Payment and Pricing Decisions in Health Care Reform
Any effort to reform health insurance in the United States must tackle the prices we pay for health care. There are many complex challenges to addressing prices. Some proposals build on the existing Medicare fee schedule, while others suggest promoting alternative payment mechanisms—or even starting from scratch. The stakes are substantial, as many reform proposals rely on reining in prices to achieve the savings necessary to expand health insurance to the uninsured. At Penn’s LDI Medicare for All and Beyond conference, a panel of researchers, hospital administrators, and policy experts considered issues related to health care payment and pricing that any health care reform proposal must address, including the implications of rate setting for providers and patients. At what level should these rates be set to assure access and quality of care, while incentivizing innovation and rewarding excellence?
Association of Homelessness with Hospital Readmissions—An Analysis of Three Large States
Sameed Ahmed M. Khatana, Rishi K. Wadhera, Eunhee Choi, Peter W. Groeneveld, Dennis P. Culhane, Margot Kushel, Dhruv S. Kazi, Robert W. Yeh, Changyu Shen
Abstract [from journal]
Background: Individuals experiencing homelessness have higher hospitalization and mortality rates compared with the housed. Whether they also experience higher readmission rates, and if readmissions vary by region or cause of hospitalization is unknown.
Objective: Evaluate the association of homelessness with readmission rates across multiple US states.
Design:...
Already in Fiscal Crisis, Rural Hospitals Face COVID-19
A Randomized Trial Of Behavioral Nudges To Improve Enrollment In Critical Care Trials
Dustin C Krutsinger, Kelly L O'Leary, Susan S Ellenberg, Cody E Cotner, Scott D Halpern, Katherine R Courtright
Abstract [from journal]
Rationale: Low and slow patient enrollment remains a barrier to critical care randomized controlled trials (RCTs). Behavioral economic insights suggest that nudges may address some enrollment challenges.
Objectives: To evaluate the efficacy of a novel pre-consent survey consisting of nudges on critical care RCT enrollment.
Methods: We conducted an RCT in 10 intensive care units (ICUs) among surrogate decision-makers (SDMs). The novel multi-component behavioral nudge survey was...
Impact Of Around-the-Clock Mental Health Staffing On Emergency Department Management of Patients Who Deliberately Self-Harm
Sara Wiesel Cullen, Amaya Diana, Mark Olfson, Ming Xie, Steven C Marcus
Abstract [from journal]
Objective: Emergency departments (EDs) offer opportunities to deliver critical frontline suicide prevention services via assessment, safety planning, and linkages with community-based mental health care after discharge. Because mental health crises can occur at any time, this study sought to evaluate whether around-the-clock mental health staffing in the ED influences the likelihood of providing these evidence-based mental health services.
Methods: ED nursing leadership from a national sample of 406...
Nonprofit Hospitals and Antitrust: Is There a Case for Special Treatment?
In the wake of a pandemic that has decimated many hospitals’ budgets, many industry insiders foresee a spike in mergers and acquisitions, in both the for-profit and nonprofit sector. How should anti-trust regulators weigh the costs and benefits of this consolidation for consumers?
Evaluating Delirium Outcomes Among Older Adults In The Surgical Intensive Care Unit
Kara J Pavone, Juliane Jablonski, Paul Junker, Pamela Z Cacchione, Peggy Compton, Rosemary C Polomano
Abstract [from journal]
Background: Delirium is prevalent in hospitalized older adults. Little is known about delirium among older adults admitted to the surgical intensive care unit (SICU).
Objectives: The purpose of this study was to describe the incidence of delirium, length of stay, 30-day readmission and mortality rates experienced by older adults in the SICU before and after a nurse-driven protocol for delirium-informed care.
Methods: This study employed a retrospective observational cohort...
Room Costs for Common Pediatric Hospitalizations and Cost-Reducing Quality Initiatives
David C. Synhorst, Matthew B. Johnson, Jessica L. Bettenhausen, Kathryn E. Kyler, Troy E. Richardson, Keith J. Mann, Evan S. Fieldston, Matt Hall
Abstract [from journal]
Background: Improvement initiatives promote safe and efficient care for hospitalized children. However, these may be associated with limited cost savings. In this article, we sought to understand the potential financial benefit yielded by improvement initiatives by describing the inpatient allocation of costs for common pediatric diagnoses.
Methods: This study is a retrospective cross-sectional analysis of pediatric patients aged 0 to 21 years from 48 children's hospitals included in the Pediatric Health
...Performance of Hospitals When Assessing Disease-Based Mortality Compared With Procedural Mortality for Patients With Acute Myocardial Infarction
Ashwin S. Nathan, Qun Xiang, Daniel Wojdyla, Sameed Ahmed M. Khatana, Elias J. Dayoub, Rishi K. Wadhera,; Deepak L. Bhatt, Daniel M. Kolansky, Ajay J. Kirtane, Sunil V. Rao, Robert W. Yeh, Peter W. Groeneveld, Tracy Y. Wang, ...
Abstract [from journal]
Importance: Quality of percutaneous coronary intervention (PCI) is commonly assessed by risk-adjusted mortality. However, this metric may result in procedural risk aversion, especially for high-risk patients.
Objective: To determine correlation and reclassification between hospital-level disease-specific mortality and PCI procedural mortality among patients with acute myocardial infarction (AMI).
Design, Setting, and Participants: This hospital-level observational cross-sectional
...How Penn Medicine Developed a Model for COVID-19 Hospital Planning
This week, the Annals of Internal Medicine published a summary of Penn’s development of an interactive, Web-based tool to inform our hospital planning at the early stages of this pandemic.
Locally Informed Simulation to Predict Hospital Capacity Needs During the COVID-19 Pandemic
Gary E. Weissman, Andrew Crane-Droesch, Corey Chivers, ThaiBinh Luong, Asaf Hanish, Michael Z. Levy, Jason Lubken, Michael Becker, Michael E. Draugelis, George L. Anesi, Patrick J. Brennan, Jason D. Christie, C. William Hanson III, Mark E. Mikkelsen...
Abstract [from journal]
Background: The coronavirus disease 2019 (COVID-19) pandemic challenges hospital leaders to make time-sensitive, critical decisions about clinical operations and resource allocations.
Objective: To estimate the timing of surges in clinical demand and the best- and worst-case scenarios of local COVID-19–induced strain on
Safety and Quality of Pediatric Care in Freestanding Children's and General Hospitals
Karen B. Lasater, Margaret A. McCabe, Eileen T. Lake, Warren D. Frankenberger, Kathryn E. Roberts, Paula D. Agosto, Kathryn A. Riman, Amanda P. Bettencourt, Elizabeth S. Schierholz, Gianluca Catania, Linda H. Aiken...
Abstract [from journal]
Objectives: The purpose of this study was to evaluate quality and safety of care in acute pediatric settings from the perspectives of nurses working at the bedside and to investigate hospital-level factors associated with more favorable quality and safety.
Methods: Using data from a large survey of registered nurses in 330 acute care hospitals, we described nurses' assessments of safety and quality of care in inpatient pediatric settings, including freestanding children's hospitals (FCHs) (n = 21) and general
...How Can Hospitals Address Scarce Resources During Covid-19?
Relative Contributions of Hospital Versus Skilled Nursing Facility Quality on Patient Outcomes
Paula Chatterjee, Mingyu Qi, Rachel Werner
Abstract [from journal]
Background: Hospitals and health systems worldwide have adopted value-based payment to improve quality and reduce costs. In the USA, skilled nursing facilities (SNFs) are now financially penalised for higher-than-expected readmission rates. However, the extent to which SNFs contribute to, and should thus be held accountable for, readmission rates is unknown. To compare the relative contributions of hospital and SNF quality on readmission rates while controlling for unobserved patient characteristics.
Methods:
...Staffing Trends in Magnet and Non-Magnet Hospitals After State Legislation
Pamela de Cordova, Terry Jones, Kathryn A. Riman, Jeannette Rogowski, Matthew McHugh
Abstract [from journal]
Background: Evidence suggests that Magnet and non-Magnet hospitals differ with respect to quality of care.
Purpose: Our study examined registered nurse (RN) staffing over time in Magnet and non-Magnet hospitals using unit-level, publicly available data in New Jersey.
Methods: A secondary analysis of longitudinal RN staffing data was conducted using mandated, publicly reported data of 64 hospitals representing 12 nursing specialties across 8 years (2008-2015). Staffing ratios were trended
...