Pre-operative care intensity and cost for renal colic: implications for surgical value-based reforms.

OBJECTIVES: To identify pre-operative patient/facility factors associated with post-operative and total episode-related costs using renal colic as a model surgical condition to improve value-based payment models. METHODS: Using state Healthcare Cost and Utilization Project data, we performed a retrospective cohort study examining peri-operative costs for individuals presenting to an emergency department for renal colic and who ultimately underwent definitive surgical management. We estimated multivariable ordered and binary logistic regressions to examine the association between pre-operative and operative cost quartiles on the probability of specific post-operative cost quartiles after accounting for hospital and individual factors. We also performed logistic regressions to identify patients who deviated from predicted perioperative cost pathways. RESULTS: Among 2,736 individuals included in our analysis, episode-related costs ranged from $4,536 (bottom quartile) to $26,662 (top quartile). Individuals in the highest pre-operative cost quartile experienced an 11.7%-point higher probability of remaining in the highest post-operative cost quartile relative to those in the lowest pre-operative cost quartile (95% CI 0.0709, 0.163; p<0.001). Delays in surgery (95% CI 0.0869, 0.163; P<0.001) and Medicaid vs. private insurance (95% CI 0.01, 0.0728; P<0.01) were associated with a 12.5% and 4.1%-point higher probability of being in the top quartile of pre-operative costs, respectively. Treating facility experience with value-based payment models did not influence peri-operative costs. CONCLUSIONS: Using renal colic as a model surgical condition, our novel findings suggest that pre-operative costs are associated with both post-operative and total episode-related costs, and should be accounted for when designing future value-based payment models.

Does the Diagnosis-Intervention Packet Payment Reform Impact Medical Costs, Quality, and Medical Service Capacity in Secondary and Tertiary Hospitals? A Difference-in-Differences Analysis Based on a Province in Northwest China.

Purpose: To control medical costs and regulate the behavior of providers, China has formed an original widely piloted case-based payment under the regional global budget, called the Diagnosis-Intervention Packet (DIP). This study aimed to evaluated the impact of the DIP payment reform on medical costs, quality of care, and medical service capacity in a less-developed pilot city in Northwest China. Patients and Methods: We used the de-identified case-level discharge data of hospitalized patients from January 2021 to June 2022 in pilot and control cities located in the same province. We performed difference-in-differences (DID) analysis to examine the differential impact of the DIP reform for the entire sample and between secondary and tertiary hospitals. Results: The DIP payment reform resulted in a significant decrease of total expenditure per case in the entire sample (5.5%, P < 0.01) and tertiary hospitals (9.3%, P < 0.01). In-hospital mortality rate decreased significantly in tertiary hospitals (negligible in size, P < 0.05), as did all-cause readmission rate within 30 days in the entire sample (1.1 percentage points, P < 0.01) and secondary hospitals (1.4 percentage points, P < 0.01). Proportion of severe patients increased significantly in the entire sample (1.2 percentage points, P < 0.05) and tertiary hospitals (2.5 percentage points, P < 0.01). We did not find the DIP reform was associated with a significant change in relative weight per case. Conclusion: The DIP payment reform in the less-developed pilot city achieved short-term success in controlling medical costs without sacrificing the quality of care for the entire sample. Compared with secondary hospitals, tertiary hospitals experienced a greater decline in medical costs and received more severe patients. These findings hold lessons for less developed countries or areas to implement case-based payments and remind them of the variations between different levels of hospitals.

Coding and coverage for cardiac CT in the era of algorithm-based healthcare procedures and services.

In order for patients to gain the benefit of innovation in cardiac CT, it is necessary for coding, coverage, and payment to adapt to the novelty of algorithm-based healthcare procedures and services (ABHS). Appendix S to the CPT Code Set, the "AI Taxonomy", enables creation of discrete and differentiable codes for reimbursement of ABHS which has been clinically validated and FDA-labeled. Payment policy in OPPS and PFS is evolving to take account of the unique opportunities and issues arising from the clinical adoption of ABHS.

Pay-for-performance in Taiwan: A systematic review and meta-analysis of the empirical literature.

OBJECTIVES: This study aimed to assess the impact of pay-for-performance (P4P) programmes on healthcare in Taiwan. STUDY DESIGN: This was a systematic review and meta-analysis. METHODS: A systematic literature search was performed using the PubMed, Medline, Embase, Cochrane review, Scopus, Web of Science and PsycINFO databases up to July 2023. Meta-analysis of the available outcomes was conducted using a random-effects model. RESULTS: The search yielded 85 studies, of which 58 investigated the programme for diabetes mellitus (DM), eight looked at the programme for chronic kidney disease (CKD), and the remaining studies examined programmes for breast cancer, tuberculosis, schizophrenia and chronic obstructive pulmonary disease. The DM P4P programme was a cost-effective strategy associated with reduced hospitalisation and subsequent complications. The CKD P4P was associated with a lower risk of dialysis initiation. The P4P programme also improved outcomes in breast cancer, cure rates in tuberculosis, reduced admissions for schizophrenia and reduced acute exacerbation in chronic obstructive pulmonary disease. The meta-analysis revealed that the P4P programme for DM (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.48-0.73) and CKD (OR = 0.73; 95% CI = 0.67-0.81) significantly reduced mortality risk. However, participation rate in the DM P4P programme was only 19% in 2014. CONCLUSIONS: P4P programmes in Taiwan improve quality of care. However, participation was voluntary and the participation rate was very low, raising the concern of selective enrolment of participants (i.e. 'cherry-picking' behaviour) by physicians. Future programme reforms should focus on well-designed features with the aim of reducing healthcare disparities.

Diagnosis-Related Groups payment reform and hospital cost control.

BACKGROUND: This study explores the influence of Diagnosis-Related Groups (DRG) payment reform on hospital cost control and offers pertinent cost management strategies for public hospitals. It situates the research by elucidating the significance of the DRG payment method and comparing its advantages and drawbacks with the traditional 'pay per project' model. OBJECTIVE: The primary aim is to assess the impact of DRG payment reform on hospital cost control and propose effective cost management strategies for public hospitals. The objective is to provide insights into DRG payment implications and attempt practical recommendations for its implementation in the public healthcare sector. METHODS: Employing a comprehensive approach, the study analyzes DRG payment, delineates advantages and drawbacks, and proposes cost management strategies. Methods include staff training, an information management platform, disease analysis, and optimized cost accounting. The study highlights the potential for improved medical diagnosis and treatment through industry-finance integration. RESULTS: Findings reveal advantages and limitations of DRG payment, emphasizing strategies for optimizing hospital operations. Enhanced medical diagnosis and treatment procedures through industry-finance integration contribute to overall cost control effectiveness. CONCLUSION: The study serves as a practical guide for implementing DRG payment reforms, offering valuable insights for policymakers and healthcare professionals in navigating the complexities of cost control in public healthcare.

Social network, fair payment, subjective well-being, and general health: a moderation mediation analysis.

Objective: This research aimed to investigate whether subjective general health mediated the relationship between social networks and subjective well-being and whether the perception of fair payment moderated the mediating effect of subjective general health on subjective well-being. Methods: Data were drawn from round 9 of the European Social Survey (ESS), involving 3,843 respondents from 19 countries, with ages ranging from 65 to 90 years (Meanage = 73.88 ± 6.61 years). The participants completed self-reported measures assessing subjective well-being, social networks, subjective general health, and perception of fair payment. Results: Subjective general health played a mediating role in the relationship between social networks and subjective well-being. The perception of fair payment emerged as a moderator in the mediating effect of subjective general health on the association between social networks and subjective well-being. Conclusion: This study suggests that the impact of social networks on both subjective general health and subjective well-being is contingent upon individuals' perceptions of fair payment. These results highlight the significance of social networks in fostering social connections and promoting overall subjective well-being.

A Framework for the Design of Risk-Adjustment Models in Health Care Provider Payment Systems.

Prospective payments for health care providers require adequate risk adjustment (RA) to address systematic variation in patients' health care needs. However, the design of RA for provider payment involves many choices and difficult trade-offs between incentives for risk selection, incentives for cost control, and feasibility. Despite a growing literature, a comprehensive framework of these choices and trade-offs is lacking. This article aims to develop such a framework. Using literature review and expert consultation, we identify key design choices for RA in the context of provider payment and subsequently categorize these choices along two dimensions: (a) the choice of risk adjusters and (b) the choice of payment weights. For each design choice, we provide an overview of options, trade-offs, and key references. By making design choices and associated trade-offs explicit, our framework facilitates customizing RA design to provider payment systems, given the objectives and other characteristics of the context of interest.

Green investment and dividend payouts: An intercontinental perspective.

In this research paper, we conduct an examination of the impact of green investments on dividend policies within both polluting and environmentally friendly firms. Utilizing two distinct model assumptions, we analyze a global sample of firms from 21 countries spanning the period from 2013 to 2022 to derive our primary empirical findings and perform robustness tests. Our analysis incorporates two estimation techniques: Ordinary Least Squares (OLS) and System-GMM (Generalized Method of Moments). Our findings reveal that green investment policies have a positive influence on environmentally friendly companies while exerting a detrimental effect on the dividend distributions of polluting companies. This influence is statistically and economically significant. Furthermore, our results remain consistent when employing alternative tests based on agency costs, other stakeholders and before and during Covid-19. On the other hand, when we used system-GMM method, our results also showed that green investment policies have a positive influence on environmentally friendly companies while exerting a detrimental effect on the dividend distributions of polluting companies.

A cost-effectiveness analysis of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain.

BACKGROUND CONTEXT: Randomized trials have demonstrated the superiority of intraosseous basivertebral nerve ablation (BVNA) compared with sham and standard care in terms of improvements in pain, disability, and health-related quality of life in patients with vertebrogenic chronic low back pain (cLBP). PURPOSE: To assess the cost effectiveness of BVNA in patients with vertebrogenic cLBP compared to standard care alone. STUDY DESIGN/SETTING: A model-based economic analysis. PATIENT SAMPLE: Base case analysis used INTRACEPT, a randomized trial comparing BVNA with standard care in 140 patients with vertebrogenic cLBP, recruited from 23 sites across the United States, with a follow-up, up to 5 years. Scenario analyses compared data from the Surgical Multi-center Assessment of Radiofrequency Ablation for the Treatment of Vertebrogenic Back Pain (SMART) randomized trial against a sham control, and a single-arm study. OUTCOME MEASURES: Costs and quality-adjusted life years (QALYs) were calculated to determine the incremental cost-effectiveness ratio (ICER). METHODS: A cost-effectiveness model was built in Microsoft Excel® to evaluate the costs and health outcomes of patients undergoing BVNA using the Intracept Procedure (Relievant Medsystems) to treat vertebrogenic cLBP from a US payor perspective. Alternative scenario sensitivity analyses and probabilistic sensitivity analyses were conducted to assess the robustness of the model results. QALYs were discounted at 3.0% per year. RESULTS: Base case analysis showed that BVNA relative to standard care alone was a cost-effective strategy for the management of patients with vertebrogenic cLBP, with an ICER of US$11,376 per QALY at a 5-year time horizon from introduction of the procedure. Modeling demonstrated a >99% probability that this was cost effective in the US, based on a willingness-to-pay threshold of US$100,000 to US$150,000. Various sensitivity and scenario analyses produced ICERs that all remained below this threshold. CONCLUSIONS: BVNA with the Intracept Procedure offers patients with vertebrogenic cLBP, clinicians, and healthcare systems a cost-effective treatment compared to standard care alone.

Skilled Nursing and Home Health Policy: A Primer for the Hospital Clinician.

This paper addresses the increasing challenges faced by hospital clinicians in coordinating and recommending postacute care for patients, focusing on issues related to access to the most common postacute services: skilled nursing facilities (SNFs) and home health agencies (HHAs). In coordinating discharges, hospital clinicians have minimal information on care delivery in these settings. This knowledge gap is exacerbated by the disrupted continuum of patient care between acute care hospitals, SNFs, and HHAs. To address these challenges, hospital clinicians must understand how recent federal policies have impacted SNF and HHA care provision. The paper provides an overview of recent Centers for Medicare and Medicaid Services (CMS) policies and programs affecting SNFs and HHAs, including: (1) fee-for-service reimbursement reform (ie, Patient Driven Payment Model [PDPM] and the Patient Driven Groupings Model [PDGM]); (2) bundled payment programs; (3) accountable care organizations; (4) Medicare Advantage plans. Overall, this paper aims to help hospital clinicians stay informed about the evolving landscape of postacute care delivery by providing relevant information on how recent policy changes have impacted patient care.

Patients' intention to make an up-front payment at private outpatient clinics in Malaysia as a no-show reduction method.

Regulating patients' no-show behavior is critical from the standpoints of sustainable medical services and operational efficiencies. The purpose of this study was to evaluate the patients' intention to make partial up-front payments at outpatient clinics. This was a cross-sectional study design introducing a self-administered questionnaire to 221 outpatients at a private health facility. The questionnaire measured the patient's demographic characteristics, perceived usefulness (PU), trust in the health facility, and intention to make upfront partial payments. Out of the total respondents, 57.4% were female. There were 34.8% Malays, 40.6% Chinese and 24.6% Indians. The majority (66.5%) of the respondents attained tertiary education. Nearly a third of the respondents (30.5%) reported an income between 3000 and 5000 Malaysian Ringgit (RM). Regarding payment mode, just more than half (51.1%) made self-payment, and 21.8% by guaranteed letter. A quarter (24.9%) waited more than 3 h for consultation and 59.6% visited the health facility more than 2 times in a year. Initial analysis showed that PU, trust, age, education, number of visits, and hours of waiting were significantly associated with the intention to make a partial payment. Multiple linear regression showed that perceived usefulness (B = 0.517, p < 0.001); trust in hospital management (B = 0.288, p < 0.001) and number of visits (B = 0.216, p < 0.001) were associated with the intention to make partial payment. Intention to make partial up-front payments is associated with higher perceived usefulness in making such payments and hospital trust. Visiting the health facility frequently was associated with a higher intention to make upfront partial payment. The result may guide further studies on potential remedies to no-show.

The impact of internet usage on the mental health of older adults in China: empirical analysis from a multi-dimensional perspective.

Background: The process of population aging in China is currently undergoing rapid acceleration. Simultaneously, the swift advancement of digitalization is fundamentally transforming individuals' lifestyles. The usage of the internet and mobile internet tools by the older adults population is relatively inadequate. The issue of digital exclusion and its impact on the life quality of the older adult population has received significant attention. Objective: This study utilized microdata from the China Health and Retirement Longitudinal Study (CHARLS 2020) to empirically investigate the impact of internet usage on the mental health of older adult individuals. The depression index was utilized to assess the mental health, while four variables were employed to evaluate internet usage among the older adults in this study. Methods: The Center for Epidemiological Studies Depression Scale (CES-D) in CHARLS data was used to measure the depression index of older adults. Four variables including usage of internet, usage of WeChat, usage of WeChat moments and usage of mobile payment were used to represent the internet use of older adults, and there was progressive relationship between these four variables. In the empirical study, multiple regression analysis was adopted to empirically analysis the impact of internet usage on the mental health of older adults. In order to reduce the influence of endogenous problems on regression results, the propensity score matching method was used to verify the validity and robustness of regression results. Results: (1) Internet usage can significantly reduce the psychological depression of older adults and promote the formation of positive psychology; (2) With the increase of the depth of internet usage, especially the use of mobile internet and mobile payment, the internet use will have greater improvement effect on the depression; (3) The heterogeneity test found that there were certain differences in the impact of internet usage on different older adult groups; (4) Through a step-by-step analysis of 10 sub-indicators of depression index, the study found that Internet use mainly affected four indicators: "life hope," "happiness," "loneliness" and "life confidence," while demonstrating no significant effect on other sub-indicators. Conclusion: According to the research, internet usage can significantly reduce the psychological depression index of the older adults and promote the formation of positive psychology. In China, digital exclusion is more prevalent in rural areas and among the less educated older adults. Public policies can be formulated to enhance internet adoption among these older adults population.

Cost Analysis of Outpatient Colectomy in a Tertiary Center: A Projected Medico-Economic Evaluation.

Aim of the study: Short stay processes are incentives to unburden chronically stressed healthcare systems. The aim of this study is to analyze financial implications of day admission (DAS) and outpatient strategies for colon resections in a prospective payment system (PPS) using Diagnosis Related Group (DRG) coding. Methods: Consecutive patients undergoing left and right colonic resections between January 1, 2019 and December 31, 2020 were included. Medico-economic evaluations of the virtual outpatient and day admission surgery groups based on predefined criteria were compared to the identical group of patients who underwent surgery in the actual traditional inpatient setting. In a second step, postoperative complications of the virtual outpatient group were assessed. Cost-revenue analysis was performed using a micro-costing approach including direct medical costs. Results: Overall (N = 257), 97 (37.7%) colectomies would have been potentially eligible for an outpatient strategy. The global costs of the actual inpatient strategy totaled USD 3 634 392 with a global revenue of USD 3 571 069, corresponding to a cost coverage rate of 98%. The result of the virtual DAS strategy would have been a net loss of USD 15 800 (coverage rate of 99%) due to 4 low length of stay outliers triggering a reimbursement reduction and preventing a positive net result of USD 16 208. The pilot reference outpatient case's revenue and cost amounted to respectively USD 7479 and USD 6911 (cost coverage of 108%). Conclusion: From both any given hospital and healthcare system point of view, elective outpatient colectomy for selected patients is the most cost-saving option. However, in a prospective payment system implemented to avoid bad incentives, the latter can unintentionally disadvantage best performing hospitals and impede widespread adoption of high-value strategies.

Factors Influencing Health Care Providers Payment Reforms in Central and Eastern European Countries.

Central and Eastern European (CEE) countries have recently implemented reforms to health care provider payment systems, which include changing payment methods and related systems such as contracting, management information systems, and accountability mechanisms. This study examines factors influencing provider payment reforms implemented since 2010 in Bulgaria, Croatia, Czechia, Estonia, Latvia, Lithuania, Hungary, Poland, and Romania. A four-stage mixed methods approach was used: developing a theoretical framework and data collection form using existing literature, mapping payment reforms, consulting with national health policy experts, and conducting a comparative analysis. Qualitative analysis included inductive thematic analysis and deductive approaches based on an existing health policy model, distinguishing context, content, process, and actors. We analyzed 27 payment reforms that focus mainly on hospitals and primary health care. We identified 14 major factor themes influencing those reforms. These factors primarily related to the policy process (pilot study, coordination of implementation systems, availability of funds, IT systems, training for providers, reform management) and content (availability of performance indicators, use of clinical guidelines, favorability of the payment system for providers, tariff valuation). Two factors concerned the reform context (political willingness or support, regulatory framework, and bureaucracy) and two were in the actors' dimension (engagement of stakeholders, capacity of stakeholders). This study highlights that the content and manner of implementation (process) of a reform are crucial. Stakeholder involvement and their capacities could influence every dimension of the reform cycle. The nine countries analyzed share similarities in barriers and facilitators, suggesting the potential for cross-country learning.

Growing divergence between Medicare Advantage plan bids and payments to plans.

As the Medicare Advantage (MA) program grows in enrollment and costs, there has been increasing concern that federal payments to MA plans exceed necessary levels. Estimates suggest that, in 2023, MA plans were paid up to 6% more per enrollee than would have been spent had that beneficiary instead enrolled in traditional Medicare (TM). We evaluated the factors driving this overpayment, characterizing trends in MA benchmarks, bids, and total payments from pre-Affordable Care Act (pre-ACA) levels through 2023. We found that, despite an overall decrease in risk-adjusted bids relative to average risk-adjusted TM enrollee costs, total payments to plans have modestly increased since 2015. Decomposing these trends into various factors in the MA payment formula, we found that divergent trends in benchmarks and bids are, in part, due to the increasing influence of payment adjustments, such as quartile spending adjustments, quality bonus payments, and risk adjustment. Our results suggest that current payment rules have contributed to overpayments and policy reform may be necessary.

A critical review of the use of R2 in risk equalization research.

Nearly all empirical studies that estimate the coefficients of a risk equalization formula present the value of the statistical measure R2. The R2-value is often (implicitly) interpreted as a measure of the extent to which the risk equalization payments remove the regulation-induced predictable profits and losses on the insured, with a higher R2-value indicating a better performance. In many cases, however, we do not know whether a model with R2 = 0.30 reduces the predictable profits and losses more than a model with R2 = 0.20. In this paper we argue that in the context of risk equalization R2 is hard to interpret as a measure of selection incentives, can lead to wrong and misleading conclusions when used as a measure of selection incentives, and is therefore not useful for measuring selection incentives. The same is true for related statistical measures such as the Mean Absolute Prediction Error (MAPE), Cumming's Prediction Measure (CPM) and the Payment System Fit (PSF). There are some exceptions where the R2 can be useful. Our recommendation is to either present the R2 with a clear, valid, and relevant interpretation or not to present the R2. The same holds for the related statistical measures MAPE, CPM and PSF.

Toward sustainable environmental management: Insights from Chinese first-tier cities' consumers' response to green electricity payment policies.

China's renewable energy industry is facing the challenge of overcapacity. The environmental management literature suggests that consumers' participation in the green electricity market holds immense potential in addressing renewable energy consumption concerns. However, the question of how payment policies influence China's consumers' willingness to pay for green electricity remains unresolved. Based on 2854 valid questionnaires from a survey conducted in China's four first-tier cities in 2023, our research findings reveal: (1) While 97.9% of consumers express a willingness to use green electricity, only 63.1% are willing to pay a higher cost, indicating the existence of a "value-action" gap between environmental awareness and actual willingness to pay. (2) China's consumers' willingness to pay for green electricity is approximately 38.4 RMB per month. This figure has decreased by 5.7 RMB compared to our survey in 2019. (3) Consumers' willingness to pay will be influenced by the attitudes of those around them. (4) The voluntary payment policy positively impacts consumers' willingness to pay for green electricity. (5) Male, younger, lower education level, higher income, and larger household size consumers exhibit a higher willingness to pay. (6) Electricity price sensitivity weakens the impact of payment policies on willingness to pay.

Value of interventional radiology and their contributions to modern medical systems.

Interventional radiology (IR) is a unique specialty that incorporates a diverse set of skills ranging from imaging, procedures, consultation, and patient management. Understanding how IR generates value to the healthcare system is important to review from various perspectives. IR specialists need to understand how to meet demands from various stakeholders to expand their practice improving patient care. Thus, this review discusses the domains of value contributed to medical systems and outlines the parameters of success. IR benefits five distinct parties: patients, practitioners, payers, employers, and innovators. Value to patients and providers is delivered through a wide set of diagnostic and therapeutic interventions. Payers and hospital systems financially benefit from the reduced cost in medical management secondary to fast patient recovery, outpatient procedures, fewer complications, and the prestige of offering diverse expertise for complex patients. Lastly, IR is a field of rapid innovation implementing new procedural technology and techniques. Overall, IR must actively advocate for further growth and influence in the medical field as their value continues to expand in multiple domains. Despite being a nascent specialty, IR has become indispensable to modern medical practice.

Who participates in value-based care models? Physician characteristics and implications for value-based care.

Value-based care (VBC) payment models are becoming increasingly prevalent as alternatives to the traditional fee-for-service paradigm. This research quantifies the relationship between physician characteristics and participation in VBC payment models using the Association of American Medical Colleges' 2022 National Sample Survey of Physicians. We specified logistic regressions using physician-level variables to assess associations with current and new participation in Accountable Care Organizations, Primary Care First model, capitation, and bundled payments. Our results indicate that most respondents engaged in at least 1 VBC. Participation varied based on several characteristics, and physician specialty was highly predictive of overall participation. Compared with primary care physicians (PCPs), hospital-based physicians (odds ratio [OR] = 0.6, P < .001), medical specialists (OR = 0.5, P < .001), psychiatrists (OR = 0.4, P < .001), and surgeons (OR = 0.5, P < .001) were less likely to participate in VBC models. Medical specialists and surgeons were less likely to participate in commercial capitation than PCPs, while medical specialists and obstetricians/gynecologists were more likely to participate in certain bundles than PCPs. We suggest several policies to close the cross-specialty participation gap by including specialists and appealing to providers and patients.