Medicare ACOs With Cardiologists Save More Money Than ACOs That Exclude Them

AHRQ Stats: Healthcare Premiums and Workforce Gender

Among companies where women accounted for 75 percent or more of the workforce, employer-sponsored healthcare premiums averaged $7,233 for single coverage in 2018. Premiums averaged $6,400, meanwhile, where women accounted for less than 25 percent of the workforce. Women have higher medical expenses than men, which influences premiums. (Source: AHRQ, Medical Expenditure Panel Survey Statistical Brief #525: Premiums and Employee Contributions to Employer-Sponsored Health Insurance by Workforce Gender and Firm Size, Private Industry, 2018.)

Today's Headlines:

• Medicare ACOs With Cardiologists Save More Money Than ACOs That Exclude Them.
• Data on Physician Practices Now Available From AHRQ’s Comparative Health System Performance Initiative.
• New AHRQ Views Blog Post—Empowering Primary Care Using Data and Analytics To Build a Healthier America.
• AHRQ Report Provides Comprehensive Definition of “Omissions of Care” in Nursing Homes.
• Highlights From AHRQ’s Patient Safety Network.
• Register Now for Oct. 30 Webinar on Updates to Hospital Survey on Patient Safety Culture.
• Topic Nominations for Future Evidence Reports Due by November 4.
• AHRQ in the Professional Literature. 

Medicare ACOs With Cardiologists Save More Money Than ACOs That Exclude Them

Medicare accountable care organizations (ACOs) that include cardiologists as part of their physician networks had lower beneficiary costs for cardiovascular disease than ACOs that exclude them without compromising quality, an AHRQ-funded study found. Annual spending for beneficiaries in a Medicare ACO with cardiologist participation was about $200 lower compared with beneficiary spending in ACOs without cardiologists as a result of lower spending for skilled nursing facilities, evaluation and management services and procedural care. AHRQ-funded researchers analyzed Medicare data of approximately 1.6 million patients per year with cardiovascular disease (heart attacks, atrial fibrillation, congestive heart failure and ischemic heart disease). Even though the number of ACOs more than tripled over the study period (from 114 in 2012 to 392 in 2015), the proportion of ACOs with cardiologist participation remained stable (80 percent in 2012 to 83 percent in 2015). Clinical outcomes, as measured by heart failure admission rates, emergency department visit rates and hospital readmission rates, were essentially the same between the two ACO models. In light of the prevalence of cardiovascular disease, the study findings strengthen the evidence for including cardiologists in ACOs, the study said. Access the abstract of the study published in Circulation: Cardiovascular Quality and Outcomes.

Data on Physician Practices Now Available From AHRQ’s Comparative Health System Performance Initiative

A new data file added to AHRQ’s Compendium of U.S. Health Systems identifies 36,303 physician group practices and allows researchers, policymakers and others to assess how the practices are organized and owned according to the nation’s 626 health systems. The group practice data are publicly available so users can identify practices within health systems and then, linking to additional data sources, explore characteristics of the systems and their group practices, such as cost and quality of care. The compendium was developed by AHRQ’s Comparative Health System Performance Initiative, which studies how healthcare delivery systems promote evidence-based practices and patient-centered outcomes research in delivering care. 

New AHRQ Views Blog Post—Empowering Primary Care Using Data and Analytics To Build a Healthier America

A new blog post by three AHRQ experts notes that innovations in primary care have the potential to improve patient health by increasing their capacity to address social factors influencing health related to where people live, work and play. Authors in AHRQ's Center for Evidence and Practice Improvement—Arlene Bierman, M.D., M.S., center director; Cindy Brach, M.P.P, senior healthcare researcher; and Brent Sandmeyer, M.P.H., social science analyst—point out that healthcare delivery alone accounts for only 20 percent of population health, and that lack of attention to social determinants of health may contribute to the United States’ relatively poor health systems performance rankings. To improve chronic disease prevention and management and population health, AHRQ has awarded three grants to organizations that will integrate data on chronic disease, social determinants of health and community services to create actionable dashboards to support better management of high-risk individuals and populations. Access the blog post. To receive all blog posts, submit your email address and select “AHRQ Views Blog."

AHRQ Report Provides Comprehensive Definition of “Omissions of Care” in Nursing Homes

An AHRQ-funded team of experts has developed a comprehensive definition of omissions of care for nursing homes. Preventing adverse events and poor health outcomes for nursing home residents is an ongoing challenge for residents and staff. Residents’ complex needs, along with challenging working conditions for staff, increase the chance of residents experiencing harmful, yet avoidable, adverse events. While omissions of care have been cited frequently for contributing to subpar care, a comprehensive definition has not existed. The new definition, intended as a meaningful and actionable reference for researchers, nursing home residents and caregivers, states: “Omissions of care in nursing homes encompass situations when care—either clinical or nonclinical—is not provided for a resident and results in additional monitoring or intervention or increases the risk of an undesirable or adverse physical, emotional, or psychosocial outcome for the resident.” The definition was designed to guide quality improvement efforts, training and education for care providers and additional research. Access Understanding Omissions of Care in Nursing Homes.

Highlights From AHRQ’s Patient Safety Network

AHRQ’s Patient Safety Network (PSNet) highlights journal articles, books and tools related to patient safety. Articles featured this week include:

• Medicare's Hospital-Acquired Condition Reduction Program and Community Diversity in the United States: The Need to Account for Racial and Ethnic Segregation.
• What Is the Return on Investment for Implementation of a Crew Resource Management Program at an Academic Medical Center?
• A demonstration project on the impact of safety culture on infection control practices in hemodialysis.

Review additional new publications in PSNet’s current issue or access recent cases and commentaries in AHRQ’s WebM&M (Morbidity and Mortality Rounds on the Web). 

Webinar on Updates to Hospital Survey on Patient Safety Culture

A webinar on Oct. 30, 2019 taught about the updated Hospital Survey on Patient Safety Culture™ (SOPS™) 2.0. The hospital survey was revised and pilot tested after incorporating user feedback. The Hospital SOPS survey, which has been used by hundreds of hospitals in the United States and overseas, allows healthcare providers and staff to assess a hospital’s patient safety culture. Speakers at the upcoming webinar will discuss what’s different and what to expect when transitioning to the revised survey. Access the SOPS Hospital Survey 2.0 survey documents and resources, including a user’s guide, as well as results from a 2019 Pilot Test of Version 2.0 and frequently asked questions.

Topic Nominations for Future Evidence Reports Due by November 4

AHRQ’s Evidence-based Practice Center (EPC) Program is seeking ideas for future evidence reports to address challenging questions in healthcare decision-making. The EPC Program reviews and summarizes the available evidence on current healthcare issues. Its comprehensive reports help clinicians and policymakers understand the benefits and harms of different tests and treatments; inform health systems and policymakers about the best options for implementing a new program or intervention; and help patients make better decisions about their healthcare options. Topic nominations for this year are due November 4. Access more information about the nomination process or send questions to epc@ahrq.hhs.gov

AHRQ in the Professional Literature

Older adult Internet use and ehealth literacy. Arcury TA, Sandberg JC, Melius KP, et al. J Appl Gerontol 2018 Oct 24:733464818807468. [Epub ahead of print.] Access the abstract on PubMed®.

Advancing patient safety through the clinical application of a framework focused on communication. Manojlovich M, Hofer TP, Krein SL. J Patient Saf 2018 Oct 31. [Epub ahead of print.] Access the abstract on PubMed®. 

Pneumocystis jirovecii pneumonia (PJP) prophylaxis patterns among patients with rheumatic diseases receiving high-risk immunosuppressant drugs. Schmajuk G, Jafri K, Evans M, et al. Semin Arthritis Rheum 2019 Jun;48(6):1087-92. Epub 2018 Nov 3. Access the abstract on PubMed®. 

Testing a web-based interactive comic tool to decrease obesity risk among minority preadolescents: protocol for a pilot randomized control trial. Leung MM, Mateo KF, Verdaguer S, et al. JMIR Res Protoc 2018 Nov 9;7(11):e10682. Access the abstract on PubMed®.

Variation in identifying sepsis and organ dysfunction using administrative versus electronic clinical data and impact on hospital outcome comparisons. Rhee C, Jentzsch MS, Kadri SS, et al. Crit Care Med 2019 Apr;47(4):493-500. Access the abstract on PubMed®.

Risk factors for septicemia deaths and disparities in a longitudinal US cohort. Kempker JA, Kramer MR, Waller LA, et al. Open Forum Infect Dis 2018 Nov 15;5(12):ofy305. eCollection 2018 Dec. Access the abstract on PubMed®.

Improving patients' choice of clinician by including roll-up measures in public healthcare quality reports: an online experiment. Cerully JL, Parker AM, Rybowski L, et al. J Gen Intern Med 2019 Feb;34(2):243-9. Epub 2018 Nov 16. Access the abstract on PubMed®. 

Re-examining the association between "4/20" and fatal crashes-doobie-ous data? Aydelotte JD, Mardock AL, Teixeira PG, et al. JAMA Intern Med 2018 Nov 1;178(11):1565. Access the abstract on PubMed®.