Unbiased Analysis of Today's Healthcare Issues
The Government Accountability Office (GAO) last week published a report evaluating the Merit-based Incentive Payment System (MIPS). MIPS is an approach for CMS to pay physicians caring for Medicare beneficiaries based not just on volume but on value. MIPS evaluates provider value along four dimensions: (1) quality, (2) improvement activities, (3) promoting interoperability, and (4)…
The 2021 Medicare Trustees Report–formerly known as the “Annual Report of the Boards of Trustees of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund“–had some grim news. Expenditures ($925.8 billion) exceeded revenues ($899.9 billion) in 2020. More worrying, the estimated depletion date for the Medicare (i.e., Hospital Insurance) trust…
In 2008, the Centers for Medicare & Medicaid Services (CMS) implemented the Hospital-Acquired Conditions Present on Admission (HAC-POA) program. The goal of this program was to reduce the frequency of high-cost complications among Medicare beneficiaries. The mandatory program penalized hospitals as it would no longer reimburse them for treating of preventable complications that developed during…
How does Medicare cover vaccines? Are the paid for by Medicare Part B or Part D? MedPAC’s June 2021 report provides a nice overview. Medicare covers vaccines under Part B and Part D. Part B covers vaccines for influenza, pneumococcal disease, hepatitis B (for patients at high or intermediate risk), and coronavirus disease 2019 (COVID-19),…
In 2021, CMS expects to operate 12 alternative payment models (APMs) offering 25 distinct tracks for providers to choose from that involve different payment options and risk arrangement… providers serving about 20 percent of Medicare beneficiaries participate in this APM That is a quote from a June 2021 MedPAC report on CMS APM’s serving Medicare…
Medicare Advantage has grown over time. In 2020, nearly four in ten (39%) of all Medicare beneficiaries – 24.1 million people out of 62.0 million Medicare beneficiaries overall – were enrolled in Medicare Advantage (MA) plans. With MA enrollment growing, a key question is who provides higher quality care: Medicare fee-for-service (FFS) or MA? Who…
Many Medicare payment initiatives aim to link reimbursement to value. Value includes both cost and quality of care. However, measuring quality of care during a pandemic is problematic. Further, most of CMS’ value-based purchasing programs–such as Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program (HRRP) and the Hospital-Acquired Condition (HAC) Reduction Program all…
Is your hospital high quality? Well, this depends on what quality means. Does it have low readmission rates? Low rates of mortality? Do they follow clinical guidelines? Are patients satisfied? Are they good at cardiology care? What about cancer treatment? Combining all these different dimensions of quality is a complex task. The Centers for Medicare…
Medicare Part D has a confusing benefit system. Prior to 2011, patients had a deductible, then a general coverage benefit (with 25% coinsurance) then a donut hole (with no coverage) and then catastrophic insurance (with a 5%) copayment. When the Affordable Care Act passed, it aimed to fill the donut hole. Beginning in 2011, Part…
Here are a few highlight’s from the March 2021 report on Medicare Payment Policy from the Medicare Payment Advisory Commission (MedPAC). Leading causes of death The leading cause of death are heart disease, cancer, and respiratory disease. Note that these figures are from 2018. MedPAC notes that the 3rd leading cause of death in 2020…