jueves, 12 de enero de 2017

Hospital Affiliation With Health Systems and Managed Care Plans May Increase Quality But Not Cost Savings

The increasing prevalence of health systems and hospital managed care ownership may lead to higher quality but is unlikely to reduce hospital discharge costs, according to a new AHRQ study. Researchers used data from the agency’s Healthcare Cost and Utilization Project to evaluate average costs, the duration of inpatient stays and quality performance at more than 3,900 hospitals. Hospitals were classified based on whether they participated in a health system, whether that system centrally managed hospitals, and whether the system had an ownership stake in the managed care insurance products offered to patients. Hospitals participating in centrally managed systems generally provided similar or better care than independent hospitals, but at a higher cost per discharge, researchers found. Those systems with an ownership stake in insurance products also experienced higher costs, but with mixed results in quality. Researchers concluded that the study could have implications for policymakers or hospitals seeking mergers as a way to lower costs while maintaining or improving care. The article, “Impact of Health System Affiliation on Hospital Resource Use Intensity and Quality of Care,” was published in the December issue of Health Services Research. Access the abstract.

Impact of Health System Affiliation on Hospital Resource Use Intensity and Quality of Care. - PubMed - NCBI

2016 Dec 22. doi: 10.1111/1475-6773.12631. [Epub ahead of print]

Impact of Health System Affiliation on Hospital Resource Use Intensity and Quality of Care.

Henke RM1, Karaca Z2, Moore B1, Cutler E1, Liu H3, Marder WD1, Wong HS2.

Author information

Abstract

OBJECTIVE:

To assess the impact of hospital affiliation, centralization, and managed care plan ownership on inpatient cost and quality.

DATA SOURCES:

Inpatient discharges from 3,957 community hospitals in 44 states and American Hospital Association Annual Survey data from 2010 to 2012.

STUDY DESIGN:

We conducted a retrospective longitudinal regression analysis using hierarchical modeling of discharges clustered within hospitals.

DATA COLLECTION:

Detailed discharge data including costs, length of stay, and patient characteristics from the Healthcare Cost and Utilization Project State Inpatient Databases were merged with hospital survey data from the American Hospital Association.

PRINCIPAL FINDINGS:

Hospitals affiliated with health systems had a higher cost per discharge and better quality of care compared with independent hospitals. Centralized systems in particular had the highest cost per discharge and longest stays. Independent hospitals with managed care plans had a higher cost per discharge and better quality of care compared with other independent hospitals.

CONCLUSIONS:

Increasing prevalence of health systems and hospital managed care ownership may lead to higher quality but are unlikely to reduce hospital discharge costs. Encouraging participation in innovative payment and delivery reform models, such as accountable care organizations, may be more powerful options.