Unbiased Analysis of Today's Healthcare Issues

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. […]

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The problems of administrative billing

J.K. Wall provides an apt analogy at The Health Care Blog of why hospital billing is so confusing:   If McDonald’s operated like a hospital, when you ordered a Happy Meal with a burger, fries and drink, you would be charged a separate price for the meat, bun, cheese, pickle, mayo and paper wrapper, the […]

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Is Medicare no longer a budget buster?

Not entirely, but the 2015 Medicare Trustees report is certainly more optimistic than in the past. Brookings reports: The Trustees have dramatically lowered their projections of long-run Medicare expenditure growth. In 2009, for example, the Trustees projected that Medicare spending would reach 11.2 percent of GDP by 2080—compared with just 6 percent in this year’s […]

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What is they key driver of cancer care spending?

High-cost cancer drugs often get bad press. Cancer treatment certainly is expensive. However, drug costs are not the primary driver of high cost of cancer treatment; hospitalizations are. Using data from SEER-Medicare, Brooks et al. (2014) examine regional variation in the cost of cancer care and find: Acute hospital care was the largest component of […]

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Depression Among the Elderly & Medicare Part D

How did the enactment of Medicare Part D affect the mental health of the elderly? This is the question Ayyagari and Shane attempt to answer in their recent JHE paper. The authors use data from the Health and Retirement Study (HRS) between 2010 and 2010 to measure changes in depressive symptoms among patients aged 60-70. […]

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Medicare Advantage vs. FFS

Austin Frakt summarizes some recent research presented at AcademyHealth. There are three principle MA plan types: HMOs, PPOs, and private fee for service (PFFS) plans. It’s HMOs that are lowest in cost, because they tend to offer the most restrictive networks. As Biles et al. report, based on 2012 data, HMOs have costs 7 percent […]

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Medicare starts using prior authorization

Included within the many changes to physician payment in HR2, is one provision that may surprise people; a subset of Medicare physicians will be required to receive prior authorization to conduct imaging services. Beginning with 2017, and in consultation with stakeholders, the Secretary will identify ordering professionals with low adherence to applicable [appropriate use criteria] […]

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‘Doc fix’ fixed?

This may be the case.  Fox News reports: The Senate overwhelmingly passed legislation permanently overhauling how Medicare pays physicians late Tuesday in a rare show of near-unanimity from Congress. The legislation headed off a 21 percent cut in doctors’ Medicare fees that would have taken effect Wednesday, when the government planned to begin processing physicians’ […]

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Fixing the “doc fix”

The sustainable growth rate (SGR) was implemented by Congress in1998.  The SGR’s aim was to slowly bring down or at least decellerate Medicare compensation for physicians compensation.  However, each year, it gets reversed by Congress. Now, instead of a gradual decline, the implementation of SGR would  result in about at 25%pay cut for Medicare docs. […]

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The Next Generation ACO

Medicare currently has two Accountable Care Organizations (ACOs)–the more popular Medicare Shared Savings Program (MSSP) and the Pioneer ACO program. However, these ACOs have generated only limited cost savings. Only 11 of 23 Pioneer ACOs and 58 of 220 MSSP participants generated cost savings. To address some provider concerns and due to the limited cost […]

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