Unbiased Analysis of Today's Healthcare Issues
A number of studies (e.g., Wasfy et al. 2017, Desai et al. 2016) have found that the Centers for Medicare and Medicaid Services (CMS) Hospital Readmissions Reduction Program (HRRP) reduce hospital readmissions. However, are these findings valid? A recent paper by Ody et al. (2019) argues maybe not. Because readmission rates are risk-adjusted, changing coding…
The answer is ‘perhaps’ according to a new paper by Wadhera et al. (2018). They use data from 2005 to 2015, and apply an inverse probability–weighted 30-day and 45-day post-discharge mortality measure stratified by whether there was an associated readmission. They examine admissions for acute myocardial infarction, heart failure, and pneumonia. Among Medicare beneficiaries, the HRRP…
CMS is increasingly moving to alternative payment models whereby providers are paid based on their ability to improve/maintain quality and hold the line on cost. A key question then, is how does CMS evaluate quality of care? Today, the Healthcare Economist will answer this question for the case of Medicare’s Shared Savings Program (MSSP), which…
A recent report from the Health Care Payment Learning and Action Network (HCP LAN) examines how providers are getting paid in the U.S. today. Traditionally, health care providers (e.g., physicians, hospitals) were paid via fee-for-service (FFS). Fee-for-service means that every time a provider does a service, they get paid. This is truly largely regardless of…
Pharmaceuticals on the one hand can greatly improve patients health and quality of life. At the same time, some of these treatments are expensive and–despite clinical trial results–evidence from the real-world is lacking at the time of a drug launch. To address these issues, Oklahoma’s Medicaid program is taking the lead by adopting two different…
Medicare’s Merit-based Incentive Payment System (MIPS) aims to link physician quality of care to their reimbursement. At first glance, paying more to high quality physicians seems like a great idea. However, a paper by Liao et al. (2018) surveys physicians from a large national sample maintained by the American College of Physicians (ACP). They find…
CMS has focused in recent years on payment reform–especially alternative payment models–in Medicare’s fee-for-service (FFS) reimbursement system, but much less has been paid to beneficiaries enrolled in Medicare’s managed care program (i.e., Medicare Advantage). Currently, however, more than 1 in 3 beneficiaries are enrolled in an Medicare Advantage plan, and by 2028 that number could…
It appears that the answer is ‘yes’. Many studies by the Dartmouth Atlas team have shown that regions that spend more on medical care do not always get better outcomes. However, a recent paper by my Precision Health Economics colleagues James Baumgardner, Ahva Shahabi, Mark Linthicum, Seanna Vine, and Darius Lakdawalla as well as Chris Zacker…
Outcomes-based contracts are supposed to be the next big thing. When payers are not sure about the real-world benefits or cost of a treatment, outcomes-based contracts and help them diversity risk. For instance, CMS will only pay for the CAR-T product Kymriah when “…these patients respond to Kymriah by the end of the first month…
An interest Health Affairs blog post on outcomes-based pricing from Daniel M. Blumenthal Samuel Nussbaum Neil J. Weissman and Mark Linthicum. Insurers are increasingly tying health service payments to clinical outcomes to improve care value and quality. Outcomes-based pricing—setting treatment reimbursements to reflect their prospectively determined value to patients and the health care system—is a promising alternative payment…