In order for Medicare to reimburse post-acute care in a skilled nursing facility (SNF), Medicare beneficiaries must have a 3-day hospital stay. Some hospital stays, however, are not counted as hospital stays; rather, they may be defined as “observation status” care that do not merit an inpatient admission. Patients may stay overnight at the hospital [...]
Read the rest of this entry »Archive for the 'Medicaid/Medicare' Category
A drop in the bucket…
Every year, the Centers for Medicare and Medicaid Services (CMS) conducts a recovery audit. In a recent report, Medicare collected over $797 million in Medicare overpayments in 2011. Where do these overpayments come from? Inpatient: $677m Durable Medical Equipment & Other: $35m Physician: $33m Outpatient: $17m Skilled Nursing Facilities: $0.2m Recovery Audit Contractors returned $488 [...]
Read the rest of this entry »The Most Important Health Policy Study of Our Generation
Perhaps the most important paper on the effect of health insurance on health, spending, and access to care was released this week. Although randomized controlled trials are rare for measuring the effect of insurance, the design of the Oregon Medicaid program introduced random variation into who received Medicaid coverage. The authors write: In 2008, Oregon [...]
Read the rest of this entry »A glitch in ACO beneficiary assignement?
For most managed care plans, beneficiaries elect to participate in the plan. In exchange, beneficaries often have lower premiums, but often restricted access to providers (e.g., referral requirements, copayment differentials for out-of-network physicians). Medicare’s Accountable Care Organizations (known as Shared Savings Plans (SSP)) also assign beneficaries to organizations. The SSPs are groups of providers that [...]
Read the rest of this entry »Medicare Part D Prescription Drug Enrollment Trends in 2013
According to research from Avalere, Medicare beneficiaries are overwhelmingly choosing low-cost Part D prescription drug plans . In 2013, more than 500,000 beneficiaries enrolled in the brand new AARP Saver Plus plan—catapulting it to a position in the top 10 list of plans in its first year. With the addition of Humana/Walmart and First Health Part D Value Plus, nearly 3 million beneficiaries are choosing low-premium plans with preferred [...]
Read the rest of this entry »Regional Variation in Medicare Spending and Utilization: 1974-2003
A paper by Cutler and Sheiner claim that if all areas in the United States had the level of spending prevailing at the 10th percentile from a ranking of 315 metropolitan statistical areas (MSAs) by Medicare spending, Medicare spending would fall by almost 30%. However, this may only be true in a static sense. If the high-cost [...]
Read the rest of this entry »Variation in Healthcare Spending: Medicare vs. Private Insurance
Is regional variation in health care spending larger for Medicare beneficiaries or those enrolled in private health plans? Before answering that question, one should better understand the sources of this variation. Regional variation in spending can be due to variation in the utilization, variation in prices, or both. A paper by Philipson et al. (2010) [...]
Read the rest of this entry »Medicare Spending Growth 1992-2010
In addition to detailed work examining regional variation in Medicare spending between 2007 and 2009, I also conducted a study examining trends in regional variation in Medicare spending and quality between 1992 and 2010. The study was unique because: (i) it covers 19 years of data up to 2010, (ii) the data rely on 100% [...]
Read the rest of this entry »Geographic Variation in Health Care Spending and Promotion of High-Value Health Care: Preliminary Committee Observations
Last week I shared a report I wrote at Acumen that described regional variation in spending, utilization and quality for Medicare and Medicaid beneficiaries. Based on our work, an Institute of Medicine committee (lead by Joseph P. Newhouse, Alan Garber, and Robin P. Graham) reached the following conclusions in their newly released report: Health care [...]
Read the rest of this entry »Geographic Variation in Health Care Spending and Promotion of High-Value Care: Interim Report
The Healthcare Economist has a new report out for the Institute of Medicine. The report is co-authored with a number of outstanding individuals at Acumen including: Thomas MaCurdy, Jay Bhattacharya, Daniella Perlroth, Anita Au-Yeung, Hani Bashour, Camille Chicklis, Kennan Cronen, Brandy Lipton, Shahin Saneinejad, Elen Shrestha, and Sajid Zaidi. IOM summarizes the goals of the [...]
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