Unbiased Analysis of Today's Healthcare Issues
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)…
When you think of health care workers, many think of physicians, nurses and hospital administrators, who often make an above average salary. Not all health care workers, however, are well-paid and many even suffer from food insecurity according to a study by Srinivasan et al. (2021): Using nationally representative data from the period 2013–18, this…
That is the title from a study from Lee and Bagley (2011). They examine the potential impact of direct to consumer advertising (DTCA) and the impact of physicians decisions not to prescribe a patient-preferred drug on patient retention. A total of 818 of 2,988 participants in a national telephone survey (27.4%) who had received DTCA…
An interesting paper from Kevin Chiu in the Journal of Health Economics looks at the relationship between certificate of need laws and health outcomes: Certificate of need (CON) regulations requires that health care providers obtain state approval before offering a new service or expanding existing facilities. The purported goal of CON regulations is to reduce…
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…
No, this is not coming nation-wide, but it may be on its way in California. Kaiser Health News reports: A provision in California’s newly approved state budget will eliminate the asset test for the 2 million Californians enrolled in both Medi-Cal and Medicare, the federal health insurance program for people 65 and older and people…
I recently finished reading the book titled The Hospital: Life, Death and Dollars in a Small American Town by Brian Alexander. The premise of the book is very interesting. It takes a detailed look at a hospital in rural America, Bryan, Ohio to be specific. The book touches on the challenges a small-town hospital from…
Increasingly, integrated delivery networks (IDNs) are creating their own full-blown specialty pharmacies. Many are familiar with the integrated payer-provider model from groups such as Kaiser Permanente. However, other IDNs are getting into the game according to a recent white paper. Why are IDNs considering creating their own specialty pharmacies? Address patient access concerns. The number…
New regulation is making hospital prices available to patients. The Kaiser Family Foundation (KFF) reports: As of January 1 of this year, hospitals are required to post prices of common health services on their websites via consumer-friendly tools for patient use. Prior to implementation of this rule, hospitals were only required to publish their gross,…