Unbiased Analysis of Today's Healthcare Issues
Much of my own research has focused on how physician financial incentives affect the quantity and quality of medical care. It should come as no surprise that I found a recent New York Times article on the topic stimulating. Dr. Sandjeep Jauhar examines how hospital and physician financial incentives affect the length of a patient’s…
In 1998, Medicare enacted the sustainable growth rate (SGR) which would slowly bring down Medicare physician compensation. However, each year, it gets reversed by Congress. Now, instead of a gradual decline, the implementation of SGR would result in a 21.2% pay cut for Medicare docs. Before the Thanksgiving holiday, however, Congress once again reversed the…
One laudable goal is to improve medical quality while reducing cost. One way members of Congress have proposed to accomplish this is to use episode groupers in order to provide feedback to doctors regarding their resource use. None other than Max Baucus has advocated this (see p. 45 of this white paper). However, matching patient…
According to a N.Y. Times editorial, the Congressional Budget Office has consistently underestimated costs savings from a variety of institutional changes to Medicare. For instance: Medicare enacts the prospective payments system (PPS) for reimbursing inpatient hospital stays. The CBO projected total Medicare spending will rise to $60 billion in 1986. Actual Medicare spending in 1986…
The Social Security Administration’s Office of the Actuary projects Medicare costs up to 75 years in the future. How much of your taxable income will be going to pay for Medicare in the next 10, 25, or 75 years? Take a look at this chart. By 2085, 12.24% of your taxable income will need to…
The largest provider of medical services in the United States is Medicare. Forty five million Americans receive Medicare. Out of this total only 85% are elderly (aged 65 or older). Disabled individuals, individuals with end-stage renal disease or Lou Gehrig’s disease are also eligible for Medicare coverage. Medicare has 4 parts. Part A provides coverage…
The healthiest 76% of Medicare beneficiaries consume only 14% of program expenditures. The sickest 15% consume 75% of Medicare expenditures. Hughes et al. (2004).
The Medicare Reimbursement series continues with a look at physician reimbursement in more detail. The source of this information is MedPAC’s Payment Basics. Physician Reimbursement Physicians payment is based on 3 factors: RVU, GPCI and the MEI conversion factor. Relative value units (RVUs) measure the relative costliness of three types of resources used to provide…
The Medicare Reimbursement series continues with the big money payments: acute inpatient hospital care, long-term care facilities and critical access hospitals. The sources of this information is MedPAC’s Payment Basics. Hospital Acute Inpatient Services Payments made under the acute inpatient prospective payment system (IPPS) totaled $105 billion and accounted for about 25 percent of Medicare…
The Medicare Reimbursement series continues with today’s focus on outpatient care. The sources of this information is MedPAC’s Payment Basics. Outpatient Hospital Services Outpatient hospital procedures range from injections to complex surgical procedures that require anesthesia. Outpatient hospital care accounted for $19 billion of total Medicare spending in 2007. Currently, outpatient hospital reimbursement is based…