Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Medicaid/Medicare' Category

Appropriate Use Criteria, or how I learned to love CMS telling doctors what to do

As part of Section 218(b) of the Protecting Access to Medicare Act, CMS instituted the appropriate use criteria (AUC) for the use of advanced diagnostic imaging.  In order to be reimbursed for these diagnostic imaging services, physicians must consult with and document that they used AUC software before recommending advanced diagnostic imaging.  Failing to document use […]

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Why Medicaid patient access to physicians is limited.

In short, the reason is that Medicaid reimbursement rates for providers is too low.  Saurabh Jha, however, explains the point a bit more artistically in his Health Care Blog piece. Medicaid pays a cardiologist, with years of training, $25-40 for a consultation to manage a complex patient with multiple comorbidities, on polypharmacy, where the cardiologist […]

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Medicare’s value-based purchasing fail?

Value-based payment is the latest hot topic.  One question remains, however, does it work?  Does paying for quality improve quality.  A study by Zuckerman et al. (2016) finds that the hospital readmissions reduction program (HRRP) did appear to reduce re-hospitalization rates among the targeted conditions. What about the hospital value-based purchasing program (HVBP).  Beginning in […]

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Will Better Care deliver better care?

The Senate’s new health care bill, the Better Care Reconciliation Act of 2017, proposes a number of changes to the Affordable Care Act.  The Kaiser Family Foundation has a detailed breakdown of the bill and compares it with the Affordable Care Act that President Obama passed and the American Health Care Act that was proposed […]

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Are bundled payments the solution? Five key barriers to implementation

Alternative payment models, bundled payment and episode-based payments are the latest trend in reducing unnecessary care and making sure care is delivered efficiently.  However, what is a “bundle”?  Based on a recent report from the Health Care Payment Learning and Action Network (HCP LAN), bundled payment can be designed at three levels: At the setting […]

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Will MACRA kill small physician practices?

Depending on the source, 34% to 59% percent of physicians are employed in practices of less than 10 physicians.  On the other hand, 39% of physicians are employed by hospitals.  How will these proportions change over time? An interesting paper by Casalino (2017) examines the impact of the  Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on […]

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Do Incentives for Healthy Behaviors Work? A Case Study of Medicaid in Iowa

One of the primary changes in the healthcare system directed by the Affordable Care Act was providing funding for states to expand Medicaid.  Many states did so; many others did not.  Some states expanded Medicaid but put additional hurdles in front of beneficiaries to receive this coverage at no cost.  Consider the case of the State of Iowa. […]

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Effect of Medicare Part D on Mortality

Huh and Reif (2017) have an interesting study of the effect of Medicare Part D on mortality.  The abstract is below. We investigate the implementation of Medicare Part D and estimate that this prescription drug benefit program reduced elderly mortality by 2.2% annually. This was driven primarily by a reduction in cardiovascular mortality, the leading cause of […]

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How does payment reform affect providers in competitive vs. non-competitive markets?

How does payment reform affect access to care?  And what does payment reform mean? Payment reform can mean manythings but in this context we will mean substituting fee-for-service or cost-plus reimbursement schemes for fixed reimbursement for a fixed episodes of care or fixed bundles of services during a specific time frame. One example of how payment reform worked, […]

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What is causing U.S. debt to explode?

According to the Congressional Budget Office’s (CBO’s) 2017 Long-Term Budget Outlook, you need to look no further than entitlements for the elderly. Mandatory programs have accounted for a rising share of the federal government’s noninterest spending over the past few decades, exceeding 60 percent for the past several years. Much of the growth has occurred because […]

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