Darn. I want one of those spells. eBay is banning the sale of spells, hexes, healings, blessings, prayers, and other similar supernaturalia. HT: Tyler.
House Ways and Means Committee: AARP has no credibility on Medicare reform.
Avik Roy examines the case for the defense and finds it wanting:
Excuse #1. Paul Ryan’s GOP budget did it too.
Excuse #2. ObamaCare’s Medicare cuts don’t harm seniors’ health benefits.
Excuse #3. ObamaCare cuts wasteful spending from the Medicare Advantage program.
Excuse #4. The Romney plan for Medicare is worse, because it would shift costs to seniors.
But you already knew that didn’t you? I usually disagree with Steffie Woodhandler and David Himmelstein but (like a stopped clock) they are occasionally correct. This is their view on why pay-for-performance doesn’t work:
Intensive coding — that is, embellishing diagnoses to maximize payment under per case or risk adjusted capitation schemes — also makes patients seem sicker on paper, and hence boosts risk adjusted quality scores. Under US Medicare’s DRG (diagnosis related groups) hospital payment system, recoding a diagnosis as “aspiration pneumonia with acute or chronic systolic heart failure” rather than simply “pneumonia with chronic heart failure” triples the payment and increases the risk score. Such “upcoding” is endemic among private health maintenance organizations that contract with Medicare for risk adjusted capitation payments, as well as among hospitals.
HT: Sarah Kliff.
In Anchorage, however, fewer than three out of every four doctors accepts Medicare patients and only 13 percent of Anchorage primary care physicians accept new Medicare patients.
In 2009, Medicare paid doctors in Anchorage $118 for a new patient, 30 minute visit. This is 39 percent less than private insurance companies pay doctors in Anchorage ($187).
Who will see new Medicare patients in Anchorage? The answer is safety net providers.
Research summary by Rosyland Frazier and Mark Foster. HT: Jason Shafrin.
In what may be a new low in managerial competence, the ObamaCare law penalizes Medicare providers for economy-wide productivity improvements in future years. The Medicare Trustees Report calculates that if these penalties are not repealed, this requirement will begin bankrupting hospitals, skilled nursing facilities, and home health agencies by 2019:
For all Part A services and most other (non-physician) Part B services, payment updates will be reduced in all future years by the increase in economy-wide multifactor productivity. By the end of the long-range projection period, payment rates for affected providers would be about 56 percent lower than their level in the absence of these reductions. Currently, the Medicare payment rates for inpatient hospital services are about 67 percent of those paid by private health insurance. If future improvements in productivity remain similar to what providers have achieved in the recent past (about 0.4 percent annually), then Medicare payment levels for inpatient hospital services at the end of the long-range projection period would be less than 40 percent of the corresponding level paid by private health insurance. Absent other changes, the lower Medicare payment rates would result in negative total facility margins for an estimated 15 percent of hospitals, skilled nursing facilities, and home health agencies by 2019, and this percentage would reach roughly 25 percent in 2030 and 40 percent by 2050.
Hospitals treating the poor are the hardest hit by Medicare’s readmissions penalties.
NBER study: Average effect of electronic medical records: slightly higher hospital costs.
In most maritime disasters, women and children don’t deboard first. The Titanic may have been a case of noblesse oblige.
Not as progressive as you might think. This is from Health Affairs via Sarah Kliff:
We know that education has a big impact on earnings and the ability to find employment. It also turns out to have a huge influence on how long Americans live: White men with less than a high school diploma had a life expectancy 12.9 years shorter than those with 16 or more years of education, according to new research in the journal Health Affairs. For women, the life expectancy gap stands at 10.4 years.
The Social Security payout formula is progressive. But less educated workers can expect to receive more than a decade’s worth of fewer benefits. Ditto for Medicare. See our previous post here.
This just up at Health Affairs:
Although 96 percent of physicians accepted new patients in 2011, rates varied by payment source: 31 percent of physicians were unwilling to accept any new Medicaid patients; 17 percent would not accept new Medicare patients; and 18 percent of physicians would not accept new privately insured patients. Physicians in smaller practices and those in metropolitan areas were less likely than others to accept new Medicaid patients.
Remember: one-half of the newly insured under ObamaCare are going into Medicaid.
