Category: Medicare

One In Five Doctors Say: “No New Medicare Patients”

If you learned that 93 percent of non-pediatric primary care physicians took Medicare patients and 94 percent took patients with private insurance, you would likely conclude that Medicare is doing just fine.

Unfortunately, such data do not describe physicians’ behavior at the margin, which is what will determine future access to Medicare. The Kaiser Family Foundation/Commonwealth Fund 2015 National Survey of Primary Care Providers also asks which physicians are not accepting new patients: 21 percent are not taking new Medicare patients and 14 percent are not taking new privately insured patients. That is, the proportion not taking new Medicare patients is 1.5 times greater than the proportion not taking new privately insured patients.

Dec 01, 2015 | 32 comments | by John R. Graham

Improper Payments Up 18 Percent, Mostly Medicare & Medicaid

The Government Accountability Office (GAO) has just reported that “improper payments” (that is fraud and abuse) are up to $124. 7 billion in 2014 from $105.8 billion in 2013. Most of this is Medicare and Medicaid:

The almost $19 billion increase was primarily due to the Medicare, Medicaid, and Earned Income Tax Credit programs, which account for over 75 percent of the government-wide improper payment estimate. Federal spending in Medicare and Medicaid is expected to significantly increase, so it is critical that actions are taken to reduce improper payments in these programs.

Oct 06, 2015 | 2 comments | by John R. Graham

Are Medicare ACOs Gaining A Foothold?

This blog has never gotten very excited by Medicare’s Accountable Care Organizations (ACOs). ACOs are risk-sharing arrangements between Medicare and providers, which are supposed to save money through efficiency. As a concept, they are fine – certainly an improvement over the incumbent, Soviet-style fee schedule. However, it is unlikely that the government has the incentives to get the risk-sharing incentives right.

I had anticipated that ACOs might end “with a whimper.” The Centers for Medicare & Medicare Services (CMS) have released results of Pioneer ACO’s third year of operation and 2014 results for Medicare Shared Savings Program (MSSP) ACOs which launched in 2012 through 2014. While ACOs are hardly taking off like the administration hoped, they seem to have gained a foothold.

Sep 18, 2015 | 3 comments | by John R. Graham

Bundled Payments, Barely Hatched, Go the Way of the Dodo

Last month, I wrote about Accountable Care Organizations (ACOs), medical groups accountable to the federal government for management of healthy populations. Even Zeke Emanuel recognizes that they are failing. Dr. Emanuel advised Medicare should “lump together” all the services associated with a procedure, such as a hip replacement, and pay one fee for the entire services.

As I noted, Medicare already does this via its Bundled Payments for Care Initiative (BPCI) which launched in 2013. At the time, hospitals and other providers were offered voluntary participation. Just a few weeks ago, the Medicare decided to make bundled payments mandatory for some procedures in some areas. Now we know why: Providers are learning that the bundles don’t work.

Aug 19, 2015 | 7 comments | by John R. Graham

Bush Scores on Medicare

Former Florida governor and presidential candidate Jeb Bush stepped outside the political comfort zone and endorsed dramatic reforms to Medicare:

Republican presidential candidate Jeb Bush said Wednesday that we ought to phase out Medicare, the federal program that provides health insurance to Americans once they’re 65.

“We need to make sure we fulfill the commitment to people that have already received the benefits, that are receiving the benefits,” Bush said. “But we need to figure out a way to phase out this program for others and move to a new system that allows them to have something, because they’re not going to have anything.”

Bush praised Rep. Paul Ryan (R-Wis.) for proposing to change Medicare to a system that gives seniors medical vouchers instead of paying their bills directly.

(Arthur Delaney & Jeffrey Young, “Jeb Bush says we should phase out Medicare,” HuffingtonPost, July 23, 2015)

That kind of straight talk deserves praise, especially as so many Americans have allowed a few years of Medicare Trustees’ reports, which show a trivial improvement in the program’s finances, to give them an excuse to dodge the need for reform.

Jul 23, 2015 | 8 comments | by John R. Graham

2015 Medicare Trustees Report: No Pot O’ Gold in Medicare’s Future

The Trustees for Social Security and Medicare released their 2015 Trustees’ Report. Liberal stalwart, Mother Jones, proclaimed how wonderful it was. Political blogger Kevin Drum had an interesting argument showing how long-term medical cost projections were down from a decade ago. However, he also conceded that others think the current slowdown is temporary. Yet, if you look at the report itself the news isn’t very reassuring. In 2000, Medicare spending as a percentage of GDP was just above 2 percent. It’s now about 3.5 percent and will be four percent by 2023.

Jul 23, 2015 | 11 comments | by Devon Herrick

Zeke Emanuel Hammers Obamacare Again

Obamacare’s best frenemy, Dr. Ezekiel Emanuel, and his colleagues at the Center for American Progress, gave up on Obamacare last year. In yesterday’s Wall Street Journal, he and Topher Spiro emphasizes that Accountable Care Organizations, which Obamacare established to co-ordinate care and lower costs in Medicare, are failing to achieve either goal:

Jul 08, 2015 | 3 comments | by John R. Graham

Doctor Who Billed Medicare Over $16 Million in 2013 Explains It on YouTube

Last year, I had a very rare opportunity to congratulate the Obama Administration for its decision to release Medicare’s physician payment data for public scrutiny. It followed up quickly with a data dump of hospital claims.

I also anticipated that this would lead the physicians with the highest spending to justify their claims to the citizens at large. Last week, the Administration released the 2013 physician file, which is causing a this to happen. Here is one high-cost specialist explaining his practice on YouTube:

I discovered this thanks to USA Today, which has done a first cut of the 2013 dataset:

Jun 10, 2015 | 2 comments | by John R. Graham

Accountable Care Organizations Hate Medicare’s Final ACO Rule

Last Thursday, the Centers for Medicare & Medicaid Services published the final rule for Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs). At almost 600 pages, it differs in many ways from the proposed rule issued last December:

Creates a new Track 3, based on some of the successful features of the Pioneer ACO Model, which includes higher rates of shared savings, the prospective assignment of beneficiaries, and the opportunity to use new care coordination tools;
Streamlines the data sharing between CMS and ACOs, helping ACOs more easily access data on their patients in a secure way for quality improvement and care coordination that can drive critical improvements in beneficiaries’ care;
Establishes a waiver of the 3-day stay Skilled Nursing Facility (SNF) rule for beneficiaries that are prospectively assigned to ACOs under Track 3; and
Refines the policies for resetting ACO benchmarks to help ensure that the program continues to provide strong incentives for ACOs to improve patient care and generate cost savings, and announces CMS’ intent to propose further improvements to the benchmarking methodology later this year.

“Successful features of the Pioneer ACO model”? That’ll be a struggle. As we’ve discussed, the Pioneer ACOs have had very meager results, and will probably end up as a footnote to Medicare’s history.

Jun 09, 2015 | Leave a Comment | by John R. Graham

Hip Replacements in L.A.: $12,457 to $17,609

A short drive in the Los Angeles area can yield big differences in price for knee or hip replacement surgery.

New Medicare data show that Inglewood’s Centinela Hospital Medical Center billed the federal program $237,063, on average, for joint replacement surgery in 2013.

That was the highest charge nationwide. And it’s six times what Kaiser Permanente billed Medicare eight miles away at its West L.A. hospital. Kaiser billed $39,059, on average, and Medicare paid $12,457.

The federal program also paid a fraction of Centinela’s bill — an average of $17,609 for these procedures. (Chad Terhune & Sandra Poindexter, “Price of a common surgery varies from $39,000 to $237,000 in L.A.,” Los Angeles Times, June 2, 2015)

Okay, hospital bills are silly. We already know that. Let me point out two things.

Jun 02, 2015 | 9 comments | by John R. Graham

Category: Medicare

One In Five Doctors Say: “No New Medicare Patients”

Improper Payments Up 18 Percent, Mostly Medicare & Medicaid

Are Medicare ACOs Gaining A Foothold?

Bundled Payments, Barely Hatched, Go the Way of the Dodo

Bush Scores on Medicare

2015 Medicare Trustees Report: No Pot O’ Gold in Medicare’s Future

Zeke Emanuel Hammers Obamacare Again

Doctor Who Billed Medicare Over $16 Million in 2013 Explains It on YouTube

Accountable Care Organizations Hate Medicare’s Final ACO Rule

Hip Replacements in L.A.: $12,457 to $17,609

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Category: Medicare

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