Bundled Payment Episodes Initiated by Physician Group Practices: Medicare Beneficiary Perceptions of Care Quality

2021 ◽  
Author(s):  
Sean R. McClellan ◽  
Matthew J. Trombley ◽  
Jaclyn Marshall ◽  
Daver Kahvecioglu ◽  
Colleen M. Kummet ◽  
...  
Keyword(s):  
Medicare Beneficiary ◽  
Care Quality ◽  
Bundled Payment ◽  
Physician Group ◽  
Group Practices ◽  
Perceptions Of Care

scholarly journals As predicted by theory: choice and competition in a publicly funded and regulated regional health system yield improved access and cost control

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jonas Wohlin ◽  
Clara Fischer ◽  
Karin Solberg Carlsson ◽  
Sara Korlén ◽  
Pamela Mazzocato ◽  
...  
Keyword(s):  
Cost Control ◽  
Care Quality ◽  
Patient Choice ◽  
Public Healthcare ◽  
Successful Implementation ◽  
Publicly Funded ◽  
Public And Private ◽  
Bundled Payment ◽  
Private Providers ◽  
Number Of Patients

Abstract Background New Public Management (NPM) has been widely used to introduce competition into public healthcare. Results have been mixed, and there has been much controversy about the appropriateness of a private sector-mimicking governance model in a public service. One voice in the debate suggested that rather than discussing whether competition is “good” or “bad” the emphasis should be on exploring the conditions for a successful implementation. Methods We report a longitudinal case study of the introduction of patient choice and allowing private providers to enter a publicly funded market. Patients in need of hip or knee replacement surgery are allowed to choose provider, and those are paid a fixed reimbursement for the full care episode (bundled payment). Providers are financially accountable for complications. Data on number of patients, waiting lists and times, costs to the public purchaser, and complications were collected from public registries. Providers were interviewed at three points in time during a nine-year follow-up period. Time-series of the quantitative data were exhibited and the views of actors involved were explored in a thematic analysis of the interviews. Results The policy goals of improving access to care and care quality while controlling total costs were achieved in a sustained way. Six themes were identified among actors interviewed and those were consistent over time. The design of the patient choice model was accepted, although all providers were discontent with the level of reimbursement. Providers felt that quality, timeliness of service and staff satisfaction had improved. Public and private providers differed in terms of patient-mix and developed different strategies to adjust to the reimbursement system. Private providers were more active in marketing and improving operation room efficiency. All providers intensified cooperation with referring physicians. Close attention was paid to following the rules set by the purchaser. Discussion and conclusions The sustained cost control was an effect of bundled payment. What this study shows is that both public and private providers adhere long-term to regulations by a public purchaser that also controls entrance to the market. The compensation was fixed and led to competition on quality, as predicted by theory.

scholarly journals Hearing Loss and Help-Seeking Behavior

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 797-797
Author(s):  
Nicholas Reed
Keyword(s):  
Health Care ◽  
Hearing Loss ◽  
Help Seeking ◽  
Health Care Quality ◽  
Medicare Beneficiary ◽  
Care Quality ◽  
The Past ◽  
Help Seeking Behaviour ◽  
Seeking Behavior ◽  
Future Work

Abstract Hearing Loss (HL) is common among older adults and is associated with poor health care quality outcomes include 30-day readmissions, length of stay, poorer satisfaction, and increased medical expenditures. These associations may manifest in changes in help-seeking behaviour. In the 2015 Current Medicare Beneficiary Study (MCBS) (n=10848; weighted sample=46.3 million), participants reported whether they knowingly had avoided seeking care in the past year and self-reported HL was measured as degree of trouble (none, a little, or a lot) hearing when using a hearing aid if applicable. In a model adjusted for demographic, socioeconomic, and health factors, those with a little trouble (OR= 1.612; 95% CI= 1.334-1.947; P<0.001) and a lot of trouble hearing (OR= 2.011; 95% CI= 1.443-2.801; P<0.001) had 61.2% and 101.1% higher odds of avoiding health care over the past year relative to participants with no trouble hearing. Future work should examine whether hearing care modifies this association.

The impact of person-centered care on residents' perceptions of care quality in nursing homes: an intervention study

2018 ◽  
Vol 7 (2) ◽  
pp. 118-124
Author(s):  
Vigdis Abrahamsen Grøndahl ◽  
Liv Berit Fagerli ◽  
Heidi Karlsen ◽  
Ellen Rosseland Hansen ◽  
Helena Johansson ◽  
...  
Keyword(s):  
Nursing Home ◽  
Intervention Study ◽  
Care Quality ◽  
Legal Rights ◽  
Nursing Home Administrators ◽  
Person Centered Care ◽  
Before And After ◽  
Centered Care ◽  
The Impact ◽  
Perceptions Of Care

Background: The quality of care offered to older people is still poor. Nursing home administrators often claim that they provide person-centered care, but research indicates that institutional goals take precedence. Aim: The aim was to explore the impact of person-centered care on residents’ perceptions of care quality.  Methods: An intervention study was conducted in one nursing home (41 residents). Person-centered care was operationalized into the interventions: greeting the resident on each shift, one-to-one contact (resident – carer) for 30 minutes twice a week, informing the residents continuously about changes in medication, and informing the residents about their legal rights at admission and three months after admission. The interventions were systematically conducted for 12 months. Face-to-face interviews using the Quality from Patient’s Perspective (QPP) questionnaire were conducted both prior to interventions and immediately after the 12-month period. Descriptive and comparative statistics were used to test for differences between care quality perceptions before and after intervention (p ≤ .05). Results: The residents rated all four quality dimensions (caregivers’ medical-technical competence and identity-oriented approach, care organization’s socio-cultural atmosphere, and physical-technical conditions) more highly after the 12-month period, and the socio-cultural atmosphere was rated significantly more highly. At item level, 44 items received higher scores, and, among them, significantly higher scores were given to 6 items. One item received a significantly lower score. Conclusions: Residents’ perceptions of care quality increase when person-centered care is operationalized and takes precedence over the ward’s routines or is part of the ward’s routines. The results indicate that it is possible to design a care system where the residents are at the centre of the health care offered.

Authentic leadership and nurses' voice behaviour and perceptions of care quality

2010 ◽  
Vol 18 (8) ◽  
pp. 889-900 ◽  
Author(s):  
CAROL A. WONG ◽  
HEATHER K. SPENCE LASCHINGER ◽  
GRETA G. CUMMINGS
Keyword(s):  
Authentic Leadership ◽  
Care Quality ◽  
Perceptions Of Care

Linking commercial claims and state registry data to assess cancer care quality at the medical group level: Early lessons from California.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 269-269
Author(s):  
Ann Woo ◽  
Kathleen A. Foley
Keyword(s):  
Cancer Care ◽  
Quality Measures ◽  
Public Reporting ◽  
Care Quality ◽  
Registry Data ◽  
Data Sets ◽  
Medical Group ◽  
Group Level ◽  
Physician Group ◽  
Technical Specifications

269 Background: The Integrated Healthcare Association (IHA) is a non-profit organization which runs the largest Pay for Performance program in California. We describe a feasibility study to apply NQF cancer quality measures to linked commercial claims and state registry data and calculate results at the physician organization level. We describe phase I of the study: identifying appropriate measures and securing access to the data. Methods: We requested technical specifications for 9 NQF breast and colon cancer quality measures from the measure stewards and 2009 –2012 claims data from 7 California health plans. Results: Two barriers were identified in phase I: First, California Cancer Registry (CCR) data policies, designed for public health surveillance and not quality measurement, caused delays and present hurdles to public reporting. CCR data is not available until it is at least 95% complete, so 2011 data was not available until October 2013. Moreover, CCR requires that they conduct the data linkage, which required new data use agreements between the data aggregator and each participating insurer – costly in both time and legal fees. Finally, obstacles to public reporting any of the CCR data at the provider level still exist. Barrier 2: NQF measure specifications for linked claims-registry data sets do not currently exist, so the project team developed them, adding to the problem of proliferating non-harmonized quality measures. Conclusions: While the application of NQF measures to claims-registry linkage appears feasible for measurement of cancer care quality at the medical group level, registry policies and the lack of standard technical specifications for linked claims-registry data sets adversely impact the timeliness, usability, and comparability of results using two widely available data sources. More flexible policies on the part of data registries and attention to measure harmonization could improve data quality and usability for cancer care quality assessment and public reporting, and should be considered. In phase 2, we will apply the measures at the physician group level, and assess the feasibility of public reporting at the physician group level.

The Effect of Waiting Time on Patient Perceptions of Care Quality

2018 ◽  
Vol 25 (1) ◽  
pp. 32-45 ◽  
Author(s):  
Quinton J. Nottingham ◽  
Dana M. Johnson ◽  
Roberta S. Russell
Keyword(s):  
Waiting Time ◽  
Care Quality ◽  
Patient Perceptions ◽  
Perceptions Of Care

Perceptions of care quality and the effect on patient satisfaction

2016 ◽  
Vol 33 (8) ◽  
pp. 1202-1229 ◽  
Author(s):  
Dana M. Johnson ◽  
Roberta S. Russell ◽  
Sheneeta W. White
Keyword(s):  
Patient Satisfaction ◽  
Service Quality ◽  
Multiple Regression ◽  
Paired Comparison ◽  
Time Frame ◽  
Care Quality ◽  
Content Type ◽  
Time Period ◽  
The Impact ◽  
Perceptions Of Care

Purpose This research models the impact of patient perceptions of care quality on overall patient satisfaction in a rural healthcare organization over a three-year time period. The purpose of this paper is to determine if the factors that influence perceptions of service quality change over time and if the change affects overall patient satisfaction. Design/methodology/approach Data were collected for three fiscal years (2012-2014) using a 36-question, Likert-scaled attitudinal survey. Multiple regression analysis was performed to identify which constructs of five different service quality dimensions were statistically significant in predicting overall patient satisfaction. Paired comparison of means and ANOVA F-tests highlighted significant differences across years and demographics. Findings Multiple regression models of overall patient satisfaction over a three-year time period had significant repeat variables, indicating salience of the dimensions and constructs of service quality that predict patient satisfaction. However, some dimensions of service quality did not remain significant from one year to another, indicating there may be a gap in the patient service cycle over an extended time frame. Originality/value This paper explored the sequential relationship between patient satisfaction survey data and perceptions of service quality over a multi-year time frame. The research focussed on outpatient medical clinics, while the majority of previous studies have focussed on acute care or inpatient stays. A longitudinal study is especially relevant for outpatient clinics where continuity of care is important.

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