Unbiased Analysis of Today's Healthcare Issues
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…
Many politicians claim that there is much fraud waste and abuse in the Medicare system. Would prosecuting executives accused of wrong-doing decrease the amount of fraud in the system? Some policymakers think so. The recent actions of the health department go further. The Office of Inspector General (OIG) has long barred people convicted of certain…
…and three other questions about physician care. Do Medicare patients have shorter waiting times than those with commercial insurance? In the 2010 survey, among those seeking an appointment, most beneficiaries (75 percent) and most privately insured individuals (72 percent) reported “never” having to wait longer than they wanted for an appointment for routine care. Another…
Why is it so difficult to get physicians to work together to coordinate care for their patients? Here’s why: “The typical primary care physician has 229…other physicians working in 117…practices with which care must be coordinated, equivalent to an additional 99 physicians and 53 practices for every100 Medicare beneficiaries managed by the primary care physician.”…
Recent research from Avalere Health, LLC using Medicare Part D reveals some interesting trends. Overall, premiums for fee-for-service prescription drug plans (PDPs) increased by 3%. For beneficiaries who enrolled in a Top 10 plan, however, premiums actually decreased by 6%. This result was driven by a 12% decrease in premiums for the largest PDP, AARP…
Would Congressman Ryan’s proposal solve this problem? Medicare Part B pays outpatient physicians according to the billed Current Procedural Terminology (CPT) codes, which differ in procedure and intensity….Using nationally representative data from the 2001 to 2003 Medicare Current Beneficiary Survey, this paper…finds strong evidence that these fee differentials influence physician’s coding choice for billing purposes…
Medicare is the largest payer in the $2.5 trillion dollar health care sector. Medicare made up one-fifth of that amount. Where does this money go? In a previous post I examined where Medicare payments went in 2008, and today I update those figures for 2010. Source: MedPAC. Report to The Congress: Medicare Payment Policy, March 2011.
Congressman Paul Ryan’s budget proposal has made significant waves. Many will fear that the Ryan proposal means the end of Medicare and Medicaid. Although these programs will not end, there will be significant changes. One can think of many of these changes as a transfer of risk. Consider the Medicare program. Although Medicare will not…
Previous research by the team at Dartmouth Atlas found that there is significant regional variation in spending and disease diagnosis frequency, but this variation is not correlated with higher quality. However, regional variation may be overstated. According to Zuckerman et al. (2010): “Unadjusted Medicare spending per beneficiary was 52% higher in geographic regions in the…
Research by the Dartmouth Atlas team has indicated that Medicare spending is concentrated regionally. States such as Florida spend much more per beneficiary than do doctors who treat similar patients in low cost states like Minnesota. A recent paper by Reschovsky and co-authors, however, has determined that variation in supply-induced demand is not a major driver…