Health policy and research

Medicare payments to providers can vary significantly depending on the site where service is provided. A site-neutral payment policy would equalize payment for the same service irrespective of the site of service, potentially lowering Medicare expenditures. This report describes a method for identifying inpatient surgical cases that could reasonably be performed in an outpatient setting and a method for identifying equivalent outpatient surgical cases.

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This 3M Clinical and Economic Research report examines the extent of geographic variation in the rate of post-acute care (PAC) facility admissions for Medicare Fee-for-Service (FFS) beneficiaries and quantifies the financial impact of excess PAC facility admissions on Medicare expenditures.

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In this 3M Clinical and Economic Research report, the Potentially Preventable Emergency Department Visits (PPVs) methodology was used to identify emergency department visits that may be potentially preventable. If there are an excess number of PPVs compared to a national norm within a managed care plan or geographic region, it is likely the excess PPVs represent emergency department visits that could be avoided if the delivery system functioned effectively. Based on a risk-adjusted national norm, the analysis found considerable PPV performance variation across census regions, states and Core Based Statistical Areas (CBSAs) from the Office of Management and Budget.

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Health care expenditures continue to steadily increase with hospital stays making up about one-third of health care expenditures. A well-functioning delivery system within a managed care plan or a geographic region should be able to minimize the need for hospitalizations. In this 3M Clinical and Economic Research report, the Potentially Preventable Admissions (PPAs) methodology was used to identify hospital admissions that may be potentially preventable. If there are an excess number of PPAs compared to a national norm within a managed care plan or geographic region, it is likely the excess PPAs represent hospital admissions that could be avoided if the delivery system functioned effectively.

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While there is increasing consensus that comparative mortality data should be included in hospital payment incentive systems, attempts to develop clinically credible and unbiased measure of mortality have proved challenging. The primary intent of mortality measurement is to provide hospitals the incentive and the information to improve mortality performance through quality improvement initiatives. To be effective for quality improvement, the measure of mortality should be limited to patients for whom a hospital is reasonably responsible for the patient outcome and thereby amenable to quality improvement efforts. A comprehensive method of measuring and comparing surgical mortality was developed for this report.

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This 3M Clinical and Economic Research report focuses on the four Quality Outcome Performance Measures (QOPMs) that relate to hospital inpatient care or care in the emergency department that directly impact the volume of inpatient admissions and bed days. The report examines the impact of inpatient quality outcome performance on the overall functioning of the inpatient delivery system for the Medicare population in each state.

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Early COVID-19 studies indicate that when older people contract the virus, they have a poorer prognosis, especially those 80 years or more and those with diabetes, chronic respiratory or cardiac diseases, immunosuppression or with multiple major comorbid chronic conditions. These COVID-19 risk factors were analyzed in conjunction with a comprehensive identification of patients with multiple high-severity comorbid chronic conditions to develop an operational definition of individuals with a high risk of a COVID-19 poor prognosis.

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This supplement to the report “The Financial Impact of Geographic Variation in Hospital Quality Performance in Medicare” examines the geographic variation in quality outcome performance measures (QOPMs) for specific disease and procedure categories. The description and details of the QOPMs, the methods of risk adjustment, determination of national and best practice norms, methods for computing expected values and methods of estimating the financial impact of QOPM performance differences are contained in the “Financial Impact of Geographic Variation in Hospital Quality Performance in Medicare.”

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In a major new research study from 3M Clinical and Economic Research, 3M healthcare policy experts evaluate variation in inpatient and outpatient quality performance across geographic regions and simulate hospital payment system reforms based on hospital quality performance. Using clinically credible quality measures, the study quantifies the financial impact of quality performance in terms of the relative impact on Medicare payments. The overall objective of the study is to provide regulators, payers, and hospital-based organizations with meaningful and actionable information that can promote quality improvement efforts.

Read the report (PDF, 977 KB).