Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Medicaid/Medicare' Category

What happens to CHIP?

The Children’s Health Insurance Program (CHIP) is a federal program that provides matching funds to states in order for them to provide health insurance to children.  The program was designed to cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid. Currently, however, the program is in jeopardy.  In fact, federal funding for […]

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Does the value-modifier improve quality and reduce health disparities?

In short, no.  That is the answer Roberts, Zaslavsky and McWilliams reach in their 2017 paper in Annals. Some background on the value modifier program.  In 2013, practices with 100 or more eligible clinicians were rewarded just from reporting quality measures. By 2014, however: Practices with 100 or more clinicians were subject to upward, downward, […]

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Will MIPS work?

CMS in the past was on a value-based binge. They aimed to reward physicians based on quality of care (PQRS), based on cost (a component in the value modifier), based on use of EHR (meaningful use bonuses).  However, this imposed a large reporting bonus on physicians, pulling them away from patient care.  To solve the […]

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The problem of cutting Medicaid rates

A new paper by Sharma et al. (2017) finds that Medicaid patients living in states with lower Medicaid reimbursement have more challenges accessing primary care services. We found that states with higher Medicaid fees had higher probabilities of appointment offers and shorter wait times for Medicaid patients, and lower probabilities of appointment offers and longer […]

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The cost of cancer care: Examining four common cancers

An interesting study by Chen et al. (2017) examines the cost of cancer care among Medicare patients.  Using SEER-Medicare data of people diagnosed with cancer between 2007 and 2011, they found: Over the year of diagnosis, mean per-patient annual Medicare spending varied substantially by cancer type: $35,849 for breast cancer, $26,295 for prostate cancer, $55,597 […]

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The market works!

In 2011, CMS created a demonstration to have competitive bidding for durable medical equipment (DME).   Prior to the implementation of this program, CMS used an administrative fee schedule, similar to how physicians are currently reimbursed.  How did this market-based solution fare?  A paper by Newman, Barrette, and McGraves-Lloyd (2017) answers this question. We compared […]

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Should we put an end to Medicare Advantage?

Austin Frakt of the Incidental Economist argues convincingly–and I agree with him–that the answer is no. Medicare Advantage plans have been found to be of higher quality than traditional Medicare. They also reduce wasteful use of health care by managing care, something the traditional program doesn’t do at all. Finally, they fill in gaps in coverage and […]

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Can Medicaid beneficiaries access primary care providers?

In general the answer is yes, but often with some difficulty.  AJMC recaps the findings from a the CDC Morbidity and Mortality Weekly Report (MMWR) Quick Stats section from July 21, 2017. 88.9% of primary care physicians said they are accepting new patients, based on 2015 data from the National Electronic Health Records Survey. However, […]

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How many people don’t have any health insurance options

Much of the news has claimed that the Affordable Care Act is a failure because individuals in many counties have few or even no health insurance options.  However, how many counties truly will have zero Obamacare exchange insurance options in 2018 ? The Kaiser Family Foundation reports that there are only 17 counties covering 9,595 […]

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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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