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Observational Study
. 2022 Mar 31;12(3):e053629.
doi: 10.1136/bmjopen-2021-053629.

Identifying high-value care for Medicare beneficiaries: a cross-sectional study of acute care hospitals in the USA

Jeph Herrin  1   2 , Huihui Yu  3   4 , Arjun K Venkatesh  5 , Sunita M Desai  6 , Cassandra L Thiel  6 , Zhenqiu Lin  7   4 , Susannah M Bernheim  4   8 , Leora I Horwitz  6   9
Affiliations
Observational Study

Identifying high-value care for Medicare beneficiaries: a cross-sectional study of acute care hospitals in the USA

Jeph Herrin et al. BMJ Open. .

Abstract

Objectives: High-value care is providing high quality care at low cost; we sought to define hospital value and identify the characteristics of hospitals which provide high-value care.

Design: Retrospective observational study.

Setting: Acute care hospitals in the USA.

Participants: All Medicare beneficiaries with claims included in Center for Medicare & Medicaid Services Overall Star Ratings or in publicly available Medicare spending per beneficiary data.

Primary and secondary outcome measures: Our primary outcome was value defined as the difference between Star Ratings quality score and Medicare spending; the secondary outcome was classification as a 4 or 5 star hospital with lowest quintile Medicare spending ('high value') or 1 or 2 star hospital with highest quintile spending ('low value').

Results: Two thousand nine hundred and fourteen hospitals had both quality and spending data, and were included. The value score had a mean (SD) of 0.58 (1.79). A total of 286 hospitals were classified as high value; these represented 28.6% of 999 4 and 5 star hospitals and 46.8% of 611 low cost hospitals. A total of 258 hospitals were classified as low value; these represented 26.6% of 970 1 and 2 star hospitals and 49.3% of 523 high cost hospitals. In regression models ownership, non-teaching status, beds, urbanity, nurse to bed ratio, percentage of dual eligible Medicare patients and percentage of disproportionate share hospital payments were associated with the primary value score.

Conclusions: There are high quality hospitals that are not high value, and a number of factors are strongly associated with being low or high value. These findings can inform efforts of policymakers and hospitals to increase the value of care.

Keywords: health policy; quality in health care; statistics & research methods.

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Conflict of interest statement

Competing interests: SMB, JH, ZL and AKV recieve salary support from the Centers for Medicare and Medicaid Services to develop, implement and maintain hospital performance outcome measures, including the methodology for the Overall Hospital Star Ratings, that are publicly reported. LIH and HY have worked under contract to the Centers for Medicare and Medicaid Services to develop quality measures, including some used in the Overall Hospital Star Ratings program.

Figures

Figure 1
Figure 1
Medicare spending per beneificiary by overall star rating. MSPB, Medicare spending per beneificiary.
Figure 2
Figure 2
Value score versus star rating summary score.
See this image and copyright information in PMC

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