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.

Regional Variation in Standardized Costs of Care at Children’s Hospitals

Nov. 8, 2017

Jennifer A. Jonas, Samir S. Shah, Isabella Zaniletti, Matthew Hall, Jeffrey D. Colvin, Laura M. Gottlieb, Marion R. Sills, Jessica Bettenhausen, Rustin B. Morse, Michelle L. Macy, Evan S. Fieldston

In the Journal of Hospital Medicine, Evan Fieldston and colleagues investigated regional cost variation for three inpatient pediatric conditions, assessed the potential drivers of variation, and estimated the cost savings that could result from reducing variation. With some areas of the country spending close to three times more on health care than others, regional variation in health care spending has been a focus of national attention.

The authors analyzed hospitalizations for asthma, diabetic ketoacidosis (DKA), and acute gastroenteritis (AGE) at 46 children’s hospitals...

Reimagining the Future of Medicare Across the Care Continuum

Oct. 30, 2017

Reforming Medicare to protect the health of an aging and vulnerable population is a pressing policy concern. To share some perspective, Dr. Mary Naylor led a panel entitled “Shaping the Future of Medicare” at Penn LDI’s 50th Anniversary Symposium.

The panelists addressed several core themes, including cost-effective personal care in the home, end-of-life care, Medicare payment reforms, and reimagining care for families of an aging population.

Pediatric Price Transparency: Still Opaque With Opportunities for Improvement

Oct. 25, 2017

Laura J. Faherty, Charlene A. Wong, Jordyn Feingold, Joan Li, Robert Town, Evan Fieldston, Rachel M. Werner

In Hospital Pediatrics, Laura J. Faherty and colleagues, including Evan Fieldston and Rachel Werner, describe online price transparency data for pediatric care and the consumer experience of obtaining an out-of-pocket estimate from children’s hospitals for a common procedure. Price transparency is gaining importance as families’ portion of health care costs rise.

The study consisted of three parts: an audit of 45 children’s hospital Web sites, "secret shopper" calls to the hospitals to request price estimates for a common pediatric procedure (a tonsillectomy-adenoidectomy...

System Redesign and the Health Care Workforce

Oct. 19, 2017

An interdisciplinary panel of experts from health care management, economics, and nursing came together at LDI’s 50th Anniversary Symposium to discuss their perspectives on how “organizational innovation” can be used to redesign health care systems and care delivery.

Moderator:
Linda Aiken, PhD, RN, University of Pennsylvania

Nursing Care Disparities in Neonatal Intensive Care Units

Oct. 11, 2017

Eileen T. Lake, Douglas Straiger, Erika Miles Edwards, Jessica G. Smith, Jeannette A. Rogowski

In Health Services Research, Eileen Lake and colleagues, including Jessica Smith and Jeannette Rogowski, compared missed nursing care for infants in neonatal intensive care units (NICUs) across hospitals with a predominantly-black versus non-black patient population. The authors sought to understand the factors that cause nurses to miss care. At sites across four states, NICU nurses completed a survey on the floor’s average patient load, nursing environment, and nursing professional characteristics, as well as their individual patient load and the care that they missed on their...

Accuracy of Billing Codes Used in the Therapeutic Care of Diabetic Retinopathy

Aug. 1, 2017

Marisa Lau, Jonathan L. Prenner, Alexander J. Brucker, Brian L. VanderBeek

In JAMA Ophthalmology, Marisa Lau and colleagues, including Brian VanderBeek, seek to determine the accuracy of diagnostic, procedural, and therapeutic billing codes used in the treatment of diabetic retinopathy. As insurance billing claim databases represent a growing field of scientific inquiry within ophthalmology, validating the accuracy of billing claim codes is of increasing importance. The authors conducted a retrospective medical record review at three clinical practices, examining each patient’s billing data and medical record, measuring positive and negative predictive...

Public Awareness of and Contact With Physicians Who Receive Industry Payments: A National Survey

Jul. 27, 2017

Genevieve Kanter, Michelle M. Mello, Lisa Soleymani Lehmann, Eric G. Campbell, and Daniel Carpenter 

In the Journal of General Internal Medicine, Genevieve Kanter and colleagues investigate public awareness and physicians’ perceptions of industry payments to doctors. As part of the Affordable Care Act, pharmaceutical and medical device manufacturers are now required to report payments that they make to health care providers to a database called Open Payments. This provision was partially motivated by concerns that industry payments could sway physicians’ decisions on patient care, and that patients may not know about these payments when selecting a provider. The authors conducted...

Is American Pet Health Care (Also) Uniquely Inefficient?

Jun. 29, 2017

Liran Einav, Amy Finkelstein, Atul Gupta

In American Economic Review, Liran Einav and colleagues, including Atul Gupta, examine similarities between human and pet health care in the U.S.. The authors note similarities in rapid growth in spending in both industries, with wealthier families spending significantly more on both human and pet health. They also note a rapid increase in employment of health care providers in both industries, an increase in medical technology use, and a similar propensity for high spending at the end of life. While human and pet health care share a number of similarities, they also note...

Association Between Hospital Participation in a Medicare Bundled Payment Initiative and Payments and Quality Outcomes for Lower Extremity Joint Replacement Episodes

Jun. 29, 2017

Laura A. Dummit, Daver Kahvecioglu, Grecia Marrufo, Rahul Rajkumar, Jaclyn Marshall, Eleonora Tan, Matthew J. Press, Shannon Flood, L. Daniel Muldoon, Qian Gu, Andrea Hassol, David M. Bott, Amy Bassano, Patrick H. Conway

In JAMA, Laura Dummit and colleagues, including Matthew Press, evaluate whether a Centers for Medicare and Medicaid Services (CMS) bundled payment pilot program is associated with a reduction in Medicare payments. Specifically, the authors assess if Bundled Payments for Care Improvement (BPCI) reduced Medicare payments and maintained quality in lower extremity joint replacement. This CMS program was launched in 2013 to test whether linking payments for services provided during an episode of care can reduce Medicare payments and maintain quality. The authors used a difference-in-...

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