Readmissions, Observation, and Improving Hospital Care

Reducing Hospital Use Because hospitals are expensive and often cause harm, there has been a big focus on reducing hospital use.  This focus has been the underpinning for numerous policy interventions, most notable of which is the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals for higher than expected readmission rates.  The […]

Readmissions Penalty at Year 3: How Are We Doing?

A few months ago, the Centers for Medicare and Medicaid Services (CMS) put out its latest year of data on the Hospital Readmissions Reduction Program (HRRP). As a quick refresher – HRRP is the program within the Affordable Care Act (ACA) that penalizes hospitals for higher than expected readmission rates. We are now three years […]

Readmissions and Surgical Quality: Finally some good news

Co-written with Thomas Tsai, MD, MPH, Department of Surgery, Brigham and Women’s Hospital       Why readmission penalties are controversial Penalizing hospitals for high readmission rates has been pretty controversial.  Critics of the program have argued that readmissions have little to do with what happens while the patient is in the hospital and are […]

Is the Readmissions Penalty Off Base?

I’ve been getting emails about the New York Times piece and my quotation that the penalties for readmissions are “crazy.”  It’s worth thinking about why the ACA gets hospital penalties on readmissions wrong, what we might do to fix it—and where our priorities should be. A year ago, on a Saturday morning, I saw Mr. […]

Misunderstanding Propublica: transparency, confidence intervals, and the value of data

In July the investigative journalists at ProPublica released an analysis of 17,000 surgeons and their complication rates. Known as the “Surgeon Scorecard,” it set off a firestorm. In the months following, the primary objections to the scorecard have become clearer and were best distilled in a terrific piece by Lisa Rosenbaum. As anyone who follows […]

Changing my mind on SES Risk Adjustment

I’m sorry I haven’t had a chance to blog in a while – I took a new job as the Director of the Harvard Global Health Institute and it has completely consumed my life.  I’ve decided it’s time to stop whining and start writing again, and I’m leading off with a piece about adjusting for […]

An Update on Value-Based Purchasing: Year 2

The most commonly heard comment in healthcare these days is that we have to move from paying for volume to paying for value.  While it may sound trite, it also turns out to be pretty true.  Right now, most healthcare services are paid for on a fee-for-service basis – with little regard for the quality […]

Love to a fault: How the best of intentions is hurting care for Americans who live in rural areas

Ensuring that Americans who live in rural areas have access to health care has always been a policy priority.  In healthcare, where nearly every policy decision seems contentious and partisan, there has been widespread, bipartisan support for helping providers who work in rural areas.  The hallmark of the policy effort has been the Critical Access […]