Lessons from the hospital readmissions reduction program

A commentary from Sheehy et al. (2023) argues that the hospital readmissions reduction program has been a disappointment. “If you can’t measure it, you can’t improve it”—a quote featured prominently on the Centers for Medicare & Medicaid Services (CMS) Measures Management website.3 But like any initiative intended to improve quality, evaluation, and iteration is key…

Medicaid Prescription Drug Rebate program: A review

A helpful reminder of what rebates are for drugs covered under State Medicaid Agencies. ICER reports in their California, based on a helpful summary from the Kaiser Family Foundation: For brand name drugs, the [Medicaid] rebate is 23.1% of Average Manufacturer Price (AMP) or the difference between AMP and “best price,” whichever is greater. Certain…

Quality Measurement of German Hospitals

Public reporting of hospital quality of care could improve the care patients receive through at least two pathways. First, patients (or their physicians) could send patients to higher quality hospitals (i.e., the selection pathway). Alternatively, hospitals themselves could have behavioral responses to the metrics and may improve quality of care in response to public reporting…

Medicare moving to reference pricing?

That is the summary takeaway I had form reviewing the 91 page CMS guidance on the Inflation Reduction Act (IRA) maximum fair price (MFP) negotiation released about 10 days ago. Below, I summarize some of the key findings. SELECTING DRUG FOR PRICE NEGOTIATION Unsurprisingly, CMS is looking for the highest cost drugs among the 10…

Is it time to end 340B?

A Health Affiairs Forefront article by DiGiorgio (2023) argues the 340B has outlived its purposes. He writes:  By mandating that drug companies give a large discount to covered entities, the majority of which are hospitals with disproportionate share or critical access designations, the 340B program was intended to provide a financial buffer for institutions such as the…