Unbiased Analysis of Today's Healthcare Issues
Since its inception in 2006, Medicare Part D beneficiaries had to contend with the dreaded “doughnut hole”. The “doughnut hole” is a coverage gap during which patients were required to pay 100% of treatment cost. To help defray some of these costs, the Patient Protection and Affordable Care Act (ACA) implemented provisions to reduce the…
According to a paper by Rodriguez et al. (2022), the answer is ‘yes’. They use data from the 2017–18 National Survey of Healthcare Organizations and Systems (NSHOS), to determine if a physician practice has a “robust set of care management capabilities.” The specific capabilities that were used to determine whether the health system was robust…
Medicare pays higher reimbursement to teaching hospitals through indirect medical education (IME) payments to hospitals that train a high share of residents. IME inflate standard reimbursements in an attempt to compensate hospitals for these additional costs. Medicare also pay hospitals directly for some cost of training residents through the graduate medical education (GME). A key…
While generic drugs frequently replace their branded counterparts after the latter lose their market exclusivity, the uptake of biosimilar products is often slower. Further, biosimilars are relatively more expensive compared to generic small molecule drugs. A key question then is how much could payers save by switching to biosimilars after loss of exclusivity. The is…
The answer is ‘yes’, but the magnitude of these savings are relatively small and more than offset by additional OCM program costs. Keating et al. (2021) writes: In this exploratory difference-in-differences study of Medicare fee-for-service beneficiaries with cancer undergoing chemotherapy (483 310 beneficiaries with 987 332 episodes treated at 201 OCM participating practices and 557 354 beneficiaries with…
A Health Affairs article (Meyer 2021) discusses the potential benefits of Medicare Diabetes Prevention Programs (MDPP). MDPP aims to reduce patient weight and prevent patients from becoming diabetic. Commenting on her Medicare clientele enrolled in the program, one instructor noted: “I’ve seen a lot of Medicare people do really well with the program because they…
If you are on Medicare, how much will you pay for insulin? The answer is in the graph below (via MedPAC’s Payment Basics) Seem confusing? Well it is. Medicare Part D beneficiaries have a deductible, then the standard coverage phase with 25% cost sharing, then a coverage gap where beneficiaries pay 25% of cost (manufacturers…
Created by Section 3021 of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Innovation (CMMI; aka The CMS Innovation Center) has been tasked with creating new reimbursement strategies to improve quality and decrease costs. Over the past decade, CMMI has tested over 50 new payment models, and in just the last 3…
The Government Accountability Office (GAO) last week published a report evaluating the Merit-based Incentive Payment System (MIPS). MIPS is an approach for CMS to pay physicians caring for Medicare beneficiaries based not just on volume but on value. MIPS evaluates provider value along four dimensions: (1) quality, (2) improvement activities, (3) promoting interoperability, and (4)…
The 2021 Medicare Trustees Report–formerly known as the “Annual Report of the Boards of Trustees of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund“–had some grim news. Expenditures ($925.8 billion) exceeded revenues ($899.9 billion) in 2020. More worrying, the estimated depletion date for the Medicare (i.e., Hospital Insurance) trust…