Late last month we wrote about criticism leveled at the federal government’s latest bundled payment proposal.
Since then, other experts have come forward to criticize not only the Comprehensive Care for Joint Replacement (CCJR) proposal announced last month, but also the Bundled Payments for Care Initiative (BPCI) program that began in April 2013. Both programs come from the federal Centers for Medicare & Medicaid Services.
You can find detailed criticism of CCJR from Harold Miller, president of the Center for Healthcare Quality and Payment Reform, on the CHQPR’s blog, and from Suzanne Delbanco, executive director of Catalyst for Payment Reform, and Francois de Brantes, executive director of the Health Care Incentives Improvement Institute (HCI3), on the Health Affairs blog. For an explanation of how CMS can improve the BPCI program, see this HCI3 blog post from de Brantes. Continue reading
Vox’s Sarah Kliff, who has an AHCJ Reporting Fellowship on Health Care Performance, is writing a series about fatal, preventable medical errors.
Not the inevitable tragic things that can happen to a patient – but the ones that we know how to avoid, the lives that should not be at risk. Kliff spent several months on one story – actually a story and accompanying video and graphics – that combined insights about how hospitals think central line infections and a gripping narrative about the death of a 3-year-old girl. You can find the story here.
Kliff wrote a “How I did It” essay for AHCJ that addresses a lot of the nuts and bolts of a vast project like this. She outlines how she reached out to patients/families, how she organized the voluminous – initially not searchable – medical records, how she found researchers who could elucidate things she did not fully understand in those records.
And she talks about the power of a good analogy to both organize a 5000-word narrative and give readers an accessible entry point to her work. Read about how she did it.
Hospice use is a common indicator of quality end-of-life care. The timing of hospice enrollment is an important component of that care, and a recent study finds wide variations among states.
Researchers from Yale University compared 2011 hospice use data on a state-by-state basis of 660,000 Medicare patients during the last six months of their lives. They identified several key trends among states in the rates of very short or very long hospice stays (reflecting late or early enrollment) and of patients leaving hospice before their deaths. Continue reading
Quality measures are good, right? We all want our doctors and hospitals to follow best practices and be held to them.
It’s not so simple.
Put aside for the moment whether the measure is accurate – we don’t always know or agree on what the best thing is in health care (Exhibit A: mammograms).
There’s another quality problem.
There too many quality measures. Oodles and oodles of quality measures. Continue reading
A new survey of state laws around dementia training reveals a patchwork of requirements and standards across settings, professional licensure and personnel. It found that existing laws and training are not keeping up with the growing needs of people who are cognitively impaired.
The survey and accompanying analyses looked at existing laws and gaps in training, as well as required curriculums in all 50 states, plus the District of Columbia and Puerto Rico. Continue reading
If it seems the newest studies are always reporting some new link – an association between two things or an increase or decrease in this, that or the other – it’s not your imagination.
Positive findings, those which find … “something,” tend to end up in journals more often. But a recent study in PLOS ONE suggests that this trend has decreased, thanks to a change in trial reporting standards around the year 2000. Continue reading
The Center for Medicare & Medicaid Innovation, created by the Affordable Care Act, is trying new ways of delivering health care and testing new incentives and payment models. Some ideas are likely, even expected, to fail. Others may lead to new ways of delivering higher quality care for less money.
CMMI also is supposed to help spread new ideas so they’ll take root in the real world. The U.S. Department of Health and Human Services has the authority to expand approaches that reduce spending – and halt those that do not. This is a more flexible approach than officials had with “demonstration projects” prior to the ACA.
The agency’s website is a goldmine of health care innovation. Read more about what CMMI is tasked with doing, how it will do it and how the success or failures of its projects will be determined in this new tip sheet.
Photo: Susan HeaveyTransportation and other social determinants of health are covered in the Rural Assistance Center’s recently updated guide on the topic. Seen here is an older form of rural transportation from Fort Worth, Texas, where AHCJ recently held a workshop on rural health issues.
When I flew to Forth Worth, Texas, recently for AHCJ’s Rural Health Workshop, I should have read this first.
The Rural Assistance Center, a collaborative and federally-funded information portal on rural health and related services, offers a topic guide on the social determinants of health, specifically looking at social factors such as affordable transportation, access to food and the environment and their impact on people’s health.
The recently updated guide, “Social Determinants of Health for Rural People,” is a great primer for anyone starting to delve into how certain aspects of life for those living in less populated areas affect their well-being. Continue reading
Is housing a prescription for better health for the poor? And, if so, who pays for it?
That was the question before a several experts this month at briefing on Capitol Hill. Hosted by the Alliance for Health Reform, a nonpartisan health policy group, the panel examined the role of Medicaid and housing, and how the joint federal-state program also could be used to provide more stable housing with the goal of boosting health. Continue reading
Photo courtesy of Bart Roach
Sara Schilling of the Tri-City Herald in Kennewick, Wash., recently caught up with a local dentist who channels his wanderlust into helping others.
His name is Bart Roach.
When Roach is not taking care of his own patients and pitching in at a local clinic for the poor, he is trekking to faraway places where children are suffering from untreated disease.
The walls of his office are decorated with images and souvenirs of his travels. The computer in his office is filled with the photographs, Schilling writes. Continue reading