TY  - JOUR
AU  - Doyle, Joseph J, Jr.
AU  - Graves, John A
AU  - Gruber, Jonathan
TI  - Evaluating Measures of Hospital Quality
JF  - National Bureau of Economic Research Working Paper Series
VL  - No. 23166
PY  - 2017
Y2  - February 2017
DO  - 10.3386/w23166
UR  - http://www.nber.org/papers/w23166
L1  - http://www.nber.org/papers/w23166.pdf
N1  - Author contact info:
Joseph J. Doyle Jr.
MIT Sloan School of Management
100 Main Street, E62-516
Cambridge, MA 02142
Tel: 617/452-3761
Fax: 617/258-6855
E-Mail: jjdoyle@mit.edu

John A. Graves
Vanderbilt University
2525 West End Ave.
Suite 1200
Nashville, TN 37203
Tel: 6179352824
E-Mail: john.graves@vanderbilt.edu

Jonathan Gruber
Department of Economics, E52-434
MIT
77 Massachusetts Avenue
Cambridge, MA 02139
Tel: 617/253-8892
Fax: 617/253-1330
E-Mail: gruberj@mit.edu
AB  - In response to unsustainable growth in health care spending, there is enormous interest in reforming the payment system to “pay for quality instead of quantity.” While quality measures are crucial to such reforms, they face major criticisms largely over the potential failure of risk adjustment to overcome endogeneity concerns. In this paper we implement a  methodology for estimating the causal relationship between hospital quality measures and patient outcomes. To compare similar patients across hospitals in the same market, we  xploit ambulance company preferences as an instrument for patient assignment. We find that a variety of measures used by insurers to measure provider quality are successful: assignment to a higher-scoring  hospital results in better patient outcomes. We estimate that a two-standard deviation improvement in a composite quality measure based on existing data collected by CMS is causally associated with reductions in readmissions and mortality of roughly 15%.
ER  -