Prescription drugs often play an important role in keeping people healthy, especially for people with chronic conditions. Medicare beneficiaries with diabetes or asthma, for example, might take regular medicines to prevent emergencies that would put them in the hospital. Hospital stays, doctor’s appointments, and other medical services covered under...
Medicare program payment methods are highly complex and change constantly. The Affordable Care Act (ACA) makes further, very significant changes to how Medicare pays hospitals, physicians, post-acute providers, and Medicare Advantage health plans. In a series of excellent briefs, the Medicare Payment Advisory Commission (MedPAC) explains the basics of Medicare reimbusement, including...
Medicare Advantage plans provide many benefits to Medicare beneficiaries, including lower costs, added services, higher quality than traditional fee-for-service (FFS), and less paperwork. However, the way Medicare paid Medicare Advantage health plans led to a situation where Medicare was paying health plans more than the average cost of Medicare FFS...
Medicare is slowly but steadily moving toward value-based methods of reimbursing physicians, hospitals, and other health care providers differentially based on quality and cost of care. The evolving payment methods add performance or value-based modifiers to traditional Medicare fee-for-service reimbursement. For physicians, new value-based payment modifiers will adjust each provider's payment rates under the Medicare Part B fee...
Care management for Medicare beneficiaries at high risk of hospitalization can significantly reduce hospital admissions without increasing costs, according to two studies in Health Affairs and sponsored by the Robert Wood Johnson Foundation. The studies found decreases in Medicare inpatient admissions of 17 percent and 8 to 33 percent, respectively. Care management...
Much attention has been paid to the federal deficit, and a great deal of this discussion has centered on Medicare and Medicaid spending. As a means for controlling what has been considered “out of control” health care costs, some have pushed for major program restructuring, most notable premium support...
Several Medicare reform proposals have concentrated on realigning financial incentives within Medicare’s provider payment and delivery system to improve program cost-effectiveness and quality, a key health policy challenge. There have been calls to modernize Medicare’s fee-for-service (FFS) benefit design and address other beneficiary incentive issues as a means of...
The Congressional Budget Office’s issue brief, Lessons from Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment, provides details on the outcome of 10 major Medicare demonstrations following independent researcher evaluation.
Demonstrations were conducted during a 20-year span within two categories. Demonstrations were aimed at improving health care...
A study conducted by the HHS Office of Inspector General, Hospital Incident Reporting Systems Do Not Capture Most Patient Harm, analyzed the ways in which hospitals use incident reporting systems and incident reports to determine how accurately this reflected actual patient harm occurring within hospitals. The study also aimed...
Because preventative care can reduce expenditures and improve health outcomes, the GAO conducted a study examining actual preventative service use in relation to the U.S. Preventative Services Task Force (USPSTF) and Advisory Committee on Immunization Practices (ACIP) by Medicare fee-for-service (FFS) beneficiaries. This study also examined whether or not the...
