Unbiased Analysis of Today's Healthcare Issues
Medicare payments for End Stage Renal Disease rely on a value-based purchasing (VBP) system known as the Quality Incentive Program (QIP). Today I review proposed changes to the QIP that will effect the payments for dialysis centers in 2013 and 2014. Payment Year 2013 Two measures have been adopted for the payment year (PY) 2013…
Health reform not only changes the health care market for the demand side (e.g., patients, insurers), but also for the supply side (e.g., hospitals, physicians). In the Medicare setting, a number of initiatives have aimed to pay providers who provide high-quality or low-cost care more money, and pay providers who provide low-quality or high-cost care…
In short, the answer is no. The CBO released an issue brief examining two types of demonstrations. Disease management and care coordination demonstrations have sought to improve the quality of care of beneficiaries with chronic illnesses and those whose health care is expected to be particularly costly. Value-based payment demonstrations have given health care providers…
In 2015, Medicare will begin implementing a value-based purchasing (VPB) program for physicians. Initially the program will target only certain physicians and groups of physicians, but by 2017 all physicians is participate in this program. The VBP program will evaluate physicians along two broad dimensions: quality and cost. In the final rule: Section 1848(p) of…
The Medicare billing system is complex. There an alphabet soup of acronyms, (e.g., RVUs, CPT, HCPCS, GPCI) and each of these affects payments in different ways. In addition to the standard payment terms, Medicare is also creating additional payment incentives. These payment incentives fall into three broad categories: Quality reporting e-Prescribing (eRx) Electronic Health Records…
CSC provies a nice overview of some of Medicare’s hospital quality initiatives. These initiatives include a value-based purchasing (VBP) program, reduced reimbursement for excessive hospital readmissions, and reduced reimbursement for hospital-acquired conditions (HAC). Each of these three broad quality initiatives is described in more detail after the jump. It is important to note that these…
Massachusetts’ Medicaid program instituted a pay-for-performance program in 2008. Did it work? According to this paper, the answer is no. MassHealth P4P Background The MassHealth pay-for-perfrmance P4P program was implemented in 2008. At first the program was implmented using a P4P structure for pneumonia and pay-for-reporting for surgical infection prevention (SIP) and transitioning to P4P…
At a recent AcademyHealth presentation, Cheryl Damberg discussed her research to design a P4P program for implementation for Integrated Healthcare Association (IHA). One thing I noticed about the presentation was that smaller provider groups had patients with lower risk scores (i.e., healthier patients). Is it really the case that small providers treat much healthier patients?…
The Healthcare Economist has already commented on the impending Medicare implementation of a hospital value-based purchased (VBP) system. Now, Medicare’s hospital VBP program has garnered the attention of the popular press. According to the New York Times: “The administration plans to establish ‘Medicare spending per beneficiary’ as a new measure of hospital performance…Hospitals could be…
One large insurer is planning to begin paying hospitals based on quality. “WellPoint is replacing the system it uses to help offset rising medical and other costs at hospitals in 14 states that serve its Blue Cross Blue Shield plans, which cover 34 million people. In recent years, it has raised its payments to those…