TY - JOUR
T1 - Identifying high-value care for Medicare beneficiaries
T2 - a cross-sectional study of acute care hospitals in the USA
AU - Herrin, Jeph
AU - Yu, Huihui
AU - Venkatesh, Arjun K.
AU - Desai, Sunita M.
AU - Thiel, Cassandra L.
AU - Lin, Zhenqiu
AU - Bernheim, Susannah M.
AU - Horwitz, Leora I.
N1 - Funding Information:
Funding This work was funding by grant R01HS022882 from the Agency for Healthcare Quality and Research. SMD was also supported by grant number K01HS026980 from the Agency for Healthcare Research and Quality.
Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.
PY - 2022/3/31
Y1 - 2022/3/31
N2 - Objectives High-value care is providing high quality care at low cost; we sought to define hospital value and identify the characteristics of hospitals which provide high-value care. Design Retrospective observational study. Setting Acute care hospitals in the USA. Participants All Medicare beneficiaries with claims included in Center for Medicare & Medicaid Services Overall Star Ratings or in publicly available Medicare spending per beneficiary data. Primary and secondary outcome measures Our primary outcome was value defined as the difference between Star Ratings quality score and Medicare spending; the secondary outcome was classification as a 4 or 5 star hospital with lowest quintile Medicare spending ( € high value') or 1 or 2 star hospital with highest quintile spending ( € low value'). Results Two thousand nine hundred and fourteen hospitals had both quality and spending data, and were included. The value score had a mean (SD) of 0.58 (1.79). A total of 286 hospitals were classified as high value; these represented 28.6% of 999 4 and 5 star hospitals and 46.8% of 611 low cost hospitals. A total of 258 hospitals were classified as low value; these represented 26.6% of 970 1 and 2 star hospitals and 49.3% of 523 high cost hospitals. In regression models ownership, non-teaching status, beds, urbanity, nurse to bed ratio, percentage of dual eligible Medicare patients and percentage of disproportionate share hospital payments were associated with the primary value score. Conclusions There are high quality hospitals that are not high value, and a number of factors are strongly associated with being low or high value. These findings can inform efforts of policymakers and hospitals to increase the value of care.
AB - Objectives High-value care is providing high quality care at low cost; we sought to define hospital value and identify the characteristics of hospitals which provide high-value care. Design Retrospective observational study. Setting Acute care hospitals in the USA. Participants All Medicare beneficiaries with claims included in Center for Medicare & Medicaid Services Overall Star Ratings or in publicly available Medicare spending per beneficiary data. Primary and secondary outcome measures Our primary outcome was value defined as the difference between Star Ratings quality score and Medicare spending; the secondary outcome was classification as a 4 or 5 star hospital with lowest quintile Medicare spending ( € high value') or 1 or 2 star hospital with highest quintile spending ( € low value'). Results Two thousand nine hundred and fourteen hospitals had both quality and spending data, and were included. The value score had a mean (SD) of 0.58 (1.79). A total of 286 hospitals were classified as high value; these represented 28.6% of 999 4 and 5 star hospitals and 46.8% of 611 low cost hospitals. A total of 258 hospitals were classified as low value; these represented 26.6% of 970 1 and 2 star hospitals and 49.3% of 523 high cost hospitals. In regression models ownership, non-teaching status, beds, urbanity, nurse to bed ratio, percentage of dual eligible Medicare patients and percentage of disproportionate share hospital payments were associated with the primary value score. Conclusions There are high quality hospitals that are not high value, and a number of factors are strongly associated with being low or high value. These findings can inform efforts of policymakers and hospitals to increase the value of care.
KW - health policy
KW - quality in health care
KW - statistics & research methods
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U2 - 10.1136/bmjopen-2021-053629
DO - 10.1136/bmjopen-2021-053629
M3 - Article
C2 - 35361641
AN - SCOPUS:85127380297
VL - 12
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 3
M1 - e053629
ER -