Evaluation of US Hospital Episode Spending for Acute Inpatient Conditions After the Patient Protection and Affordable Care Act

Ibrahim, Andrew M.; Nuliyalu, Ushapoorna; Lawton, Emily; O'Neil, Stephen; Dimick, Justin B.; Gulseren, Baris; Sinha, Shashank S.; Hollingsworth, John M.; Engler, Tedi A.; Ryan, Andrew M.

doi:10.1001/jamanetworkopen.2020.23926

Cited by 5 publications

(3 citation statements)

References 30 publications

(61 reference statements)

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“…Future work should test new policy initiatives to augment the ACA to improve the quality of care received by the most vulnerable individuals, including social care and upstream initiatives . Our work builds on prior research by extending findings through 2016 with a DiD analysis and comprehensively examining a broad range of measures reflective of the functioning of the health care system including novel analyses of high-value and low-value care, patient experience, communication, access, utilization of pharmacy, preventive visits, and other measures.…”

Section: Discussionmentioning

confidence: 99%

Association of the Patient Protection and Affordable Care Act With Ambulatory Quality, Patient Experience, Utilization, and Cost, 2014-2016

et al. 2022

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Key Points Question How were ambulatory quality, patient experience, utilization, and cost associated with implementation of the Patient Protection and Affordable Care Act (ACA)? Findings In this nationally representative cross-sectional study of 123 171 individuals, the ACA was associated with more high-value diagnostic and preventive testing, improved patient experience and access, and decreased out-of-pocket expenditures for lower income US individuals. The ACA was not associated with changes to most quality measures, utilization, or the total cost of care. Meaning These findings suggest that policy makers and health system leaders seeking to further improve value should combine insurance expansion with additional policy initiatives to see broader improvements in care.

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Section: Discussionmentioning

confidence: 99%

Association of the Patient Protection and Affordable Care Act With Ambulatory Quality, Patient Experience, Utilization, and Cost, 2014-2016

et al. 2022

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“…We found that research on VBC has increased significantly over the last decade. A driving factor could be the increasing pressure on health systems with rising costs, e.g., higher procedure volumes in surgery that are not necessarily in combination with better outcomes [ 14 ]. Furthermore, digitalization in general as well as improved accessibility and availability of digital outcome measurement devices and thus more precise outcome measures (e.g., sensors measuring real world walking speed) could have led to an increase in VBC research, as these developments facilitate comparing costs to outcomes [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Healthcare Providers’ Knowledge of Value-Based Care in Germany: An Adapted, Mixed-Methods Approach

Kuck

Kinscher

Fehring

et al. 2022

IJERPH

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Background: Value-Based Care (VBC) is being discussed to provide better outcomes to patients, with an aim to reimburse healthcare providers (HCPs) based on the quality of care they deliver. Little is known about German HCPs’ knowledge of VBC. This study aims to investigate the knowledge of HCPs of VBC and to identify potential needs for further education toward implementation of VBC in Germany. Methods: For evidence generation, we performed a literature search and conducted an online survey among HCPs at 89 hospitals across Germany. The questionnaire was based on published evidence and co-developed with an expert panel using a mixed methods approach. Results: We found HCPs to believe that VBC is more applicable in surgery than internal medicine and that well-defined cycles of care are essential for its application. HCPs believe that VBC can reduce health care costs significantly. However, they also assume that implementing VBC will be challenging. Conclusions: The concept in general is well perceived, however, HCPs do not want to participate in any financial risk sharing. Installing an authority/independent agency that measures achieved value, digital transformation, and that improves the transition between the inpatient and the outpatient sectors are top interests of HCPs.

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“…4 For clinicians to navigate the shift toward new payment models, it is important to recognize how each of these elements-declining hospital admissions, spending per inpatient episode, and payment rates-affect spending trends for inpatient services and associated care. Previous articles on overall Medicare inpatient spending have examined inpatient stays alone 5 or focused mainly on spending per episode 6,7 without quantifying how these elements contributed to overall episode-related OBJECTIVE: To describe Medicare inpatient episode spending trends between 2009 and 2017 as inpatient use declined among traditional Medicare beneficiaries.…”

mentioning

confidence: 99%

Traditional Medicare Spending on Inpatient Episodes as Hospitalizations Decline

Keohane

Kripalani

Buntin

2021

Journal of Hospital Medicine

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OBJECTIVE: To describe Medicare inpatient episode spending trends between 2009 and 2017 as inpatient use declined among traditional Medicare beneficiaries. METHODS: Inpatient episodes included claims for all traditional Medicare inpatient, outpatient, and Part D services provided during the 30 days prehospitalization, the inpatient stay, and the 90 subsequent days. We describe the mean number of episodes per 1000 beneficiaries, mean episode-related spending per beneficiary, and mean spending per episode for all beneficiaries and for specific populations and types of episodes. Spending measures are reported with and without adjustment for payment rate increases over the study period. RESULTS: The number of inpatient-initiated episodes per 1000 beneficiaries declined by 18.2% between 2009 and 2017 from 326 to 267. After adjusting for payment rate increases, Medicare spending per beneficiary on episode-related care declined by 8.9%, although spending per episode increased by 11.4% over this period. Between 2009 and 2017, all subgroups defined by age, sex, race, or Medicaid status experienced declines in inpatient use accompanied by decreased overall episode-related spending per beneficiary and increased spending per episode. Larger declines in the number of episodes per 1000 beneficiaries were seen among episodes that began with a planned admission (28.8%) or involved no use of post–acute care services (23.9%). When comparing admissions according to medical diagnosis, the largest decline occurred for episodes initiated by a hospitalization for a cardiac or circulatory condition (31.8%). CONCLUSION: Medicare inpatient episodes per beneficiary decreased, but spending decreases due to declining volume were offset by increased spending per episode.

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Evaluation of US Hospital Episode Spending for Acute Inpatient Conditions After the Patient Protection and Affordable Care Act

Cited by 5 publications

References 30 publications

Association of the Patient Protection and Affordable Care Act With Ambulatory Quality, Patient Experience, Utilization, and Cost, 2014-2016

Association of the Patient Protection and Affordable Care Act With Ambulatory Quality, Patient Experience, Utilization, and Cost, 2014-2016

Healthcare Providers’ Knowledge of Value-Based Care in Germany: An Adapted, Mixed-Methods Approach

Traditional Medicare Spending on Inpatient Episodes as Hospitalizations Decline

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