Austin Frakt, "Changing How We Pay for Care" webinar, 3.19.15

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Austin Frakt's presentation from "Changing How We Pay for Care," a ReportingOnHealth.org webinar, 3.19.15

Healthcare

Why quality?
Austin Frakt, PhD
TheIncidentalEconomist.com
A focus on research, an eye on reform.
School of Medicine
School of Public Health
Views expressed are my own and do not necessarily reflect the position
or policy of the Department of Veterans Affairs or Boston University.

Why measure/pay for quality?
• If it’s so simple, why is it a (relatively) new idea?
• Medicare has cut payments to providers before
• Bad things can happen
• When hospitals are paid less, they cut something.
Is it the right thing?
For more, see Frakt, NYT, 5 Jan 2015.

Medicare is cutting again
For more, see CMS, 13 May 2011.

Can hospitals keep up?
For more, see Frakt, TIE, 12 July 2013.

This time is different (?)
• ACOs (are they just HMOs all over again?)
• Quality measurement
• Value-based purchasing
• Bundled payments
• Penalties and bonuses tied to quality
• New IT capabilities
• Private-side innovations (e.g., AQC)
For more, see Frakt, NYT, 19 Jan 2015 and Song and Chokshi, JAMA, 6 Jan 2015.

But, consolidation isn’t a good sign
• Consolidation is rampant
– More hospital mergers & acquisitions
– Physicians coalescing into larger groups
– More hospitals employing more physicians
– More integrated delivery systems offering
insurance products
• Consolidation pushes prices up and rarely
improves quality
For more, see Frakt, NYT, 23 Jun 2014 and Frakt, JAMA, 11 Nov 2014.

Source: The Health Care M&A Information Source, Dec. 2014 (via Leemore Dafny)
Hospital consolidation

Does higher quality justify higher
prices?
• Our analysis of Medicare Advantage plans
offered by providers suggests not
– Even accounting for quality increase, premiums
were 70% above what could be justified
For more, see Frakt, TIE, 1 July 2013 and Frakt, TIE, 16 March 2015.

The US delivery system runs on markets
• Spending growth is driven by price growth
– IOM: 70% of spending variation due to markups
– Recent spending growth driven by prices
• Signature of consolidation
• Compromises public and private efforts
For more, see Frakt, NYT, 23 Jun 2014 and Frakt, JAMA, 11 Nov 2014.

Skeptic or optimist?
• I find much of this troubling
• Yet, I’m cautiously optimistic
– Present is different enough from the past that we
might get different results
– David Cutler & Peter Orszag are smarter than I am
• But, we must not guess
• We must do the research
For more, see Frakt, TIE, 15 Oct 2014 and Herzlinger et al, NEJM, 4 Mar 2015.

Cause for celebration
For more, see Romley et al, Health Affairs, Feb 2015.

Austin Frakt, "Changing How We Pay for Care" webinar, 3.19.15

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