medicare
kkrisberg | July 22, 2017With the future of the Affordable Care Act still up in the air, most of the news coverage has gone to insurance coverage, premiums and Medicaid. And rightly so. But also included in the massive health reform law were a number of innovative measures to improve the quality and value of the medical care we actually get in the doctor’s office. With repeal still on the table, those measures are at risk too.
One of those ACA efforts is the Hospital Readmissions Reduction Program, which reduces Medicare payments to hospitals with relatively high rates of often-preventable hospital readmissions. The…
kkrisberg | October 28, 2016While health policy hasn’t been at the forefront of this year’s presidential election, the next person to sit in the White House could have a transformative effect on health care access, affordability and inequity. Of course, with so many variables in play, it’s hard to predict what either candidate could realistically accomplish on the health care front. However, a new report might provide some insightful clues.
Published this week in the New England Journal of Medicine, the report complied results from 14 national public opinion polls from various sources and conducted as recently as…
kkrisberg | September 24, 2015In the U.S., the gap in life expectancy by income is getting wider. To be even clearer: Life expectancy for people with higher incomes has gone up over time, while life expectancy for people earning lower incomes has actually declined.
In “The Growing Gap in Life Expectancy by Income: Implications for Federal Programs and Policy Responses,” which the National Academies of Sciences, Engineering and Medicine released last week, authors analyzed life expectancy patterns among Americans born in 1930 and compared them with projections among a group of Americans born in 1960. They found that top-…
lborkowski | July 30, 2015On July 30th, 1965, President Lyndon Johnson signed into law the Social Security Amendment Act that created Medicare and Medicaid. At the signing ceremony, President Johnson enrolled President Truman as the first Medicare beneficiary and gave a speech on the importance of the legislation. The President’s description of the law’s impact describes the conditions it aimed to alleviate:
No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy…
lborkowski | April 20, 2015Last week, President Obama signed long-awaited legislation that will put an end to periodic panic at the prospect of massive, sudden cuts to Medicare physician payments. The bipartisan “doc fix” bill repeals the Sustainable Growth Rate formula that aimed, but failed, to control growth in Medicare physician payments (Medicare Part B).
When it was first adopted in 1997, the SGR probably seemed like a good idea for controlling spending growth. When total Medicare Part B payments exceeded the targeted amounts, the SGR mechanism was supposed to automatically reduce physician payment rates. But…
lborkowski | April 14, 2014The Washington Post's After the Wars series offers an in-depth look at the challenges facing veterans returning from Iraq and Afghanistan. This past week, it's featured Rajiv Chandrasekaran's "The Other Wounds," about veterans' injuries and illnesses that aren't the direct results of enemy attacks, and Stephanie McCrummen's "The Choice," about one of the difficult decisions facing survivors of military sexual assault.
An unprecedented release of Medicare data has allowed for a lot of reporting on how much Medicare pays physicians; Puneet Kollipara rounds up several articles in Wonbook. Two…
oracknows | August 23, 2013About a week and a half ago, I wrote about a local oncologist who was arrested by the FBI for massive Medicare fraud in which physician involved diagnosed cancers that weren't there, gave chemotherapy to patients who either didn't have cancer or were in remission and thus didn't need it, and had developed a self-referral system to his own imaging facility. The story of this oncologist, Dr. Farid Fata, founder of a very large multi-location oncology practice (Michigan Hematology Oncology), made international news, which is exactly not the sort of coverage Detroit needs right now, given all the…
oracknows | August 12, 2013I've spent a lot of time on this blog discussing failures of the medical system. Usually, such discussions occur in the context of how unscientific practices and even outright quackery have managed to infiltrate what should be science=based medicine (SBM) in the form of so-called "complementary and alternative medicine" (CAM) or "integrative medicine," in which the quackery of alternative medicine is "integrated" with SBM. However, as big a problem as the infiltration of unscientific CAM practices into medicine is, there is a threat at least as grave here in the U.S. (and, I presume, in many…
kkrisberg | July 26, 2013With immigration at the forefront of national debate, Jim Stimpson decided it was time to do a little more digging.
"There's a lot of rhetoric around immigrants' use of public services in general and health care specifically, and I thought with impending federal immigration reform it would be useful to have some sort of contribution about the facts of unauthorized immigrants' use of health services in the United States," said Stimpson, a professor within the University of Nebraska's School of Public Health and director of the university's Center for Health Policy.
So together with colleagues…
denialism | February 25, 2013Steven Brill's extensive piece in Time has generated a good discussion once again on why Americans pay so much more for health care than other countries, and while I agree with most of his critiques, he seems to have gotten overly hung-up on the hospital chargemaster.
Readers of this blog know I've also discussed reform in health care, the diverse sources of excess cost including price gouging on pharmaceuticals, defensive medicine, expensive end-of-life care, the high cost of primary care in the ER etc, and both Brill and I appear to have relied on the same sources of data in the McKinsey…
lborkowski | January 21, 2013This is the part of President Obama's 2013 inaugural address that resonated with me the most:
We, the people, still believe that every citizen deserves a basic measure of security and dignity. We must make the hard choices to reduce the cost of health care and the size of our deficit. But we reject the belief that America must choose between caring for the generation that built this country and investing in the generation that will build its future.
For we remember the lessons of our past, when twilight years were spent in poverty, and parents of a child with a disability had nowhere to turn…
lborkowski | October 4, 2012Monday was the start date for an Affordable Care Act provision aimed at reducing high rates of hospital readmission among Medicare patients. This year, hospitals determined to have excess readmissions for patients with acute myocardial infarctions, heart failure, and pneumonia can lose up to one percent of their Medicare reimbursements for the year -- and in future years, the list of applicable conditions will get longer and the percentage of payments at risk will rise to three percent. But to what extent are readmissions under hospitals' control?
First, a bit of background: Readmissions are…
lborkowski | August 13, 2012Presumptive Republican presidential nominee Mitt Romney’s selection of Congressman Paul Ryan (R-Wisconsin) as his running mate this past weekend has provided plenty of fodder for discussions about the role of the US government. Unlike Romney, who has often declined to provide specifics about policies he’d pursue as president, Ryan has been very clear about what he thinks the government should do. As chair of the House Budget Committee, Ryan authored the “Path to Prosperity” budget proposal that the House passed earlier this year.
The New Yorker's Ryan Lizza describe Ryan's evolution as a…
lborkowski | February 21, 2012By Kim Krisberg
Friday wasn't a great day for public health.
That day, Congress voted to raid the Affordable Care Act's Prevention and Public Health Fund to the tune of $5 billion. The move comes as part of a deal to delay scheduled cuts to Medicare physician payment rates and was part of a legislative package to extend the payroll tax cut and unemployment benefits. Both the Senate and House voted by wide margins to pass the bill, and President Obama is expected to sign it.
Of course, this was hardly the intent of the Prevention and Public Health Fund, which was created via the Affordable…
lborkowski | January 24, 2012Last week, the Congressional Budget Office released some disappointing news: several demonstration projects aiming to contain growth in healthcare spending are not showing cost savings. Specifically, the Centers for Medicare and Medicaid Services have been focusing on programs involving either disease management and care coordination or value-based payment systems for the fee-for-service Medicare population. A CBO issue brief reviews programs in both these categories that have been conducted over the past two decades, and I'm particularly interested in what it says about the disease…
lborkowski | October 3, 2011One thing that drove me nuts during the healthcare reform debate was the scare tactic of claiming that proposed legislation would result in rationing of healthcare. The problem with making such a claim is that healthcare is already rationed in the US. We ration healthcare based on insurance status and ability to pay. And, as a story from NPR's Richard Knox points out, we ration when there are supply shortages -- as there are now with several important drugs. Here's Knox's overview of the problem:
The shortages involve a wide range of medications: cancer chemotherapy agents, anesthetics,…
sastyk | June 24, 2010From HuffPo, this article about the likely outcome that the Democrats will fail to pass an unemployment extension - unfortunately it was bound to happen sooner or later, but it will be crushingly hard on millions of people who have just been barely making it, and now aren't.
The legislation, known as the "tax extenders" bill, would reauthorize extended unemployment benefits for people out of work for six months or longer, would protect doctors from a 21 percent pay cut for seeing Medicare patients, and would provide billions in aid to state Medicaid programs.
Come Friday, 1.2 million people…
palmd | June 24, 2010Medicare is the government health care program for the elderly. For internists such as me, Medicare patients make up around half our practice. Because of historical budget tools, every year Congress goes through the motion of watching our reimbursement cut, and quickly fixing it. It's a terrible system. As a small business, my costs are pretty much fixed: rent, employee pay, health insurance, supplies, etc. Every year, a Medicare pay cut goes into effect, and then our checks are held while Congress puts together a temporary fix.
This year, the pay cut is 21%. That means that I will…
lborkowski | May 27, 2010A New York Times article by Jane Gross highlights a costly healthcare problem: avoidable hospital readmissions, which affect one in five patients and account for $17.4 billion of the current $102.6 billion Medicare budget. (When people talk about readmissions, they're generally referring to an admission within 30 days of the previous admission for the same condition.)
When patients end up back in the hospital, it's often because their care didn't continue appropriately when they were first discharged. Patients leaving the hospital should receive detailed instructions about what they need to…
denialism | August 31, 2007Leave it to AEI writing for the WSJ editorial page to allege a grand conspiracy of the government against pharmaceutical companies. Their proof? The government wants to compare the efficacy of new drugs to older ones to make sure they're actually better.
The reauthorization of the State Children's Health Insurance Program (Schip), created in 1997 to cover children from lower-income families who make too much to qualify for Medicaid, is up for renewal this fall. Tucked into page 414, section 904 of the House bill is a provision to spend more than $300 million to establish a new federal "…