics with the HVBP performance scores. The results indicate that less efficient hospitals are more likely to have lower patient satisfaction scores and total performance scores compared with more efficient hospitals. Hospital size, ownership, and payer mix also have significant impact on HVBP performance scores. The findings of this study provide significant policy practice implications. On the one hand, hospitals should consider investing their limited resources into identifying implementing the most cost-effective procedures to improve their patient experience total performance scores. On the other hand, policymakers should consider the unintended negative impact that these new payment incentives will likely have on hospitals that serve a higher proportion of low-income racial ethnic minority populations.

Five myths of the Chinese health care system.

As China continues its moves from a socialist ideology to a market economy, the impact of its presence is being felt globally. This is especially true with Chinas health care system and the challenges that it is experiencing with its 1.3 billion population. The erosion of Chinas socialist ideology was accompanied by an erosion of the governments subsidy of health services, placing the major responsibilities of providing health care services on regional governments. Unfortunately, the impact of these policies on Chinas health care system is not commonly understood, resulting in confusion and propagation of myths. For example, many believe that the Chinese government provides free health care for all citizens, and the population has not accepted Western medicine and relies primarily on traditional Chinese medicine. In addition, it is believed that there is no shortage of nurses, as the majority of care is provided at home. Finally, it is commonly believed that Chinas health care issues are different from those of the United States. Exploration of these myths provides us with a better understanding and an improved ability to engage with this emerging economic global leader.

Utilization, cost, payment, and patient satisfaction of rehabilitative services in Shandong, China

OBJECTIVES Chinas transformation into a market-based and global economy has had dramatic health policy implications on a system that serves roughly 1.3 billion people. This global perspective is resulting in the integration of Traditional Chinese Medicine (TCM) and western medicine for the treatment of an increasing number of morbidities. However, little research has been conducted that examines patient response to this convergence. This study researches the utilization, cost, payment and patient satisfaction with rehabilitative services received in China. METHODS A structured questionnaire was administered to 192 patients receiving rehabilitative services in Chinas Shandong Province. RESULTS The most frequently ordered TCM therapies were acupuncture (14.1%) and massage therapy (15.6%). The most frequently ordered western therapies were physical therapy (62.5%) and occupational therapy (6.3%). Physical therapy was considered the most cost-effective service at almost half the cost of acupuncture. Almost 85% of respondents had some form of health insurance and 90% expressed satisfaction with their therapy. CONCLUSIONS Healthcare providers should consider offering TCM and western medicine for morbidities requiring rehabilitative services. In a more global healthcare marketplace, the convergence of these two treatment modalities can lead to higher patient satisfaction and more cost-effective treatments.

Immediate Physical Therapy Initiation in Patients With Acute Low Back Pain Is Associated With a Reduction in Downstream Health Care Utilization and Costs

Background. Physical therapy is an important treatment option for patients with low back pain (LBP). However, whether to refer patients for physical therapy and the timing of initiation remain controversial. Objective. The objective of this study was to evaluate the impact of receiving physical therapy and the timing of physical therapy initiation on downstream health care utilization and costs among patients with acute LBP. Design. The design was a retrospective cohort study. Methods. Patients who had a new onset of LBP between January 1, 2009, and December 31, 2013, in New York State were identified and grouped into different cohorts on the basis of whether they received physical therapy and the timing of physical therapy initiation. The probability of service use and LBP‐related health care costs over a 1‐year period were analyzed. Results. Among 46,914 patients with acute LBP, 40,246 patients did not receive physical therapy and 6668 patients received physical therapy initiated at different times. After controlling for patient characteristics and adjusting for treatment selection bias, health care utilization and cost measures over the 1‐year period were the lowest among patients not receiving physical therapy, followed by patients with immediate physical therapy initiation (within 3 days), with some exceptions. Among patients receiving physical therapy, those receiving physical therapy within 3 days were consistently associated with the lowest health care utilization and cost measures. Limitations. This study was based on commercial insurance claims data from 1 state. Conclusions. When referral for physical therapy is warranted for patients with acute LBP, immediate referral and initiation (within 3 days) may lead to lower health care utilization and LBP‐related costs.

Malpractice paid losses and financial performance of nursing homes

BACKGROUND Floridas nursing home industry has experienced significant financial pressure over the past decade. One of the primary reasons is the dramatic increase in litigation activity for nursing home providers claiming negligent care and abuse. Although anecdotal reports indicate a higher cost because of malpractice in nursing facilities, few studies have examined the extent of malpractice paid losses and their effect on the financial performance of nursing homes. PURPOSE The purpose of this study was to examine the impact of malpractice paid losses on the financial performance of nursing homes. METHODOLOGY/APPROACH Medicare Cost Report data and Online Survey, Certification, and Reporting data for Florida skilled nursing facilities over the 6-year period from 2001 to 2006 were used to calculate the malpractice paid losses and the financial performance indicators as well as the nursing home organizational and market factors. Descriptive analysis and multivariate regression analysis were used to examine the effect of paid loss on financial performance. FINDINGS The paid loss for malpractice claims was strongly associated with financial performance. Nursing facilities with malpractice paid losses had consistently lower total margins over the study period. The threat of nursing home litigation may create an incentive for nursing homes to improve quality of care; however, large paid claims can also force nursing homes into a financial situation where the organization no longer has the resources to improve quality. PRACTICE IMPLICATIONS Nursing home managers must assess their malpractice litigation risk and identify tactics to mitigate these risks to better provide a safe and secure environment for the older persons. In addition, this research offers support for local, state, and federal policymakers to revisit the issue of malpractice litigation and the nursing home industry through its insight on the relationship of nursing home margins and litigation.

Response to modeling and notation of DEA with strong and weak disposable outputs

In this brief communiction we respond to comments on our earlier publication, which contained some notational errors.

Does value-based purchasing affect US hospital utilization pattern: A comparative study

ABSTRACT We evaluated the effect US hospital performance as measured by the Medicare hospital value-based purchasing (HVBP) program has on the volume of hospitals inpatient and outpatient services. We analyzed data from the 2013 to 2014 American Hospital Association database, HVBP total performance scores database through Centers for Medicare and Medicaid Services (CMS) and the area health resources files database through CMS. This study utilized a multinomial logistic regression and transaction cost economic theory, adjusting for the Herfindahl–Hirschman Index, number of facility beds, beds per thousand, individuals 65+, teaching status, location, ownership, and system affiliation. The prominent study findings indicate a significant relationship between percent utilization of inpatient, outpatient and HVBP score. Furthermore, environmental factors such as the Herfindahl–Hirschman Index, and system participation were found to significantly impact hospitals ratio of inpatient to outpatient. Relative risk ratios show that hospitals with overall lower HVB are more likely to be in the top 25 percentile for outpatient services. With the decline in inpatient volume of services and the rise in outpatient utilization, inpatient metrics will continue to be relevant as key indicators of quality of care. Inpatient services will never become irrelevant to the overall financial profile of hospital performance.