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Examining Interventions to Address Infant Mortality in Allegheny County, Pennsylvania
Authors: --- ---
Year: 2021 Publisher: Santa Monica, Calif. RAND Corporation

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Poor birth and infant outcomes and pronounced racial disparities persist in Allegheny County, Pennsylvania, despite robust maternal and child health and social service systems. The authors use predictive models of which interventions women are likely to participate in, develop a causal inference framework to estimate the effectiveness of those interventions, and reveal how that effectiveness varies for women with different risk and other factors.

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Survey-Based Reporting of Post-Operative Visits for Select Procedures with 10- or 90-Day Global Periods: Final Report
Authors: --- --- ---
Year: 2019 Publisher: Santa Monica, Calif. RAND Corporation

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For many surgeries and procedures, Medicare and most other insurers cover a bundle of services, including post-operative visits, during the global period. As part of 2015 MACRA legislation, Congress mandated that the Centers for Medicare & Medicaid Services (CMS) collect data on the number and level of post-operative visits delivered in the global period to assess accuracy of payment. Among other efforts, CMS conducted a practitioner survey to assess the level of visits, using three procedures as proof of concept: cataract surgery, hip arthroplasty, and complex wound repair. Using data reported via the survey, the authors found that reported physician time and work for cataract surgery and hip replacement post-operative visits were generally similar — but slightly less — than the levels expected based on the evaluation and management visits assumed to typically occur when valuing these procedures. Reported physician time and work for complex wound repair post-operative visits were higher than Physician Time File levels. Based on experiences with various approaches to collecting data on the level of post-operative visits as well as the status quo, the authors suggest thinking of these data collection methods as a spectrum with both benefits and trade-offs. Given the strengths and weaknesses of these approaches, the authors recommend consideration of a claims-based approach coupled with information about the level of service or the use of G-codes. A survey instrument could serve as a complement to a claims-based approach for procedures or groups of procedures for which valuation is thought to be particularly problematic.

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Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods
Authors: --- --- --- --- --- et al.
Year: 2021 Publisher: Santa Monica, Calif. RAND Corporation

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This report was initially published in 2019; this update was published in 2021 and includes clarification on RAND's definition of clean procedures. Medicare payment for many health care procedures covers not just the procedure itself but also most post-operative care over a fixed period of time (the "global period"). The Centers for Medicare & Medicaid Services (CMS) sets payment rates assuming that a certain number and type of post-operative visits specific to each procedure typically occur. This report describes how CMS might use new claims-based data on the number of post-operative visits to adjust valuation for procedures with 10- and 90-day global periods. There are links between the number of bundled post-operative visits and the components of valuation addressed in this report: work, practice expense (PE), and malpractice relative value units (RVUs). There is some ambiguity regarding how a reduction in post-operative visits translates into changes in work RVUs. In contrast, a reduction in post-operative visits has clear implications on physician time and direct PE. Changes in physician work, physician time, and direct PE will in turn affect the allocation of pools of PE and malpractice RVUs to individual services. The idiosyncrasies of the resource-based relative value scale system used to determine payment for Medicare services result in some ambiguity about how procedures should be revalued to reflect reductions in post-operative visits. These results may inform further policy development around revaluation for global procedures.

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Book
Responses to Comments on RAND Global Services Reports
Authors: --- --- ---
Year: 2021 Publisher: Santa Monica, Calif. RAND Corporation

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This report was initially published in 2019; this update was published in 2021 and includes clarification on RAND's definition of clean procedures. In July 2019, as part of a contract with the Centers for Medicare & Medicaid Services (CMS), the RAND Corporation published three complementary reports related to post-operative visits bundled into Medicare payments for many procedures. The reports build on a new CMS requirement that some practitioners report on when bundled post-operative visits occur using a no-pay claim. CMS invited comments on these reports in the calendar year 2020 Physician Fee Schedule Proposed Rule. Although some organizations supported CMS's efforts to collect data on post-operative visits and the related RAND reports, others expressed concerns about CMS's claims-based data collection and the content of the reports. In this follow-up report, RAND researchers respond to those criticisms. The authors remain confident in their main conclusion that fewer post-operative visits were provided than expected, leading to Medicare overpayment for some procedures and underpayment for nonprocedure services, such as office visits. They recommend that CMS consider revaluing procedures with bundled post-operative visits in consideration of the newly available data on the number of post-operative visits actually provided to patients.

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A Needs Assessment of Women Veterans in Western Pennsylvania: Final Report to Adagio Health
Authors: --- --- --- ---
Year: 2023 Publisher: RAND Corporation

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Women make up an increasingly large share of the U.S. veteran population, and their numbers continue to grow while the overall number of veterans is on the decline. Yet programs designed to support veterans' health and well-being have largely focused on men. Women's military experiences and postservice needs often differ from those of men, and women veterans also differ in significant ways from their nonveteran counterparts. Few studies have explored these variations, and this has translated to potentially missed opportunities to improve support for women during and after their transition from military to civilian life. Adagio Health, a provider of health, wellness, and nutrition services based in Western Pennsylvania, has taken steps to improve care for women veterans in its service area. To identify opportunities to further expand and enhance Adagio Health's efforts to support women veterans' health and wellness, the authors quantitatively and qualitatively assessed the needs of women veterans in the Adagio Health service area. The assessment provides a clearer picture of this often-underserved population, available services and resources, gaps in support, barriers to access, and areas to prioritize to provide the best support possible for the health and well-being of women who served. With the approaches recommended in this assessment, Adagio Health can continue increasing its capacities and capabilities for supporting its women veteran patients and making progress toward its goal of advancing their health and well-being.

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Book
Measuring success in health care value-based purchasing programs
Authors: --- --- --- --- --- et al.
ISBN: 9780833085511 0833085514 9780833083951 0833083953 Year: 2014 Publisher: Santa Monica, CA RAND Corporation

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Measuring success in health care value-based purchasing programs : summary and recommendations
Authors: --- --- --- --- --- et al.
Year: 2014 Publisher: Santa Monica, CA : RAND Corporation,

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Value-based purchasing (VBP) refers to a broad set of performance-based payment strategies that link financial incentives to health care providers' performance on a set of defined measures in an effort to achieve better value. The U.S. Department of Health and Human Services (HHS) is advancing the implementation of VBP across an array of health care settings in the Medicare program in response to requirements in the 2010 Patient Protection and Affordable Care Act, and policymakers are grappling with many decisions about how best to design and implement VBP programs so that they are successful in achieving stated goals. This report summarizes the current state of knowledge about VBP programs, focusing on pay-for-performance programs, accountable care organizations, and bundled payment programs. The authors discuss VBP program goals and what constitutes success; the evidence on the impact of these programs; factors that characterize high- and low-performing providers in VBP programs; the measures, incentive structures, and benchmarks used by VBP programs; evidence on spillover effects and unintended consequences; and gaps in the knowledge base. The report concludes with a set of recommendations for the design, implementation, and monitoring and evaluation of VBP programs and a discussion of HHS's efforts in this regard.


Book
Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data
Authors: --- --- --- --- --- et al.
Year: 2021 Publisher: Santa Monica, Calif. RAND Corporation

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Abstract

Medicare payment for many health care procedures covers not only the procedure itself but also most post-operative care over a fixed period of time (the "global period"). The Centers for Medicare & Medicaid Services (CMS) sets payment rates assuming that a certain number and type of post-operative visits specific to each procedure typically occur. This report describes how CMS might use claims-based data on the number of post-operative visits to adjust valuation for procedures with 10- and 90-day global periods. There are links between the number of bundled post-operative visits and the components of valuation addressed in this report: work, practice expense (PE), and malpractice relative value units (RVUs). There is some ambiguity regarding how a reduction in post-operative visits translates into changes in work RVUs. In contrast, a reduction in post-operative visits has clear implications on physician time and direct PE. Changes in physician work, physician time, and direct PE will, in turn, affect the allocation of pools of PE and malpractice RVUs to individual services. The idiosyncrasies of the resource-based relative value scale system used to determine payment for Medicare services result in some ambiguity about how procedures should be revalued to reflect reductions in post-operative visits. These results may inform further policy development around revaluation for global procedures.

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Book
Evaluation of the use of performance measures in health care
Authors: --- --- --- --- --- et al.
ISBN: 0833079387 9780833079381 Year: 2011 Publisher: Santa Monica, CA RAND

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