PUP 4931r Lecture Notes - Lecture 55: Fairview Health Services, Electronic Health Record, The Slippery Slope
16 May 2018
School
Department
Course
Professor
Patient Characteristics and Differences in Hospital Readmission Rates; Bennett et.
al (JAMA 9/14/15 online first)
Medicare adjusters for risk of readmission discriminate against safety net
hospitals
22 characteristics not used by Medicare for risk adjustment in P4P found to
significantly predict readmission
Those predictors also discriminated high versus low quartile readmission hospitals
Hospitals with more patients at risk of readmission were likely to have more
readmissions and were fined.
More factors should be included in Medicare formula
Fairview Health Services PCP Compensation Model
Minneapolis, 2010-12
40% of compensation based upon clinical outcomes
Diabetes care; vascular care; cancer screening; depression care; asthma
care.
Big improvement in lowest tertile
3 times more than average
6 times more than top tertile improvement
But overall, P4P group improvement no greater than in comparable medical
groups in state
Key Elements of Success, Agreement Among Many Authors
Close monitoring, feedback, and tracking
Payments large enough to compensate for extra costs and uncertainty
Coupling incentives with other quality improvement programs, e.g., reporting
Using targets supported by providers
Close communication with providers
Room for improvement in outcomes
San Diego: external monitoring and feedback was cited as top reason for success
Additional Success Factors (Less Agreement)
Focusing on chronic care (especially diabetes) rather than acute care
Using case managers
Electronic medical records
Intermittent rather than end-of-project payments
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Patient characteristics and differences in hospital readmission rates; bennett et. al (jama 9/14/15 online first) Medicare adjusters for risk of readmission discriminate against safety net hospitals. 22 characteristics not used by medicare for risk adjustment in p4p found to significantly predict readmission. Those predictors also discriminated high versus low quartile readmission hospitals. Hospitals with more patients at risk of readmission were likely to have more readmissions and were fined. More factors should be included in medicare formula. Diabetes care; vascular care; cancer screening; depression care; asthma care. But overall, p4p group improvement no greater than in comparable medical groups in state. Key elements of success, agreement among many authors. Payments large enough to compensate for extra costs and uncertainty. Coupling incentives with other quality improvement programs, e. g. , reporting. San diego: external monitoring and feedback was cited as top reason for success. Focusing on chronic care (especially diabetes) rather than acute care. New funds rather than reallocation of existing funds.
