Medicare Dashboards

For which drugs does Medicare spend the most money?  For which inpatient hospital treatments does Medicare have the highest expenses.  CMS’s new Dashboards provide an easy to use source to access these high level summary statistics.  You can find this information here: Medicare Inpatient Hospital Dashboard (website, description) Medicare Prescription Drug Benefit Dashboard (website, description)…

Do you support ACOs?

Do you support Accountable Care Organizations?  Many policymakers think they are a great idea.  Why?  If ACOs better integrate care coordination between a variety of physician specialists and other providers, ACOs can increase the efficiency of the health care system.  Improving quality and reducing cost sounds like a great idea. To implement these integrated care settings in…

MedPAC’s Home Health Recommendations

In their latest 2011, MedPAC made four recommendations to alter payment policy in the home health setting.  These include the following: The Secretary, with the Office of Inspector General, should conduct medical review activities in counties that have aberrant home health utilization.  The Secretary should implement the new authorities to suspend payment and the enrollment…

Hospital VBP gains the attention of the New York Times

The Healthcare Economist has already commented on the impending Medicare implementation of a hospital value-based purchased (VBP) system.  Now, Medicare’s hospital VBP program has garnered the attention of the popular press.  According to the New York Times: “The administration plans to establish ‘Medicare spending per beneficiary’ as a new measure of hospital performance…Hospitals could be…

Medicare Payment Adequacy

How do policymakers  determine if Medicare payment levels are adequate?  The Medicare Payment Advisory Commission (MedPAC) uses the following criteria: Access to care determined by the number of providers and volume of services. Quality of care Provider access to capital Provider margins. Although these measures do provide valuable information, they are far from perfect.  Access…

The CMS HCC Model

The CMS-HCC risk adjustment model is used to adjust payments for Part C benefits offered by MA plans and Program of All-Inclusive Care for the Elderly (PACE) organizations to aged/disabled beneficiaries. The CMS-HCC model includes both diseases and demographic factors. There are separate sets of coefficients for beneficiaries in the community, beneficiaries in long term care…