Research Roundup: Hospital Performance

Higher health spending linked to better outcomes in emergency care

Economists from MIT will soon publish a study in the Journal of Political Economy finding that higher cost emergency care was associated with better health outcomes for Medicare patients in New York state. The researchers took advantage of ambulance dispatch patterns to examine “what happens when similar patients located just on opposite sides of emergency-dispatch boundary lines wound up in different types of hospitals.”

“[W]e find that patients who are brought to higher cost hospitals achieve better outcomes. Our estimates imply that a one standard deviation increase in Medicare reimbursement leads to a 4 percentage point (or 10 percent) reduction in mortality; the implied cost per at least one year of life saved is approximately $80,000.”

Joseph J. Doyle Jr. and colleagues, in the Journal of Political Economy

No association between health outcomes and hospital participation in surgical outcomes monitoring

A recent study examined surgical outcomes monitoring programs and found that participating hospitals failed to show greater improvements in complications or mortality than non-participating hospitals. The method used by the researchers (a difference-in-difference design) accounts for trends that would otherwise occur (e.g. improvements in surgical outcomes regardless of hospital participation in outcomes monitoring).

“The failure of this and other studies to demonstrate an association between outcomes-oriented reporting systems and improved surgical outcomes may be related to difficulties translating outcomes reports into evidence-based approaches to quality improvement.”

David A. Etzioni and colleagues, in JAMA

Hospital readmissions may be driven more by community factors than hospital performance

Health Research & Educational Trust researchers examined county-level variation in hospitals with publicly reported readmission rates for acute myocardial infarction, heart failure, and pneumonia. The study found that most of the variation in readmission rates could be explained by the hospital’s county, and that less than half of the variation in readmissions is explained by hospital performance.

“[C]ounty measures, including socioeconomic status, physician mix, and nursing home quality, explain nearly half of this county-level variation. Thus, hospital readmission rates might be more effectively reduced if community-based readmission reduction strategies are added to ongoing, hospital-focused improvement efforts.”

Jeph Herrin and colleagues, Health Research & Educational Trust

Hospital productivity greater when accounting for illness severity and outcomes

University of Southern California economists examined productivity growth in U.S. hospitals from 2002 through 2011. Prior studies have suggested that hospital productivity has lagged in relation to other industries, but the USC researchers note these previous studies had not accounted for changes in severity of patient cases or quality of care.

Without adjusting for illness severity or quality, the researchers similarly found negative trends in productivity growth for the illnesses studied (heart attack, heart failure, and pneumonia). However, when then researchers adjusted for trends in outcomes and severity, productivity growth was positive for each of these diseases.

“Productivity growth is relevant to recent changes in Medicare payment policy. In the past, reimbursement rates to providers have been increased each year based on the rate of health care cost inflation, to ensure ‘payment adequacy’ for providers. In the absence of productivity improvement, an increase in reimbursement equal to the increase in the price of labor, capital, and materials would ensure that providers could continue to deliver the same level of care. With productivity improvement, providers could actually deliver a higher quality or greater quantity of care.”

John A. Romley and colleagues, in Health Affairs

Quality measures often miss common reasons for which patients seek care

A study published in JAMA last week categorized quality measures endorsed by the National Quality Forum (NQF) to see whether the endorsed indicators assess healthcare quality before or after diagnosis. There is some concern that if quality measures are not focused on pre-diagnostic care, other incentives may prevail and cause delays in diagnosis, which could lead to worse outcomes.

“[W]e believe that using a comprehensive set of endorsed sign/symptom-based measures could help patients receive timely care as payment models are changed and may prevent financial incentives from resulting in underuse of necessary care.”

Hemal K. Kanzaria and colleagues, in JAMA

The researchers found that the majority of NQF process measures were tied to established diagnoses and that very few measures reflected the common reasons patients seek care (e.g. coughs, shortness of breath, headaches, rashes).  This is also of note because ill-defined conditions are one of the fastest area of spending growth and highest-cost disease categories.