Unbiased Analysis of Today's Healthcare Issues
An interesting article by Mor (2023) examines the history of the requirement for a 3-day hospital stay for Medicare to cover a skilled nursing facility (SNF) transfer. The 3-day requirement: …was introduced very early in the history of the Medicare SNF benefit at a time when most nursing homes (NHs) offered primarily custodial care and…
That is the title of a new USC Schaeffer Center white paper authored by Dana Goldman, Joe Grogan, Darius Lakdawalla, Barry Liden, Kyi-Sin Than, Erin Trish and myself. An excerpt from the press release is below, and the full white paper is here (HTML, PDF). 1. Bring transparency and a focus on value to the…
When you buy a car, there is the sticker price and what you actually paid after haggling with the dealer over discounts. For pharmaceuticals, the media typically reports on list prices which are analogous to the “sticker price” for cars. However, what really matters is the net price, which is the price after discounts and…
In the past, I have written about the Enhancing Oncology Model (EOM), including an overview of the EOM program as well as a more detailed review of EOM’s payment methodology. A new paper in JAMA Health Forum by Kocher and Adashi (2023) describes their perspective on the EOM program. First, they provide a nice overview…
That is the question posed by Buntin et al. (2022). The authors used data from the 2007-2018 Medicare Master Beneficiary Summary File and then ran a regression adjustment to control for patient demographics (i.e., age, sex), number of chronic conditions (none, 1-3, ≥4), and whether the individual had Part A or Parts A and B…
Back in July, I provided an overview of the Enhancing Oncology Model (EOM). Today I build upon that post focusing largely on CMS’s EOM’s Payment Methodology. I use a Q&A format as well. What is the goal of EOM? According to CMS “EOM is a CMMI alternative payment model designed to advance health equity, promote…
In the past, seniors in Medicare had to pay for all their prescription drugs out-of-pocket. For elderly individuals with multiple medical conditions, this lack of coverage was highly burdensome. To address this issue, in 2006, Medicare Part D began which provided some coverage for prescription drugs. To keep the cost of Part D down, however,…
Many people might know that generally the answer is commercial health plans have the most generous reimbursement compared to government plans. However, a key question is how much more do they pay? Commercial vs. Medicare rates A January 2022 report by the Congressional Budget Office finds that commercial payers reimburse hospitals at 223% of Medicare…
The answer is ‘yes’, but the magnitude of these savings are relatively small and more than offset by additional OCM program costs. Keating et al. (2021) writes: In this exploratory difference-in-differences study of Medicare fee-for-service beneficiaries with cancer undergoing chemotherapy (483 310 beneficiaries with 987 332 episodes treated at 201 OCM participating practices and 557 354 beneficiaries with…
If you are on Medicare, how much will you pay for insulin? The answer is in the graph below (via MedPAC’s Payment Basics) Seem confusing? Well it is. Medicare Part D beneficiaries have a deductible, then the standard coverage phase with 25% cost sharing, then a coverage gap where beneficiaries pay 25% of cost (manufacturers…