Unbiased Analysis of Today's Healthcare Issues
Performance-based risk sharing (PBRS) have grown in importance in recent years. While most PBRS are used for expensive pharmaceutical products, PBRS also have been used with medical device and diagnostic manufacturers. Device/diagnostic PBRS may differ from those of pharmaceuticals for a number of reasons. First, while health insurers bear the burden of paying for most…
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…
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…
In the provider space, alternative payment models are increasingly common. These models aim to pay more money when providers improve quality and lower total cost and pay providers less when quality is suboptimal or total cost rise. Because there is significant uncertainty in quality of care and variability across providers, value-based purchasing is sensible in…
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…
That is the question posted by Ganguli et al. (2021). The define low value care as one of 41 specific services. They then use data across 556 health systems serving more than 11m beneficiaries to answer this question. Which types of low value care are most commonly used? The most common low-value services were preoperative…
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)…
In 2008, the Centers for Medicare & Medicaid Services (CMS) implemented the Hospital-Acquired Conditions Present on Admission (HAC-POA) program. The goal of this program was to reduce the frequency of high-cost complications among Medicare beneficiaries. The mandatory program penalized hospitals as it would no longer reimburse them for treating of preventable complications that developed during…
For years, Medicare and other payers have used quality measures to evaluate the quality of care patients receive at various types of providers settings (e.g., hospital, home health agencies, skilled nursing homes). For some payers, higher quality scores/higher star ratings lead to direct increases in reimbursement through a value-based purchasing arrangement. Typically, value-based payment systems…
In 2021, CMS expects to operate 12 alternative payment models (APMs) offering 25 distinct tracks for providers to choose from that involve different payment options and risk arrangement… providers serving about 20 percent of Medicare beneficiaries participate in this APM That is a quote from a June 2021 MedPAC report on CMS APM’s serving Medicare…