Unbiased Analysis of Today's Healthcare Issues
Should Medicare pay hospitals located in New York City more for the same care as hospitals in Montana? Prima facie, one might believe that New York hospitals should receive higher wages since the costs of operating a hospital are much higher in New York. Labor (i.e., nurses, doctors, etc.) may prefer to live in an…
How will health reform affect state health care costs? Will reform bankrupt states as some Republicans say? Or will costs be negligible, as Democrats claims? According to a study by Holahan and Dorn (2010) the answer is somewhere in the middle. Most of the additional costs will come from expanding Medicaid to newly eligible population,…
In Virginia, there are over one million people age 60 and older and over 90,000 Virginians age 85 and older. These figures will only grow in the upcoming decades. Thus will put increasing strain on public programs and will require service providers to reorient medical care toward providing continued, high-quality long term care services. Long…
For Part B services, Medicare pays physicians based on the services they provide. The American Medical Association (AMA) developed Current Procedural Terminology (CPT) codes to create a taxonomy of procedures that physicians perform. Does the Centers for Medicare and Medicaid Services (CMS) use these codes for payment? The answer is yes and no. Officially, CMS…
Although Medicaid is currently one of the largest programs in any state’s budget, Congress enacted this welfare health insurance scheme as almost an afterthought. Consider the news coverage for Medicaid at the time. According to the chart below, the New York Times didn’t even mention Medicaid an any article in 1965 and Medicaid was mentioned…
The cost of running a hospital in New York City is much higher than running a hospital in Bozeman, Montana. To take into account these cost differences, the Centers for Medicare and Medicaid Services (CMS) has created a wage index to adjust the inpatient prospective payment system (IPPS) for differences in labor costs. However, the…
Medicare and Innovation in the same sentence? Yes indeed. As part of Health Reform [i.e, Patient Protection and Affordable Care Act (PPACA)], the government mandated the creation of the Center for Medicare and Medicaid Innovation (CMI). What does CMI do? “The stated purpose of the CMI is to test innovative payment and service delivery models…
Yesterday, I mentioned that low-income individuals on Medicare can also qualify for Medicaid and, as full-beneift dual eligible beneficiaries, they have significantly lower cost sharing than the typical Part D beneficiary. How does CMS identify these individuals? For currently beneficiaries on Medicaid who ‘age’ into Medicare, this process is fairly easy. CMS can auto-enroll these…
Health insurers face a conundrum. Increased cost sharing helps to reduce patient utilization of medical resources and–at least inititally–lowers the cost of care. Too much cost sharing, however, can lead to decreased patient adherence. In this case, the patients may get sick and require hospitalization, which will actually increase cost. Cost sharing’s affect on adherence…
As the baby boomers age, the responsibility for the care of many of these individuals will fall to their children. For the elderly who have trouble running errands, dressing themselves, or even bathing themselves, having a family member as a caregiver can significantly improve the elderly’s quality of life. Many of these caregivers get burnt…