Unbiased Analysis of Today's Healthcare Issues

Archive for November, 2012

Friday Reading

End 401(k)’s. Progress on Exchanges in California. Sports commentary. Another State opts out of building an exchange. The real cost of losing weight.

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How does UnitedHealth Evaluate Physician Performance?

The UnitedHealth Premium Physician Designation Program assesses the quality and efficiency of physicians’ practice patterns. UnitedHealth uses Quality of care is measured using measures from the NQF and NCQA.  Cost efficiency (i.e., being low cost) is measured using the Symmetry ETG and PEG episodes. The information generated by this program is used to i) give […]

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CoR #171

Emily Holbrook of the Risk Management Monitor hosts this week’s episode of the Cavalcade of Risk featuring the best of risk-related posts from around the blog-o-sphere. It’s short, sweet and packs a punch.

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Medicare Payments Cut for Low-Quality Hospitals

In the past, Medicare basically paid hospitals the same amount for every type of admission regardless of quality.  Of course, Medicare did adjust payments to hospitals based on the their cost of labor (hospital wage index adjustment), share of low-income patients (disproportionate share hospital payment), and number of medical school residents (indirect medical education payment), […]

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Expenditure vs. Price Index: Part II

Health care prices have risen dramatically in recent years so that health care spending makes up more than 16% of the U.S. economy.  Howmuch of this increase is due to the increase in the price of medical care?  In a previous article, I noted that there are two main ways to measure price increases for […]

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Calcuating Health Insurance Exchange Plan’s AV

One of the key components of Health Reform (a.k.a. Obamacare, a.k.a. the Affordable Care Act) is the creation of Health Insurance Exchanges. Not any plan can participate in the exchanges however. First, these plans must cover certain Essential Health Benefits (EHB). Second, the plans must meet certain actuarial value (AV) thresholds. Health Plans are grouped […]

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Pre-Thanksgiving Links

Low quality physicians more likely to serve minorities. “Let Them Eat Cake” Clinical Decision Support System. Is assisted living a substitute for nursing home care? Just what is Banner Health planning? Teleport anywhere in the world.

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Does the Optimal Medical Treatment of Hepatitis C depend on whether the Patient is Incarcerated?

Incarcerated individuals are more likely to have the hepatitis C virus (HCV) than those who live in the community.  The high prevalence of HCV infection in the prison population is largely due tot he fact that prisoners hare more likely to have a history of intravenous drug use.  “A history of intravenous drug use is […]

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Chronic Care Management: Does it work?

According to one recent study, the answer is ‘yes’. “…mortality is reduced by chronic care management, irrespective of the differences between the studies included. Furthermore, the meta-regression analysis revealed that all-cause hospitalization and the quality of life could significantly be improved by chronic care management. The study quality, the length of follow-up, and the number […]

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Competitive Bidding for Durable Medical Equipment: Round 2

Previously I wrote about Medicare’s efforts to introduce competitive bidding for durable medical equipment (DME). Today I provide additional details on the program, an update of the initial competitive bidding implementation (Round 1) and a look ahead at the competitive bidding process in fiscal year (FY) 2013 (Round 2). In FY 2011 and 2012 (i.e., […]

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