Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Medicaid/Medicare' Category

Regulatory Tsunami?

Medicare is working hard to make sure that doctors are efficiently providing high-quality care. Programs such as the Physician Quality Reporting System (PRQS) and the Value-Based Payment Modifier all are aimed to improve quality and lower cost. The downside of such programs, however, is that the impose reporting burdens on physicians. For instance, Medicare can […]

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Reimbursement Rates and Quality

How do reimbursement rates affect quality?  One school of thought holds that decreased reimbursement decreases quality in the short-run and decreases innovation in the long-run.  Another school of thought believes that there is so  much inefficiency in the health care system, that reducing reimbursement rates will have no affect  on quality.  Which answer is correct? A study […]

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What can Geographic Variation in Health Care Spending Tell Us About Efficiency?

In a project with the Institute of Medicine (IOM), I examined the sources of regional variation in Medicare and Medicaid spending and spending growth. The IOM wisely concluded that policymakers should target decision-makerss rather than geography when attempting to improve the efficiency of the healthcare system. I recent paper by the Louise Sheniner of the […]

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Docs benefiting from Medicaid Expansions

PwC’s Health Research Institute reports that times are good if you are a safety net provider in a state that expanded Medicaid coverage: Physicians, hospitals and health systems operating in the 26 states and the District of Columbia that pursued the option to broaden Medicaid coverage with federal dollars have seen a significant rise in […]

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Why don’t payers adopt my technology?

Why don’t payers adopt innovative approaches to treat mental illness? For instance, crisis intervention programs, recovery-focused consumer education programs, telehealth programs, and on-line treatment programs have sometimes have had problems receiving reimbursement from payers. Monica Oss of OpenMinds takes the payers’ perspective: Often, the organization proposing the new program comes to the table with an […]

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Medicare Advantage Plans: Thumbs Up or Down?

Austin Frakt says although Medicare Advantage plans used to be considered high cost, low-quality options, in recent years, these Medicare Advantage plans have vastly increased quality of care and have become less focused on cream-skimming healthier patients.   Medicare Advantage plans — private plans that serve as alternatives to the traditional, public program for those […]

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How did Medicare pay for chemotherapy pre-2006?

A working paper by Jacobson et al. (2014) not only provides the answer, but describes how reimbursement policy change over the past decade. Although Medicare did not offer a drug benefit for oral drugs (pills) until 2006, Medicare Part B, which covers physician services, has from inception covered physician-administered drugs such as IV chemotherapy, anti-nausea, […]

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Disparities in Schizophrenia Care

Do African Americans and Latinos receive the same quality care as Caucasians?  This is the question asked by Horvitz-Lennon et al. (2014). Quality of Care Before one can answer this question, one first has to define what “quality care” means.  The authors use the following definition for pharmacological indicators: Any use of antipsychotic drugs, Conditional on […]

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Did Hospital VBP work?

How can Medicare improve quality and reduce cost? One idea is to introduce value-based purchasing (VBP). For instance, Medicare’s hospital value-based purchasing (HVBP) system increases payment rates for hospitals that demonstrate high quality. A paper by Ryan et al. (2014) explains the program in more detail. Under HVBP, acute care hospitals—those paid under Medicare’s Inpatient […]

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Was Newt Gingrich Right about Medicare?

In 1995, Newt Gingrich claimed that Medicare would end. He stated that “going to wither on the vine because we think people are voluntarily going to leave it — voluntarily.”  Was he right? In the one hand, Medicare total enrollment and spending is rising and the program still has widespread political support. On the other […]

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