Because the snow exhibits no signal of stopping, we’d as nicely keep cozy inside and skim up on the most recent well being coverage analysis from January! This month we examine affected person care after non-public fairness acquisition of hospitals, and methods to enhance risk-adjustment accuracy in Medicare Benefit.
Adjustments in Affected person Care Expertise After Non-public Fairness Acquisition of US Hospitals
Anjali Bhatla, Victoria L. Bartlett, Michael Liu, ZhaoNian Zheng, Rishi Wadhera. JAMA. January 2025. Out there right here.
Researchers funded by the American Coronary heart Affiliation used information from Irving Levin Associates and Pitchbook, the American Hospital Affiliation, and CMS Affect Information to guage whether or not the acquisition of hospitals by non-public fairness (PE) corporations was related to modifications within the high quality of affected person care, compared with non-PE hospitals chosen as controls.
What it Finds
- Following acquisition of a hospital there was a lower in patient-reported workers responsiveness at PE hospitals in contrast with management hospitals.
- International measures of affected person care expertise worsened after a hospitals’ acquisition by non-public fairness, and the distinction in general affected person care expertise measures between PE hospitals and non-PE hospitals grew annually following acquisition reaching round 5 proportion factors by yr three post-acquisition.
- These modifications exceeded the nationwide 3.6% decline in affected person care expertise scores noticed in the course of the COVID-19 pandemic.
Why it Issues
Enhancing patient-centered care is a nationwide precedence, and these findings spotlight how affected person care expertise could decline with non-public fairness possession, elevating questions in regards to the high quality of medical care, staffing ranges, and affected person outcomes. This evaluation discovered that the lower in affected person expertise scores at PE hospitals in contrast with management hospitals grew annually following acquisition, suggesting that the results of organizational modifications carried out by PE could compound over time. The findings recommend that personal fairness methods could prioritize monetary returns over affected person care, which may have long-term penalties on well being outcomes and medical high quality. Policymakers want to contemplate the implications of personal fairness possession on affected person care and discover choices for oversight to safeguard affected person pursuits.
Combining Affected person Survey Knowledge With Prognosis Codes Improved Medicare Benefit Danger-Adjustment Accuracy
Meghan Bellerose, Hannah O. James, Jay Shroff, Andrew M. Ryan, David J. Meyers. Well being Affairs. January 2025. Out there right here.
A analysis crew at Brown College linked 2016-2019 medical and pharmaceutical claims to Client Evaluation of Healthcare Suppliers and Programs (CAHPS) survey responses of Medicare Benefit (MA) enrollees to match the predictive accuracy of various risk-adjustment methods versus the usual Hierarchical Situation Classes (HCC) method.
What it Finds
- Survey-based fashions, notably when mixed with HCC scores (which CMS estimates from beneficiaries’ prognosis codes and demographic traits), had been discovered to enhance prediction of MA utilization, particularly for beneficiaries with the best and lowest predicted healthcare use.
- The exclusion of prognosis codes from well being danger assessments (HRAs) and chart evaluations resulted in barely much less predictive accuracy in comparison with commonplace HCC scores, although including survey information enhanced mannequin efficiency.
Why it Issues
Enhancing risk-adjustment fashions is essential to making sure that Medicare Benefit plans are reimbursed pretty for managing their enrollees’ care whereas lowering incentives for discretionary prognosis coding or upcoding. Higher danger adjustment may additionally enhance the monetary sustainability of the Medicare program. Integrating well being survey responses into danger adjustment may assist counteract risk-score inflation and be certain that greater funds are directed to plans masking sicker populations. If CMS excludes diagnoses most vulnerable to upcoding, surveys may fill in gaps of essential well being info and enhance equity in funds to plans serving high-need beneficiaries.