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…

Dual eligibles: A statistical overview

Medicare covers largely elderly individuals, the disabled, and individuals with end stage kidney disease. Medicaid covers low-income individuals. So who are dual eligibles, that qualify for both programs? The Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MedPAC) put out a report last year providing a summary of the…

What is the Enhancing Oncology Model (EOM)?

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…