CMMI programs increased Medicare spending

That is the finding from a recent report from the Congressional Budget Office (CBO) on the activities of the Centers for Medicare and Medicaid Innovation (CMMI) CBO previously estimated that CMMI’s activities would reduce net federal spending but now estimates that they increased that spending during the first 10 years of the center’s operation and will…

CMS selects 10 drugs for price negotiation

Here is the CMS Factsheet and news coverage from NY Times. The companies that make each of these drugs is listed below. Eliquis – Bristol Myers Squibb and Pfizer Jardiance- Boehringer Ingelheim and Eli Lilly Xarelto – Johnson & Johnson Januvia – Merck Farxiga – AstraZeneca Entresto – Novartis Enbrel – Amgen Imbruvica,- AbbVie and…

CMS = HTA?

The U.S. is one of the the few developed nations without a government-run health technology assessment (HTA) body. Or are they? A recent perspective in the New England Journal of Medicine by Peter Neumann and Sean Tunis argues that the Centers for Medicare and Medicaid Services (CMS) already is serving as a de facto HTA…

On which drugs does Medicare spend the most?

The Kaiser Family Foundation (KFF) identifies the Part D drugs on which Medicare spends the most money. This is an important question since CMS will begin drug price negotiation under the Inflation Reduction Act (IRA) based on the top 10 top spending Part D drugs. Some relevant statistics and figures are below. In 2021, Medicare…

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…

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…