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Archive for the 'Medicare' Category

What is Comprehensive Care for Joint Replacement?

Bundled Payments for Care Improvement (BPCI)A helpful post from Steven A. Farmer, Meaghan George and Mark B. McClellan explains.  Comprehensive Care for Joint Replacement (CCJR) is a bundled payment structure for hip and knee replacements.  CMS notes that: 2013, there were more than 400,000 inpatient primary procedures in Medicare, costing more than $7 billion for hospitalization alone. […]

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The problems of administrative billing

J.K. Wall provides an apt analogy at The Health Care Blog of why hospital billing is so confusing:   If McDonald’s operated like a hospital, when you ordered a Happy Meal with a burger, fries and drink, you would be charged a separate price for the meat, bun, cheese, pickle, mayo and paper wrapper, the […]

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Is Medicare no longer a budget buster?

Not entirely, but the 2015 Medicare Trustees report is certainly more optimistic than in the past. Brookings reports: The Trustees have dramatically lowered their projections of long-run Medicare expenditure growth. In 2009, for example, the Trustees projected that Medicare spending would reach 11.2 percent of GDP by 2080—compared with just 6 percent in this year’s […]

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Depression Among the Elderly & Medicare Part D

How did the enactment of Medicare Part D affect the mental health of the elderly? This is the question Ayyagari and Shane attempt to answer in their recent JHE paper. The authors use data from the Health and Retirement Study (HRS) between 2010 and 2010 to measure changes in depressive symptoms among patients aged 60-70. […]

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Medicare Advantage vs. FFS

Austin Frakt summarizes some recent research presented at AcademyHealth. There are three principle MA plan types: HMOs, PPOs, and private fee for service (PFFS) plans. It’s HMOs that are lowest in cost, because they tend to offer the most restrictive networks. As Biles et al. report, based on 2012 data, HMOs have costs 7 percent […]

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What is MIPS?

Yesterday I posted about MIPS, the new Medicare physician reimbursement program set to begin in 2019.  The Health Affairs blog provides a nice summary of some of the changes. First and probably most importantly, the formulaic approach to setting base payment rates is gone, replaced with automatic increases for all doctors from 2015 through 2019. For […]

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‘Doc fix’ fixed?

This may be the case.  Fox News reports: The Senate overwhelmingly passed legislation permanently overhauling how Medicare pays physicians late Tuesday in a rare show of near-unanimity from Congress. The legislation headed off a 21 percent cut in doctors’ Medicare fees that would have taken effect Wednesday, when the government planned to begin processing physicians’ […]

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The Next Generation ACO

Medicare currently has two Accountable Care Organizations (ACOs)–the more popular Medicare Shared Savings Program (MSSP) and the Pioneer ACO program. However, these ACOs have generated only limited cost savings. Only 11 of 23 Pioneer ACOs and 58 of 220 MSSP participants generated cost savings. To address some provider concerns and due to the limited cost […]

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Regional Growth in Medicare Spending, 1992–2010

Below is an abstract from a paper I co-wrote with Camille Chicklis, Thomas MaCurdy, Jay Bhattacharya, and Dan Rodgers.  The title of the paper is Regional Growth in Medicare Spending, 1992–2010. Objective: To determine if regions with high Medicare expenditures in a given setting remain high cost over time. Data Sources/Study Setting: One hundred percent of national Medicare Parts […]

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What’s wrong with the SGR?

Why are doctor’s always complaining about the sustainable growth rate (SGR) issue? What is the SGR? The Brookings blog has a nice primer on the SGR. What is the SGR Put in place through the Balanced Budget Act of 1997, the SGR is a system designed to control the costs of Medicare payments for physicians. […]

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