HCMG LATEST QUESTIONS AND ANSWERS UPDATE: A
MASTERING A+ MATERIAL!
Reducing low-value therapies is a focus, with insurers cutting reimbursements, but disadoption
occurs more slowly than adoption.
Mechanisms driving abandonment decisions
Externally produced signals
- Financial Incentives
- Peer influence
Internally produced signals
- Relative skill
How does relative skill impact low-value care?
Physicians' skills affect their response to information, with low-value care linked to the ability to
successfully provide cost-effective alternatives.
Post-acute care:
Care provided to patients who have been released from hospital; can take place in many
settings
What are key changes in home health care reimbursement and quality?
Medicare introduced the IPS in 1997 and PPS in 2000, improving efficiency, while the 2004
Home Health Quality Initiative focused on accountability and public performance disclosure.
Home health care
Because distance is not a factor, quality of care may be a more important attribute in choosing
a home health care provider
Competition is affected by state level regulation (e.g. certificate of need)
The overall success of federal regulatory policies depends on well-functioning competitive
markets
Certificate of Need (CON)
regulation, which requires to establish public need before moving forward with major capital
expenditures for health care services.
Purpose of CONs
, restricts hospital expansions and costly equipment purchases to control capacity, benefiting
nonprofit hospitals by improving quality and subsidizing services.
Vertical integration in healthcare
organizations combine different levels of care, like hospitals, clinics, and insurance, to improve
coordination, efficiency, and cost savings.
Replacing the last day of hospitalization with home health visits or an earlier transition to
skilled nursing can ____ ______
save money
What are the 3 hypotheses of vertical integration in home health?
1) V.I. hospitals transition patients faster.
2) V.I. hospitals use their own home health agencies for intensive care.
3) Quality is not lower for faster transitions in V.I. hospitals.
What are the effects of vertical integration in hospitals?
Vertically integrated hospitals discharge patients sooner and in poorer health, but outcomes
are better for those transitioning to the hospital's own facilities, addressing task misalignment
issues.
Omitted variable bias:
- Unobserved original plan of care (only observe actual visits)
- Unobserved dynamics in health status over the episode of care
Causation
Handoffs increase the likelihood of hospital readmissions
How do nurse handoffs affect hospital readmissions?
Nurse handoffs increase readmissions by 42%, but eliminating them, especially from salaried
nurses, could prevent 1 in 5 readmissions.
Better scheduling and staffing can also help reduce readmissions.
Longer home health visits _____ the likelihood of hospital readmissions
decrease
Endogeneity concerns (identification challenges)
MASTERING A+ MATERIAL!
Reducing low-value therapies is a focus, with insurers cutting reimbursements, but disadoption
occurs more slowly than adoption.
Mechanisms driving abandonment decisions
Externally produced signals
- Financial Incentives
- Peer influence
Internally produced signals
- Relative skill
How does relative skill impact low-value care?
Physicians' skills affect their response to information, with low-value care linked to the ability to
successfully provide cost-effective alternatives.
Post-acute care:
Care provided to patients who have been released from hospital; can take place in many
settings
What are key changes in home health care reimbursement and quality?
Medicare introduced the IPS in 1997 and PPS in 2000, improving efficiency, while the 2004
Home Health Quality Initiative focused on accountability and public performance disclosure.
Home health care
Because distance is not a factor, quality of care may be a more important attribute in choosing
a home health care provider
Competition is affected by state level regulation (e.g. certificate of need)
The overall success of federal regulatory policies depends on well-functioning competitive
markets
Certificate of Need (CON)
regulation, which requires to establish public need before moving forward with major capital
expenditures for health care services.
Purpose of CONs
, restricts hospital expansions and costly equipment purchases to control capacity, benefiting
nonprofit hospitals by improving quality and subsidizing services.
Vertical integration in healthcare
organizations combine different levels of care, like hospitals, clinics, and insurance, to improve
coordination, efficiency, and cost savings.
Replacing the last day of hospitalization with home health visits or an earlier transition to
skilled nursing can ____ ______
save money
What are the 3 hypotheses of vertical integration in home health?
1) V.I. hospitals transition patients faster.
2) V.I. hospitals use their own home health agencies for intensive care.
3) Quality is not lower for faster transitions in V.I. hospitals.
What are the effects of vertical integration in hospitals?
Vertically integrated hospitals discharge patients sooner and in poorer health, but outcomes
are better for those transitioning to the hospital's own facilities, addressing task misalignment
issues.
Omitted variable bias:
- Unobserved original plan of care (only observe actual visits)
- Unobserved dynamics in health status over the episode of care
Causation
Handoffs increase the likelihood of hospital readmissions
How do nurse handoffs affect hospital readmissions?
Nurse handoffs increase readmissions by 42%, but eliminating them, especially from salaried
nurses, could prevent 1 in 5 readmissions.
Better scheduling and staffing can also help reduce readmissions.
Longer home health visits _____ the likelihood of hospital readmissions
decrease
Endogeneity concerns (identification challenges)
