Unbiased Analysis of Today's Healthcare Issues

The value of surrogate endpoints for predicting real-world survival across five cancer types

You can find one of my recent papers measuring how well survival measures from clinical trials (i.e., overall survival, progression free survival, time to progression) translate into real-world survival outcomes in Current Medical Research and Opinion here.  The abstract is below.   Objective It is unclear how well different outcome measures in randomized controlled trials (RCTs) perform in […]

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Who pays for the elderly’s medical care in the U.S.?

In the U.S., the answer is largely the government.  An NBER paper by Mariacristina De Nardi, Eric French, John Bailey Jones, and Jeremy McCauley provide some helpful statistics using data from 1996 to 2010 waves of the Medicare Current Beneficiary Survey (MCBS). The government pays for two-thirds of health care spending by the elderly, with Medicare […]

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2016 ASSA: How does consumer inattention affect pricing?

Why do Medicare patients choose to stay in their current Part D prescription drug plan or switch to another? Are they rational actors maximizing their their financial benefit or do other factors play a role. A paper by Kate Ho and co-authors (NBER WP version) presented at the 2016 ASSA meetings find the switch rates […]

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Reforming Medicare Provider Payment

With the ACA and now MARCA, Congress is moving full steam ahead with payment reform. An article by Paul Ginsburg and Gail Wilensky (2015) consider some of the implications of these reform efforts. This belief – that a set of metrics can be developed or delivery systems specified that could lead to the delivery of […]

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Who is participating in BPCI?

In 2013, Medicare launched the Bundled Payments for Care Improvement (BPCI) initiative.  There were 4 models included in the program: Model 1 (least comprehensive): includes Part A services for the index hospitalization alone, and thus most closely resembles current fee-for-service payment. Model 2 (most comprehensive): encompasses Part A and Part B services for the index hospitalization, readmissions, and all other post […]

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Why Medicare Advantage is thriving

In the 1990s, managed care began to take over the health care marketplace. However, backlash against managed care lead to a retrenchment in managed care in the late 1990s.  A paper by Sinaiko and Zeckhauser (2015) notes that: After the MA-plan payment cuts imposed through the Balanced Budget Act of 1997, HMO availability dropped by nearly […]

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What is MACRA?

MACRA is the Medicare Access & CHIP Reauthorization Act, also know colloquially as the ‘permanent doc fix’.  Although MACRA is know for repealing the Sustainable Growth Rate (SGR) provisions that would have significantly cut physicians salaries (but was reversed every December), there are other provisions. Although physicians may take comfort in avoiding the year end doc […]

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Over half of federal spending on entitlements

Here’s a graphic from the NIHCM foundation summarizing where federal revenues come in an where they are spent.  As you can see about one quarter of the budget is spent on  Medicare, Medicaid, CHIP and ACA Subsidies and another quarter is spent on Social Security.  This is not news if you have been reading the Healthcare Economist diligently […]

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Increased access to CMS data

The Research Data Assistance Center (ResDAC) has announced that individuals and firms will now be able to get access to more CMS data.  They describe their “Innovator Research” program as follows: Innovators and entrepreneurs may now access CMS data as part of a research study to create products or tools that they intend to sell […]

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2015 Medicare Advantage Enrollment

About two-thirds of Medicare beneficiaires are enrolled in tradiational Medicare FFS, but the remaining thrid is now enrollingin Medicare Advantage plans.  Which plans are dominant? The following figure from Avalere provides a breakdown. Note that this figure obscures significant regional variation in plan market share. For instance, Kaiser Permanente has almost half (48%) of the […]

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