Unbiased Analysis of Today's Healthcare Issues
According to the Congressional Budget Office’s (CBO’s) 2017 Long-Term Budget Outlook, you need to look no further than entitlements for the elderly. Mandatory programs have accounted for a rising share of the federal government’s noninterest spending over the past few decades, exceeding 60 percent for the past several years. Much of the growth has occurred because…
What does CMS consider to be innovative oncology care? The following three programs won a CMS Health Care Innovation Award for their initiative. Community Oncology Medical Home (COME HOME). This model relied on three key principles: (i) triage pathways to help first responders and nurses identify and manage patient symptoms; (ii) enhanced access to care through…
Consumer Reports‘ “Choosing Wisely” initiative aims to identify high-cost, low-value treatments that can often be avoided. One question remains is why do providers still offer these services? Do payer coverage policies or reimbursement rules affect these choices? A paper by Colla et al. (2017) attempts to answer that question. The authors used commercial payer claims data…
Medicare’s cost are growing due to an aging population, technological advances, and other factors. One of those factors may be upcoding that is occurring among Medicare Advantage plans. Rick Kronick writes in Health Affairs that: Over the past decade, the average risk score for Medicare Advantage (MA) enrollees has risen steadily relative to that for fee-for-service…
According to a January 2017 report from the Congressional Budget Office (CBO), spending on entitlement programs for the elderly is the primary factor driving increased budget deficets over the next 10 years. The CBO states: Outlays rise faster than revenues—by about 5 percent a year, on average—increasing from 20.7 percent of GDP in 2017 to…
Maybe not. That is the answer from a study by Thompson et al. (2016). Using data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) for six states (AR, FL, IA, MA, NY,WA) from 2011 to 2013, the authors measure hospital performance reliability for the Hospital Readmission Reduction Program (HRRP). The define reliability as follows:…
BPCI is Medicare’s Bundled Payments for Care Improvement initiative. For selected conditions, hospitals receive bundled payments that can include concurrent physician payments, post acute-care or other arrangements. The question is, does this payment approach improve quality and reduce cost? A study by Dummit et al. (2016) looked at lower extremity joint replacement at a BPCI-participating hospital. They found the…
The Congressional Budget Office provides some gloomy news on the fiscal health of the federal government in their recent 2016 Long Term Budget Outlook. They state: If current laws governing taxes and spending did not change, the United States would face steadily increasing federal budget deficits and debt over the next 30 years, according to projections…
CMS announced last week that they are extending their value-based insurance design (VBID) program to more states and more patients. I describe VBID and the proposed changes below. What is VBID? Value-Based Insurance Design (VBID) generally refers to health insurers’ efforts to structure enrollee cost sharing and other health plan design elements to encourage enrollees…
Accountable Care Organizations aim to link providers through the supply chain (i.e., hospitals, physicians, post-acute care facilities) to incentivize providers to improve quality and reduce costs. In addition to its ACO program (the Medicare Shared Savings Program), the Centers for Medicare and Medicaid Services (CMS) have implemented a number of value-based payment programs, including the…