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Hospital Readmissions Reduction Program does not provide the right incentives: Issues and remedies

Kenan Arifoğlu
Ph.D.

Konuşmacı Hakkında

Dr. Kenan Arifoğlu meslek hayatına UCL School of Management'da öğretim görevlisi olarak devam etmektedir. Doktorasını 2012 yılında Northwestern University' de Industrial Engineering and Management Sciences (IEMS) alanında yaparak tamamlamıştır. Aynı zamanda Koç Üniversitesi'nde Endüstri Mühendisliği (2007) ve Northwestern University'de IEMS (2008) alanlarında yüksek lisans dereceleri bulunmaktadır. Lisans eğitimini ise 2005 yılında Koç Üniversitesi'nde tamamlamıştır. UCL'e katılmadan önce University of Michigan'a bağlı Ross Business School'da doktora sonrası çalışmasını tamamlamıştır.

Kenan şu anda tedarik zinciri ve servis sistemleri üzerinde tüketici davranışlarının etkisi alanında çalışmaktadır. Buna ek olarak sağlık sektöründeki operasyonlar, tedarik zinciri yönetimi, üretim ve envanter sistemleri, fiyatlandırma ve ciro yönetimi ve pazarlama ve operasyon arayüzü alanlarıyla da ilgilenmektedir.

The Abstract

*Seminer İngilizce gerçekleşeceğinden özeti de İngilizce olarak sunulmuştur.

The Hospital Readmissions Reduction Program (HRRP) reduces Medicare payments to hospitals with higher-than-expected readmission rates where the expected readmission rate for each hospital is determined based on national average readmission levels. Although similar relative performance-based schemes are shown to lead to socially optimal outcomes in other settings, HRRP differs from these schemes in three respects: (i) deviation from the targets are adjusted using a multiplier; (ii) the total financial penalty for a hospital with higher-than-expected readmission rate is capped; and (iii) hospitals with lower-than-expected readmission rates do not receive bonus payments. We study three regulatory schemes derived from HRRP to determine the impact of each feature, and use a principle-agent model to show that: (i) HRRP over-penalizes hospitals with excess readmissions because of the multiplier and its effect can be substantial; (ii) having a penalty cap can curtail the effect of financial incentives and result in a no-equilibrium outcome when the cap is too low; and (iii) not allowing bonus payments leads to many alternative symmetric equilibria, including one where hospitals exert no effort to reduce readmissions. These results show that HRRP does not provide the right incentives for hospitals to reduce readmissions. Next we show that a bundled payment type reimbursement method, which reimburses hospitals once for each episode of care (including readmissions), leads to socially optimal cost and readmissions reduction efforts. Finally, we show that, when delays to accessing care are inevitable, the reimbursement schemes need to provide additional incentives for hospitals to invest sufficiently in capacity.

EMBA 102
Nisan 8, 2019 - 13:00