Are Medicare Benefits Determined Nationally? If so, what are Local Coverage Determinations?

For most categories of services covered, Medicare pays for “reasonable and necessary” services.  This definitions, however, is fairly vague.  CMS does issue about 20 national coverage determinations (NCDs) each year to clarify which services are permitted.  [Here is a list of the CMS’s pending national coverage analyses]. Foote et al. (2008) elaborate on how NCDs are implemented. CMS can…

Is EHR a Money Loser for Physicians?

In most cases, the answer is yes. Policymakers, however, have been very excited about EHR and for good reason.  For instance, the  Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the 2009 stimulus package, provided direct dollars to doctors and hospitals who adopt and “meaningfully use” an EHR system. A paper by Milstein, Green…

What does a NICE health economist do?

What role do health economists at the UK’s National Institute for Health and Clinical Excellence (NICE) play and how do they conduct their cost effectiveness analyses for new treatments? I answer this question today based on NICE’s own documents.  According to their guidelines manual, the role of the health economist in clinical guideline development is to:…

Sequester Day!

The Sequester is here.  Whether you support the sequester or not, failing to reverse the sequester is likely to have large effects on government spending.  If you like big government, you will like the sequester.  If you like small government, you still likely will not like the sequester in principal.  Does it makes sense to…

Theory vs. Reality: End of Life Care

Charles Ornstein is a well-regarded health journalist who has written extensively about end-of-life care. Then his mother became sick. How did his preconceptions about end-of-life care change (if at all) as a result of his experience. An excerpt from the full article is below.   I’ve always thought that the high cost of end-of-life care is…