Unbiased Analysis of Today's Healthcare Issues

Innovative Cancer Care models

What does CMS consider to be innovative oncology care?  The following three programs won a CMS Health Care Innovation Award for their initiative. Community Oncology Medical Home (COME HOME).  This model relied on three key principles: (i) triage pathways to help first responders and nurses identify and manage patient symptoms; (ii) enhanced access to care through […]

Read the rest of this entry »

Will federal government spending be captured by the elderly?

According to a January 2017 report from the Congressional Budget Office (CBO), spending on entitlement programs for the elderly is the primary factor driving increased budget deficets over the next 10 years.  The CBO states: Outlays rise faster than revenues—by about 5 percent a year, on average—increasing from 20.7 percent of GDP in 2017 to […]

Read the rest of this entry »

Did BPCI work?

BPCI is Medicare’s Bundled Payments for Care Improvement initiative.  For selected conditions, hospitals receive bundled payments that can include concurrent physician payments, post acute-care or other arrangements. The question is, does this payment approach improve quality and reduce cost? A study by Dummit et al. (2016) looked at lower extremity joint replacement at a BPCI-participating hospital.  They found the […]

Read the rest of this entry »

The coming U.S. debt crisis

The Congressional Budget Office provides some gloomy news on the fiscal health of the federal government in their recent 2016 Long Term Budget Outlook.  They state: If current laws governing taxes and spending did not change, the United States would face steadily increasing federal budget deficits and debt over the next 30 years, according to projections […]

Read the rest of this entry »

Do ACOs reduce spending?

Medicare’s Shared Savings Program (MSSP) is a program that created accountable care organizations (ACOs).  Providers in get bonuses if they are able to reduce health care costs and also maintain quality.  In theory, the program makes sense, increase reimbursement for high-quality, low-cost providers.  The key question, however, is whether it works. A recent study in NEJM […]

Read the rest of this entry »

“Adjustments” drive variation in Medicare hospital reimbursement rates

In my previous work, I have examined regional variation in Medicare and Medicaid costs through reports to the Institute of Medicine and publications in peer-reviewed journals.  We found significant variation in health care costs across regions, that high-cost regions tended to remain high cost over time, but that a region that is high-cost for treating one medical condition […]

Read the rest of this entry »

Impact of Medicare Advantage on Hospital Admissions

Do patients who enroll in Medicare Advantage go to the hospital less frequently? The answer is yes. However, this fact may not be causal. Patients who enroll in Medicare Advantage are generally younger and healthier than patients who enroll in Medicare’s fee-for-service (FFS) program. A paper by Duggan, Gruber and Vabson (2016) uses a novel […]

Read the rest of this entry »

Part B drug reimbursement

In the past Medicare has reimbursed physicians that administer Part B drugs–typically injectable medications administered in a physician’s office–at 6% of the drug’s cost.  The 6% aims to cover the cost of purchasing and storing the drug as well as administering it.  Because physician reimbursement is proportional to the cost of the drug, physicians have […]

Read the rest of this entry »

Managing post-acute care cost

Medicare’s move towards bundling payment for acute and post-acute care means that hospitals have an incentive to carefully monitor care received after discharge.  But what are the key drivers of post-acute care cost: hospital readmissions? use of any post-acute care? type of post-acute care used? A paper by Huckfeldt et al. (2016) examines Medicare claims data […]

Read the rest of this entry »

Health care spending a key driver of future budget deficets

The Congressional Budget Office (CBO) released its 2016 10-year budget projections last month and the numbers do not look good.  CBO estimates that the 2016 federal budget deficit will be more than half a trillion dollars ($544 billion), which will cause the total level of federal government debt to increase to 76% of GDP. How […]

Read the rest of this entry »