health affairs

Study: P4P may have little impact on quality

Anne Zieger — Mon, 28 Jul 2008 09:05:11 -0400

Of late, health plans and employers have been rolling out pay-for-performance programs aggressively on the assumption that such programs offer a helpful method for improving healthcare quality. In fact, more than 150 programs built around rewarding evidence-based care exist, according to research by American Medical News. However, according to one piece of research, some of these efforts might be wasted. That, at least, is the conclusion drawn by a new analysis of quality incentives published in Health Affairs.

The study, which compared 81 Massachusetts physician groups in incentive programs with 73 that were not, found that while overall performance on preventive measures like breast cancer screening and well-child visits improved 73 percent, it was impossible to distinguish one group of physicians from the other statistically. In other words, all physicians' quality improved, whether or not they were jockeying for a bonus.

These results don't necessarily suggest that all P4P programs don't work, the study's authors stressed. The impact of P4P initiatives can vary dramatically depending on how the program is implemented, they noted. Also, American P4P programs tend to offer rewards in the range of 5 percent to 9 percent of payments, which may not be enough to motivate doctors. (In contrast, British doctors can more than double their income by meeting quality targets.)

To learn more about this study:
- read this AMNews piece

Related Articles:
CMS P4P program shows improvements
Top P4P hospitals to score $7M in bonuses from CMS
Calif. group pays out $55M in P4P incentives
Case study: MI groups make P4P dollars through IT use

Study: CDHPs motivate patients to avoid care, discontinue drugs

Anne Zieger — Thu, 10 Jul 2008 13:27:22 -0400

While some continue to encourage more use of CDHPs, a recent study suggests that they may have a significant downside. This is important data given that the number of large companies offering a CDHP has almost doubled over the last two years, according to research by Watson Wyatt and the National Business Group on Health.

The study by Oregon researchers suggests that the plans can encourage plan members to avoid care and stop taking drugs to treat chronic medical conditions. The study, published this week in Health Affairs, compared enrollees in high-deductible, low-deductible and PPO plans. They found that people enrolled in CDHPs were more likely to stop taking drugs to treat high blood pressure and lower cholesterol than those in traditional commercial health plans. During the second year of the study, they found that even some enrollees in lower-deductible CDHPs were postponing medical procedures or cutting back on their use of prescribed drugs. Meanwhile, the University of Oregon researchers failed to see behaviors produced that proponents of CDHPs expected to see, including more use of health information, higher generic use or more comparison shopping among diagnostic test providers.

To learn more about the study:
- read this Portland Business Journal piece

Related Articles:
CDHPs will need to step up outreach efforts
Study: CDHPs are more expensive for women
Study: Employers like CDHPs, but consumers don't

Study: MDs who treat minorities face quality challenges

Wed, 23 Apr 2008 06:59:55 -0400

Doctors who treat minorities tend to face a unique set of quality and financial challenges, according to a new study appearing in Health Affairs. The researchers, who used data from the 2004-05 Community Tracking Study Physician Survey, concluded that 26 percent of physicians in high-minority practices disagreed that it was possible to provide high-quality care to all patients, while only 16 percent of low-minority practices agreed with this statement. What's more, high-minority practices were more likely to report that having too little time during office visits impacted their ability to provide high-quality care. This study was supported by The Commonwealth Fund.

To learn more about this study:
- read this Modern Physician article

Related Articles:
GA minorities suffer big health disparities
Racial disparities persist in health outcomes
Study: 'Medical homes' cut racial care disparities
Study: Hispanics get lower-quality medical care
CMS hopes to close Medicare race, ethnicity gap

Study: MDs refer profitable patients to their ASCs

Wed, 19 Mar 2008 07:59:57 -0400

This isn't too surprising, but it's not something policymakers will like, either. A new study of referral patterns in the Philadelphia and Pittsburgh metros suggests that physicians who are high-admitters to physician-owned ASCs send far more privately insured patients to those facilities, while sending Medicaid enrollees to hospital outpatient departments, in many cases. The study, published in Health Affairs and completed through the University of Chicago, looks at whether having a stake in an ASC affects the types of patients a physician would refer to a facility. Research found that for the top 50 percent of physician referrals to ASCs, 45 percent of Medicaid patients were sent to hospital outpatient departments, while 92 percent of privately insured patients were sent to physician-owned ASCs.

Folks, these numbers seem to pretty much clinch the argument that ASCs keep the best-paying patients for themselves, while blocking the poor from getting whatever benefits the specialized ASC services might offer. Looks like this could kick off some heated discussions on Capitol Hill.

To get more information on the study:
- read the Health Affairs report
- read this Modern Healthcare article (reg. req.)

Related Articles:
NY accuses ASCs of collecting overpayments. Reports
Number of PA ASCs keeps growing, but profits level off. Report
CMS updating rules for ASC Medicare participation. Report
Doctors sue HealthSouth over surgery centers sale. Report
Profits way up for Penn ASCs. Report
Georgia physicians battle for looser ASC regs. Report
Ohio bill would force hospitals to have 24x7 EDs. Report

MD self-referrals for imaging slipping through

Tue, 17 Apr 2007 20:01:38 -0400

A new study published in Health Affairs suggests that some physicians may be dodging Stark regulations when billing for advanced imaging services. The study, which used data from an unnamed California insurer, found that 33 percent of providers who billed for MRIs, 22 percent of those billing for CT scans and 17 percent of those who billed for PET scans could be classed as self-referrals. These physicians are avoiding the appearance of conflict by leasing or payment-per-scan referral arrangements, researchers said. In fact, 61 percent of doctors who billed for MRIs and 64 percent of those billing for CT scans didn't own imaging equipment. If the referring physicians were prescribing appropriate tests, and the charge for the test was no higher than rates at other facilities, physicians would probably avoid legal trouble, but researchers concluded that some arrangements would probably violate either federal or state self-referral laws.

To find out more about the study:
- read this Health Affairs abstract

Related Articles:
CMS cracks down on testing self-referrals. Report
Florida closes self-referral loophole. Report
TX specialty hospitals prompt self-referral discussion. Report

SPOTLIGHT: Outsiders should see FDA safety data

Wed, 07 Mar 2007 19:01:32 -0500

Some say that if outside researchers had access to drug safety data, disasters like the Vioxx scandal might have been avoided. At present, however, the FDA doesn't let outsiders see clinical trial data unless forced to do so. This secrecy can only do harm, suggests a new commentary in Health Affairs. Report

Study: Physicians say P4P would harm care

Tue, 06 Mar 2007 19:01:36 -0500

While they agree that pay for performance approaches can improve care, about three-quarters of primary care physicians worry that public data reporting would have a negative impact on patient relationships, according to a new study published this month in Health Affairs. The research, which involved a survey of 550 randomly chosen general internists, concluded that physicians weren't satisfied that P4P schemes would measure the right factors in the right way. While most PCPs felt that physicians should be rewarded for providing high quality care--provided that the measurements were accurate--less than one-third felt that current measures would do the trick. A majority (66 percent) felt that health plans and the government were unlikely to exert the effort to make such measures accurate. Roughly eight out of ten worried that pay for performance schemes would force doctors to avoid high-risk patients--or even kick such patients out of their practices.

To find out more about the research:
- read this United Press International article

Related Articles:
CMS extends pay-for-performance program. Report
Medicare P4P results show care improvements. Report
Positive results for Medicare P4P pilot. Report
Exclusive: How to make P4P work. Interview
HMO pay for performance plans common. Report

Medicaid's future better than expected

Sun, 25 Feb 2007 19:01:38 -0500

According to a new report, Medicaid's future may be better than previously thought. The Kaiser Commission on Medicaid and the Uninsured has concluded that projected growth in government revenues should support Medicaid spending for at least 40 years. This is, in part, because the program's share of national health expenditures isn't expected to grow dramatically. As of 2005, Medicaid was 16.5 percent of national health expenditures, but should only climb 2.5 percent, to 19 percent, by 2045. Not only is Medicaid sustainable on the federal level, but under all but the most pessimistic projections, states, too, will enjoy enough revenue growth to support their Medicaid contribution.

To learn more about Medicaid's future:
- read this Modern Healthcare article
- read the Kaiser report in Health Affairs

Related Articles:
Critics, fans debate Medicaid HMO benefits. Report
HHS awards $103M to improve Medicaid programs. Report

Higher co-pays for less useful treatment cuts costs

Tue, 30 Jan 2007 19:01:35 -0500

Consumers may not be thrilled with this approach, which might feel to them as though their freedom has been compromised. Still, it looks as if higher co-pays may steer them away from treatments researchers consider to be less useful. In a paper appearing this week in Health Affairs, Harvard University health policy professor Michael Chernew outlines a strategy by which insurance companies can save money--while improving care--if they raise co-pays for procedures or treatments that don't seem to be carrying their weight financially. Chernew argues that health benefit designers should make cost-effective treatments available for free or at a low cost, but charge more for treatments that don't get enough bang for the buck. "Traditional health insurance plans…trust patients to purchase healthcare based on the value of each specific treatment," Chernew said. "The trouble is, as experience has shown time and time again, patients are unable to spend their healthcare dollars wisely. Employers such as Pitney Bowes have already saved money by adopting this approach, says Chernew.

For more information on the study:
- read this United Press International article

EHRs boost quality, costs at community clinics

Thu, 18 Jan 2007 19:01:36 -0500

Electronic health records (EHRs) certainly do help improve the quality of care at community health centers, but do not necessarily provide any financial benefits, a new study says. Writing in the January/February issue of Health Affairs, University of California, San Francisco, researchers Robert H. Miller and Chris West find that quality improvements from performance reports and point-of-care clinical reminders can be substantial, but of the six centers that participated in the study, five lost money on the EHR investment.

"Because CHCs are paid differently than most other practices, they really can't use the EHR as a tool for revenue enhancement," Miller was quotes as saying in Healthcare IT News. "In the CHC world, it is flat-rate payments from Medicaid, and lump sum payments from the Bureau of Primary Health Care."

For more:
- access the Health Affairs report
- read the Healthcare IT News article