Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Medicare' Category

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 […]

Read the rest of this entry »

‘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’ […]

Read the rest of this entry »

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 […]

Read the rest of this entry »

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 […]

Read the rest of this entry »

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. […]

Read the rest of this entry »

Medicare to Pay for Value

I have spilled much ink on this blog discussing the pros and cons of pay-for-performance approaches to medicine.  Incentivizing high quality care is good in theory, but in practice changes in quality have been modest and providers may be able to readily game the system.  Despite these challenges, Medicare announced this week that it would being  tying 30 […]

Read the rest of this entry »

Treating Dual Eligibles

The PBS Newshour has an interesting story on the treatment of the 9 million dual-eligible beneficiaries in the US.  They discuss integrated care model in California, Cal MediConnect.  

Read the rest of this entry »

Donuts and drugs

Medicare patients are likely to discontinue their medication in December. Why? Are they busy with the Christmas holidays? Do they have additional expenses for gifts and limited funds for prescription drugs? Perhaps. Another idea advanced by Kaplan and Zhang (2014) is that Medicare’s benefit structure encourages discontinuation. Why is that? Medicare’s Part D drug plan […]

Read the rest of this entry »

Regulatory Tsunami?

Medicare is working hard to make sure that doctors are efficiently providing high-quality care. Programs such as the Physician Quality Reporting System (PRQS) and the Value-Based Payment Modifier all are aimed to improve quality and lower cost. The downside of such programs, however, is that the impose reporting burdens on physicians. For instance, Medicare can […]

Read the rest of this entry »

Reimbursement Rates and Quality

How do reimbursement rates affect quality?  One school of thought holds that decreased reimbursement decreases quality in the short-run and decreases innovation in the long-run.  Another school of thought believes that there is so  much inefficiency in the health care system, that reducing reimbursement rates will have no affect  on quality.  Which answer is correct? A study […]

Read the rest of this entry »