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Small Area Studies Based On Large Medicare Databases

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What do you think about using small area studies based on large Medicare databases, such as the one presented here, to identify outliers? Small area analysis is appropriate for certain situations, however, it is not appropriate when comparing to a larger Medicare database concerning outliers. For example small area studies help with determining disparities in healthcare, or assisting with determining where to allocate resources, or looking at what other factors into why a condition is worsening. Basically, small area studies can help with problems or concerns you may not otherwise see or if that area is your only concern. They also can be helpful in understanding a community needs, access to healthcare, behavioral norms and…show more content…
First implemented in 1985 by Aetna (previously U.S. Healthcare), P4P programs were used to reward top performers and improve outcomes (Bruno, 2012). The incentives were meant to improve the quality of patient care by basing incentives on patient outcomes. Conversely, fee-for-service reimbursements are based on the treatments and set limits on the amount reimbursed for services. Because of these limits, incentives for use of pharmaceuticals and non-invasive procedures can impact how physicians practice. Financial incentives play a significant role in how care is provided. The North Ohio Heart Center was found to perform more angioplasties compared to the Cleveland Clinic performing bypass surgeries resulting in different incentive rates (McLaughlin & McLaughlin, 2015). These non-invasive procedures (angioplasties) generated highly profitable incomes for the physicians involved at the North Ohio Heart Center. The physicians perceived these procedures to be a safer option of treatment as opposed to drug treatment or bypass surgery. These decisions impacted patient care by causing more patient visits and more tests being performed generating a cumulative higher reimbursement. These incentives are moving us away from what is best for the patient. Robert Doherty, ACP senior vice president, stated, “we need to move away from the piecemeal approach: how many visits you can generate, how many tests
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