scholarly journals Luck of the draw: Role of chance in the assignment of medicare readmissions penalties

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261363
Author(s):  
Andrew D. Wilcock ◽  
Sushant Joshi ◽  
José Escarce ◽  
Peter J. Huckfeldt ◽  
Teryl Nuckols ◽  
...  
Keyword(s):  
Pay For Performance ◽  
Hospital Readmissions ◽  
Safety Net ◽  
Teaching Hospitals ◽  
Health Plans ◽  
Random Events ◽  
Discharged Patients ◽  
The Impact

Pay-for-performance programs are one strategy used by health plans to improve the efficiency and quality of care delivered to beneficiaries. Under such programs, providers are often compared against their peers in order to win bonuses or face penalties in payment. Yet luck has the potential to affect performance assessment through randomness in the sorting of patients among providers or through random events during the evaluation period. To investigate the impact luck can have on the assessment of performance, we investigated its role in assigning penalties under Medicare’s Hospital Readmissions Reduction Policy (HRRP), a program that penalizes hospitals with excess readmissions. We performed simulations that estimated program hospitals’ 2015 readmission penalties in 1,000 different hypothetical fiscal years. These hypothetical fiscal years were created by: (a) randomly varying which patients were admitted to each hospital and (b) randomly varying the readmission status of discharged patients. We found significant differences in penalty sizes and probability of penalty across hypothetical fiscal years, signifying the importance of luck in readmission performance under the HRRP. Nearly all of the impact from luck arose from events occurring after hospital discharge. Luck played a smaller role in determining penalties for hospitals with more beds, teaching hospitals, and safety-net hospitals.

scholarly journals Quality of Care at Safety-Net Hospitals and the Impact on Pay-for-Performance Reimbursement

2019 ◽  
Vol 105 (1) ◽  
pp. S179
Author(s):  
R.R. Sarkar ◽  
K. Bachand ◽  
P. Sheridan ◽  
P. Riviere ◽  
Z.D. Guss ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Pay For Performance ◽  
Safety Net ◽  
The Impact

scholarly journals Quality of care at safety‐net hospitals and the impact on pay‐for‐performance reimbursement

Cancer ◽  
2020 ◽  
Vol 126 (20) ◽  
pp. 4584-4592
Author(s):  
Reith R. Sarkar ◽  
P. Travis Courtney ◽  
Katie Bachand ◽  
Paige E. Sheridan ◽  
Paul J. Riviere ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Pay For Performance ◽  
Safety Net ◽  
The Impact

scholarly journals Quality of care at safety-net hospitals and the impact on pay-for-performance reimbursement

2019 ◽  
Author(s):  
Reith R. Sarkar ◽  
Patrick T. Courtney ◽  
Katie Bachand ◽  
Paige Sheridan ◽  
Paul Riviere ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Cancer Patients ◽  
Low Income ◽  
Pay For Performance ◽  
Young Male ◽  
Quality Measures ◽  
Safety Net ◽  
High Burden ◽  
The Impact

AbstractBackgroundPay-for-performance reimbursement ties hospital payments to standardized quality of care metrics. The impact of pay-for-performance reimbursement models on safety-net hospitals, which care primarily for uninsured or underinsured patients, remains poorly defined. This study evaluates how standardized quality of care metrics vary by a hospital’s safety-net status, and helps us better understand the potential impact that pay-for-performance reimbursement could have on funding of safety-net hospitals.MethodsWe identified 1,703,865 bladder, breast, cervix, colon, endometrium, gastric, lung, ovary, or rectum cancer patients treated at 1,344 hospitals diagnosed between 2004 and 2015. Safety-net burden was defined for each hospital as the percentage of uninsured or Medicaid patients cared for by that hospital. Hospitals were grouped into low-, medium-, and high-burden hospitals. We evaluated the impact of safety-net burden on concordance with 20 standardized quality of care measures, adjusting for differences in patient age, gender, stage at diagnosis, and comorbidity.ResultsPatients seen at high-burden hospitals were more likely to be young, male, black, Hispanic, and to reside in a low-income and low-educated region. High-burden hospitals had lower adherence to 13 of 20 quality measures compared to low-burden hospitals (all p<0.05). Among the 350 high-burden hospitals, the quality measures were lowest for those caring for the highest fraction of uninsured or Medicaid patients, minority serving hospitals, and those caring for less educated patients (all p<0.001).DiscussionCancer care at safety-net hospitals was associated with lower concordance to standardized quality of care measures. Under a pay-for-performance reimbursement model these lower quality of care scores could decrease payments to safety-net hospitals, potentially increasing health disparities for at-risk cancer patients.

scholarly journals The impact of a structured handover checklist for intraoperative staff shift changes on effective communication, OR team satisfaction, and patient safety: a pilot study

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Ebrahim Nasiri ◽  
Mojgan Lotfi ◽  
Seyyed Muhammad Mahdi Mahdavinoor ◽  
Mohammad Hossein Rafiei
Keyword(s):  
Patient Safety ◽  
Positive Impact ◽  
Teaching Hospitals ◽  
Control Intervention ◽  
Significant Difference ◽  
Or Team ◽  
Omission Rate ◽  
The Impact

Abstract Objective Handover without a structured format is prone to the omission of information and could be a potential risk to patient safety. We sought to determine the effect of a structured checklist on the quality of intraoperative change of shift handover between scrubs and circulars. Methods We conducted a control intervention study on operating room wards of two teaching hospitals from 20 Feb to 21 Nov 2020. This research was conducted in three stages as follows: assessing the current situation (as a group before the intervention), performing the intervention and evaluating the effect of using a checklist on handover quality after the intervention in two groups: with and without checklist. We examined the quality of handover between scrub and circular personnel in terms of handover duration and quality, omission of information and improvement in OR staff satisfaction. Results A total of 120 handovers were observed and evaluated. After intervention in the group using the checklist, the percentage of information omission in surgical report was decreased from 19.5 to 12.1% between scrubs (P < 0.00) and from 16.8 to 14.1% between circulars (P < 0.03). Also, in the role of scrub, the mean overall score of handover process quality was significantly higher after the intervention (x̄ = 7 ± 1.5) than before it (x̄ = 6.5 ± 0.9) (p < 0.02). In the role of circulating, despite the positive effect of overall score checklist, no significant difference was observed (p < 0.08). The use of checklist significantly increased the handover duration between scrubs (p < 0.03) and circulars (p < 0.00). The overall mean percentage of handover satisfaction increased from 67.5% before the intervention to 85.5% after the intervention (p < 0.00). Conclusion The implementation of a new structured handover checklist had a positive impact on improving the quality of communication between the surgical team, reducing the information omission rate and increasing the satisfaction.

Strategic Role of Zakat in Multidimensional Quality of Life in Sijunjung, Indonesia

2018 ◽  
Vol 15 (1) ◽  
pp. 55-72
Author(s):  
Herlin Hamimi ◽  
Abdul Ghafar Ismail ◽  
Muhammad Hasbi Zaenal
Keyword(s):  
Quality Of Life ◽  
Positive Impact ◽  
Wealth Distribution ◽  
Absolute Poverty ◽  
Before And After ◽  
The Status ◽  
Being There ◽  
The Impact

Zakat is one of the five pillars of Islam which has a function of faith, social and economic functions. Muslims who can pay zakat are required to give at least 2.5 per cent of their wealth. The problem of poverty prevalent in disadvantaged regions because of the difficulty of access to information and communication led to a gap that is so high in wealth and resources. The instrument of zakat provides a paradigm in the achievement of equitable wealth distribution and healthy circulation. Zakat potentially offers a better life and improves the quality of human being. There is a human quality improvement not only in economic terms but also in spiritual terms such as improving religiousity. This study aims to examine the role of zakat to alleviate humanitarian issues in disadvantaged regions such as Sijunjung, one of zakat beneficiaries and impoverished areas in Indonesia. The researcher attempted a Cibest method to capture the impact of zakat beneficiaries before and after becoming a member of Zakat Community Development (ZCD) Program in material and spiritual value. The overall analysis shows that zakat has a positive impact on disadvantaged regions development and enhance the quality of life of the community. There is an improvement in the average of mustahik household incomes after becoming a member of ZCD Program. Cibest model demonstrates that material, spiritual, and absolute poverty index decreased by 10, 5, and 6 per cent. Meanwhile, the welfare index is increased by 21 per cent. These findings have significant implications for developing the quality of life in disadvantaged regions in Sijunjung. Therefore, zakat is one of the instruments to change the status of disadvantaged areas to be equivalent to other areas.

Zmiana modelu zarządzania i nadzoru nad jakością kształcenia w szkolnictwie wyższym. Perspektywa doświadczeń Republiki Federalnej Niemiec

2020 ◽  
pp. 137-149
Author(s):  
Krzysztof Szewior
Keyword(s):  
Quality Of Education ◽  
Research Approach ◽  
University Management ◽  
Strategic Partner ◽  
Higher Education Reforms ◽  
The University ◽  
The Impact ◽  
Desk Research

The author focuses on the manner and effects of German higher education reforms that have changed the model of university management. The point of reference is the quality of education and its role, how universities ensure it, and how it is verified through evaluation and accreditation. These elements divide the article into two parts: a part about quality and a part about evaluation and accreditation. The analysis includes the impact of global processes and Europeanization. The research approach is characteristic for public policies, sciences of management and quality. The theories used in this article: the theory of systems and neo-institutionalism, as well as perspectives: the university as an active strategic partner, entrepreneurial university, the third role of universities. The publication is based on desk research and on the analysis of processes.

scholarly journals Threat or Corrective? Assessing the Impact of Populist Parties in Government on the Qualities of Democracy: A 19-Country Comparison

2021 ◽  
pp. 1-21
Author(s):  
Davide Vittori
Keyword(s):  
Negative Impact ◽  
Quality Of Democracy ◽  
Clear Cut ◽  
Liberal Democratic ◽  
Country Comparison ◽  
Democratic Regimes ◽  
Different Types ◽  
The Impact

Abstract Scholars have long debated whether populism harms or improves the quality of democracy. This article contributes to this debate by focusing on the impact of populist parties in government. In particular, it inquires: (1) whether populists in government are more likely than non-populists to negatively affect the quality of democracies; (2) whether the role of populists in government matters; and (3) which type of populism is expected to negatively affect the quality of liberal-democratic regimes. The results find strong evidence that the role of populists in government affects several qualities of democracy. While robust, the findings related to (2) are less clear-cut than those pertaining to (1). Finally, regardless of their role in government, different types of populism have different impacts on the qualities of democracy. The results show that exclusionary populist parties in government tend to have more of a negative impact than other forms of populism.

scholarly journals A Comprehensive Review Evaluating the Impact of Protein Source (Vegetarian vs. Meat Based) in Hepatic Encephalopathy

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 370
Author(s):  
Umair Iqbal ◽  
Ravirajsinh N. Jadeja ◽  
Harshit S. Khara ◽  
Sandeep Khurana
Keyword(s):  
Hepatic Encephalopathy ◽  
Protein Intake ◽  
Alternative Therapy ◽  
Case Series ◽  
Current Evidence ◽  
Branch Chain Amino ◽  
The Impact ◽  
Protein Diets

Hepatic encephalopathy (HE) is a common neurological consequence in patients with cirrhosis and has a healthcare burden of USD 5370 to 50,120 per patient annually. HE significantly hampers the quality of life and is a major cause of morbidity and mortality. Patients with cirrhosis are at a high risk for protein-calorie malnutrition due to altered metabolism. Current evidence has changed the old belief of protein restriction in patients with cirrhosis and now 1.2 to 1.5 g/kg/day protein intake is recommended. Case series and studies with small numbers of participants showed that a vegetarian protein diet decreases the symptoms of HE when compared to a meat-based diet, but the evidence is limited and requires further larger randomized controlled trials. However, vegetable or milk-based protein diets are good substitutes for patients averse to meat intake. Branch chain amino acids (BCAA) (leucine, isoleucine and valine) have also been shown to be effective in alleviating symptoms of HE and are recommended as an alternative therapy in patients with cirrhosis for the treatment of HE. In this review, we provide an overview of current literature evaluating the role of protein intake in the management of HE in cirrhosis.

Practitioner Review: Continuity and Change: The Fair Work Act in Aviation

2011 ◽  
Vol 53 (3) ◽  
pp. 392-401 ◽  
Author(s):  
Sue Bussell ◽  
John Farrow
Keyword(s):  
Industrial Relations ◽  
Safety Net ◽  
Aviation Industry ◽  
Continuity And Change ◽  
National Debate ◽  
New Development ◽  
Key Issues ◽  
The Individual ◽  
The Impact

This article begins by discussing the specific industrial relations challenges of the highly competitive aviation industry. It then reflects on the outcome of the recent intense national debate over industrial relations, exploring the consequences of that debate for practice and policy, and discusses some key issues that remain in play. Although the Fair Work Act 2009 may have come about as a reaction to what many perceive as the ‘excesses’ of Work Choices, the new Act does not so much ‘wind back the clock’ as represent a significant new development in Australia’s long and unique industrial relations history. This article will discuss the impact of the changes, to date, made by the Fair Work Act on one organization, including the expansion of the ‘safety net’, and how the new compromise between the role of the ‘collective’ and the role of the ‘individual’ struck by the Act has the potential to fundamentally change the nature and structure of bargaining. We offer these comments as practitioners who have worked under successive industrial relations regimes since the early 1980s.

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