Payment & Delivery

How insurers and providers are organized and paid to deliver care. Research by LDI Senior Fellows examines the shift from fee-for-service payments to newer models of paying for and delivering value, such as Accountable Care Organizations and Patient-Centered Medical Homes.

Health Care Costs Of Alzheimer's And Related Dementias Within A Medicare Managed Care Provider

Norma Coe, PhD, PARC Co-Director
Sep. 1, 2020

Paul A. Fishman, Lindsay White, Bailey Ingraham, Sungchul Park, Eric B. Larson, Paul Crane, Norma B. Coe 

Abstract [from journal]

Background: Although one third of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, there is limited information about the cost of treating Alzheimer disease and related dementias (ADRD) in these settings.

Objective: The objective of this study was to estimate direct health care costs attributable to ADRD among older adults within a large MA plan.

Research design: A retrospective cohort design was used to estimate direct total, outpatient, inpatient

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The Psychological Experience Of Obstetric Patients And Health Care Workers After Implementation Of Universal SARS-CoV-2 Testing

Aug. 5, 2020

Whitney R. Bender, Sindhu Srinivas, Paulina Coutifaris, Alexandra Acker, Adi Hirshberg

Abstract [from journal]

Objective: This study was aimed to describe the hospitalization and early postpartum psychological experience for asymptomatic obstetric patients tested for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) as part of a universal testing program and report the impact of this program on labor and delivery health care workers' job satisfaction and workplace anxiety.

Study design: This is a cohort study of asymptomatic pregnant women who underwent SARS-CoV-2 testing between April 13,

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Receipt Of Home-Based Medical Care Among Older Beneficiaries Enrolled In Fee-For-Service Medicare

Bruce Kinosian, MD
Aug. 3, 2020

Jennifer M. Reckrey, Mia Yang, Bruce Kinosian, Evan Bollens-Lund, Bruce Leff, Christine Ritchie, Katherine Ornstein

Abstract [from journal]

Millions of older Americans are homebound and may benefit from home-based medical care. We characterized the receipt of this care among community-dwelling, fee-for-service Medicare beneficiaries ages sixty-five and older surveyed in the National Health and Aging Trends Study between 2011 and 2017. Five percent of those surveyed received any home-based medical care between 2011 and 2017 (mean follow-up time per person was 3.4 years), and 75 percent of home-based medical care recipients were homebound. Only 11 percent of the total

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A Passive Monitoring Tool Using Hospital Administrative Data Enables Earlier Specific Detection Of Healthcare-Acquired Infections

Jul. 31, 2020

Jeffrey Rewley, Laura Koehly, Christopher Steven Marcum, Felix Reed-Tsochas

Abstract [from journal]

Background: Healthcare-associated infections impose a significant burden on the health care system. Current methods for detecting these infections are constrained by combinations of high cost, long processing times, and imperfect accuracy, reducing their effectiveness.

Methods: We examine whether the quantity of time a patient spends in a ward with other patients clinically-suspected of infection, which we call co-presence, can be used as a tool to predict subsequent healthcare-associated

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Health Care Costs of Alzheimer and Related Dementias Within A Medicare Managed Care Provider

Jul. 23, 2020

Paul A. Fishman, Lindsay White, Bailey Ingraham, Sungchul Park, Eric B. Larson, Paul Crane, Norma B. Coe

Abstract [from journal]

Background: Although one third of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, there is limited information about the cost of treating Alzheimer disease and related dementias (ADRD) in these settings.

Objective: The objective of this study was to estimate direct health care costs attributable to ADRD among older adults within a large MA plan.

Research design: A retrospective cohort design was used to estimate direct total, outpatient, inpatient

...

Stakeholder Perspective On Opioid Stewardship After Prostatectomy: Evaluating Barriers And Facilitators From The Pennsylvania Urology Regional Collaborative

Jul. 22, 2020

Daniel J. Lee, Ruchika Talwar, James Ding, Thenappan Chandrasekar, Kaynaat Syed, Claudette Fonshell, John Danella, Serge Ginzburg, Thomas Lanchoney, Jeffrey Tomaszewski, Edouard Trabulsi, Adam Reese, Marc Smaldone, Robert Uzzo, Jay D. Raman, ...

Abstract [from journal]

Objective: To evaluate existing practice patterns and potential barriers to implementing opioid stewardship protocols after robot-assisted prostatectomies among providers in the Pennsylvania Urology Regional Collaborative.

Methods: The Pennsylvania Urology Regional Collaborative (PURC) is a voluntary quality improvement initiative of 11 academic and community urology practices in Pennsylvania and New Jersey representing 97 urologists. PURC distributed a web-based survey of 24 questions, with

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Stakeholder Perspective On Opioid Stewardship After Prostatectomy: Evaluating Barriers And Facilitators From The Pennsylvania Urology Regional Collaborative

Jul. 22, 2020

Daniel J. LeeRuchika Talwar, James Ding, Thenappan Chandrasekar, Kaynaat Syed, Claudette Fonshell, John Danella, Serge Ginzburg, Thomas Lanchoney, Jeffrey Tomaszewski, Edouard Trabulsi, Adam Reese, Marc Smaldone, Robert Uzzo, Jay D. Raman, Thomas J. Guzzo

Abstract [from journal]

Objective: To evaluate existing practice patterns and potential barriers to implementing opioid stewardship protocols after robot-assisted prostatectomies among providers in the Pennsylvania Urology Regional Collaborative.

Methods: The Pennsylvania Urology Regional Collaborative (PURC) is a voluntary quality improvement initiative of 11 academic and community urology practices in Pennsylvania and New Jersey representing 97 urologists. PURC distributed a web-based survey of 24 questions, with

...

Overlap Between Medicare's Comprehensive Care For Joint Replacement Program And Accountable Care Organizations

Jul. 22, 2020

Joshua M. Liao, Eric Z. Shan, Yueming Zhao, Yash Shah, Deborah S. Cousins, Amol S. Navathe

Abstract [from journal]

Background: Overlap between Medicare's Comprehensive Care for Joint Replacement (CJR) model and accountable care organizations (ACOs) may result in positive or negative synergies. In this study, we describe the overlap between the programs at the beneficiary and hospital levels.

Methods: We conducted a retrospective study of patient and hospital characteristics using data from 2016 Medicare claims, the US Census Bureau, the American Hospital Association annual survey, Hospital Compare, and the

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Economic Implications Of Chinese Diagnosis-Related Group–Based Payment Systems For Critically Ill Patients In ICUs

Jul. 1, 2020

Zhaolin Meng, Yanan Ma, Suhang Song, Ye Li, Dan Wang, Yafei Si, Ruochen Sun, Ruochen Zhang, Hao Xue, Limei Jing, Huazhang Wu

Abstract [from journal]

Objectives: To evaluate the economic implications of payments based on Chinese diagnosis-related groups for critically ill patients in ICUs in terms of total hospital expenditure, out-of-pocket payments, and length of stay.

Design: A pre-post comparison of patient cohorts admitted to ICUs 1 year before and 1 year after Chinese diagnosis-related group reform was undertaken. Demographic characteristics, clinical data, and

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The Income-Based Mortality Gradient Among US Health Care Workers: Cohort Study

Jun. 30, 2020

Sasmira Matta, Paula Chatterjee, Atheendar S. Venkataramani 

Abstract [from journal]

The health care industry is the largest employer in the USA. The health care workforce encompasses a range of occupations that vary widely by income, including home health aides, food service workers, clerical workers, nurses, physicians, and executives....

Payment and Pricing Decisions in Health Care Reform

Issue Brief
Jun. 23, 2020

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 State Medicaid Expansion With Hospital Community Benefit Spending

May. 29, 2020

Genevieve P. Kanter, Bardia Nabet, Meredith Matone, David M. Rubin

Abstract [from journal]

Importance: Medicaid expansion was widely expected to alleviate the financial stresses faced by hospitals by providing additional revenue in the form of Medicaid reimbursements from patients previously receiving uncompensated care. Among nonprofit hospitals, which receive tax-exempt status in part because of their provision of uncompensated care, Medicaid expansion could have released hospital funds toward other community benefit activities.

Objective: To examine changes in nonprofit hospital spending on...

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