Unbiased Analysis of Today's Healthcare Issues
How does Medicare adjust payments to physician practices to account for regional differences in input costs such as employee wages, office rent, malpractice insurance and other expenses? I recently co-authored a report in support of the CMS final rule which explains how CMS will make these adjustments for 2012. Among the key revisions are an…
Starting in fiscal year 2014, Medicare will start rewarding hospitals with high quality care and penalizing hospitals with low quality care. The rewards and penalties will be financial in nature. High-quality hospitals will receive a bonus and low-quality hospitals will receive a financial penalty. There is a lot of existing documentation on this hospital value-based…
Are elderly Medicare beneficiaries able to choose Part D health plans optimally? Many researchers may believe the answer is no. Certain elderly individuals (e.g., those with Alzheimer’s) may be cognitively impaired. Inertia is also a problem; switching plans is mentally taxing and involves a spending a significant amount of time researching plan alternatives. Nevertheless, a…
CMS has a wealth of publicly available summary statistics regarding enrollment, spending, treatment patterns, cost sharing and other topics for both Medicare and Medicaid beneficiaries. This information can be accessed through the Medicare & Medicaid Statistical Supplement website. The site includes statistics on the following topics: Personal Health Care Expenditures Medicare Enrollment Medicare Program Payments…
President Obama released a proposal last week to jump start the economy and reduce the deficit. The proposal includes many cuts to Medicare and increased cost sharing. Senators Coburn and Lieberman are supporting these cuts. Increased cost sharing is a common theme in Medicare, Medicaid, but also for other programs as well. For instance, the…
Does having a specialist as your usual source of care (USOC) increase costs? “Among high-cost beneficiaries, the 27.8 percent attributed to a medical specialist as their USOCphysician had U.S.$1,839 greater costs than those attributed to primary care physicians, representing roughly 4 percent of the mean cost of care. Although this may reflect unmeasured patient preferences…
Medicare recently release a request for proposal for health care agencies to participate in both the Medicare Shared Savings Program and the Pioneer Accountable Care Organization (ACO) pilot project. The Pioneer ACO project is similar to the Shared Savings Program but has higher levels of cost sharing and (in year 3 of the pilot) partially…
Basic Statistics In 2010, 47.5 million people were covered by Medicare: 39.6 million aged 65 and older, and 7.9 million disabled. About 25 percent of beneficiaries have chosen to enroll in Part C private health plans that contract with Medicare to provide Part A and Part B health services. Total benefits paid in 2010 were…
Today I review how Medicare pays for long-term care hospitals (LTCHs) based on information from MedPAC’s 2011 Report to Congress. LTCHs furnish care to patients with clinically complex problems—such as multiple acute and chronic conditions—who need hospital-level care for relatively extended periods. These facilities can be freestanding or colocated with other hospitals as hospitals within…
Today I will review how Medicare treats patients with end-stage renal disease (ESRD), relying largely on data from MedPAC’s 2011 Report to Congress. In 2009, about 340,000 dialysis beneficiaries were covered by fee-for-service (FFS) Medicare. Compared with all Medicare beneficiaries, dialysis FFS beneficiaries are disproportionately younger and African American. Ninety two percent of there beneficiaries…