Variation in Health Care Spending

Newhouse, Joseph P.; Garber, Alan M.; Graham, Robin P.; McCoy, Margaret A.; Mancher, Michelle; Kibria, Ashna

doi:10.17226/18393

Cited by 19 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite these limitations, this study strongly suggests that there is wide variation across the United States in the value of the inpatient care delivered to Medicare beneficiaries, just as there are substantial differences in quality and cost of care. [1] Variation in value points to the existence of important opportunities for achieving uniformly high-value care, with better quality and / or lower costs for Medicare beneficiaries who suffer heart attacks. There are likely lessons to be learned from the practices and cultures of high-performing hospitals, to then be implemented by providers whose value in care delivery lags behind.…”

Section: Discussionmentioning

confidence: 99%

“…The Institute of Medicine has taken the position that “the only sensible way to restrain costs is to enhance the value of the health care system.”[1] Value is an elusive term in health care, but good value tends to mean high quality in relation to cost [2], and an array of initiatives in the private and public sectors seek to improve quality while containing costs. For example, the Centers for Medicare and Medicaid Services implemented its Hospital-Value Based Purchasing and Hospital Readmissions Reduction Programs in 2013, and has recently been rolling out Advanced Alternative Payment Models.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Geographic variation in the delivery of high-value inpatient care

et al. 2019

View full text Add to dashboard Cite

ObjectivesTo measure value in the delivery of inpatient care and to quantify its variation across U.S. regions.Data sources / Study settingA random (20%) sample of 33,713 elderly fee-for-service Medicare beneficiaries treated in 2,232 hospitals for a heart attack in 2013.Study designWe estimate a production function for inpatient care, defining output as stays with favorable patient outcomes in terms of survival and readmission. The regression model includes hospital inputs measured by treatment costs, as well as patient characteristics. Region-level effects in the production function are used to estimate the productivity and value of the care delivered by hospitals within regions.Data collection / Extraction methodsMedicare claims and enrollment files, linked to the Dartmouth Atlas of Health Care and Inpatient Prospective Payment System Impact Files.Principal findingsHospitals in the hospital referral region at the 90th percentile of the value distribution delivered 54% more high-quality stays than hospitals at the 10th percentile could have delivered, after adjusting for treatment costs and patient severity.ConclusionsVariation in the delivery of high-value inpatient care points to opportunities for better quality and lower costs.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Geographic variation in the delivery of high-value inpatient care

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Some have suggested, however, that a substantial proportion of healthcare spending brings little or no value [ 4 ]. The Institute of Medicine stated that “the only sensible way to restrain costs is to enhance the value of the healthcare system, thus extracting more benefit from the dollars spent.” [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Trends in the quality and cost of inpatient surgical procedures in the United States, 2002–2015

2021

View full text Add to dashboard Cite

Objectives This study documents trends in risk-adjusted quality and cost for a variety of inpatient surgical procedures among Medicare beneficiaries from 2002 through 2015, which can provide valuable insight on future strategies to improve public health and health care. Methods We focused on 11 classes of inpatient surgery, defined by the Agency for Health Research and Quality’s (AHRQ’s) Clinical Classification System. The surgical classes studied included a wide range of surgeries, including tracheostomy, heart valve procedures, colorectal resection, and wound debridement, among others. For each surgical class, we assessed trends in treatment costs and quality outcomes, as defined by 30-day survival without unplanned readmissions, among Medicare beneficiaries receiving these procedures during hospital stays. Quality and costs were adjusted for patient severity based on demographics, comorbidities, and community context. We also explored surgical innovations of these 11 classes of inpatient surgery from 2002–2015. Results We found significant improvements in quality for 7 surgical classes, ranging from 0.08% (percutaneous transluminal coronary angioplasty) to 0.74% (heart valve procedures) per year. Changes in cost varied by surgery, the significant decrease in cost ranged from -2.59% (tracheostomy) to -0.34% (colorectal resection) per year. Treatment innovation occurred with respect to surgical procedures utilized for heart valve procedures and colorectal resection, which may be associated with the decrease in surgical cost. Conclusions Our results suggest that there was significant quality improvement for 7 surgery categories over the 14-year study period. Costs decreased significantly for 6 surgery categories, and increased significantly for 3 other categories.

show abstract

“…The phrase 'postacute care' refers to all services provided immediately following hospitalizations (e.g., home health, skilled nursing facilities, independent rehabilitation facilities or hospice) that are not rendered in physicians' offices or hospital inpatient settings [14]. In a 2013 Institute of Medicine study [15], fully 70% of the variation across hospital referral regions for Medicare beneficiaries was related to varying rates of use and costs for postacute care [16]. Rehospitalization played a relatively minor role in this variation.…”

mentioning

confidence: 99%