Unbiased Analysis of Today's Healthcare Issues

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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AMA wants more money for docs

File under “least shocking development of the day”: The American Medical Association opposes cuts to physician salaries. In a letter on Monday, the AMA stated that it expreses: …strong support for the “SGR Repeal and Medicare Provider Payment Modernization Act of 2014” (H.R. 4015/S. 2000)…Previous Congresses have spent more than $150 billion over the past […]

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History of Medicare Home Health Payments

Medicare pays home health agencies (HHAs) to care for patients who cannot care for themselves in their own homes.  HHAs, however, have experienced significant changes in the way Medicare pays them over the past 30 years.  A recent paper by Huckfeldt et al. (2014) summarizes these changes: 1983: Medicare switches to an inpatient prospective payment […]

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The End of Hospital Cost Shifting?

Medicare is cutting reimbursement to hospitals.  Austin Frakt (HSR 2013) gives some highlights findings from a CMS report: [The ACA] will permanently reduce the Medicare payments hospitals would otherwise receive. Its ‘productivity adjustment’ will scale payments downward by the average rate at which private nonfarm businesses’ productivity increases. That rate has been estimated to be […]

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Doc Fix: 2014 Edition

It’s that time of year.  The time of year where Medicare threatens to cut physician salaries by double digits (in this case 24.4%).  This is no idle threat.  Under current law, CMS is mandated to cut physician salaries under the sustainable growth rate formula.   Its the time of year that physician lobbyists (rightly) complain that […]

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Walmart is the low-price leader

…at least when it comes to prescription drugs.  Health Pocket reports that the lowest cost Part D plan is the Humana/Walmart RX plan which charges a monthly premium of $12.60.  In 2013, AARP MedicareRX Saver Plus from UnitedHealthcare was the lowest cost plan and charged a premium of $15.  In 2014, however, the monthly premium […]

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Medicare: Expert vs. Public Opinion

A great article from NEJM summarizes the differences on the problems Medicare faces as seen by experts and the public.  This press release summarizes the results. One reason that many Americans believe Medicare does not contribute to the deficit is that the majority thinks Medicare recipients pay or have prepaid the cost of their health […]

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Increased prescription drug use reduces spending on medical services

Increased use of prescription drugs could either increase or decrease spending on medical services.  On the one hand, increased use of pharmaceuticals could decrease hospitalizations and ER visits if pharmaceuticals are able to help patients control chronic conditions and prevent the onset of incidents requiring acute care.  On the other hand, increased use of pharmaceuticals […]

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The Unintended Consequences of P4P

Pay-for-performance (P4P) may be better at improving documentation of outcomes rather than actually improving outcomes.  Farmer, Black and Bonow give the following example: Beginning in the fourth quarter of 2008, [CMS] ceased to reimburse for costs due to selected preventable adverse events, including patient safety indicator 5 (PSI-5) (leaving a foreign object in the body […]

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