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.

Selective Hearing: Physician Ownership and Physicians’ Response to New Evidence

Jun. 4, 2016

David H. Howard, Guy David, and Jason Hockenberry

In the Journal of Economics & Management Strategy, Guy David and colleagues examine whether physicians who own their surgical practices respond to new medical evidence differently from physicians who work in hospital-owned practices. In 2002, a clinical trial demonstrated that knee surgery did not benefit patients with osteoarthritis, which led to an overall decrease in knee surgeries. The authors took advantage of this “information shock” in 2002 to whether assess the impact of physician vs. hospital ownership status on these surgical practice patterns. They identified all...

Cost-Effectiveness of Field Trauma Triage among Injured Adults Served by Emergency Medical Services

May. 25, 2016

Craig D Newgard, Zhuo Yang, Daniel Nishijima, K John McConnell, Stacy A Trent, James F Holmes, Mohamud Daya, N Clay Mann, Renee Y Hsia, Tom D Rea, N Ewen Wang, Kristan Staudenmayer, M. Kit Delgado

In the Journal of the American College of Surgeons, M. Kit Delgado and colleagues evaluate the cost-effectiveness of field trauma triage practices (the criteria used to decide whether to transport an injured patient to a major trauma center). The authors compare current triage practices with alternatives that meet national policy benchmarks set by the American College of Surgeons Committee on Trauma (a high-sensitivity field triage strategy that would miss no more than 5% of seriously injured patients) and a moderate sensitivity, high-specificity approach (in which at least 65% of...

Generic Medication Prescription Rates After Health System–Wide Redesign of Default Options Within the Electronic Health Record

May. 19, 2016

Mitesh Patel, Susan Day, Scott Halpern, William Hanson, Joseph Martinez, Steven Honeywell Jr, Kevin Volpp

In JAMA Internal Medicine, Mitesh Patel and colleagues, including Scott Halpern and Kevin Volpp, evaluate how changing electronic health record (EHR) defaults affects physician prescribing of generic drugs. For the study, the researchers utilized a systemic change to the University of Pennsylvania Health System’s EHR defaults. As part of this change, an opt-out checkbox labeled “dispense as written” was added to the prescription screen, and if left unchecked the generic-equivalent medication was prescribed. The authors find that generic prescribing rates increased significantly...

Urgent Care Needs Among Nonurgent Visits to the Emergency Department

May. 11, 2016

Renee Hsia, Ari Friedman, Matthew Niedzwiecki

In JAMA Internal Medicine, Renee Hsia and colleagues, including Ari Friedman, investigate whether nonurgent status determined in the emergency department effectively ruled out the possibility of serious pathologic conditions, and compared these findings with visits deemed as urgent from triage. The authors used data from the National Hospital Ambulatory Medical Care Survey to compare characteristics and outcomes of nonurgent visits with those of urgent visits. They find that a nontrivial proportion of ED visits that were deemed nonrurgent arrived by ambulance, received diagnostic...

Common and Costly Hospitalizations Among Insured Young Adults Since the Affordable Care Act

May. 11, 2016

Alexander Bain, Charlene Wong, Gail Slap, Daniel Polsky, Raina Merchant, Yaa Akosa Antwi, David Rubin, Carol Ford

In the Journal of Adolescent Health, Alexander Bain and colleagues, including Charlene Wong, Daniel Polsky, Raina Merchant, and David Rubinm, identify the most prevalent and costly inpatient hospitalizations in a national cohort of privately insured young adults since the implementation of the Affordable Care Act. The researchers analyzed 158,777 hospitalizations among 4.7 million young adults from January 2012 to June 2013. They find that the top diagnoses for young adult female hospitalizations were pregnancy related (71.9%) and mental illness (8.9%). The top diagnoses for young...

Click Worthy: Stories Encourage Emergency Physicians to Learn More About Opioid Prescribing Guidelines

Research Brief
Zachary F. Meisel, MD
May. 5, 2016

New study finds that narrative vignettes outperform standard summaries in promoting engagement with opioid prescription guidelines among a national sample of emergency physicians. 

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...

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