Unbiased Analysis of Today's Healthcare Issues
While most patients in Medicare use the traditional fee-for-service route, a growing percentage of Medicare beneficiaries are relying on managed care plans through Medicare Advantage. Medicare Advantage provides beneficiaries with additional choice and also serves as a competitive alternative to traditional Medicare. In theory, Medicare should just allocate a beneficiary’s funding to a managed care…
Medicare provides health insurance for 58.4 million Americans. To provide health care to largely elderly Americans, it spent $710 billion in 2017. One key question is, does the federal government have the funds to continue to support this program as the baby boomers retire? According to the 2018 Medicare Trustees report, the answer is increasingly…
This is the question put forth in a paper by Chen et al. (2017). The authors examine Medicare’s Acute Care Episode (ACE) Demonstration Program, which was a small, voluntary episode-based bundled payment program. According to the CMS website, There were 28 cardiac and 9 orthopedic inpatient surgical services and procedures included in the bundled payment demonstration. These…
Patients and providers should be able to securely access a patient’s medical record wherever they are. Not having a patient’s full record could result in poor treatment choices and suboptimal patient outcomes. The dream of a seamless, cloud-based electronic medical record (EMR), however, is years away. Consider the example shared by CMS administrator Seema Verma…
In December, CMS listed its quality measures that it is considering for incorporation into some of their value-based payment programs and quality reporting programs. However, which Medicare quality reporting and payment initiatives use quality measures? A full list is below. Ambulatory Surgical Center Quality Reporting Program (ASCQR) End-Stage Renal Disease Quality Incentive Program (ESRD QIP)…
In short, no. That is the answer Roberts, Zaslavsky and McWilliams reach in their 2017 paper in Annals. Some background on the value modifier program. In 2013, practices with 100 or more eligible clinicians were rewarded just from reporting quality measures. By 2014, however: Practices with 100 or more clinicians were subject to upward, downward,…
CMS in the past was on a value-based binge. They aimed to reward physicians based on quality of care (PQRS), based on cost (a component in the value modifier), based on use of EHR (meaningful use bonuses). However, this imposed a large reporting bonus on physicians, pulling them away from patient care. To solve the…
An interesting study by Chen et al. (2017) examines the cost of cancer care among Medicare patients. Using SEER-Medicare data of people diagnosed with cancer between 2007 and 2011, they found: Over the year of diagnosis, mean per-patient annual Medicare spending varied substantially by cancer type: $35,849 for breast cancer, $26,295 for prostate cancer, $55,597…
In 2011, CMS created a demonstration to have competitive bidding for durable medical equipment (DME). Prior to the implementation of this program, CMS used an administrative fee schedule, similar to how physicians are currently reimbursed. How did this market-based solution fare? A paper by Newman, Barrette, and McGraves-Lloyd (2017) answers this question. We compared…
Austin Frakt of the Incidental Economist argues convincingly–and I agree with him–that the answer is no. Medicare Advantage plans have been found to be of higher quality than traditional Medicare. They also reduce wasteful use of health care by managing care, something the traditional program doesn’t do at all. Finally, they fill in gaps in coverage and…