Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Medicare' Category

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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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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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 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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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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Innovative Cancer Care models

What does CMS consider to be innovative oncology care?  The following three programs won a CMS Health Care Innovation Award for their initiative. Community Oncology Medical Home (COME HOME).  This model relied on three key principles: (i) triage pathways to help first responders and nurses identify and manage patient symptoms; (ii) enhanced access to care through […]

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