Going Beyond One Size Fits All in Surgical Bundled Payments

“In existing [bundled payment] programs, surgeons are subject to identical episode length, metrics, and reimbursement. One potential unintended consequence of this one-size-fits-all approach is an uneven playing field for different surgeons and organizations—a dynamic that may explain why hospitals that bundle joint replacement differ from those that do not. Our anecdotal experiences at academic medical centers corroborate this evidence: hesitation among colleagues often stems from a belief of poor fit due to practice setting and patient case mix. [..] One approach to attracting more surgeons could be to create options (“participation tracks”) that involve delivering different sets of services to … Read More

Clover, Walmart launch Medicare Advantage plans in Georgia

“A new health insurance plan will include Walmart’s Health Centers as a feature. The retailer is teaming up with insurance startup Clover to offer Medicare Advantage plans across the state of Georgia. The “Live Healthy” plans will be structured as a PPO — consistent with Clover’s other MA plans in the eight states where it operates. Members will have access to Walmart Health’s clinics across the state, which offer primary care, dental, hearing, x-rays and other services. [..] The plans have no copay for primary care visits, lab tests, and preventive dental exams. They also include other benefits, including $100 … Read More

MedPAC supports changes to the development of MA plan payment benchmarks

“The Medicare Payment Advisory Commission [..] was largely in favor of creating a new payment approach that calculates MA [Medicare Advantage] payments based on a blend of local and national spending as opposed to the current methodology, which sets benchmarks on a county-by-county basis. [..] the meeting underscored the panel’s desire to make reforms to the MA payment structure. MedPAC data show that MA plan payments are on average 2% higher than traditional Medicare. [..] MA plans submit a bid that details the estimated revenue the plan will need to cover the basic Medicare benefit in Parts A and B. … Read More

Association of Preferences for Participation in Decision-making With Care Satisfaction Among Hospitalized Patients

“Variation in patient preferences and expectations concerning engagement may be associated with patient-reported quality metrics, including satisfaction, ratings of care, quality of life, and other measures of health service quality. Because preferences and expectations exhibit geographic variation, such associations could complicate the interpretation of patient-reported outcomes (PROs) as measures of clinician performance. Despite the growing use of such performance metrics, literature on the association of PROs with preferences for participation in decision-making is limited, particularly among urban minority racial/ethnic populations. Because race/ethnicity has important associations with patient trust and satisfaction, studies that include diverse populations are essential to understand preferences … Read More

A Unique Deal in Dutch Health Care: Private Insurers and Providers Find Common Ground to Address Covid-19 Effects

“The Covid-19 pandemic has added another twist in the U.S. health-care saga. While some providers initially struggled financially as elective and outpatient care were cancelled or deferred, private health insurers saw record profits in the second quarter. In fact, major insurance companies such as UnitedHealthcare, Anthem, and Humana doubled their profit margins, pushing Democrats to launch an investigation into insurers’ practices. During a time when public confidence in political and corporate institutions is low, the paradox of soaring insurers’ profits and unprecedented providers’ losses is painful, potentially detrimental, and likely unnecessary. [..] Under Affordable Care Act (ACA) regulations, insurers’ excess … Read More

Observed to Expected Mortality for the United States, Updated October 3, 2020

This week’s refresh of the excess mortality count from the CDC (last updated September 30). The federal agency identified nearly 263,000 excess deaths across the country since the start of this year (about 13,000 more than last week’s estimate). The overall excess mortality rate increased slightly from 11.0% last week to 11.1% this week. Data from the CDC’s National Center for Health Statistics, updated September 30, 2020

Taming The Paper Tiger

“If health care is going to spend less, some inputs will need to be paid less. This post explores the possibility of saving money by reducing the administrative costs of health care. Reducing administrative costs is attractive for several reasons. Administrative costs are high, perhaps a quarter of health spending, so reductions in administrative costs could yield a good deal of savings. Further, the goal of medical care is clinical care, so reducing administrative staff likely has a smaller effect on quantity and quality of care than would reductions in clinical staff. Finally, excess administrative hassles adversely affect peoples’ ability … Read More

The Mismatch of Telehealth and Fee-for-Service Payment

“the “virtual check in” code introduced in the 2019 MPFS [Medicare Physician Fee Schedule] initiated payment for short communications with patients to avoid unneeded office visits. During the PHE [Public Health Emergency], restrictions on both telehealth visits and non-visit-based communications were loosened further, importantly permitting telehealth services to originate from the patient’s home instead of a medical facility. The Centers for Medicare and Medicaid Services also agreed to pay for routine phone calls between patients and their practitioners. Medicare initially set the rate for a 5- to 10-minute call comparable to a virtual check in—about $15—pegging the fee to relative … Read More

The online anti-vaccine movement in the age of COVID-19

“A new report by the Centre for Countering Digital Hate (CCDH) has lambasted social media companies for allowing the anti-vaccine movement to remain on their platforms. The report’s authors noted that social media accounts held by so-called anti-vaxxers have increased their following by at least 7·8 million people since 2019. “The decision to continue hosting known misinformation content and actors left online anti-vaxxers ready to pounce on the opportunity presented by coronavirus”, stated the report. [..] The CCDH calculated that the anti-vaccine movement could realise US$1 billion in annual revenues for social media firms. As much as $989 million could … Read More

This Overlooked Variable Is the Key to the Pandemic: It’s not R.

Excerpt – many people have heard about R0—the basic reproductive number of a pathogen, a measure of its contagiousness on average. But unless you’ve been reading scientific journals, you’re less likely to have encountered k, the measure of its dispersion. The definition of k is a mouthful, but it’s simply a way of asking whether a virus spreads in a steady manner or in big bursts, whereby one person infects many, all at once. After nine months of collecting epidemiological data, we know that this is an overdispersed pathogen, meaning that it tends to spread in clusters, but this knowledge … Read More