Posts Tagged “Medicare”
ShowHide 3rd Party PapersCMS Innovation: Bundled Payments for Care Improvement
National Center for Policy Analysis: The new health care law enacted last spring will be devastating for the elderly and the disabled because of draconian cuts in payments to doctors and hospitals
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MedPAC Annual Report, Part III
by Kevin Roche on Thursday, April 18, 2013
In this post, we look at MedPAC’s recommendations in regard to Medicare Advantage, Special Needs Plans and Part D.
Tags: Medicare
MedPAC Annual Report, Part II
by Kevin Roche on Wednesday, April 17, 2013
In today’s post on the MedPAC Annual Report to Congress, we cover payment observations and recommendations on several provider types, including physicians, home health and nursing homes.
Tags: Medicare
2013 MedPAC Report to Congress, Part I
by Kevin Roche on Tuesday, April 16, 2013
This is the first of several posts on the Medicare Payment Advisory Commissions 2013 Annual Report to Congress, which covers a variety of provider types and other issues. In this post we cover the introduction and some of the specific provider payment recommendations in regard to hospitals.
GAO on Medicare Advantage Payments
by Kevin Roche on Thursday, March 14, 2013
Adding to the controversy about Medicare Advantage payments, a Government Accounting Office report suggests that diagnoses coding excesses may be inflating payments.
Tags: Health Care Costs, Medicare
The Effect of Medicare Advantage Payment Cuts
by Kevin Roche on Wednesday, March 6, 2013
The Centers for Medicare and Medicaid Services recently released its initial cut at Medicare Advantage payment rates for 2014, indicating a likely low to mid-single digit decrease in reimbursement for most plans. A report sponsored by America’s Health Insurance Plans suggests that such a reimbursement cut would have untoward effects.
End-of-Life Care and Place of Death
by Kevin Roche on Tuesday, February 12, 2013
Most people want to die at home, but few do. A study published in the Journal of the American Medical Association examines changes in place of death and use of hospice care over the last decade for Medicare beneficiaries.
Tags: End-of-Life Care, Health Care Costs, Health Care Quality, Medicare
Medicare Advantage Disenrollees
by Kevin Roche on Thursday, February 7, 2013
A study from the Centers for Medicare and Medicaid Services Office of the Actuary looks at characteristics of Medicare beneficiaries who disenroll from Medicare Advantage and their spending patterns following disenrollment.
Star Ratings and Medicare Enrollment
by Kevin Roche on Thursday, January 31, 2013
One primary purpose of quality reporting is to help consumers make informed decisions about where they get their care from or where they purchase insurance. Research in JAMA indicates there is a positive connection between CMS’ star ratings and beneficiary enrollment in Medicare Advantage plans.
Tags: Health Care Quality, Medicare
MedPAC and Medicare Physician Reimbursement
by Kevin Roche on Thursday, January 24, 2013
At its annual meeting in January, the Medicare Payment Advisory Commission explores issues regarding payment for various providers, beneficiary access to care and quality. This January’s presentation on physician issues has some interesting data.
Tags: Health Care Costs, Medicare, Physicians
Medicare and Medicaid Cost Projections
by Kevin Roche on Thursday, December 13, 2012
The Congressional Budget Office releases a presentation on how it calculates long-term projections fro Medicare and Medicaid spending. More than a little frightening, and the absence of serious bipartisan discussion about reducing this spending is disturbing in its economic implications.
Tags: Government, Health Care Costs, Medicare
Medicare Advantage and Traditional Medicare
by Kevin Roche on Wednesday, December 12, 2012
For reasons that are truly mysterious, the Medicare Advantage program has been controversial. New research published in Health Affairs shows that the program has better utilization and spending control than traditional Medicare and does not have significant favorable selection.
CBO on Drug/Medical Cost Interaction
by Kevin Roche on Monday, December 10, 2012
One of the selling points for prescription drugs has been that their use often prevents use of more costly services, like hospitalizations. A new brief from the Congressional Budget Office explores the extent to which that might be true for Medicare beneficiaries.
Tags: Drugs, Health Care Costs, Medicare
NCQA Annual Health Report
by Kevin Roche on Tuesday, December 4, 2012
The National Committee for Quality Assurance releases its annual report on the state of health care quality in America, based on its collection of various quality measures from health plans. One striking finding is the improvement in and level of quality in Medicare Advantage plans.
Medicare Payment Policies and Their Consequences
by Kevin Roche on Monday, December 3, 2012
The Centers for Medicare and Medicaid Services is forever tinkering with reimbursement for various providers, usually not getting exactly the results it seeks. An example of this is given in research published in the Archives of Internal Medicine regarding changes for primary care and specialty physician office visits.
Tags: Health Care Costs, Medicare, Physicians, Reimbursement
2012 Potpourri XXXVI
by Kevin Roche on Friday, November 30, 2012
Another in our series of Potpourris, tasty, succulent morsels of health data food, including this week the effect of mammography screening, improving health and health costs, state costs to run health insurance exchanges, family caregiving and the costs of fixing Medicare’s physician reimbursement.
Tags: Elder Care, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance Exchange, Medicare, Wellness and Prevention, Workplace
Medicare Part B Drug Spending
by Kevin Roche on Wednesday, November 21, 2012
The Government Accounting Office examines trends in drug spending in Medicare Part B, which covers drugs administered in a doctor’s office. Looking at the 55 most expensive Part B drugs, GAO found that Medicare accounts for much of the overall spending on these products.
Tags: Drugs, Medicare, Physicians
2012 Potpourri XXXV
by Kevin Roche on Friday, November 16, 2012
Thanks be given for our last Potpourri before Thanksgiving, a table spread with delectable bites of information on hospital readmissions and quality measure performance, health plan enrollment growth, health price rises, use of deductibles in employer-based health insurance and trends in employment of physicians.
Tags: Consumers, Health Care Costs, Health Care Quality, Health Insurance, Hospital Readmissions, Medicare, Pay For Performance, Physicians
Health Care Spending and the Deficit
by Kevin Roche on Thursday, November 15, 2012
The “fiscal cliff” deficits, and debt are very much in the news these days. A Congressional Budget Office report indicates how much of our spending difficulty is attributable to health care and lays out alternative scenarios for coping with that spending and its effect on the debt.
Tags: Health Care Costs, Medicare
2012 Potpourri XXXIV
by Kevin Roche on Friday, November 9, 2012
Thank God the election is finally over, but our Potpourri is never-ending, this week bringing you the latest on why comparative effectiveness research results don’t translate to practice, innovations to reduce health spending, the value of medication adherence, factors related to end-of-life quality and MedPAC on new quality measures for avoidable hospital and ER use.
Tags: Comparative Effectiveness, Drugs, End-of-Life Care, Health Care Costs, Health Care Quality, Hospital, Medicare
Medicare Advantage Plan Analysis
by Kevin Roche on Thursday, November 8, 2012
A brief from the Urban Institute examines the premium support proposal to reform Medicare, suggesting instead that Medicare Advantage be changed. This ideologically driven report ignores basic economics and the looming dangers to beneficiaries in traditional Medicare.
Tags: Medicare
Health Insurance Exchanges and Switching Coverage
by Kevin Roche on Tuesday, November 6, 2012
Another paper from the National Bureau of Economic Research, this one examining consumer behavior in the context of the Medicare Part D exchange and finding that beneficiary inertia seems to result in less than optimal choices and lost savings opportunities.
Tags: Consumers, Drugs, Health Insurance Exchange, Medicare
2012 Potpourri XXXII
by Kevin Roche on Friday, October 26, 2012
The light fades but not our evanescent Potpourri, this week featuring stories on computerized point of entry ordering, the presence of large treatment effects in research, characteristics of patients with readmissions, a survey on Medicare physician reimbursement and a study on family caregivers.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Research, HIT, Hospital Readmissions, Medicare, Physicians
Pay for Performance Has Problems
by Kevin Roche on Monday, October 22, 2012
Research reported in the New England Journal of Medicine reveals that the Centers for Medicare and Medicaid Services program of not paying for certain hospital acquired infections is not working, to put it mildly. The program seems to have had absolutely no impact on the targeted infection rates.
Tags: Health Care Quality, Hospital, Medicare, Pay For Performance
2012 Potpourri XXIX
by Kevin Roche on Friday, October 5, 2012
Our first Potpourri in a while is as diverse and flamboyant as the fall colors, including items on the effectiveness of telemonitoring, the history of health “reform” in the United States, mortality and Medicaid eligibility expansions, continued issues with cost affecting access in Massachusetts and methods to help control imaging use.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Reform, Medicaid, Medicare, Telemedicine
CMS’ Physician Group Practice Demo Results
by Kevin Roche on Wednesday, October 3, 2012
The Physician Group Practice Demonstration conducted by Medicare has largely wrapped up , to be supplanted by the accountable care organization programs. The PGP demo appears to have led to slightly improved quality and has led to slightly lower cost savings over traditional fee-for-service Medicare.
Tags: Care Management, Disease Management, Health Care Costs, Health Care Quality, Medicare, Physicians
Providers Using EHRs to UpCode–Shocking, Just Shocking
by Kevin Roche on Monday, October 1, 2012
The Center for Public Integrity has pointed out what was an obvious unintended consequence of greater use of electronic health records–providers will use the additional clinical information to feed billing systems that use the data to maximize coding for reimbursement. Medicare is already feeling the effects and other payers are likely to do so also.
Tags: EHRs, Health Care Costs, HIT, Medicare
MedPAC on Readmissions
by Kevin Roche on Wednesday, September 19, 2012
We, among many others, have been harsh critics of Medicare’s misguided hospital readmissions penalty program, which begins this year. MedPAC has weighed in with its views on how to “refine” the program, but its recommendations will only exacerbate the flaws in the current regulations.
Tags: Health Care Costs, Health Care Quality, Hospital Readmissions, Medicare
2012 Potpourri XXVII
by Kevin Roche on Friday, August 24, 2012
Yet another brilliant collection of health care data points, including use of gene profiling tests to guide breast cancer care, 30-day mortality models for stroke performance, hospital medication administration errors, the costs of the Medicare physician payment fix and patient-sharing networks among physicians.
Tags: Drugs, Genomics, Health Care Costs, Health Care Quality, Hospital, Medicare, Physicians
Early Hospital Readmission Experience
by Kevin Roche on Thursday, August 23, 2012
The first year of experience with Medicare’s readmission program is in and Kaiser has done an initial analysis of the results. A large number of hospitals will be penalized, mostly those who can least afford it, and the program continues to show how poorly designed it is and what severe unintended consequences will ensue from its implementation.
Tags: Health Care Quality, Hospital, Medicare, Readmissions
2012 Potpourri XXVI
by Kevin Roche on Friday, August 17, 2012
Another sunny Potpourri, brightening your day with rays of data on hospital at home; Medicare care coordination programs; an employer survey on impacts of the reform law; a survey on health habits and employee productivity; first quarter health plan results and ER use and end-of-life care.
Tags: Care Management, End-of-Life Care, Health Care Costs, Health Care Reform, Health Insurance, Hospital, Medicare, Wellness and Prevention, Workplace
Characteristics of Home Health Care Episodes
by Kevin Roche on Thursday, August 2, 2012
The Alliance for Home Health Quality and Innovation sponsored a useful report on characteristics of home health care and other post-acute care services by Medicare beneficiaries, with a focus on those surrounding hospital readmissions, a significant current issue for hospitals.
Tags: Health Care Costs, HomeCare, Hospital Readmissions, Medicare
Imaging Utilization Slows
by Kevin Roche on Wednesday, August 1, 2012
Imaging has been a poster boy for alleged excessive and inappropriate utilization, resulting in higher than necessary spending. A study reported in Health Affairs finds that, for Medicare and commercial insurers, imaging growth has slowed, and the researchers explore why this may be so.
Tags: Health Care Costs, Medicare
2012 Potpourri XXIII
by Kevin Roche on Friday, July 27, 2012
At the height of the summer, with dryness across the land, there is no drought of information in our Potpourri, this week including use of an interactive health record to increase preventive care, Medicare and Medicaid geographical variation, shared decision-making, readmissions for heart attacks and Japan’s all-payer rate setting system.
Tags: Consumers, Health Care Costs, Health Care Quality, HIT, Hospital, Hospital Readmissions, Medicaid, Medicare, Physicians, Wellness and Prevention
2012 MedPAC Report
by Kevin Roche on Monday, July 9, 2012
The Medicare Payment Advisory Commission delivers an annual report to Congress on what it views as the pressing issues for the Medicare program. This year’s report touches on several issues, which have relevance for health care in general.
Tags: Government, Health Care Costs, Medicare
What Will Medicare Really Cost?
by Kevin Roche on Wednesday, June 20, 2012
When the Congressional Budget Office and the Board of Trustees of the Medicare trust funds make projections about future Medicare expenditures and revenues, they are required to utilize current law, even when everyone knows it doesn’t reflect likely reality. A memo from the Office of the Actuary presents an alternative, probably more accurate, set of Medicare projections.
Tags: Health Care Costs, Medicare
2012 Potpourri XIX
by Kevin Roche on Friday, June 1, 2012
Summer is heating up and our Potpourri is smoking too, with nuggets on a silly provision in the final MLR rule; research on causes of readmissions, some within hospital control, some not; why are some hospitals more costly in treating heart failure than others and an unintended consequence of a change in dialysis drug reimbursement.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Hospital, Medicare, Physicians, Readmissions, Reimbursement
Medicare Part D Spending
by Kevin Roche on Wednesday, May 16, 2012
Among government health care programs, the Part D prescription drug benefit in Medicare has been extremely successful, costing less than projected. Beneficiaries also are satisfied with the program, which consists of all private plans. A Kaiser report examines Part D spending trends.
Tags: Drugs, Health Care Costs, Medicare
DME Competitive Bidding
by Kevin Roche on Monday, May 14, 2012
The Government Accounting Office reports on initial results from the Medicare competitive bidding program for durable medical equipment, finding that it appeared to have succeeded in reducing spending, while not unduly affecting beneficiary access.
Tags: Devices, Health Care Costs, Medicare
2012 Potpourri XV
by Kevin Roche on Friday, April 27, 2012
Another tremendous edition of our Potpourri, featuring accountable care organization results, waste in our health system, self-referral costs, calculating hospital readmission rates and the benefits, if any, of telemonitoring frail seniors.
Tags: ACO, Care Management, Disease Management, Health Care Costs, Hospital Readmissions, Medicare, Physicians, Regulation, Telemedicine
GAO on Medicare Advantage
by Kevin Roche on Tuesday, April 24, 2012
A report from the Government Accounting Office trashes the Administration’s Medicare Advantage bonus “demonstration”, suggesting it was a thinly-veiled subterfuge, wasn’t likely saving money and wasn’t likely to improve quality.
Tags: Health Care Costs, Medicare
Dual Eligible Data
by Kevin Roche on Wednesday, April 18, 2012
The segment of the population which is elderly and poor, thus often eligible for both Medicare and Medicaid coverage, is often not in good health and has very high expenses. The travails of this population and how Medicare might be able to control spending for this group are explored in a new Kaiser Foundation Report.
Tags: Health Care Costs, Medicaid, Medicare
So Hows That EHR Incentive Program Working Out?
by Kevin Roche on Monday, April 16, 2012
A Medicare Payment Advisory Commission report summarizes the federal incentive program for adoption and meaningful use of electronic health records and reports on progress, which appears to be very slow.
2012 Potpourri XI
by Kevin Roche on Friday, March 30, 2012
Welcome to another Potpourri of health information, focusing on workers’ comp medical prices, cost-sharing on asthma meds, the Medicare Advantage program, doctors’ experience of quality improvement programs, a review of the last 60 years in health economics and the value of teledermatology.
Tags: Care Management, Consumers, Drugs, Health Care Costs, Health Care Quality, Medicare, Physicians, Telemedicine, Workplace
2012 MedPAC Report
by Kevin Roche on Thursday, March 29, 2012
Every year the Medicare Payment Advisory Commission puts out a report on its views on the current state of Medicare, its major issues and recommendations to Congress and the Centers for Medicare and Medicaid Services about how to improve the program. The 2012 report is out with a plethora of useful information.
Tags: Health Care Costs, Medicare
2012 Potpourri VIII
by Kevin Roche on Friday, March 2, 2012
Its March and spring nears; our Potpourri blooms with nuggets of health care information, including comparative regulation of medical devices in the US and Europe, do physicians always truthful with patients, CMS’ oversight of home health care agencies, the validity of a CMS’ measure of ER scanning, and patient-centered care.
Tags: Consumers, Devices, FDA, Health Care Quality, HomeCare, Medicare, Pay For Performance, Physicians
Managed Care Medicare Plan Hospital Readmission Rates
by Kevin Roche on Thursday, March 1, 2012
The CMS program to reduce, or at least penalize hospitals for, unnecessary readmissions is in full swing this year. A new study looks at how Medicare Advantage plans do in regard to readmissions for their beneficiaries and compares this performance to that for fee-for-service beneficiaries.
Tags: Health Care Costs, Health Care Quality, Hospital, Hospital Readmissions, Medicare
Physicians Leaving Medicare
by Kevin Roche on Wednesday, February 22, 2012
One of the concerns around the continued wrangling over the long-term setting of physician compensation for services to Medicare beneficiaries is whether payment, and other aspects of the program, have reached a level where beneficiary access may be impacted. A recent Office of Inspector General report found inadequate data to address the question.
Tags: Medicare, Physicians
Regional Variation in Drug Spending
by Kevin Roche on Monday, February 13, 2012
Geographic variation in health care spending is an ongoing controversial topic primarily because the most significant implication is that many physicians have practice patterns that unnecessarily raise costs and changing those patterns could save significant dollars. A New England Journal of Medicine article discusses variation in Medicare drug spending.
Tags: Drugs, Health Care Costs, Medicare
2012 Potpourri V
by Kevin Roche on Friday, February 3, 2012
Another Potpourri brimming with doses of useful information that you eagerly await each week, including Medicare special needs plans and patients with diabetes, health information technology venture capital funding and M & A, identifying overuse in health care, what makes a better medical group, does merging weak hospitals help them and interventions that appear to work to prevent development of diabetes.
Tags: Care Management, Chronic Disease, Financings, Health Care Costs, Hospital, M&A, Medicare, Physicians
CBO on Medicare’s Care Management Demos
by Kevin Roche on Tuesday, January 24, 2012
The Centers for Medicare and Medicaid Services has engaged in a number of care management demonstrations over the years. The Congressional Budget Office adds its assessment to the body of research examining the outcomes of those demostrations.
Tags: Care Management, Chronic Disease, Disease Management, Health Care Costs, Health Care Quality, Medicare
2012 Potpourri III
by Kevin Roche on Friday, January 20, 2012
Winter is getting long and tedious by now, but our Potpourri offers a welcome respite, with refreshing tidbits on hospital uncompensated care, teledermatology, Medicaid controls of antipsychotic use, Medicare cuts to osteoporosis testing payments, the relationship between primary care access and mortality risk, and where the United States will find cost-savings.
Tags: Drugs, Health Care Costs, Health Care Quality, Hospital, Medicaid, Medicare, Telemedicine
2012 Potpourri II
by Kevin Roche on Friday, January 13, 2012
Our latest Potpourri reveals details about causes of workplace injuries, the effect of raising the Medicare eligibility age, benefit levels in existing health policies, false claims prosecutions and off-label drug use, ICU staff perceptions of the appropriateness of care, and malpractice liability from clinical decision support systems.
Tags: Care Management, Drugs, Health Insurance, HIT, Medicare, Workplace
Medicare Advantage Marketing
by Kevin Roche on Wednesday, January 11, 2012
Research in the New England Journal of Medicine suggests that Medicare Advantage health plans use offering of certain non-required benefits, like fitness club memberships, to attract and retain healthier beneficiaries, thereby supposedly boosting their profits. The article is a weak-design piece of ideological hogwash.
Tags: Health Insurance, Medicare
2012 Potpourri I
by Kevin Roche on Friday, January 6, 2012
Welcome to 2012, when you can once again expect a series of high-quality Potpourris from our immense data bank! Our initial foray includes the Independence at Home CMS demo, discharge summaries and hospital readmissions, CMS’ quality measures for Medicaid patients, private equity fundraising, medical homes and cost savings for Medicaid patients and the effect of poor discharge summaries on nursing home patients.
Tags: Care Management, Financings, Health Care Quality, HomeCare, Hospital, Medicaid, medical home, Medicare, Readmissions
End-of-Life Care
by Kevin Roche on Tuesday, January 3, 2012
A draft evidence report from AHRQ looks at end-of-life and hospice care. End-of-life care is often fingered as one of the causes of increasing health spending. The report finds moderate evidence supporting beneficial effects from many of the studied interventions.
Tags: End-of-Life Care, Health Care Costs, Health Care Quality, Medicare
Health Spending by State
by Kevin Roche on Tuesday, December 27, 2011
How much does health spending per person vary across the fifty states and does that variance occur equally in the commercially insured population, Medicaid eligibles and Medicare beneficiaries? These and other questions are answered in research published in the Medicare and Medicaid Research Review.
Tags: Health Care Costs, Medicaid, Medicare
2011 Potpourri XXXXIX
by Kevin Roche on Friday, December 23, 2011
Our penultimate Potpourri delivers the quality you are accustomed to (for good or bad), including presents of health information on the Medicare physician payment method, telemonitoring results in the UK, the effect of eprescribing on fill rates, issues relating to use of health information technology in the home, the effect of social network on health behavior and whether imaging results actually influence decision-making or outcomes. Merry Christmas and Happy Holidays!
Tags: Consumers, Drugs, HIT, HomeCare, Medicare, Physicians, Telemedicine, Wellness and Prevention
Commercial and Medicare Spending Variation
by Kevin Roche on Thursday, December 22, 2011
A study reported in the American Journal of Managed Care follows up on the comparative geographic variation in spending on Medicare patients and commercially insured ones in Texas, finding that the pattern of variation is similar for the two groups.
2011 Potpourri XXXXVI
by Kevin Roche on Friday, December 2, 2011
The holiday shopping season is in full swing but our Potpourri is free, filled with useful data on high-deductible health plans and utilization, Medicare Advantage plan Stars bonuses, drug complications and hospitalizations, physician office visit trends, premium increases, and patient expectations.
Tags: Consumer Directed Health, Drugs, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Medicare, Patient Satisfaction, Physicians
Medicare Cost-Sharing
by Kevin Roche on Thursday, December 1, 2011
The Kaiser Foundation looks at proposals to revamp Medicare’s cost-sharing design, including possible changes to Medigap benefits, finding that changes could save billions for the program and reduce costs for many beneficiaries.
Tags: Consumers, Health Care Costs, Medicare
Medicare Disease Management Pilots
by Kevin Roche on Wednesday, November 16, 2011
A final summary of Medicare’s disease management pilots gives a bleak picture of the value of the efforts. While there are design and methodological critiques of the Medicare program that may make the results not generalizable, the outcomes do suggest that if disease management is to show value, design and execution need to be improved.
Tags: Disease Management, Health Care Costs, Health Care Quality, Medicare
2011 Potpourri XXXXIII
by Kevin Roche on Friday, November 4, 2011
Winter nears but our Potpourri will distract you from the cold breezes, providing compelling nuggets on prostate screening recommendations, consumer use of technology for health, insurer medical cost trends, what to do about Medicare’s physician payments, heart failure hospitalization and mortality rates and rates of non-filling of new prescriptions.
Tags: Chronic Disease, Disease Management, Drugs, Health Care Costs, Health Insurance, HIT, Hospital, Medicare, Physicians, Telemedicine, Wellness and Prevention
Predicting Readmissions
by Kevin Roche on Monday, October 31, 2011
Hospital readmissions are targeted as a quality metric and a reimbursement adjustment. The program used by CMS in particular appears flawed, and a recent study examining readmission-risk models supports that conclusion.
Tags: Hospital, Medicare, Readmisssions
2011 Potpourri XXXXII
by Kevin Roche on Friday, October 28, 2011
Another brilliant Potpourri, with scintillating health care gems, including revising the FDA’s 510(k) process, the essential benefits package for health exchanges, the future of Medicare Advantage, the lack of labor productivity in health care, variation in elective procedure rates and the OIG’s work plan.
Tags: Care Management, Devices, FDA, Government, Health Care Costs, Health Care Reform, Health Insurance, Medical Care, Medicare, Physicians
Care Coordination for the Dual Eligible Population
by Kevin Roche on Wednesday, October 26, 2011
Medicare/Medicaid dual eligibles are relatively poor, elderly or disabled persons who have very high health spending. A report from America’s Health Insurance Plans discusses how care coordination programs can achieve significant savings for the programs and better health outcomes for the patients.
Tags: Care Management, Chronic Disease, Health Care Costs, Medicaid, Medicare
2011 Potpourri XXXXI
by Kevin Roche on Friday, October 21, 2011
Another Potpourri, with tidbits on the Medicare Star program results for 2012, pain management, blood pressure management, Massachusetts’ physicians’ views on work and health care, online error reporting and the FDA and CMS parallel medical device review process.
Tags: Care Management, Devices, FDA, Health Insurance, Malpractice, Medical Care, Medicare, Physicians, Telemedicine
2011 Potpourri XXXX
by Kevin Roche on Friday, October 14, 2011
The leaves fall but not the quality of our Potpourri, this week covering beneficiaries’ use of Medicare Star ratings, quality of care guidelines and older patients, compassionate care, asthma care guidelines and outcomes, infection control in hospitals and informal caregivers in California.
Tags: Consumer Directed Health, Elder Care, evidence based medicine, Health Care Costs, Health Care Quality, Hospital, Medicare, Pay For Performance
Telehealth Care Management
by Kevin Roche on Thursday, October 13, 2011
The effect of telehealth tools on the health spending of Medicare beneficiaries with chronic disease has been controversial, with a number of studies finding no or very limited savings. New research published in Health Affairs suggests that at least one such tool may contribute to savings in a care management program for common chronic diseases.
Tags: Care Management, Disease Management, Health Care Costs, Medicare, Telehealth
Advance Directives and End-of-Life Spending
by Kevin Roche on Wednesday, October 12, 2011
End-of-life care is a significant contributor to overall health expenditures. New research in the Journal of the American Medical Association probes the effect of advance directives on end-of-life spending, with a particular focus on geographic variations both in the use of directives and care.
Tags: Elder Care, End-of-Life Care, Health Care Costs, Health Care Quality, Medicare
2011 Potpourri XXXIX
by Kevin Roche on Friday, October 7, 2011
October already!! Our 39th Potpourri of the year has many autumnal pleasures including selections on CMS’ Comprehensive Primary Care Initiative, a proposed guidance for FDA to use for mHealth regulation, end-of-life care discussions, CMS’ multi-payer database award, expected 2012 medical trend, and delivery of unnecessary care by doctors.
Tags: Care Management, Comparative Effectiveness, End-of-Life Care, FDA, Health Insurance, HIT, medical home, Medicare, Physicians, Telemedicine
Medicare’s Coverage Determination Process
by Kevin Roche on Wednesday, September 28, 2011
As Medicare pays more and more of the nation’s total health bill, its decisions on what products and services it will reimburse for are more significant for vendors and for the growth of the overall health bill. A new RWJ brief examines that coverage process and recommends changes.
Having Many Medicare Advantage Choices Has Its Disadvantages
by Kevin Roche on Thursday, September 1, 2011
The application of theories of consumer buying behavior to Medicare Advantage indicates that having too many plan or benefit design choices may create harder decision-making for seniors, especially those with cognitive difficulties.
Tags: Consumers, Health Insurance, Medicare
Use of Cancer Drugs in Medicare
by Kevin Roche on Wednesday, August 31, 2011
Two reports from the Agency for Healthcare Research & Quality detail the use of expensive cancer biologics for Medicare beneficiaries. As for other payers, Medicare expenditures on these compounds has increased rapidly, often for off-label use.
Tags: Drugs, Health Care Costs, Medicare
Are Readmissions Really an Indicator of Poor Quality?
by Kevin Roche on Monday, August 29, 2011
CMS currently intends to implement its readmissions penalty/incentive program in a manner that may not truly distinguish between good and poor quality at hospitals, according to recent research in Canada which finds no correlation between overall readmission rates and inappropriate readmissions.
Tags: Health Care Quality, Hospital, Medicare
Kaiser Health News
by Vita Advisors on Thursday, August 25, 2011
On Tuesday, the Department of Health and Human Services unveiled a Medicare pilot program that will pay participating hospitals, doctors and other health providers one, “bundled,” payment to treat a patient for a single episode of care.
Tags: Bundled Payments, Medicare
2011 Potpourri XXXII
by Kevin Roche on Friday, August 19, 2011
Our thirty-second Potpourri of the year brings fascinating health items such as how to design wellness incentives, how Medicare could save money, the complexities of improving care, the use of community health centers to save money, designing subjective survey questions and an intervention to reduce hospital readmissions.
Tags: Care Management, Health Care Costs, Health Care Quality, Hospital, Malpractice, Medicare, Wellness and Prevention
GAO on CMS’ Physician Feedback Reports
by Kevin Roche on Monday, August 15, 2011
In the last couple of years CMS has begun providing feedback reports to physicians treating Medicare beneficiaries. A Government Accounting Office Report underlines the challenges CMS has had implementing the program and making it likely to affect physician behavior.
Tags: Health Care Costs, Medicare, Physicians
2011 Potpourri XXXI
by Kevin Roche on Friday, August 12, 2011
Mercer issued a release on its survey of employers regarding issues relating to the reform law. Among the findings are that employers have already seen a 2% enrollment jump due to having to cover children up to age 26, and that over 40% of employers expect the full implementation of the law to raise their [...]
Tags: Health Care Costs, Health Insurance, Medicare, Physicians, Workplace
Effect of Changes in Medigap Insurance
by Kevin Roche on Wednesday, August 10, 2011
Most seniors tend to purchase Medigap or Medicare Supplement insurance, which mutes the effect of Medicare’s cost-sharing provisions, potentially increasing utilization and costs for the program. A Kaiser brief examines the effect of proposed changes in permissible Medigap benefit structures.
Tags: Health Care Costs, Medicare
Hospital Pricing Behavior and Market Characteristics
by Kevin Roche on Monday, August 8, 2011
Further evidence that hospitals with market power raise prices almost at will and disregard opportunities to cut costs is provided by research reported in Health Affairs. Hospitals in concentrated markets have enormous margins on their private insurers payments.
Tags: Health Care Costs, Health Insurance, Hospital, Medicare
2011 Potpourri XXX
by Kevin Roche on Friday, August 5, 2011
This week’s Potpourri features dropped malpractice claims, the quality benefits of EHRs, improper Medicare payments, health insurer customer satisfaction, the utilization and cost effects of using hospitalists, and determining if a patient has decision-making capacity.
Tags: Consumers, EHRs, Health Care Costs, Health Care Quality, Health Insurance, HITECH, Hospital, Malpractice, Medicare, Physicians
Part D’s Effect on Overall Spending
by Kevin Roche on Thursday, August 4, 2011
Research published in the Journal of the American Medical Association finds that the onset of Part D prescription drug coverage helped reduce relative non-drug spending for those beneficiaries who previously had limited drug coverage.
Tags: Drugs, Health Care Costs, Medicare
2011 Potpourri XXIX
by Kevin Roche on Friday, July 29, 2011
Our current Potpourri contains nuggets on use of robotic surgery for prostate cancer, the effect of mandated rebates in Medicare Part D on patient costs, FDA guidance on device modifications, state Medicaid EHR incentive programs, patient understanding of trial data, and use of FQHC’s by Medicaid enrollees.
Tags: Devices, Drugs, EHRs, FDA, HIT, HITECH, Medicaid, Medical Care, Medicare
2012 Medicare Payment Rules
by Kevin Roche on Thursday, July 28, 2011
Each year CMS issues proposed, and ultimately final, rules relating to reimbursement for various categories of providers in the next year. The 2012 rules have a wealth of background and other information in them, including significant detail on the increasingly important quality measurement programs.
Tags: Hospital, Medicare, Physicians
2011 Potpourri XXVIII
by Kevin Roche on Friday, July 22, 2011
The dog days of summer bring yet another scorching hot Potpourri with a smorgasbord of data, including metabias in randomized clinical trials, the practice of defensive medicine, the status of HIEs, retail pharmacy drug costs and pricing and spending on medical devices.
Tags: Comparative Effectiveness, Devices, Drugs, HIT, Malpractice, Meaningful Use, Medicaid, Medicare, Physicians
2011 Potpourri XXVII
by Kevin Roche on Friday, July 15, 2011
A mid-summer’s evening (or weekend) Potpourri, but no heated discussion here, just soothing nuggets of knowledge, including use and misuse of PCI, how to measure blood pressure, CMS and telemedicine, preventing falls, copying and pasting EHR notes, and physicians attitude to work and compensation.
Tags: EHRs, Health Care Costs, Health Care Quality, Medical Care, Medicare, Physicians, Telemedicine
Savings from Home Health Use
by Kevin Roche on Wednesday, July 6, 2011
A study finds that using home health care after a hospital admission for Medicare beneficiaries with certain chronic illnesses reduces Medicare Part A spending and readmissions compared to a beneficiary group that used other post-discharge services.
Tags: Elder Care, Health Care Costs, HomeCare, Hospital, Medicare
2011 Potpourri XXV
by Kevin Roche on Friday, June 24, 2011
Summer waxes but no heat-induced torpor can stop us from producing our Potpourri of health snapshots, including the health care and health care coverage of young adults; malpractice incidence; Massachusetts health spending; online provider ratings; access to specialty care for children in public programs and options for dealing with the SGR mess.
Tags: Access, Consumers, Health Care Costs, Health Insurance, Malpractice, Medicaid, Medicare, Physicians
CMS’ Review of Physician Reimbursement Methodology
by Kevin Roche on Thursday, June 16, 2011
CMS issued a proposed notice regarding its regular review of relative value units for physician reimbursement under Medicare. The notice gives you a sense of the impossibility of understanding what is going on there and the outsized influence of physicians in the process.
Tags: Health Care Costs, Medicare, Physicians
More Data Available from CMS
by Kevin Roche on Thursday, June 9, 2011
CMS has proposed a rule to implement a PPACA provision allowing access to extracts of provider-level Medicare data to evaluate performance, primarily on quality measures. This is a good first step, but just a first step in being able to completely profile physician practice patterns.
Tags: Comparative Effectiveness, Health Care Costs, Health Care Quality, Medicaid, Medicare, Providers
IOM on Medicare Geographic Payment Adjustments
by Kevin Roche on Tuesday, June 7, 2011
An Institute of Medicine report finds Medicare’s geographic reimbursement adjustment formulas to be seriously flawed and suggests general principles to guide a reworking. The conclusions and follow-up reports are sure to spark substantial controversy.
Tags: Medicare
2011 Potpourri XXII
by Kevin Roche on Friday, June 3, 2011
Another round of health tidbits, including the association between primary care workforce and Medicare outcomes, comparisons of Type 2 diabetes drugs, effects of limiting DTC drug advertising, health information exchange sustainability, the effect of the Irish workplace smoking ban and barriers to diffusion of cost-effective care.
Tags: Care Management, Drugs, Elder Care, Health Care Costs, Health Care Reform, HIT, Medicare, Physicians, Wellness and Prevention, Workplace
Variation in Medicare Spending–The Search for Causes Continues
by Kevin Roche on Wednesday, June 1, 2011
The latest paper on geographic variation in Medicare spending uses a different design and statistical tool to demonstrate that higher spending on health care is associated with better health in this population, which upends the traditional analysis and should lead to more careful policymaking.
Tags: Health Care Costs, Medicare
Medicare Trust Funds Alternative Scenario
by Kevin Roche on Thursday, May 26, 2011
As noted in yesterday’s post, the Trustees of the Medicare Hospital and Supplementary Funds recognized the inadequacy of the official projections of Medicare’s financial condition, and therefore had an alternative, and bleaker, scenario prepared.
Tags: Health Care Costs, Medicare
Medicare Trustees Report
by Kevin Roche on Wednesday, May 25, 2011
The Medicare Trustees have released the 2011 report on the status of the Medicare funds, indicating that they will be exhausted sooner than anticipated, due both to the recession and higher spending.
Tags: Health Care Costs, Medicare
Health Care Spending Index
by Kevin Roche on Tuesday, May 24, 2011
An index that tracks medical spending shows that while per capita spending continues to rise, the rate of growth has slowed, particularly for Medicare. Hospital spending continues to be the fastest growing category.
Better Care for the Elderly
by Kevin Roche on Wednesday, May 18, 2011
A Health Affairs article discusses health care for elderly persons living in retirement communities and how various models might help improve care coordination and reduce spending.
Tags: Elder Care, Health Care Costs, HomeCare, Medicare
2011 Potpourri XX
by Kevin Roche on Friday, May 13, 2011
Another Potpourri, this week delivering factoids on drug companies’ use of technology to reach physicians, waiting times in Massachusetts, use of atypical antipsychotics in nursing homes, unnecessary colonoscopies, EMRs and productivity, and a stupid FDA ruling.
Tags: Drugs, EHRs, Health Care Costs, Health Care Reform, HIT, Medicare, Physicians, Wellness and Prevention
CMS Hospital Payment for 2012
by Kevin Roche on Wednesday, May 11, 2011
CMS’ proposed rule and explanations for hospital payments for 2012 are lengthy but as usual give a great background on the issues that go into the payment elements. Hospital payments are slated for at best a very modest increase.
Tags: Health Care Costs, Hospital, Medicare
Hip Replacements
by Kevin Roche on Thursday, April 28, 2011
Hip replacement is one of the most pervasive orthopedic procedures, particularly among older Americans. Research among Medicare beneficiaries reveals trends over 18 years, finding lower mortality, but potential issues on site of discharge and readmissions.
Tags: Care Management, Elder Care, Hospital, Medicare
2011 Potpourri XV
by Kevin Roche on Friday, April 8, 2011
Our Masters week Potpourri masterfully covers such items as EHR satisfaction, ICU telemedicine, effects of concierge care on Medicare, failure to fill prescriptions, percent of household spending on health care by seniors, and drug rep visits to physicians.
Tags: Drugs, EHRs, Health Care Costs, Health Care Quality, HIT, Medicare, Physicians, Telemedicine
GAO on Medicare Advantage Rates
by Kevin Roche on Wednesday, March 30, 2011
The General Accounting Office looks into the controversial topic of Medicare Advantage plan reimbursement compared to Medicare FFS spending and finds that there is probably room to pressure rates downward.
Tags: Health Insurance, Medicare
MedPAC Comments on Hospital Value Based Purchasing Rule
by Kevin Roche on Monday, March 21, 2011
The Medicare Payment Advisory Commission commented on the Medicare program’s proposed rule for a hospital value-based purchasing initiative, generally agreeing with CMS’ recommendations.
Tags: Hospital, Medicare, Pay For Performance
2011 Potpourri XII
by Kevin Roche on Friday, March 18, 2011
Our Ides of March Potpourri, featuring two studies of the impact of wellness programs; the link between hospital spending and mortality outcomes; HHS waiving the MLR requirement for Maine; bills to have CMS disclose physician practice patterns; and research on smoking cessation techniques.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Hospital, Medicare, Wellness and Prevention, Wireless
2011 Potpourri XI
by Kevin Roche on Friday, March 11, 2011
Another in our weekly series of health care nuggets, with this week’s Potpourri featuring Medicare beneficiaries and physician supply, the FDA’s position on certain device software, a wellness survey, the AMA’s stance on genetic testing, marketing of drugs, and an integrated disability and health care program.
Tags: Consumers, Drugs, FDA, Genomics, Health Care Quality, Medicare, Mobile, Physicians, Wellness and Prevention
Latest Dartmouth Atlas Work
by Kevin Roche on Thursday, March 3, 2011
The latest Dartmouth Atlas work looks at variation in elective surgery rates in the context of patient involvement in decision-making. The report highlights differences in treatment for a number of common conditions and provides good advice for patients.
Tags: Consumers, Health Care Costs, Health Care Quality, Medicare, Physicians
Medicare Advantage Stars Program
by Kevin Roche on Monday, February 28, 2011
The Medicare Advantage Stars program is reviewed in a Kaiser Family Foundation brief which discusses coming changes in the calculations and the current ratings and characteristics of a number of plans
Tags: Health Care Quality, Medicare
Yet More on Geography and Costs
by Kevin Roche on Tuesday, February 22, 2011
Yet another study has emerged on the factors responsible for apparent variation in costs of treating Medicare patients, this one focused on the high-cost quartile of beneficiaries and finding that health status accounts for much of the variation.
Tags: Elder Care, Health Care Costs, Medicare
Hospice Care By Ownership Type
by Kevin Roche on Tuesday, February 15, 2011
Researchers writing in JAMA looked at whether the ownership type of a hospice appeared to be correlated with profit-maximizing behavior under Medicare’s per diem payment scheme. They found only weak evidence which could have other explanations.
Tags: Elder Care, Health Care Costs, Medicare
2011 Potpourri VII
by Kevin Roche on Friday, February 11, 2011
Another rendition of selections from the health literature, including advance directive issues; guideline problems; physician religious beliefs and end-of-life care; health information exchanges; the results of use of modified global payments with physicians and hospitals; and physician payment reform.
Tags: Care Management, Elder Care, HIT, Medicare, Physicians
MedPAC Report on Regional Service Use Variation
by Kevin Roche on Tuesday, January 18, 2011
We have reported several times on geographic variation in health spending, primarily in regard to Medicare beneficiaries, MEdPAC released a new brief that focuses on variation in use as opposed to raw spending, showing variation but to a smaller degree.
Tags: Health Care Costs, Medicare
MedPAC’s Medicare Advantage Comments.
by Kevin Roche on Monday, January 17, 2011
MedPAC weighs in unasked on some proposed changes to the Medicare Advantage program; objecting to CMS’ intent to limit benefit design flexibility on home health care and to CMS’s proposed quality incentive “demonstration.”
Tags: Health Care Costs, HomeCare, Medicare
2011 Potpourri III
by Kevin Roche on Friday, January 14, 2011
Once more into the Potpourri breach, this week covering CBO’s scoring of a repeal of PPACA; a global wellness survey; Medicare’s failure to use its data to identify abusive providers; Canadians’ view of their health system; Walmart’s preventive care package; and use of electronic messages to improve cancer screening rates.
Tags: Health Care Reform, Health Insurance, HIT, Medicare, Physicians, Wellness and Prevention
Hospitalizations for Seniors
by Kevin Roche on Tuesday, January 4, 2011
The Agency for HealthCare Research & Quality released a brief on hospitalizations among the elderly. This category of service accounts for a significant and growing portion of national health spending and warrants attention if Medicare costs are to be contained at an affordable level.
New Year Potpourri or 20ll Potpourri I
by Kevin Roche on Friday, December 31, 2010
Happy New Year and a prosperous 2011 to all of you, a prosperity which undoubtedly will be aided by the insights from our Potpourris, which this week include physicians’ use of patient satisfaction data, drugs for children, Medicaid quality measures, health reform provisions taking effect in 2011 and the FDA’s rate of drug approval in 2010.
Tags: Drugs, FDA, Health Care Quality, Health Care Reform, HIT, Medicaid, Medicare, Physicians
CMS’ IT Systems
by Kevin Roche on Wednesday, December 29, 2010
CMS released the initial report on its plan to modernize its computer systems, which understandably could cause trepidation among the millions of beneficiaries and providers who will be affected. The vision is solid, but will the execution be there?
2010 Potpourri XLIV
by Kevin Roche on Saturday, December 18, 2010
Another week, another Potpourri, this one detailing items including high deductible insurance and delay of care; another study looking at HDHP and well-child care; a quality comparison of Medicare Advantage and fee-for-service; video games to improve health and CMS’ report on several quality demonstrations.
Tags: Care Management, Consumers, Health Care Quality, HIT, Medicare
2010 Potpourri XLIII
by Kevin Roche on Saturday, December 11, 2010
The snow is raging here in Minneapolis, but nothing stops the delivery of our Potpourri, which includes discussion of paybacks on EHRs, the fate of dialysis patients, use of telecommunciations to aid drug adherence, cost savings from select pharmacy networks and hospital readmissions.
Tags: Chronic Disease, HIT, Hospital, Medicare, Pharmaceutical, Telemedicine
More on McAllen’s Costs
by Kevin Roche on Thursday, December 9, 2010
One of the premises of the movement to constrain health spending is that there is a lot of wasteful care in some geographic areas. A notable New Yorker article last year made McAllen Texas the poster child for this thesis, but new research suggests the issue may be more complex.
Tags: Health Care Costs, Medicare
MedPAC on Retainer Medicine
by Kevin Roche on Monday, November 29, 2010
Retainer-based medicine, in which patients pay physicians a flat periodic fee to cover a package of basic medical services, often referred to as a “concierge” practice, is reviewed in a MedPac report, to ascertain if has or might have a deleterious effect on access or costs for Medicare patients.
Tags: Consumers, Medicare, Physicians
2010 Potpourri XLII
by Kevin Roche on Saturday, November 20, 2010
Thanksgiving approaches and we are thankful for the continuing stream of news to fill our Potpourri, including the effect of malpractice liability on Illinois’ ability to retain physicians; the role of prices in health spending increases; comparative health and death rates in the US and England; employer health insurance costs; CBO review of a plan to reshape to Medicare; and end-of-life decision making.
Tags: Chronic Disease, Consumer Directed Health, Elder Care, Health Care Costs, Health Insurance, Malpractice, Medicare, Physicians
Care Management for the Elderly Patient
by Kevin Roche on Wednesday, November 17, 2010
Older Americans have a high rate of chronic disease and those patients are responsible for much of overall health spending. An article in JAMA explores programs designed to manage care better for these patients.
Tags: Care Management, Chronic Disease, Elder Care, Medicare
2010 Potpourri XLI
by Kevin Roche on Saturday, November 13, 2010
The holidays approach, the Potpourri rolls on, this week unveiling information on potential savings for Medicare and Medicaid dual eligibles; EHR use’s effect on physician revenue; likely physician reaction to the SGR cuts, if implemented; characteristics of California health plan enrollees; CBO’s view of the impact of the reform law on drug prices and a health plan allowing nurse practitioners to be primary care providers.
Tags: Consumer Directed Health, Drugs, HIT, Medicaid, Medicare, Physicians, Providers
Reimbursement’s Impact on Medical Practice
by Kevin Roche on Wednesday, November 10, 2010
A New England Journal of Medicine article further solidifies the susceptibility of physicians to financial incentives to overuse care when it assists them economically. Removing those incentives does not seem to prevent continued delivery of the same care when it is needed.
Tags: Health Care Costs, Medicare, Physicians
Process of Care and Health Outcomes
by Kevin Roche on Wednesday, October 20, 2010
As the use of pay-for-reporting and pay-for-performance grows, there is more research into whether care processes being measured are really related to ultimate health outcomes. A new article says not necessarily.
Tags: Care Management, Health Care Quality, Hospital, Medicare, Pay For Performance
2010 Potpourri XXXVI
by Kevin Roche on Saturday, October 2, 2010
The days shorten but the potpourri stays strong, this week including information on the safety of FDA-cleared devices; medication adherence; genetic tests; the FDA and CMS working together to review products; state all-payer databases and the increasing control of physician practices by hospital systems.
Tags: Care Management, Devices, Drugs, Health Care Costs, HIT, Hospital, Medicare, Personalized Medicine, Physicians, Regulation
CBO Report on Medicare and Generic Drugs
by Kevin Roche on Friday, October 1, 2010
A Congressional Budget Office Report finds that Medicare Part D and its beneficiaries have accrued very significant savings, about 55%, from use of generic drugs and that more savings may be available in the near future.
Tags: Drugs, Health Care Costs, Medicare
Primary Care Cost and Quality
by Kevin Roche on Monday, September 27, 2010
The Dartmouth Atlas researches whether more primary care necessarily leads to better quality of care. The answer appears to be usually not, but the explanation for this result is complex and it may not be as simple as cause and effect.
Tags: Consumers, Health Care Quality, Medicare, Physicians
Medicare Advantage Quality Ratings
by Kevin Roche on Friday, September 24, 2010
CMS is very enamored of quality ratings for providers of all types, including the Medicare Advantage plans, which are rated on a five-star basis. A new brief examines changes to this rating program.
Tags: Health Care Quality, Medicare, Regulation
Reimbursement Changes and Physician Behavior
by Kevin Roche on Thursday, August 26, 2010
It is well-established that physicians respond to various economic incentives by changing their treatment behavior. A recent study explores this phenomenon in the context of Medicare’s cancer chemotherapy drug reimbursement policies.
Tags: Drugs, Medicare, Physicians
2010 Potpourri XXIX
by Kevin Roche on Saturday, August 14, 2010
Another Saturday, another Potpourri, featuring the acquisition of a hospital medical necessity company, Americans’ online health usage, analysis of prescriptions, California workers’ compensation, home monitoring of elderly parents, remote psychiatric evaluations and telemedicine to treat depression.
Tags: Care Management, Drugs, Elder Care, HIT, HomeCare, Medicare, Monitoring, Telemedicine, Workers Compensation
Medicare’s Solvency Extended–Or Is It?
by Kevin Roche on Friday, August 13, 2010
In a sign that the media is less willing to accept some of the Administration’s misleading pronunciations about health care, when HHS claimed that the Medicare Trustee’s report showed the new health law extended Medicare solvency by several years, most sources noted that the CMS Actuary disagreed.
Tags: Government, Health Care Costs, Medicare
Medicare Proposed Home Health Payment Changes
by Kevin Roche on Thursday, August 5, 2010
Every year Medicare puts out very lengthy and detailed proposed, and ultimately final, rules updating the reimbursement for all of the classes of providers–physicians, hospitals, etc. While reading these is a tough slog, it gives a good sense of issues which affect all payers, and of Medicare’s mindset.
Tags: Government, HomeCare, Medicare
More Geographic Variation Research
by Kevin Roche on Monday, August 2, 2010
A study of diagnostic practices for Medicare beneficiaries reveals geographic variations. These variations not only may suggest either under or overuse of diagnostic tests but they can bias other research results and payment methods. A second study suggests that caution should be applied in analyzing regional variation to ensure that all possible sources of the differences are taken into account.
Tags: Health Care Costs, Medical Care, Medicare, Physicians
Medicare’s Physician Reimbursement Problem
by Kevin Roche on Friday, July 30, 2010
There has been no more gnarly health care problem for Congress than how to deal with physician reimbursement. At some point, as a Health Affairs article points out, it will have to come up with a better solution than the temporary fixes it has used for years.
Tags: Government, Health Care Costs, Medicare, Physicians
MedPAC’s Annual Report II
by Kevin Roche on Friday, July 23, 2010
More commentary on MedPAC’s Annual Report, focusing on the care of dual-eligible beneficiaries and the use of shared decision-making in the Medicare population.
Tags: Government, Medicare
MedPAC’s Annual Report I
by Kevin Roche on Thursday, July 22, 2010
MedPAC’s annual report always contains many useful analyses of health care issues, complete with research citations. This year’s report covers several topics of general interest, including effective benefit designs and improving quality efforts.
Tags: Government, Medicare
Hospital Pay-for-Performance Programs
by Kevin Roche on Tuesday, July 6, 2010
Medicare has an impending value-based purchasing program for hospitals. Payments would be based on performance against quality standards. Some hospitals ability to improve performance may be limited by the economic and workforce characteristics of their location, according to new research.
Tags: Hospital, Medicare, Pay For Performance
Medicare and Home Infusion
by Kevin Roche on Monday, June 28, 2010
Home infusion of therapeutic agents is increasing, especially as more biologics, which tend to need infusion, are approved for use. GAO looked at how Medicare FFS handles home infusion versus how private plans do.
Tags: Drugs, Medical Care, Medicare
Geographic Variation in Drug Expenses
by Kevin Roche on Monday, June 21, 2010
Medicare’s Part D benefit covers most prescription drugs and has added significantly to the program’s cost, although not as much as originally projected. Now that the program has been in existence for a few years, researchers looked at whether the same geographic variation in spending exists for drugs as does for other Medicare services.
Tags: Drugs, Health Care Costs, Medicare
2010 Potpourri XVI
by Kevin Roche on Saturday, May 8, 2010
No mother’s day would be complete without some health care news to ruminate on. This week’s include psychiatric drugs, the cost of the SGR fix, home health care costs, telemedicine and using computers to aid in diagnosis.
Tags: Drugs, Health Care Costs, Health Care Reform, HIT, Medicare, Telemedicine
Medicare Fee Change Effect on Utilization
by Kevin Roche on Thursday, March 4, 2010
A new research article examines the link between Medicare fee changes and the volume of utilization, confirming standard economic theory that the volume, or supply, of physician services does appear to be subject to normal supply and demand curves.
Tags: Medicare, Physicians
Competition Leads to Lower Hospital Costs
by Kevin Roche on Friday, February 26, 2010
Research indicates that commercial health insurance, while it has geographic variation in spending, does not vary in the same way as Medicare. A primary factor explaining private health plan geographic spending variation appears to be the state of competition for hospital services in different locales.
Tags: Health Care Costs, Health Insurance, Hospital, Medicare
Sources of Medicare Spending Growth
by Kevin Roche on Wednesday, February 24, 2010
A Health Affairs article examines changes in the composition of Medicare spending over the last two decades, finding that chronic disease is now the primary driver of that spending and that the nature of service demand has shifted from inpatient to outpatient and prescription drugs.
Tags: Health Care Costs, Medicare
Consequences of Reimbursement Changes
by Kevin Roche on Wednesday, February 17, 2010
As part of health care reform, various reimbursement changes have proposed, such as episode bundling or time-based global payments. An article in Cancer points out that such revisions to payments don’t always have the intended effect.
Tags: Medicare, Physicians
Workers’ Compensation and Medicare
by Kevin Roche on Wednesday, February 3, 2010
Many states have created workers’ compensation fee schedules based on Medicare reimbursement for physicians. Doing so can create traps if the frequent changes in the Medicare payment mechanisms are not carefully followed. A new NCCI report examines these issues.
Tags: Medicare, Workers Compensation
Managing End-of-Life Care
by Kevin Roche on Monday, January 18, 2010
End-of-life care achieved some notoriety in the health reform debate, but it deserves thoughtful attention since it accounts for a great deal of cost and research indicates that patients’ wishes for less intensive care are often not honored. A new study looks at how physicians approach the issue.
Tags: Care Management, Medicare, Physicians
2010 Potpourri I
by Kevin Roche on Saturday, January 9, 2010
The tort lawyer lobby errand boys in Congress just don’t know when to stop. Even after Senator Rockefeller got his hand slapped for questioning CBOs analysis of potential savings from tort reform, Congressman Bruce Baley decided to go back for more. And sure enough, CBO gave him an even more detailed justification of the savings [...]
Tags: Health Care Costs, Health Insurance, Malpractice, Medicare, Personalized Medicine, Telemedicine
Does Insuring People Before Age 65 Save Money
by Kevin Roche on Tuesday, December 8, 2009
A study suggests that insuring currently uninsured adults could save Medicare money. Overall health spending, however, would clearly go up substantially and even the amounts Medicare might save are in doubt.
Tags: Health Insurance, Medicare
Weekend Potpourri IV
by Kevin Roche on Saturday, November 14, 2009
Another dose of weekend tidbits, covering PAP screenings, health insurer consolidation, Part D plan satisfaction, Rand’s look at the best methods to reduce health care costs, geographic variations in health spending and coughing into cell phones–yes you heard me right.
Tags: Drugs, Guidelines, Health Insurance, Medical Care, Medicare, Pay For Performance
CMS Physician Payment Changes
by Kevin Roche on Tuesday, November 3, 2009
CMS released its rule changes for physician payments in Medicare. Significant cuts are set forth in the rule’s 1669 pages, sure to spark a strong response from the physician community and Congress.
Tags: Medicare, Physicians
More News on Medicare Advantage’s Advantages
by Kevin Roche on Friday, October 2, 2009
Another study demonstrates quality performance and better cost benefits from Medicare Advantage plans.
Tags: Care Management, Government, Health Insurance, Medicare
Prevention and Wellness Savings for Medicare
by Vita Advisors on Friday, August 7, 2009
Healthways’ Center for Health Research put our a report estimating that Medicare could save over $100 billion a year if beneficiaries entered the program in better health and maintained good health status.
Tags: Government, Medical Care, Medicare, Wellness and Prevention
Study Looks At Part D Impact on Drug and Medical Spending
by Kevin Roche on Tuesday, June 30, 2009
A study reported in the current issue of NEJM indicates that enrollment in Part D significantly increased drug spending for those persons who previously had no or a low level of drug coverage, but also led to a lower level of medical spending.
Tags: Health Care Costs, Health Insurance, Medicare, Pharmaceutical
MEDPAC – Medicare Payment Advisory Commission
by Kevin Roche on Wednesday, June 3, 2009
The work of the Medicare Payment Advisory Commission is always worth reading carefully. (Medpac website) It is one of the government groups that seems to do its job with a high degree of professionalism. MEDPAC’s reports contain useful data and it often provide unvarnished analysis and insight into America’s health care cost issues.
Tags: CMS, Medical Care, Medicare
Cost/Quality Relationship Unclear
by Kevin Roche on Wednesday, May 27, 2009
A study reported in Health Affairs, vol. 28, page 897 (May/June 2009), provides a further input to the question of the relationship, if any, between costs and quality in health care.
Tags: Health Care Costs, Health Care Quality, Hospital, Medical Care, Medicare
ShowHide Headlines
CBO Outlines ‘Key Features’ Of Ryan Budget Proposal: ‘Substantial’ Changes To Medicare, Medicaid
Hoyer said this week that the political reality is that the program may need to save more money.
Four years ago, Medicare Part D was born – today, the program is working better than many expected