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.

Magnet® Hospital Recognition Linked to Lower Central Line-Associated Bloodstream Infection Rates

Apr. 19, 2016

Hilary Barnes, Jessica Rearden, Matthew McHugh

In Research in Nursing and Health, Hilary Barnes and colleagues, including Matthew McHugh, investigate the relationship between Magnet status and hospital central line-associated bloodstream infection (CLASBI) rates. In 2014, the Centers for Medicare and Medicaid Services (CMS) began to penalize hospitals for poor performance with respect to selected hospital-acquired conditions, including CLABSI. Magnet hospitals are recognized for their high quality of care and their supportive work environment for nurses. Barnes and colleagues find that Magnet hospital status was associated...

Built Environment Assessment: Multidisciplinary Perspectives

Apr. 19, 2016

Karen Glanz, Susan Handy, Kathryn Henderson, Sandy Slater, Erica Davis, Lisa Powell

In SSM Population Health, Karen Glanz and colleagues examine how different disciplinary perspectives can contribute to environmental context-based assessment related to obesity.  The authors also make recommendations for encouraging effective advances in built-environment assessment. A multidisciplinary team of experts convened in 2013 to discuss how their respective disciplines can collaborate to integrate environmental assessment to prevent obesity. There has been significant progress in collaboration across key disciplines that contribute to studies of built environments and...

The Nursing Home Compare Report Card: Perceptions of Residents and Caregivers Regarding Quality Ratings and Nursing Home Choice

Apr. 19, 2016

Marilyn Schapira, Judy Shea, Katia Duey, Carly Kleiman, Rachel Werner

In Health Services Research, Marilyn Schapira and colleagues, including Judy Shea and Rachel Werner, evaluate the perceived usefulness of publicly reported nursing home quality indicators. Shapira and colleagues interviewed a sample of individuals or family members recently admitted to or anticipating admission to a nursing home. Participants were asked about the understandability and relevance of information on the Nursing Home Compare website, which includes star ratings, clinical quality measures, and benchmarking of individual nursing home quality with state and national data...

Q & A with Economist Martin Gaynor

Apr. 19, 2016

Martin Gaynor, PhD recently visited Penn and presented his new paper, “The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured” (co-authored by Zack Cooper, Stuart Craig, and John Van Reenen). The national study was the first to analyze health care spending and hospital transaction prices among the privately insured—an analysis made possible by the availability of data from three of the largest private insurers in the U.S.

Detecting Potential Overbilling in Medicare Reimbursement via Hours Worked

Research Brief
Apr. 18, 2016

Overbilling for physician services under Medicare Part B has long been a concern, as some estimates show that fraudulent “upcoding” or “overcharging” might have cost the program tens of billions of dollars per year. Existing methods to detect the prevalence and financial cost of overbilling have various limitations, so the authors developed a novel approach: create estimates of actual hours worked as implied by the medical service codes that providers submit to Medicare. In an NBER Working Paper, LDI Senior Fellow Hanming Fang and co-author Qing Gong examine whether this method can generate a quicker and more robust estimation of overbilling across medical specialties and geographic areas.

Yelp Reviews Of Hospital Care Can Supplement And Inform Traditional Surveys Of The Patient Experience Of Care

Apr. 13, 2016

Benjamin Ranard, Rachel Werner, Tadas Antanavicius, H. Andrew Schwarz, Robert Smith, Zachary Meisel, David Asch, Lyle Ungar, Raina Merchant

In Health Affairs, Benjamin Ranard and colleagues, including Rachel Werner, Zachary Meisel, David Asch and Raina Merchant, compare the content of patients’ Yelp reviews of hospitals to the themes in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. They find that while the themes, or domains in HCAHPS terminology, included in Yelp reviews covered the majority of HCAHPS domains, Yelp reviews covered an additional twelve domains not found in HCAHPS. They also find that Yelp domains that most strongly correlate with positive or negative reviews are...

Change In Length of Stay and Readmissions Among Hospitalized Medical Patients after Inpatient Medicine Service Adoption of Mobile Secure Text Messaging

Apr. 13, 2016

Mitesh Patel, Neha Patel, Dylan Small, Roy Rosin, Jeffrey Rohbach, Nathaniel Stromberg, C. William Hanson, David Asch

In the Journal of General Internal Medicine, Mitesh Patel and colleagues, including Dylan Small, Roy Rosin, and David Asch, evaluate the association between an inpatient medicine service’s adoption of mobile secure text messaging and patient length of stay and readmissions. The authors observed the change in length of stay and 30-day readmissions between a control site and one that implemented text messaging. They find a significant decrease in length of stay for the intervention site during and after the rollout of inpatient text communication. There was no significant difference...

The Perfect Storm: Collision of the Business of Mental Health and the Implementation of Evidence-Based Practices

Mar. 29, 2016

Rebecca Steward, Danielle Adams, David Mandell, Trevor Hadley, Arthur Evans, Ronnie Rubin, Joan Erney, Geoffrey Neimark, Matthew Hurford, Rinad Beidas

In Psychiatric Services, Rebecca Stewart and colleagues, including David Mandell, Trevor Hadley and Rinad Beidas examine how financial factors affect the implementation of evidence-based practices (EBPs) in a large urban publicly funded mental health system. They interviewed 33 agency leaders and 16 policymakers, who described financial distress in community mental health agencies, and reported concerns about complex and expensive implementation of EBPs. These stakeholders agree that the cost of implementing EBPs should be shared between the agencies and the health system; however...

Independent Contractors in Public Mental Health Clinics: Implications for Use of Evidence-Based Practices

Mar. 29, 2016

Rinad Beidas, Rebecca Stewart, Courtney Wolk, Dainelle Adams, Steven Marcus, Arthur Evans, Kamilah Jackson, Geoffrey Neimark, Matthew Hurford, Joan Erney, Ronnie Rubin, Trevor Hadley, Frances Barg, David Mandell

In Psychiatric Services, Rinad Beidas and colleagues, including Steven Marcus, Trevor Hadley and David Mandell analyze the associations of utilizing independent contractors with clinician knowledge and attitudes toward evidence-based practices (EBP), and organizational culture and climate. They also describe the impact of using independent contractors on mental health services delivery from the perspective of organizational leadership. Community mental health clinics are increasingly utilizing independent contractors to provide clinical services. At the same time, many...

Transparency and Negotiated Prices: The Value of Information in Hospital-Supplier Bargaining

Research Brief
Mar. 21, 2016

How does price transparency affect negotiated prices in business-to-business markets? In the first empirical analysis of its kind, LDI Senior Fellows Ashley Swanson and Matthew Grennan estimate how benchmarking information could be useful to hospital buyers in their negotiations with medical technology companies. They explore two mechanisms for possible savings: first, by reducing “asymmetric information” about seller bargaining parameters (that is, not knowing the lowest price a seller would accept); and second, by helping hospitals solve the “agency problem” with their procurement negotiators (that is, allowing hospitals to monitor negotiator performance and restructure financial incentives). Taking coronary stents as their example, the authors look at whether hospitals that join a price benchmarking database, which contains average pricing based on data submitted by member hospitals, can achieve savings in future negotiations with suppliers.

Choosing Wisely in Emergency Medicine: A National Survey of Emergency Medicine Academic Chairs and Division Chiefs

Mar. 14, 2016

Brandon Maughan, Jill Baren, Judy Shea, Raina Merchant

In Academic Emergency Medicine, Brandon Maughan and colleagues, including Judy Shea and Raina Merchant, assess whether leaders of academic emergency medicine departments are aware of the Choosing Wisely campaign, and their attitudes about the campaign. The Choosing Wisely campaign seeks to promote collaboration and communication between patients and physicians regarding the appropriateness of common tests and procedures. For this study, the researchers used a web-based survey of emergency department chairs and division chiefs to examine awareness of the campaign, anticipated...

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