Unbiased Analysis of Today's Healthcare Issues
How do hospitals estimate the cost of different inpatient stays? A paper by Clement et al. (2009) reviews 3 techniques: Microcosting. “With microcosting, a detailed list of each component of a patient’s care is created and costed separately for each facet of a patient’s hospitalization. Given the level of detail, microcosting is generally considered the…
In 2004, 29% of Medicare enrollees had Medigap coverage. Are these policies priced efficiently? An NBER paper by Maestas, Schroeder and Goldman (2009) argues that the answer is no. Prior to July 1992, Medigap was minimally regulated. With the passage of the Omnibus Budget Reconciliation Act of 1990 (implemented in July 1992), Medigap plans…
Joe Paduda of Managed Care Matters has a two great posts on Medicare’s new payment structure. The first post reports how exactly Medicare is changing its reimbursement for medical services. “It looks like reimbursement for cognitive services – the 99xxx codes for readers expert in CPT-4s…office visits and similar services for others – will…
For many illnesses, Medicare pays physicians a lump sum for the entire episode of care. This is known at the prospect payment system (PPS). But how does Medicare determine the payment amount? How should Medicare determine the payment amount? Medicare generally looks at 1) what treatments are generally used on average to treat a patient…
Medicare was implemented in 1965 to cover the medical costs of the oldest members in society. In 1965, the U.S. life expectancy was only 70 years old. Now, however, life expectancy at birth is over 78 years. Medicare is now not just covering the oldest of the old, it also covers the “moderately” old since…
Recently, the San Diego Union Tribune reported that the Sharp Grossmont Hospital in eastern San Diego county was cited for a number of preventable deaths. Reporter Cherl Clark found numerous problems, which included: “staff members restraining a highly medicated, 25-year-old man with schizophrenia in such a way that he was allowed to suffocate. In addition,…
The U.S. is in a huge amount of debt. This will only worsen in the short- to medium-term as the the baby boomers retire and Medicare and Social Security budgets balloon. Here’s a movie about it. “This country has started consuming more than it produces.” – Warren Buffet
For researchers interested in studying the Medicare prescription drug benefit, CMS has claims data for Medicare Part D. Academy Health also has a useful powerpoint presentation giving some more information regarding Medicare Part D and what information is available as part of the CMS Medicare Part D claims data.
The controversy as to how much Medicare should pay doctors is continuing to brew (see N.Y. Times article). Congress passed a law overriding a pay cut to Medicare doctors. Although the president vetoed the bill, Congress garnered enough support to override the veto. Dr. Rich of The Covert Rationing Blog claims that the Medicare reimbursement…
As I noted in an earlier post, choosing a Medicare part D plan is difficult. However, there are resources to help people choose a Medicare Part D plan based on which prescriptions they are taking and where they live. Medicare has its own Personalized Plan Search. The private sector also has come up with user-friendly…