Unbiased Analysis of Today's Healthcare Issues
In 2013, Medicare launched the Bundled Payments for Care Improvement (BPCI) initiative. There were 4 models included in the program: Model 1 (least comprehensive): includes Part A services for the index hospitalization alone, and thus most closely resembles current fee-for-service payment. Model 2 (most comprehensive): encompasses Part A and Part B services for the index hospitalization, readmissions, and all other post…
In the 1990s, managed care began to take over the health care marketplace. However, backlash against managed care lead to a retrenchment in managed care in the late 1990s. A paper by Sinaiko and Zeckhauser (2015) notes that: After the MA-plan payment cuts imposed through the Balanced Budget Act of 1997, HMO availability dropped by nearly…
MACRA is the Medicare Access & CHIP Reauthorization Act, also know colloquially as the ‘permanent doc fix’. Although MACRA is know for repealing the Sustainable Growth Rate (SGR) provisions that would have significantly cut physicians salaries (but was reversed every December), there are other provisions. Although physicians may take comfort in avoiding the year end doc…
Here’s a graphic from the NIHCM foundation summarizing where federal revenues come in an where they are spent. As you can see about one quarter of the budget is spent on Medicare, Medicaid, CHIP and ACA Subsidies and another quarter is spent on Social Security. This is not news if you have been reading the Healthcare Economist diligently…
The Research Data Assistance Center (ResDAC) has announced that individuals and firms will now be able to get access to more CMS data. They describe their “Innovator Research” program as follows: Innovators and entrepreneurs may now access CMS data as part of a research study to create products or tools that they intend to sell…
About two-thirds of Medicare beneficiaires are enrolled in tradiational Medicare FFS, but the remaining thrid is now enrollingin Medicare Advantage plans. Which plans are dominant? The following figure from Avalere provides a breakdown. Note that this figure obscures significant regional variation in plan market share. For instance, Kaiser Permanente has almost half (48%) of the…
Bundled Payments for Care Improvement (BPCI)A helpful post from Steven A. Farmer, Meaghan George and Mark B. McClellan explains. Comprehensive Care for Joint Replacement (CCJR) is a bundled payment structure for hip and knee replacements. CMS notes that: 2013, there were more than 400,000 inpatient primary procedures in Medicare, costing more than $7 billion for hospitalization alone.…
J.K. Wall provides an apt analogy at The Health Care Blog of why hospital billing is so confusing: If McDonald’s operated like a hospital, when you ordered a Happy Meal with a burger, fries and drink, you would be charged a separate price for the meat, bun, cheese, pickle, mayo and paper wrapper, the…
Not entirely, but the 2015 Medicare Trustees report is certainly more optimistic than in the past. Brookings reports: The Trustees have dramatically lowered their projections of long-run Medicare expenditure growth. In 2009, for example, the Trustees projected that Medicare spending would reach 11.2 percent of GDP by 2080—compared with just 6 percent in this year’s…
High-cost cancer drugs often get bad press. Cancer treatment certainly is expensive. However, drug costs are not the primary driver of high cost of cancer treatment; hospitalizations are. Using data from SEER-Medicare, Brooks et al. (2014) examine regional variation in the cost of cancer care and find: Acute hospital care was the largest component of…