Comparing Outcomes Across Hospitals: Measurement, Selection, and Access
Payors (both public and private) often compare the relative cost and/or quality of one hospital to another when trying to incentivize hospitals to improve performance and patients often compare the relative value of hospitals when choosing the hospital at which to receive treatment. This session examines issues related to comparing outcomes measures across hospitals. The first paper uses stochastic frontier (SF) analysis to scientifically derive “best practice” outcomes. In contrast to using national averages, the SF metrics provide a stronger measure of what a hospital could achieve and are used to identify factors that can reduce the gaps between a hospital’s best possible outcome and realized outcome. The second paper utilizes a revealed preferences approach to explore the degree to which hospitals improve their observable, demand-shifting quality relative to one another in order to attract patients. The paper explores how competition between different patient groups (Medicare fee-for-service, private managed care) impacts quality choice and examines the relationship between these demand-shifting quality enhancements and clinical outcomes. The last paper explores the relationship between hospital choice (access) and a hospital’s risk-adjusted costs. Higher cost hospitals may generate, or be perceived to generate better outcomes by patients. The primary objective of this paper is to examine how the access to high-cost hospitals varies between Medicare Advantage and Medicare fee-for-service patients.