Unbiased Analysis of Today's Healthcare Issues

Regulatory Tsunami?

Medicare is working hard to make sure that doctors are efficiently providing high-quality care. Programs such as the Physician Quality Reporting System (PRQS) and the Value-Based Payment Modifier all are aimed to improve quality and lower cost. The downside of such programs, however, is that the impose reporting burdens on physicians. For instance, Medicare can […]

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Reimbursement Rates and Quality

How do reimbursement rates affect quality?  One school of thought holds that decreased reimbursement decreases quality in the short-run and decreases innovation in the long-run.  Another school of thought believes that there is so  much inefficiency in the health care system, that reducing reimbursement rates will have no affect  on quality.  Which answer is correct? A study […]

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Medicare Advantage Plans: Thumbs Up or Down?

Austin Frakt says although Medicare Advantage plans used to be considered high cost, low-quality options, in recent years, these Medicare Advantage plans have vastly increased quality of care and have become less focused on cream-skimming healthier patients.   Medicare Advantage plans — private plans that serve as alternatives to the traditional, public program for those […]

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How did Medicare pay for chemotherapy pre-2006?

A working paper by Jacobson et al. (2014) not only provides the answer, but describes how reimbursement policy change over the past decade. Although Medicare did not offer a drug benefit for oral drugs (pills) until 2006, Medicare Part B, which covers physician services, has from inception covered physician-administered drugs such as IV chemotherapy, anti-nausea, […]

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Did Hospital VBP work?

How can Medicare improve quality and reduce cost? One idea is to introduce value-based purchasing (VBP). For instance, Medicare’s hospital value-based purchasing (HVBP) system increases payment rates for hospitals that demonstrate high quality. A paper by Ryan et al. (2014) explains the program in more detail. Under HVBP, acute care hospitals—those paid under Medicare’s Inpatient […]

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Was Newt Gingrich Right about Medicare?

In 1995, Newt Gingrich claimed that Medicare would end. He stated that “going to wither on the vine because we think people are voluntarily going to leave it — voluntarily.”  Was he right? In the one hand, Medicare total enrollment and spending is rising and the program still has widespread political support. On the other […]

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Do EHRs increase “upcoding”?

Upcoding occurs when physician or hospitals artificially increase the patient’s severity of illness. For instance, a hospital may record additional comorbidities. In Medicare’s inpatient prospective payment systems (IPPS), Medicare reimburses hospitals more for caring for patients who are sicker. Some health policy experts worry that electronic health records (EHRs) will decrease the cost of documenting […]

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Medicare Pricing Distortions and Patient Satisfaction

The cost of operating a physician practices differs across states.  For instance, rent is much higher in New York City than Nebraska.  Labor costs are much higher in Los Angeles than in La Crosse, Wisconsin.  To account for differences in the cost of operating a practice, Medicare adjusts reimbursement rates in their standard physician fee […]

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Inpatient Psychiatric Facilities: Patient Population and Readmissions

The Affordable Care Act has required that CMS begin to address excess readmissions in short term acute care hospitals paid under the Inpatient Prospective Payment System (IPPS) through the Hospital Readmissions Reduction program.  This program requires CMS to reduce payments to IPPS hospitals with excessive readmissions for a set of three conditions—acute myocardial infarction (AMI), […]

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Too much competition?

Rarely due consumers think that too much competition is a problem.  According to the Centers for Medicare and Medicaid Services (CMS), however, this is a major issue for consumers when they choose Part D prescription drug health plans.  Avalere reports that: Proposed revisions to the meaningful differences policy will restrict the market’s top sponsors from […]

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