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Monthly Archives: December 2008

Medicare Part D: Comparing Prescription Drug Use in Special Needs Plans and Other Medicare Advantage Plans

Medicare beneficiaries in Special Needs Plans (SNPs) have higher Part D prescription drug utilization and costs than enrollees in other Medicare Advantage Prescription Drug Plans (MA-PDs) do. This is no surprise since, by design, Special Needs Plans serve higher-risk Medicare patients, including many dual eligibles. However, despite higher drug utilization rates in SNPs, SNP enrollees and other MA-PD enrollees...

Health Indicators: 20 Key Indicators of U.S. Health Care

The Institute of Medicine (IOM) has identified 20 key indicators that together "reflect the overall health of the nation and the efficiency and efficacy of U.S. health systems." Each of the 20 indicators can be readily measured over time using existing, publicly collected, reasonably high quality data. In addition to supporting nationwide snapshots, they permit drill-down views based on geography,...

Hospital Quality: Adverse Event Reporting by Hospitals

Historically, traditional payment policies - coupled with lax oversight by regulators, weak leadership from many corners of the hospital and physician communities, and an uninformed, reverential public - have served to perpetuate (sometimes even reward) the use of unsafe practices and antiquated technologies in the hospital industry. This, in turn, resulted in a frightening number of adverse events -...

National Health Reform: Federal Budget Options for 115 Health Reforms Proposals

To aid the incoming 111th Congress and Obama Administration, the Congressional Budget Office (CBO) released a 235-page report outlining 115 budget options for health care reform. The report catalogs most of the hottest legislative ideas on Capitol Hill, with useful background information and scores of costs and savings. Here's the list of reform ideas in the report: The Private Health...

Medicare Reimbursement: Primers on Medicare Payment Policies for Providers, Health Plans, and Drug Plans

Medicare reimbursement policies are highly complex. Yes, that could be the litotes of the decade. Thankfully, the outstanding staff at the Medicare Payment Advisory Commission (MedPAC) produce and routinely update a series of basic primers on Medicare payment methodologies for hospitals, physicians, other providers, Medicare Advantage plans, and Part D prescription drug plans. MedPAC's primers are reader friendly and crafted...

State Medicaid Budgets: Fiscal Survey of the States

Comprising 21% of state budgets and growing faster than revenues, Medicaid continues to be a serious challenge for governors, state legislatures, and state Medicaid directors. The National Association of State Budget Officers (NASBO) has released its latest budget gaps in 2009 and 2010.

Presidential Appointees: HHS, CMS, FDA, and OMB in Obama Administration

A new Administration in the White House also means an array of new political appointees. The aptly named Plum Book, a quadrennial publication, identifies 7,000 senior-level policy making positions in the Executive and Legislative Branches. It includes all the well-know top positions - such as HHS Secretary, CMS Administrator, FDA Commissioner, and OMB Director - as well as their...

Federal Budget and Health Reform: Budgeting for Health Reform

The budgetary impact of proposed health reform initiatives - whether through legislation, rules, or waivers - significantly affects the likelihood of success. The following provides a concise briefing on some key players and processes affecting cost estimates of federal health care initiatives. Congressional Budget Office (CBO): The Congressional Budget Office (CBO), a nonpartisan agency of Congress, provides Congressional committees with budgetary...

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