Unbiased Analysis of Today's Healthcare Issues
That is what various government bodies are considering. First lets turn to Medicaid via a report by Tyrus Jackson in JD Supra, The Medicaid and CHIP Payment and Access Commission (MACPAC) voted on January 27 to recommend that Congress grant states the ability to limit Medicaid coverage for drugs and biologicals approved under the FDA’s…
In the past, I have written about the Enhancing Oncology Model (EOM), including an overview of the EOM program as well as a more detailed review of EOM’s payment methodology. A new paper in JAMA Health Forum by Kocher and Adashi (2023) describes their perspective on the EOM program. First, they provide a nice overview…
That is the question posed by Buntin et al. (2022). The authors used data from the 2007-2018 Medicare Master Beneficiary Summary File and then ran a regression adjustment to control for patient demographics (i.e., age, sex), number of chronic conditions (none, 1-3, ≥4), and whether the individual had Part A or Parts A and B…
The Oncology Care Model (OCM) is dead. The Oncology Care Model was a voluntary, alternative payment model (APM), that “included financial and performance accountability for episodes of care surrounding chemotherapy administration to cancer patients.” OCM expired at the end of June 2022, and will be replaced by the Enhancing Oncology Model. EOM is a also…
Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds came out with their annual report on the state of Social Security and Medicare. First a few takeaways on the Medicare side. Overview of Medicare Part A and B Finances The Hospital Insurance (HI) Trust Fund, or Medicare Part…
In the past, seniors in Medicare had to pay for all their prescription drugs out-of-pocket. For elderly individuals with multiple medical conditions, this lack of coverage was highly burdensome. To address this issue, in 2006, Medicare Part D began which provided some coverage for prescription drugs. To keep the cost of Part D down, however,…
Medicare Part D plans have begun using preferred pharmacy networks in order to steer their beneficiaries to lower cost pharmacies. A key question is, does this work? A paper by Xu et al. (2022) aims to answer this question using 2011-2016 data. that compares Low Income Subsidy (LIS) Medicare beneficiaries and non-LIS beneficiaries. LIS beneficiaries…
Many people might know that generally the answer is commercial health plans have the most generous reimbursement compared to government plans. However, a key question is how much more do they pay? Commercial vs. Medicare rates A January 2022 report by the Congressional Budget Office finds that commercial payers reimburse hospitals at 223% of Medicare…
Since its inception in 2006, Medicare Part D beneficiaries had to contend with the dreaded “doughnut hole”. The “doughnut hole” is a coverage gap during which patients were required to pay 100% of treatment cost. To help defray some of these costs, the Patient Protection and Affordable Care Act (ACA) implemented provisions to reduce the…
According to a paper by Rodriguez et al. (2022), the answer is ‘yes’. They use data from the 2017–18 National Survey of Healthcare Organizations and Systems (NSHOS), to determine if a physician practice has a “robust set of care management capabilities.” The specific capabilities that were used to determine whether the health system was robust…