Research roundup: The push for hospital quality and concerns about disparities; Rating physicians online

Mar 3 2012

Every week, KHN reporter Shefali S. Kulkarni compiles a selection of recently-released health policy studies and briefs.

Journal of Health Care for the Poor and Underserved: Pay-For-Performance Programs To Reduce Racial/Ethnic Disparities: What Might Different Designs Achieve? -- Researchers wondered if pay-for-performance (P4P) programs, which reward hospitals for meeting quality targets, have unintentional effects on racial and/or ethnic disparities. Using federal patient-level quality data, researchers found that "many hospitals treat Whites and minorities equitably" but they noted that since many minorities tend to seek care at hospitals that "perform poorly on common quality score composites, the pay for performance efforts could unintentionally penalize hospitals serving high numbers of minorities. ... P4P programs should consider an approach that considers both overall quality and reductions in disparities when setting" incentives (Weissman et. al., February 2012).

The American Journal of Managed Care: Hospital Readmission Rates In Medicare Advantage Plans – There is evidence that nearly 20 percent of traditional Medicare fee-for-service beneficiaries  who were hospitalized were readmitted within 30 days. This study sought to determine the rate for seniors enrolled in the Medicare Advantage private plans and examine the differences between the two Medicare options. The 30-day hospital readmission rate among MA patients was 14.5% in 2006-2008. The "risk-adjusted readmission rates were approximately 13% to 20% lower in MA patients than in FFS patients." Despite noting significant differences between the two types of beneficiaries (for example, MA patients are less likely to be high school graduates), the research does not explain the readmission differences (Lemieux et al., February 2012).

Journal of Medical Internet Research: A Changing Landscape Of Physician Quality Reporting: Analysis Of Patients' Online Ratings Of Their Physicians Over A 5-Year Period -- Physicians "worry" about the increase in online rankings on consumer websites. With ranking data from RateMDs.com, demographic data from the U.S. Department of Health and Human Services, and physician-level data from the Virginia Medical Board, researchers found "statistically significant correlations between the value of ratings and physician experience, board certification, education, and malpractice claims, suggesting a positive correlation between online ratings and physician quality."  Ratings favored those who graduated from well-known medical schools (Gao et. al., 2/24).

The Urban Institute/Robert Wood Johnson Foundation: A Decade Of Coverage Losses: Implications For The Affordable Care Act -- This research finds "a notable deterioration" in employer-sponsored insurance and an "increase in uninsurance rates for adults without dependent children and parents over the past decade. These trends persist across both periods of recession and recovery, and among all income groups" although the effect is "more pronounced" among the poorest Americans. This group "will be most affected" by the federal health law, the authors state. "It appears that Medicaid and CHIP have been particularly effective at reducing the number of uninsured children, even during the recent economic downturn, but, due to more restrictive eligibility, they have not prevented increases in the number of uninsured parents and other adults" (Blavin, Holahan, Kenney and Chen, 2/24).