Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Medicare' Category

Medicare in the data analysis business?

From a recent N.Y. Times article on Vice President Joe Biden’s cancer “moonshoot”: The researchers pointed out that although genome sequencing seems to be rapidly transforming cancer research, a tiny fraction of cancer patients are having their tumors sequenced because most insurers, including Medicare, will not pay for the procedure. For a start, the group told […]

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2016 ASSA: Effect of guaranteed issue and community rating on health insurance premiums

How should insurance be regulated? Should insurance plans be able to price premiums based on health conditions? The drawbacks of this approach is that it is not equitable as sicker patients will pay higher premiums. Should all people pay the same cost? Although more equitable, using a single price would incentivize healthy people to avoid […]

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2016 ASSA: How does consumer inattention affect pricing?

Why do Medicare patients choose to stay in their current Part D prescription drug plan or switch to another? Are they rational actors maximizing their their financial benefit or do other factors play a role. A paper by Kate Ho and co-authors (NBER WP version) presented at the 2016 ASSA meetings find the switch rates […]

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Reforming Medicare Provider Payment

With the ACA and now MARCA, Congress is moving full steam ahead with payment reform. An article by Paul Ginsburg and Gail Wilensky (2015) consider some of the implications of these reform efforts. This belief – that a set of metrics can be developed or delivery systems specified that could lead to the delivery of […]

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Who is participating in BPCI?

In 2013, Medicare launched the Bundled Payments for Care Improvement (BPCI) initiative.  There were 4 models included in the program: Model 1 (least comprehensive): includes Part A services for the index hospitalization alone, and thus most closely resembles current fee-for-service payment. Model 2 (most comprehensive): encompasses Part A and Part B services for the index hospitalization, readmissions, and all other post […]

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What is MACRA?

MACRA is the Medicare Access & CHIP Reauthorization Act, also know colloquially as the ‘permanent doc fix’.  Although MACRA is know for repealing the Sustainable Growth Rate (SGR) provisions that would have significantly cut physicians salaries (but was reversed every December), there are other provisions. Although physicians may take comfort in avoiding the year end doc […]

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Increased access to CMS data

The Research Data Assistance Center (ResDAC) has announced that individuals and firms will now be able to get access to more CMS data.  They describe their “Innovator Research” program as follows: Innovators and entrepreneurs may now access CMS data as part of a research study to create products or tools that they intend to sell […]

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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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