IDEAS home Printed from https://ideas.repec.org/p/max/cprwps/192.html
   My bibliography  Save this paper

So Many Hospitals, So Little Information: How Hospital Value Based Purchasing is a Game of Chance

Author

Listed:

Abstract

As part of the 2010 Patient Protection and Affordable Care Act, participating Medicare hospitals have part of their Medicare reimbursements withheld and then redistributed based on quality performance. The Hospital Value Based Purchasing payment reimbursement plan relies partly on ordinal rankings of hospitals to determine how money is distributed. We analyze the quality metric distributions used for payment and show that there is not enough information to reliably differentiate hospitals from one another near the payment cutoffs; and conclude that a large part of the payment formula is driven by sampling variability rather than true quality information. This results in point allocation under the payment formula that is random for a large proportion of the hospitals. An alternative payment plan is discussed.

Suggested Citation

  • William C. Horrace, & Andrew I. Friedson & Allison F. Marier, 2016. "So Many Hospitals, So Little Information: How Hospital Value Based Purchasing is a Game of Chance," Center for Policy Research Working Papers 192, Center for Policy Research, Maxwell School, Syracuse University.
    • Handle: RePEc:max:cprwps:192
    as

    Download full text from publisher

    File URL: https://surface.syr.edu/cpr/225/
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. William C. Horrace & Christopher F. Parmeter, 2017. "Accounting for Multiplicity in Inference on Economics Journal Rankings," Southern Economic Journal, John Wiley & Sons, vol. 84(1), pages 337-347, July.
    2. Thomas J. Kane & Douglas O. Staiger, 2002. "The Promise and Pitfalls of Using Imprecise School Accountability Measures," Journal of Economic Perspectives, American Economic Association, vol. 16(4), pages 91-114, Fall.
    3. Canice Prendergast, 1999. "The Provision of Incentives in Firms," Journal of Economic Literature, American Economic Association, vol. 37(1), pages 7-63, March.
    4. Kenneth Y. Chay & Patrick J. McEwan & Miguel Urquiola, 2005. "The Central Role of Noise in Evaluating Interventions That Use Test Scores to Rank Schools," American Economic Review, American Economic Association, vol. 95(4), pages 1237-1258, September.
    5. William C. Horrace & Peter Schmidt, 2000. "Multiple comparisons with the best, with economic applications," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 15(1), pages 1-26.
    6. Edward C. Norton & Emily J. Lawton & Jun Li, 2023. "Moneyball in Medicare," American Journal of Health Economics, University of Chicago Press, vol. 9(1), pages 96-126.
    7. Eijkenaar, Frank & Emmert, Martin & Scheppach, Manfred & Schöffski, Oliver, 2013. "Effects of pay for performance in health care: A systematic review of systematic reviews," Health Policy, Elsevier, vol. 110(2), pages 115-130.
    8. William C. Horrace & Kurt E. Schnier, 2010. "Fixed-Effect Estimation of Highly Mobile Production Technologies," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 92(5), pages 1432-1445.
    9. Andrew Street, 2003. "How much confidence should we place in efficiency estimates?," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 895-907, November.
    10. Harvey Goldstein & David J. Spiegelhalter, 1996. "League Tables and Their Limitations: Statistical Issues in Comparisons of Institutional Performance," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 159(3), pages 385-409, May.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. William C. Horrace & Christopher F. Parmeter, 2017. "Accounting for Multiplicity in Inference on Economics Journal Rankings," Southern Economic Journal, John Wiley & Sons, vol. 84(1), pages 337-347, July.
    2. Edward C. Norton & Emily J. Lawton & Jun Li, 2020. "Moneyball in Medicare: Heterogeneous Treatment Effects," NBER Working Papers 27948, National Bureau of Economic Research, Inc.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Li Mingliang & Tobias Justin, 2005. "Bayesian Modeling of School Effects Using Hierarchical Models with Smoothing Priors," Studies in Nonlinear Dynamics & Econometrics, De Gruyter, vol. 9(3), pages 1-33, September.
    2. Rezende, Marcelo, 2010. "The effects of accountability on higher education," Economics of Education Review, Elsevier, vol. 29(5), pages 842-856, October.
    3. Barrera-Osorio, Felipe & Ganimian, Alejandro J., 2016. "The barking dog that bites: Test score volatility and school rankings in Punjab, Pakistan," International Journal of Educational Development, Elsevier, vol. 49(C), pages 31-54.
    4. Alejandra Mizala & Miguel Urquiola, 2007. "Parental choice and school markets: The impact of information approximating school effectiveness," Documentos de Trabajo 239, Centro de Economía Aplicada, Universidad de Chile.
    5. Matthew P. Steinberg, 2014. "Does Greater Autonomy Improve School Performance? Evidence from a Regression Discontinuity Analysis in Chicago," Education Finance and Policy, MIT Press, vol. 9(1), pages 1-35, January.
    6. Helen Simpson, 2009. "Productivity In Public Services," Journal of Economic Surveys, Wiley Blackwell, vol. 23(2), pages 250-276, April.
    7. Reback, Randall, 2008. "Teaching to the rating: School accountability and the distribution of student achievement," Journal of Public Economics, Elsevier, vol. 92(5-6), pages 1394-1415, June.
    8. Cory Koedel & Mark Ehlert & Eric Parsons & Michael Podgursky, 2012. "Selecting Growth Measures for School and Teacher Evaluations," Working Papers 1210, Department of Economics, University of Missouri.
    9. Lina Maria Ellegård & Jens Dietrichson & Anders Anell, 2018. "Can pay‐for‐performance to primary care providers stimulate appropriate use of antibiotics?," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 39-54, January.
    10. Andrabi, Tahir & Das, Jishnu & Khwaja, Asim Ijaz & Zajonc, Tristan, 2009. "Here Today, Gone Tomorrow? Examining the Extent and Implications of Low Persistence in Child Learning," Working Paper Series rwp09-001, Harvard University, John F. Kennedy School of Government.
    11. Cuesta, José Ignacio & González, Felipe & Larroulet Philippi, Cristian, 2020. "Distorted quality signals in school markets," Journal of Development Economics, Elsevier, vol. 147(C).
    12. Jalava, Nina & Joensen, Juanna Schrøter & Pellas, Elin, 2015. "Grades and rank: Impacts of non-financial incentives on test performance," Journal of Economic Behavior & Organization, Elsevier, vol. 115(C), pages 161-196.
    13. Nunes, Luis C. & Reis, Ana Balcão & Seabra, Carmo, 2015. "The publication of school rankings: A step toward increased accountability?," Economics of Education Review, Elsevier, vol. 49(C), pages 15-23.
    14. Karthik Muralidharan & Venkatesh Sundararaman, 2011. "Teacher Performance Pay: Experimental Evidence from India," Journal of Political Economy, University of Chicago Press, vol. 119(1), pages 39-77.
    15. Tahir Andrabi & Jishnu Das & Asim Ijaz Khwaja & Tristan Zajonc, 2011. "Do Value-Added Estimates Add Value? Accounting for Learning Dynamics," American Economic Journal: Applied Economics, American Economic Association, vol. 3(3), pages 29-54, July.
    16. Heikki Pursiainen & Mika Kortelainen & Jenni Pääkkönen, 2014. "Impact of School Quality on Educational Attainment - Evidence from Finnish High Schools," ERSA conference papers ersa14p711, European Regional Science Association.
    17. Suárez Serrato, Juan Carlos & Wang, Xiao Yu & Zhang, Shuang, 2019. "The limits of meritocracy: Screening bureaucrats under imperfect verifiability," Journal of Development Economics, Elsevier, vol. 140(C), pages 223-241.
    18. Brosig-Koch, Jeannette & Hennig-Schmidt, Heike & Kairies-Schwarz, Nadja & Wiesen, Daniel, 2016. "Physician performance pay: Evidence from a laboratory experiment," Ruhr Economic Papers 658, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    19. Chiang, Hanley, 2009. "How accountability pressure on failing schools affects student achievement," Journal of Public Economics, Elsevier, vol. 93(9-10), pages 1045-1057, October.
    20. Brosig-Koch, Jeannette & Hennig-Schmidt, Heike & Kairies-Schwarz, Nadja & Kokot, Johanna & Wiesen, Daniel, 2020. "Physician performance pay: Experimental evidence," HERO Online Working Paper Series 2020:3, University of Oslo, Health Economics Research Programme.

    More about this item

    Keywords

    Pay-for-Performance; Hospital Value Based Purchasing; Hospital Quality Scores; Ordinal Ranking; Indistinguishability;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:max:cprwps:192. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Margaret Austin or Zia Jackson or Katrina Fiacchi (email available below). General contact details of provider: https://edirc.repec.org/data/cpsyrus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.