Peer Review Organizations

Dans, Peter E.; Weiner, Jonathan P.; Otter, Sharon E.

doi:10.1056/nejm198510313131806

Cited by 60 publications

(1 citation statement)

References 53 publications

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“…Related attempts to profile quality and spending date back several decades. Beginning in the early 1980s, the Health Care Financing Administration contracted with a number of peer review organizations to monitor the spending and utilization of hospitals, physicians, managed care organizations, and skilled nursing facilities (Dans, Weiner, & Otter, 1985). Reflecting a change in national priorities following the Institute of Medicine reports that highlighted system-wide quality deficiencies, peer review organizations gradually shifted their focus toward measuring and monitoring quality of care (Jost, 1991), eventually becoming “Quality Improvement Organizations” in 2002.…”

Section: Introductionmentioning

confidence: 99%

Linking Spending and Quality Indicators to Measure Value and Efficiency in Health Care

et al. 2016

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Policy makers and stakeholders have reached a consensus that both quality and spending or resource use indicators should be jointly measured and prioritized to meet the objectives of our health system. However, the relative merits of alternative approaches that combine quality and spending indicators are not well understood. We conducted a literature review to identify different approaches that combine indicators of quality and spending measures to profile provider efficiency in the context of specific applications in health care. Our investigation identified seven alternative models that are either in use or have been proposed to evaluate provider efficiency. We then used publicly available data to profile hospitals using these approaches. Profiles of hospital efficiency using alternative models yielded wide variation in performance, underscoring the importance of model selection. By identifying the current efficiency models and evaluating their trade-offs within specific programmatic contexts, our analysis informs stakeholder and policy maker decisions about how to link quality and spending indicators when measuring efficiency in health care.

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Section: Introductionmentioning

confidence: 99%

Linking Spending and Quality Indicators to Measure Value and Efficiency in Health Care

et al. 2016

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Repair of Abdominal Aortic Aneurysms

Richardson

Main²

1991

Arch Surg

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The results of elective treatment of abdominal aortic aneurysms are excellent in many institutions. To our knowledge, however, no study has compared the results in a large geographic area in which patients were treated by a variety of surgeons and hospitals. We studied the results of repairing abdominal aortic aneurysms for all Medicare recipients during a single year in Kentucky. One hundred thirty-six operations were performed by 52 surgeons in 31 hospitals. Overall operative mortality was 18%; elective and emergency operative mortality rates were 6% and 49%, respectively. Advancing age did not affect outcome, but mortality due to ruptured aneurysms was higher in smaller hospitals than in larger hospitals. The low mortality for elective repair of abdominal aortic aneurysms in an elderly population by numerous surgeons in divergent hospitals is a strong indication for its liberal use compared with the high mortality and morbidity of emergency surgery.

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Do Frail, Disabled, Poor, and Very Old Medicare Beneficiaries Have Higher Hospital Charges?

Jencks¹

1987

JAMA

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To determine whether basing payments on diagnosis related groups (DRGs) results in mispayment for certain classes of patients, we examined the relation between total Medicare charges per hospitalization and eight beneficiary characteristics (including admission from a nursing home, extreme age, Medicaid enrollment, and disability). We controlled for the hospital in which care was given and the DRG to which the discharge was assigned. The largest effects were that average charges were 6.7% higher for beneficiaries who were disabled before the age of 65 years, and 6.2% higher for patients admitted from a nursing home; charges were 1.5% lower for Medicare beneficiaries who were also enrolled in Medicaid, 3.8% higher for those older than 80 years, and 1.3% lower for those older than 85 years compared with those aged from 80 to 84 years. Because these differences are very small compared with the average variation within DRGs, we conclude that using these beneficiary characteristics in the DRG classification system would only slightly improve DRGs. Medicare's DRG-based payments seem to be substantially equitable with regard to these beneficiary characteristics.

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Peer Review Organizations

Cited by 60 publications

References 53 publications

Linking Spending and Quality Indicators to Measure Value and Efficiency in Health Care

Linking Spending and Quality Indicators to Measure Value and Efficiency in Health Care

Repair of Abdominal Aortic Aneurysms

Do Frail, Disabled, Poor, and Very Old Medicare Beneficiaries Have Higher Hospital Charges?

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