Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Supply of Medical Services' Category

The market works!

In 2011, CMS created a demonstration to have competitive bidding for durable medical equipment (DME).   Prior to the implementation of this program, CMS used an administrative fee schedule, similar to how physicians are currently reimbursed.  How did this market-based solution fare?  A paper by Newman, Barrette, and McGraves-Lloyd (2017) answers this question. We compared […]

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Medicare’s value-based purchasing fail?

Value-based payment is the latest hot topic.  One question remains, however, does it work?  Does paying for quality improve quality.  A study by Zuckerman et al. (2016) finds that the hospital readmissions reduction program (HRRP) did appear to reduce re-hospitalization rates among the targeted conditions. What about the hospital value-based purchasing program (HVBP).  Beginning in […]

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Does more spending improve outcomes?

A number of studies have claimed that increased health expenditures may result in no better, or even worse outcomes.  For instance, a paper by Fisher et al. (2003) looking at patients with acute myocardial infarction, colorectal cancer, or hip fracture finds that “Quality of care in higher-spending regions was no better on most measures and […]

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Will MACRA kill small physician practices?

Depending on the source, 34% to 59% percent of physicians are employed in practices of less than 10 physicians.  On the other hand, 39% of physicians are employed by hospitals.  How will these proportions change over time? An interesting paper by Casalino (2017) examines the impact of the  Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on […]

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How does payment reform affect providers in competitive vs. non-competitive markets?

How does payment reform affect access to care?  And what does payment reform mean? Payment reform can mean manythings but in this context we will mean substituting fee-for-service or cost-plus reimbursement schemes for fixed reimbursement for a fixed episodes of care or fixed bundles of services during a specific time frame. One example of how payment reform worked, […]

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Hospital of the future

The Economist‘s recent article “Prescription for the future” describes some new trends in health care treatment and predicts what the hospital of the future will look like.  Some excerpts are below: When I think of the hospital of the future, I think of a bunch of people sitting in a room full of screens and phones,” […]

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The kindly physician or the profit maximizer?

In the U.S. physician fees are largely set through regulation or negotiation with insurers. For physicians accepting Medicare or Medicaid patients, fees are set by government entities (i.e., the Centers for Medicare and Medicaid Services for Medicare reimbursement for the former and state Medicaid agencies for the latter). Rates for physicians accepting patients with private […]

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Supply side health reform

Alex Tabarrok of Marginal Revolution notes that designing a health care system that focuses on benefits to consumers and is important, but one should not ignore how any health care system design affects the supply of health care, in particular incentives to create innovative goods and services. By greater spending on medical research, I mean not […]

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Immigrant Physicians

Interesting facts from Alex Tabarrok of Marginal Revolution: One percent of all the physicians in the United States come from the six countries targeted in Donald Trump’s new Executive Order. I found that a surprisingly high number. According to the Immigrant Doctors Project, those 7000 physicians provide 14 million doctors’ appointments each year and many of them […]

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Did the ACA cause industry consolidation?

The Affordable Care Act (ACA)–among other things–mandated a number of reforms to the Medicare reimbursement system.  For instance, the ACA created Accountable Care Organizations (ACOs) and bundled payment initiatives were initiatives.  If Medicare started paying providers more based on quality and total cost of care across all provider settings, one would hypothesize that industry consolidation would accelerate. […]

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