Economics of Provision of High-Cost Healthcare Services

Monday, June 13, 2016: 8:30 AM-10:00 AM
G55 (Huntsman Hall)
Prof. Jayani Jayawardhana

The increasing utilization of high-cost healthcare services such as diagnostic imaging in the delivery of healthcare has caused policy concerns for various stakeholders such as practitioners, patients, policy makers, third party payers, and leaders of healthcare organizations. This session presents three papers that investigate the impact of various policies, regulations and organizational structure of elements of the US health care system on the provision of high-cost healthcare services. The first paper investigates the extent to which the exogenous changes made in Medicare fees by Centers for Medicare and Medicaid Services (CMS) and American Medical Association in their attempt to distribute payments across services fairly and to lower overall spending affect provision of inpatient and outpatient health care services in both Medicare and privately insured populations. The second paper investigates whether the imaging efficiency metrics (IEM), introduced by CMS under the Affordable Care Act, were associated with reductions in the utilization of imaging services by hospitals. IEM, a metric consisting of six outpatient imaging services, was introduced by CMS in an effort to reduce inappropriate and unnecessary medical imaging service utilization by hospitals. The third paper investigates whether the organizational structure of a hospital (i.e. being a Magnet hospital) has any impact on its utilization of diagnostic imaging services while controlling for other factors, and evaluates the impact of such utilization on healthcare costs. The findings of these papers will contribute to the growing body of knowledge on the provision of high-cost healthcare services and the associated costs of care.

8:30 AM
Impact of Increased Cost Sharing on Utilization of Low Value Services

Author(s): Jonathan Gruber; Catherine Maclean; Kevin G. Volpp; Bill Wright; Eric Wilkinson

Discussant: Haizhen Lin

9:10 AM
The Effect of Utilization Regulation: The Case of CT Scans and the Affordable Care Act

Author(s): Darwyyn Deyo; Danny R. Hughes

Discussant: Michal HornĂ½