Payer leverage and hospital compliance with a benchmark: a population-based observational study
<p>Abstract</p> <p>Background</p> <p>Since 1976, Medicare has linked reimbursement for hospitals performing organ transplants to the attainment of certain benchmarks, including transplant volume. While Medicare is a stakeholder in all transplant services, its role in re...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2007-07-01
|
| Series: | BMC Health Services Research |
| Online Access: | http://www.biomedcentral.com/1472-6963/7/112 |
| _version_ | 1818701231159246848 |
|---|---|
| author | DeMonner Sonya Miller David C Krein Sarah L Hollingsworth John M Hollenbeck Brent K |
| author_facet | DeMonner Sonya Miller David C Krein Sarah L Hollingsworth John M Hollenbeck Brent K |
| author_sort | DeMonner Sonya |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Since 1976, Medicare has linked reimbursement for hospitals performing organ transplants to the attainment of certain benchmarks, including transplant volume. While Medicare is a stakeholder in all transplant services, its role in renal transplantation is likely greater, given its coverage of end-stage renal disease. Thus, Medicare's transplant experience allows us to examine the role of payer leverage in motivating hospital benchmark compliance.</p> <p>Methods</p> <p>Nationally representative discharge data for kidney (<it>n </it>= 29,272), liver (<it>n </it>= 7,988), heart (<it>n </it>= 3,530), and lung (<it>n </it>= 1,880) transplants from the Nationwide Inpatient Sample (1993 – 2003) were employed. Logistic regression techniques with robust variance estimators were used to examine the relationship between hospital volume compliance and Medicare market share; generalized estimating equations were used to explore the association between patient-level operative mortality and hospital volume compliance.</p> <p>Results</p> <p>Medicare's transplant market share varied by organ [57%, 28%, 27%, and 18% for kidney, lung, heart, and liver transplants, respectively (<it>P </it>< 0.001)]. Volume-based benchmark compliance varied by transplant type [85%, 75%, 44%, and 39% for kidney, liver, heart, and lung transplants, respectively (<it>P </it>< 0.001)], despite a lower odds of operative mortality at compliant hospitals. Adjusting for organ supply, high market leverage was independently associated with compliance at hospitals transplanting kidneys (OR, 143.00; 95% CI, 18.53 – 1103.49), hearts (OR, 2.84; 95% CI, 1.51 – 5.34), and lungs (OR, 3.24; 95% CI, 1.57 – 6.67).</p> <p>Conclusion</p> <p>These data highlight the influence of payer leverage–an important contextual factor in value-based purchasing initiatives. For uncommon diagnoses, these data suggest that at least 30% of a provider's patients might need to be "at risk" for an incentive to motivate compliance.</p> |
| first_indexed | 2024-12-17T15:17:33Z |
| format | Article |
| id | doaj.art-efbbcc4daf064197bca56593741c1ddc |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-17T15:17:33Z |
| publishDate | 2007-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-efbbcc4daf064197bca56593741c1ddc2022-12-21T21:43:29ZengBMCBMC Health Services Research1472-69632007-07-017111210.1186/1472-6963-7-112Payer leverage and hospital compliance with a benchmark: a population-based observational studyDeMonner SonyaMiller David CKrein Sarah LHollingsworth John MHollenbeck Brent K<p>Abstract</p> <p>Background</p> <p>Since 1976, Medicare has linked reimbursement for hospitals performing organ transplants to the attainment of certain benchmarks, including transplant volume. While Medicare is a stakeholder in all transplant services, its role in renal transplantation is likely greater, given its coverage of end-stage renal disease. Thus, Medicare's transplant experience allows us to examine the role of payer leverage in motivating hospital benchmark compliance.</p> <p>Methods</p> <p>Nationally representative discharge data for kidney (<it>n </it>= 29,272), liver (<it>n </it>= 7,988), heart (<it>n </it>= 3,530), and lung (<it>n </it>= 1,880) transplants from the Nationwide Inpatient Sample (1993 – 2003) were employed. Logistic regression techniques with robust variance estimators were used to examine the relationship between hospital volume compliance and Medicare market share; generalized estimating equations were used to explore the association between patient-level operative mortality and hospital volume compliance.</p> <p>Results</p> <p>Medicare's transplant market share varied by organ [57%, 28%, 27%, and 18% for kidney, lung, heart, and liver transplants, respectively (<it>P </it>< 0.001)]. Volume-based benchmark compliance varied by transplant type [85%, 75%, 44%, and 39% for kidney, liver, heart, and lung transplants, respectively (<it>P </it>< 0.001)], despite a lower odds of operative mortality at compliant hospitals. Adjusting for organ supply, high market leverage was independently associated with compliance at hospitals transplanting kidneys (OR, 143.00; 95% CI, 18.53 – 1103.49), hearts (OR, 2.84; 95% CI, 1.51 – 5.34), and lungs (OR, 3.24; 95% CI, 1.57 – 6.67).</p> <p>Conclusion</p> <p>These data highlight the influence of payer leverage–an important contextual factor in value-based purchasing initiatives. For uncommon diagnoses, these data suggest that at least 30% of a provider's patients might need to be "at risk" for an incentive to motivate compliance.</p>http://www.biomedcentral.com/1472-6963/7/112 |
| spellingShingle | DeMonner Sonya Miller David C Krein Sarah L Hollingsworth John M Hollenbeck Brent K Payer leverage and hospital compliance with a benchmark: a population-based observational study BMC Health Services Research |
| title | Payer leverage and hospital compliance with a benchmark: a population-based observational study |
| title_full | Payer leverage and hospital compliance with a benchmark: a population-based observational study |
| title_fullStr | Payer leverage and hospital compliance with a benchmark: a population-based observational study |
| title_full_unstemmed | Payer leverage and hospital compliance with a benchmark: a population-based observational study |
| title_short | Payer leverage and hospital compliance with a benchmark: a population-based observational study |
| title_sort | payer leverage and hospital compliance with a benchmark a population based observational study |
| url | http://www.biomedcentral.com/1472-6963/7/112 |
| work_keys_str_mv | AT demonnersonya payerleverageandhospitalcompliancewithabenchmarkapopulationbasedobservationalstudy AT millerdavidc payerleverageandhospitalcompliancewithabenchmarkapopulationbasedobservationalstudy AT kreinsarahl payerleverageandhospitalcompliancewithabenchmarkapopulationbasedobservationalstudy AT hollingsworthjohnm payerleverageandhospitalcompliancewithabenchmarkapopulationbasedobservationalstudy AT hollenbeckbrentk payerleverageandhospitalcompliancewithabenchmarkapopulationbasedobservationalstudy |