Hundreds of hospitals and medical groups have entered into contracts with insurers (notably Medicare) to deliver savings and quality gains. In return, hospitals and doctors may get a share of whatever they save. The contracts, called accountable care organizations, are popular but experimental and not without uncertainty.
One source of confusion is how best to determine which patients are included under the contract for the purposes of tallying up the savings and measuring the quality. Get it wrong and it could skew savings and quality results.
Now, researchers at Dartmouth University have crunched Medicare data to test two basic strategies for identifying patients. One picks out patients at the start of the contract and the other at the end of each year. The results were published in Health Affairs.
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Policymakers who hope to see hospitals respond to financial incentives for better quality care will be disappointed by a newly published report on costly, potentially deadly, hospital-acquired infections.
My colleague Maureen McKinney reported on the results, published in the New England Journal of Medicine: The 2008 Medicare policy to stop payment for catheter-associated bloodstream and urinary tract infections contracted by patients during a hospital stay did not produce a hoped-for drop in infection rates.
The rate of bloodstream infections, on the decline before the policy change, continued to drop at about the same pace as before the pay cut, the researcher said.
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The week began with the start of Medicare's penalties for hospitals with higher-than-average rates of heart attack, heart failure and pneumonia patients who leave the hospital only to return within 30 days.
But Medicare is not the only payer to penalize hospitals for repeat visitors. Medicaid, in some states, also cuts hospital payments based on readmissions. As we reported in late September, changes to Medicaid policy have increased financial incentives for hospitals to reduce hospital admissions.
Now Massachusetts Medicaid is scheduled to increase its readmission penalties starting Nov. 1. The state began in 2011 to cut payments by 2.2% for hospitals with excess readmissions.
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Here's an interesting new business line from one widely known health system: Geisinger Health System will seek to market downloadable quality and efficiency applications as part of the organization's new research, development and evaluation center.
The new Geisinger Center for Health Care Transformation will organize and prioritize research under way at the Danville, Pa.-based system in conjunction with app development, said Dr. Earl Steinberg, who joined Geisinger nearly a year ago as executive vice president of innovation and dissemination. “We're going to concentrate in areas where we have strengths,” he said.
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