Bring Market Prices to Medicare

Medicare is a government-run insurance program.  Can policy changes be made to add competition to Medicare, maintain quality and reduce cost?  A book titled Bring Market Prices to Medicare argues that it can through a competitive bidding process. This book makes a number of sensible arguments which I review today. The main proposal of the…

What’s a ‘dual’?

Nine million individuals qualify for both Medicare and Medicaid health insurance.  These individuals, known as dual-eligibles, rank among the most expensive Medicare and Medicaid beneficiaries.  Duals are frequently hospitalized and often need long-term care.  In fact, most state spending for dual eligibles focuses on long-term care supports and services. The federal government pays the bulk…

Is Medicare moving towards rationing your medical equipment?

Currently, Medicare fee-for-service (FFS) beneficiaries receive significantly more choice than standard commercial plans.  They can choose any provider they wish (who accepts Medicare).  There are no cost-sharing differences between in-network and out-of-network doctors (because there is no ‘in-network’ for Medicare).  Although certain Part D prescription drug plans require prior authorization for specific drugs, few services…

Does California really love Managed Care?

In short, yes. California is the land of managed care. Kaiser-Permanente–the managed care poster child–owns one third of the market.  Love for managed care is not just in the private market; in 2010, over half of all Medi-Cal and more than one-third of Medicare beneficiaries were enrolled in managed care plans.  Further, California managed care…

Another Blow to Health Reform?

The head of the Centers for Medicare and Medicaid Services (CMS), Don Berwick, announced he would step down from his post on Wednesday.  Berwick was a temporary 18 month appointment who Obama hoped would stay on longer.  The San Francisco Chronicle reports “The point man for carrying out President Obama’s health care law will be stepping down…

Medicare Physician Payment Adjustments

The Medicare billing system is complex.  There an alphabet soup of acronyms, (e.g., RVUs, CPT, HCPCS, GPCI) and each of these affects payments in different ways.  In addition to the standard payment terms, Medicare is also creating additional payment incentives.  These payment incentives fall into three broad categories: Quality reporting e-Prescribing (eRx) Electronic Health Records…

Accountable Care Organizations: Update on Medicare Implementation

Health Reform’s Accountable Care Act (ACA) mandates the creation of Accountable Care Organizations (ACOs).  Dartmouth researcher Elliott Fisher stimulating much of the interest in ACOs by introducing the concept of an “extended hospital medical staff” at a 2006 meeting of the Medicare Payment Advisory Commission (MedPAC). Today, I review an article by Berenson and Burton (2011) describing…

Medicare’s Agenda for Hospital Accountability

CSC provies a nice overview of some of Medicare’s hospital quality initiatives. These initiatives include a value-based purchasing (VBP) program, reduced reimbursement for excessive hospital readmissions, and reduced reimbursement for hospital-acquired conditions (HAC).  Each of these three broad quality initiatives is described in more detail after the jump. It is important to note that these…