Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Medicaid/Medicare' Category

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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Do EHRs increase “upcoding”?

Upcoding occurs when physician or hospitals artificially increase the patient’s severity of illness. For instance, a hospital may record additional comorbidities. In Medicare’s inpatient prospective payment systems (IPPS), Medicare reimburses hospitals more for caring for patients who are sicker. Some health policy experts worry that electronic health records (EHRs) will decrease the cost of documenting […]

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Medicare Pricing Distortions and Patient Satisfaction

The cost of operating a physician practices differs across states.  For instance, rent is much higher in New York City than Nebraska.  Labor costs are much higher in Los Angeles than in La Crosse, Wisconsin.  To account for differences in the cost of operating a practice, Medicare adjusts reimbursement rates in their standard physician fee […]

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Is current hospice care inadequate?

In recent years, demand for palliative rather than interventionist end-of-life in hospices has grown dramatically. More than a million patients each year use hospice facilities. In fact, in some cases terminally patients live longer in hospice than in more intensive care settings. However, hospice are generally most attractive when they provide treatment if patients face […]

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Wisconsin’s Unique Medicaid Non-Expansion

The Supreme Court ruled that the Affordable Care Act was legal with one exception: the federal government could not require states to increase Medicaid eligibility. Although States were not required to make Medicaid eligibility more generous, the did have an incentive to do so. The federal government will pay 90% of the cost of enrolling […]

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Inpatient Psychiatric Facilities: Patient Population and Readmissions

The Affordable Care Act has required that CMS begin to address excess readmissions in short term acute care hospitals paid under the Inpatient Prospective Payment System (IPPS) through the Hospital Readmissions Reduction program.  This program requires CMS to reduce payments to IPPS hospitals with excessive readmissions for a set of three conditions—acute myocardial infarction (AMI), […]

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Are ACOs working?

Maybe. An press release from CMS is very upbeat on ACOs. What do the numbers say? Farzad Mostashari and Ross White review the CMS report and find that results were mixed: Of the 114 ACOs in the program, 54 of the ACOs saved money and 29 saved enough money to receive bonus payments. The 54 […]

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Too much competition?

Rarely due consumers think that too much competition is a problem.  According to the Centers for Medicare and Medicaid Services (CMS), however, this is a major issue for consumers when they choose Part D prescription drug health plans.  Avalere reports that: Proposed revisions to the meaningful differences policy will restrict the market’s top sponsors from […]

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