Each year in the United States, more than 50,000 Medicare patients die undergoing inpatient surgery. Evidence of wide variations across providers suggests substantial room for improvement. To improve surgical care in the elderly, the Center for Medicare and Medicaid Services (CMS) has launched several policies. However, the extent to which these policies improve outcomes and reduce costs in surgery is unknown. We therefore propose a systematic evaluation of the impact of several policy options on the quality and cost of surgical care in the national Medicare population. With this goal in mind, our current proposal has the following aims:
Aim 1. To evaluate the impact of CMS improvement policies on surgical outcomes. We will conduct evaluations of pay-for-performance, selective referral, bundled payment, and outcomes feedback in the national Medicare population. For each policy approach, we will take advantage of a natural experiment (i.e., a specific program or policy implemented in the last 5 years). To assess outcomes, we will use risk-adjusted mortality and complications for the procedures specifically targeted by the policy. To better control for hospital case-mix and secular trends, we will use a difference-in-difference methodology.
Aim 2. To evaluate the spillover effects of these CMS policies on untargeted surgical conditions. Using national Medicare data, we will examine outcomes for untargeted procedures for which patients receive care from the same surgeons or depend on the same hospital resources. We will assess whether these policies resulted in beneficial spillover effects or caused unintended harm as resources were diverted to the targeted conditions.
Aim 3. To evaluate the impact of these policies on Medicare payments around the surgical episode. We will evaluate Medicare payments for the full range of services that can be linked to complications and poor quality care. We will include payments to the hospital, physicians, readmissions, and post-acute care. The results of this study will facilitate evidence-based policymaking by CMS and other payers. As effective policies for improving care are implemented, surgical patients will be the ultimate beneficiaries of this research.
This study will have immediate real-world impact for CMS policymakers and surgical patients. The results of this proposal will provide CMS with data on the comparative effectiveness of various initiatives for improving quality and decreasing costs. As effective strategies for improving care are implemented by CMS and other payers, surgical patients will be the ultimate beneficiaries of this research.
|Chen, Lena M; Ryan, Andrew M; Shih, Terry et al. (2018) Medicare's Acute Care Episode Demonstration: Effects of Bundled Payments on Costs and Quality of Surgical Care. Health Serv Res 53:632-648|
|Borza, Tudor; Oerline, Mary K; Skolarus, Ted A et al. (2018) Association Between Hospital Participation in Medicare Shared Savings Program Accountable Care Organizations and Readmission Following Major Surgery. Ann Surg :|
|Ibrahim, Andrew M; Dimick, Justin B; Sinha, Shashank S et al. (2018) Association of Coded Severity With Readmission Reduction After the Hospital Readmissions Reduction Program. JAMA Intern Med 178:290-292|
|Borza, Tudor; Oreline, Mary K.; Skolarus, Ted A. et al. (2018) Association of the Hospital Readmissions Reduction Program With Surgical Readmissions. JAMA Surg 153:243-250|
|Ibrahim, Andrew M; Dimick, Justin B (2017) Monitoring Medical Devices: Missed Warning Signs Within Existing Data. JAMA 318:327-328|
|Ibrahim, Andrew M; Dimick, Justin B; Joseph, Anjali (2017) Building a Better Operating Room: Views from Surgery and Architecture. Ann Surg 265:34-36|
|Ibrahim, Andrew M; Nathan, Hari; Thumma, Jyothi R et al. (2017) Impact of the Hospital Readmission Reduction Program on Surgical Readmissions Among Medicare Beneficiaries. Ann Surg 266:617-624|
|Ibrahim, Andrew M; Ghaferi, Amir A; Thumma, Jyothi R et al. (2017) Variation in Outcomes at Bariatric Surgery Centers of Excellence. JAMA Surg 152:629-636|
|Ryan, Andrew M; Krinsky, Sam; Maurer, Kristin A et al. (2017) Changes in Hospital Quality Associated with Hospital Value-Based Purchasing. N Engl J Med 376:2358-2366|
|Ibrahim, Andrew M; Hughes, Tyler G; Thumma, Jyothi R et al. (2016) Association of Hospital Critical Access Status With Surgical Outcomes and Expenditures Among Medicare Beneficiaries. JAMA 315:2095-103|
Showing the most recent 10 out of 29 publications