Tag: "Medicare"

Gouging Seniors

An “observation” patient is technically never admitted and the visit counts as “outpatient care.” In that case:

These observation patients might wind up paying a larger share of their hospital bill than inpatients, since they usually have a co-payment for doctors’ fees and each hospital service. But Medicare doesn’t pay at all for routine drugs that observation patients need for chronic conditions such as diabetes, high blood pressure or high cholesterol…

In Missouri, several Medicare observation patients were billed $18 for one baby aspirin, said Ruth Dockins, a senior advocate at the Southeast Missouri Area Agency on Aging; Pearl Beras, 85, of Boca Raton, Fla., said in an interview that her hospital charged $71 for one blood pressure pill for which her neighborhood pharmacy charges 16 cents; In California, a hospital billed several Medicare observation patients $111 for one pill that reduces nausea; for the same price, they could have bought 95 of the pills at a local pharmacy…

More from Susan Jaffe in the Kaiser Health News.

May 02, 2012 | 4 comments | by

Barney Frank on Health Care, and Other Links

Barney Frank on health care: “Obama made the same mistake Clinton made.”

The latest in rationing by waiting at Walt Disney World.

An accountant explains the federal budget. Thanks to John Dunn for the pointer.

Per capita Medicare and Medicaid spending in 2007 for dual eligibles was $29,868, more than four times the per capita spending for other Medicare beneficiaries.

In defense of oil speculation. HT: Greg Mankiw.

Apr 26, 2012 | 2 comments | by

Study: Hospital P4P Doesn’t Work

Findings:

Medicare’s largest effort to pay hospitals based on how they perform — an inspiration for key parts of the health care law — did not lead to fewer deaths, a new study has found.

Implications:

The study casts doubt on a central premise of the health law’s effort to rework the financial incentives for hospitals with the aim of saving money while improving patient care. This fall, Medicare is going to start altering its payments to more than 3,000 hospitals based on how patients rate their stays and how completely hospitals follow a handful of clinical guidelines for basic care.

Commentary:

“At the end of the day, you are going to ask people to make improvements and you want them to focus on what’s important,” Jha said. “And if you give them 18 different metrics and some are easy but not that important, and some are hard but important, people are going to naturally gravitate toward what’s easy and you’re not going to have meaningful impact.”

Mar 30, 2012 | 4 comments | by

I’m Not Sure I Believe This

The health reform law boosted Medicare fees for primary care ambulatory visits by 10 percent for five years starting in 2011. Using a simulation model with real-world parameters, we evaluate the effects of a permanent 10 percent increase in these fees. Our analysis shows the fee increase would increase primary care visits by 8.8 percent, and raise the overall cost of primary care visits by 17 percent. However, these increases would yield more than a six-fold annual return in lower Medicare costs for other services—mostly inpatient and post-acute care—once the full effects on treatment patterns are realized. The net result would be a drop in Medicare costs of nearly 2 percent. These findings suggest that, under reasonable assumptions, promoting primary care can help bend the Medicare cost curve.

Access the issue brief and technical appendices in The Commonwealth Fund.

Mar 23, 2012 | 5 comments | by

Knee Replacement May Save Lives

The US has more knee replacements per capita than any other nation. Is that because we want 85-year-olds to be able to stay on the ski slopes? More serious issues may be involved.

In a sweeping study of Medicare records, researchers from Philadelphia and Menlo Park, Calif., examined the effects of joint replacement among nearly 135,000 patients with new diagnoses of osteoarthritis of the knee from 1997 to 2009. About 54,000 opted for knee replacement; 81,000 did not.

Three years after diagnosis, the knee replacement patients had an 11 percent lower risk of heart failure. And after seven years, their risk of dying for any reason was 50 percent lower.

More from Tara Parker-Pope in The New York Times.

Mar 06, 2012 | 5 comments | by

What Difference Do Generics Make?

Generic drugs account for about 78 percent for drugs dispensed in retail settings, such as independent, chain, and mail-order pharmacies, as well as in long-term care facilitates. According to a GAO report:

[A] series of studies estimated that … substituting generic drugs for their brand-name counterparts … from 1999 through 2010 … saved more than $1 trillion. A second group of studies estimated the …  the potential for additional savings within the Medicare Part D program—which provides outpatient prescription drug coverage for Medicare—and found that if generic drugs had always been substituted for the brand-name drugs studied, about $900 million would have been saved in 2007. A third group of studies estimated the effect on health care costs of using generic versions of certain types of drugs where questions had generally been raised about whether substituting generic drugs for brand-name drugs was medically appropriate. Unlike the other two groups which focused on savings on drugs only, these studies compared savings from the lower cost of generic drugs to other health care costs that could accrue from their use, such as increased hospitalizations. The studies had mixed results regarding the effect of using these generics in that some found they raised health care costs, while others found they led to cost savings.

Mar 05, 2012 | 5 comments | by

Headlines I Wish I Hadn’t Seen

A $77 million computer system launched last summer to detect Medicare fraud before it happens found only one suspicious payment — totaling $7,591 — by the end of December.

Man Charged With Chopping Off Friend’s Hand For Insurance Money.

Letter arrives 32 years later (gated).

Mar 01, 2012 | 6 comments | by

Rethinking Medicare Advantage Plans

One in four Medicare enrollees has chosen to join a private plan. Yet, Medicare pays 10% more to these plans, other things equal. Does that mean they are less efficient? Not necessarily, according to a NEJM Perspective by Jeet Gurum and Bob Moffit. The extra payments are the artificial consequence of a screwy bidding system. Plus they seem to produce higher quality beating traditional Medicare on 9 of 11 process measures (inputs). See the chart. So what’s the answer?

A better reform, advocated by Coulam and colleagues, would break that link: traditional Medicare would also submit bids, the government would set payment levels equal to each county’s lowest bid, and beneficiaries desiring a more expensive plan would have to pay the difference.

Under that system, traditional Medicare, no longer the default option, would compete with private plans on a level playing field. Private plans would gain substantial market share by providing Medicare coverage at the lowest cost in a county. As plans experimented with coverage models, attempting to deliver benefits in attractive, inexpensive ways, the most efficient approach in each county would be reached, and the rate of growth of Medicare spending would slow.

Feb 28, 2012 | 5 comments | by

Survey Says: Contraception Coverage Does Not Save Money, and Other News

Survey: Nobody in the health insurance industry thinks that contraception coverage saves money.

If you are covered by a Medicare Advantage plan and you elect hospice, the payment for such care reverts back to fee for service Medicare (pointer from Austin Frakt).

NYT reviews the history of conservative support for a health insurance mandate. See our previous posts here, here, and here.

Feb 21, 2012 | 5 comments | by

And This Is A Liberal Democrat

“Ron Wyden, Useful Idiot,” railed New York Times columnist Paul Krugman. “Is Ron Wyden trying to get Mitt Romney elected?” fumed the Nation magazine. Ron Zerban, a Democrat running for Mr. Ryan’s seat, accused Mr. Wyden of giving the GOP cover and proclaimed him no longer a “Democrat.”

The White House went defcon, insisting that the new Wyden/Ryan plan would cause Medicare to “wither on the vine.” House Democrats hissed the plan would end “Medicare as we know it.” Most informative was the gripe of a former Senate staffer: Mr. Wyden was taking away “a key argument for Democrats that are trying to retake the House.” The nerve!

Full article by Kimberly Strassel on Senator Ron Wyden’s joint proposal with House Republican Paul Ryan in the Wall Street Journal worth reading.

Feb 17, 2012 | 5 comments | by
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