Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Medicaid/Medicare' Category

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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Use of Medicaid in old age

Many health care wonks know that Medicaid covers long-term care for poor elderly individuals.  However, the impact of Medicaid among the elderly may be underappreciated.  As a paper by Di Nardi, French and Jones, finds: Among respondents in the lowest quintile of lifetime income, nearly seventy percent are receiving Medicaid at age 74. Medicaid use […]

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AMA wants more money for docs

File under “least shocking development of the day”: The American Medical Association opposes cuts to physician salaries. In a letter on Monday, the AMA stated that it expreses: …strong support for the “SGR Repeal and Medicare Provider Payment Modernization Act of 2014” (H.R. 4015/S. 2000)…Previous Congresses have spent more than $150 billion over the past […]

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