Hamadi, Hanadi

EXECUTIVE SUMMARY Medicare’s Hospital Valued-Based Purchasing (HVBP) program measures hospitals’ total performance score (TPS); its measurement strategies have changed regularly since its rollout in 2013. Because the program influences care delivery, it is important to examine how the policy has changed hospitals’ behavior and how it may inform future policies. The purpose of this study was to assess the relationship between hospitals’ performance on TPS annually from 2013 to 2018 and organizational characteristics. Using the HVBP TPS from 2013 to 2018 and associated hospital characteristics—hospital size, teaching hospital status, system membership, ownership type, urban/rural location, average percentages of patients from Medicare and Medicaid, operating margins, percentages of inpatient revenue as a proportion of total revenue, and case mix index—we conducted a retrospective cohort study of all U.S. hospitals participating in the HVBP program. Regression and panel analyses found that organizations that were expected to have robust and rigid resources were unable to score in the superior category consistently. In addition, organizations were unable to consistently perform positively over time because of changes in the HVBP program measurement and the required organizational responses. Policymakers should consider the ability of organizations to respond to changes to the HVBP program. Likewise, healthcare managers, particularly those in larger organizations, should seek to remove bureaucracy or allow for greater resource slack to meet these changes.

Introduction Much attention has been focused on decreasing chronic obstructive pulmonary disease (COPD) hospital readmissions. The US health system has struggled to meet this goal. The objective of this study was to assess the efficacy of telehealth services on the reduction of hospital readmission and mortality rates for COPD. Methods We used a cross-sectional design to examine the association between hospital risk-adjusted readmission and mortality rates for COPD and hospital use of post-discharge telemonitoring (TM). Data for 777 hospitals were sourced from the Centers for Medicare & Medicaid Services and the American Hospital Association annual surveys. Propensity score matching using the kennel weights method was applied to calculate the weighted probability of being a hospital that offers post-discharge TM services. Results Hospitals with post-discharge TM had about 34% significantly higher odds (adjusted odds ratio (AOR) = 1.34; 95% confidence interval (CI) 1.06–1.70) of 30-day COPD readmission and 33% significantly lower odds (AOR = 0.67; 95% CI 0.50–0.90) of 30-day COPD mortality compared to hospitals without post-discharge TM services. Discussion Overall, hospitals that offer post-discharge TM services have seen an improvement in 30-day COPD mortality rates. However, those same hospitals have also experienced a significant increase in 30-day COPD readmissions. TM can potentially decrease mortality in patients recently admitted for acute exacerbation of COPD. The results provide further evidence that readmissions present a problematic assessment of health-care quality, as the need for readmission may or may not be directly related to the quality of care received while in hospital.

Background: US hospitals are penalized for excess 30-day readmissions and mortality for select conditions. Under the Centers for Medicare and Medicaid Services policy, readmission prevention is incentivized to a greater extent than mortality reduction. A strategy to potentially improve hospital performance on either measure is by improving nursing care, as nurses provide the largest amount of direct patient care. However, little is known as to whether achieving nursing excellence, such as Magnet status, is associated with improved hospital performance on readmissions and mortality. Objective: The purpose of this study was to examine the relationship between hospitals’ Magnet status and performance on readmission and mortality rates for Medicare beneficiaries. Research Design: This is a cross-sectional analysis of Medicare readmissions and mortality reduction programs from 2013 to 2016. A propensity score–matching approach was used to take into account differences in baseline characteristics when comparing Magnet and non-Magnet hospitals. Subjects: The sample was comprised of 3877 hospitals. Measures: The outcome measures were 30-day risk-standardized readmission and mortality rates. Results: Following propensity score matching on hospital characteristics, we found that Magnet hospitals outperformed non-Magnet hospitals in reducing mortality; however, Magnet hospitals performed worse in reducing readmissions for acute myocardial infarction, coronary artery bypass grafting, and stroke. Conclusions: Magnet hospitals performed better on the Hospital Value-Based Purchasing Mortality Program than the Hospital Readmissions Reduction Program. The results of this study suggest the need for The Magnet Recognition Program to examine the role of nurses in postdischarge activities as a component of its evaluation criteria.

Hospitals are expected to fulfill a role in the communities they serve by improving the health of the population in the community as mandated in the Affordable Care Act. One way hospitals achieve this is to create partnerships with diverse organizations, such as local public health departments, state/federal agencies, and other health care organizations. The aim of this study is to examine characteristics of hospitals that developed partnerships based on improving population health. This study utilized the 2015 Population Health Survey, American Hospital Association Database, and Dartmouth Atlas of Health Care. Hospital characteristics included size, ownership status, part of a system, teaching status location, Medicare percentage, Medicaid percentage, average stay length, and inpatient days per 1000 persons. Level of partnership was measured by the hospital's current working relationship with other hospitals/health care systems or local/state/other agencies. Univariate, bivariate, and multivariate regression analyses were used to analyze the relationship between hospital partnerships and organizational characteristics. Hospitals with strong relationships tend to be larger and not-for-profit hospitals, hospitals with system members and located in urban areas, and teaching-affiliated hospitals. This study also found hospital characteristics were related to hospitals' partnerships. Hospitals within health care systems and with high inpatient volume were more likely to report relationships that were stronger. This study provides a systematic and updated look at hospitals' partnership when looking at commitment to population health improvement and contributes to the literature by informing about the greater need to support rural and smaller hospitals with population health outreach activities.

SummaryThe shift from a fee‐for‐service payment to a value‐based payment scheme, sparked by the Patient Protection and Affordable Care Act, introduced pay‐for‐performance programs such Hospital Value Based Purchasing. Previous inquiry has not considered how local community factors may affect hospital system performance. This study investigated the association between local health performance and minority population in a hospital referral region (HRR). The primary objective was to ascertain whether community diversity levels are significantly associated to local health performance guided by the ecological model. Secondary data analysis collected from the 2016 American Hospital Association, Area Health Resource File, Commonwealth Fund Scorecard on Local Health System Performance, and the Dartmouth Atlas HRR dataset was used. Our primary findings show that the more diverse a HRR is, the more likely it is to be associated with lower ranking for access and affordability prevention and treatment avoidable hospital use and cost as well as healthy lives. Total performance score was significantly related to a better health ranking on prevention and treatment, hospital use, and cost, as well as healthy lives. This research supports the assertion that communities, particularly minorities in those communities, affect local health care performance in a variety of ways.