Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Medicare' Category

Did Medicare Part D reduce emergency room visits?

In 2006, the Medicare program was expanded to include prescription drug coverage through the Part D program. Previous studies have found that Medicare Part D improved prescription drug coverage rates among seniors (Levy and Weir,2010), increased medication utilization (Duggan and Morton, 2010), decreased out-of-pocket spending (Engelhardt and Gruber, 2011; Ketcham and Simon, 2008), and reduced medication […]

Read the rest of this entry »

Changes in the MSSP program

Medicare’s ACO program–the Medicare Shared Savings Plan (MSSP)–has recently been revised.  AJMC reports that Patrick Conway, MD, MSc, deputy administrator for innovation and quality and chief medical officer at CMS, describes the proposed changes to the Medicare Shared Savings Program and how they will assist accountable care organizations transitioning to tracks with more risks.

Read the rest of this entry »

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 […]

Read the rest of this entry »

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 […]

Read the rest of this entry »

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 […]

Read the rest of this entry »

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 […]

Read the rest of this entry »

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 […]

Read the rest of this entry »

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 […]

Read the rest of this entry »

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 […]

Read the rest of this entry »

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. […]

Read the rest of this entry »