Category: Medicare

More on Medicare’s Latest Data Dump

Yesterday, we noted the New York Times‘ analysis of hospital charges from the Centers for Medicare & Medicaid Services (CMS) latest data dump. The same data dump showed how the amounts Medicare paid to hospitals and other providers for different services. The Hill‘s Ferdous Al-Faruque has pointed out some extreme differences:

health-care-costsThe agency found wide discrepancies in how much services cost in different regions of the nation and within the same geographic area. In 2012 a major joint replacement surgery cost Medicare $15,901 in Baltimore while the same procedure cost $239,138 in Los Angeles, the report says.

This variation appears too extreme. If it is a quality difference, surely the lower-quality provider is so bad that it should not be accepting patients! The seeming arbitrariness of Medicare payments might be one good explanation for the variance in costs observed by the Dartmouth Health Atlas team.

Like the physician data dump, for which we praised CMS, this is a treasure trove of data. CMS has also presented the data in a reasonably user-friendly way. It took me less than ten minutes to figure out the dashboard, which allows users to make charts and tables of almost any shape and size.

Well done, CMS. Keep ‘em coming.

The Medicare Physician Payment “Data Dump”: Don’t Stop Now

In April, the Centers for Medicare & Medicaid Services (CMS) dumped a treasure trove of raw data into the public domain: The Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File.

Resisted for years by organized medicine, this release publicizes a dataset of Medicare payments to doctors by name. The data released are for 2012; and CMS plans to release more data in the future.

The New York Times was well prepared for the data dump, and has an easily navigable website where subscribers can enter any doctor’s name and find out how much he earned from Medicare in 2012. Doctors whose Medicare revenue was in the millions found TV cameras at their offices the next morning, and had microphones stuck in front of their faces. The data continue to be analyzed, with interesting results: ProPublica has concluded that 1,800 providers billed the most expensive rate for any given procedure at least 90 percent of the time, although those rates are only for the most complex cases.

Unnecessary Care

As many as 42% of Medicare beneficiaries in 2009 underwent unnecessary medical treatments, costing the federal government as much as $8.5 billion, according to a study published yesterday in JAMA Internal Medicine. The analysis is the first large-scale examination into what Medicare spends on procedures that are widely considered to be unnecessary, such as advanced imaging for lower back pain and placing stents in patients with controlled heart disease. (KHN)

The Medicare “Doc Fix” Might Not Be Such a Bad Solution After All

This is Austin Frakt:

yuHowever, from another point of view, the formula — as flawed as it is — has helped keep Medicare spending lower than it might otherwise have been. Instead of cutting physician payments by the large amount the S.G.R. demands, Congress has increased payment rates, but typically by only tiny amounts — at an annual rate of just 0.7 percent.

But, although fees have only increased 8 percent since 2000, Medicare’s spending on physicians has increased 69 percent per patient. This is because the number and intensity of treatments has increased significantly. Could doctors have responded to lower real fees by cranking up volume?

What Difference Does Drug Insurance Make?

Results indicate that obtaining prescription drug insurance through Medicare Part D was associated with an 8% decrease in the number of hospital admissions, a 7% decrease in Medicare expenditures, and a 12% decrease in total resource use. Gaining prescription drug insurance through Medicare Part D was not significantly associated with mortality.

Robert Kaester, Cuiping Long, G. Caleb Alexander, National Bureau of Economic Research.

Twofer: Ryan’s Medicare Plan Saves Taxpayers $20 Billion and Reduces Seniors’ Premiums

Paul Ryan keeps making his Medicare reform proposal more politically palatable, while still saving money all around:

08Ryan’s plan has gone through several versions, but all of them have been based on the old bipartisan idea of “premium support.” The idea was that instead of paying for senior citizens’ medical services directly, the federal government would help them purchase private coverage plans.

The CBO still projects savings for the federal government — $15 billion — but it shows that beneficiaries will pay less, too.

(Ramesh Ponnuru, Bloomberg View)

Will Cuts in Home Health Care Increase Overall Health Care Spending?

On Jan. 1, Medicare‘s home health care services, formerly serving 3.5 million elderly beneficiaries across the country, were cut under ObamaCare. The cut deleted exactly 14 percent, or an estimated $22 billion, from these lowest-income Americans over four years…

Using 2009 as a reference year, Medicare‘s average Part A and Part B payment for a home health care visit was $145, compared to $373 per day in a skilled nursing facility or a whopping $1,805 per day in a hospital. In addition, according to one leading expert, skilled home health care services saved the Medicare program $2.8 billion during the most recent three-year period. Approximately $670 million of that savings is attributable to 20,000 fewer hospital readmissions. (More)

Where Are The Medicare Dollars Going?

A recent analysis of Medicare data provided to The New York Times shows that two percent of doctors earn twenty-four percent of Medicare payments.

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Hooray! The Medicare Doc Fix is Fixed Until Next April!

Confident DoctorsCongress has given up on repealing the Sustainable Growth Rate (SGR) as a way to pay physicians under Medicare. This blog has previously written about the futility of politicians’ efforts to “fix” the way they pay physicians (especially here, here and here).

The one they just passed last week runs for a year. And, just as always, these politicians who are elected for two-year to six-year terms voted to massively increase spending today, in exchange for draconian cuts a decade hence.

According to the Congressional Budget Office’s score of the bill, it increases Medicare’s physician payments by $15.8 billion over ten years. However, $11.2 billion (71 percent) is spent by 2015, and $13.3 billion (84 percent) is spent by 2016.

The savings to pay for this? Those come later, much later: Savings don’t become greater than spending until 2020, and not significant until 2024 — the last year of the mandated scoring “window“, when the law is supposed to claw back $9.3 billion from hospitals and re-impose the sequester on Medicare.

Good luck with that. Congress continues to make a mockery of Medicare-physician payment reform.

What Happens When Medicare Overpays Medicare Advantage Plans?

The Medicare Payment Advisory Commission (MedPAC) figures that Medicare Advantage plans cost 6 percent more than if beneficiaries had been in fee-for-service Medicare. New research concludes that beneficiaries only get a small fraction of these increased payments in benefits. According to Scott Duggan and colleagues:

…[O]nly about one-fifth of the additional reimbursement is passed through to consumers in the form of better coverage. A somewhat larger share accrues to private insurers in the form of higher profits and we find suggestive evidence of a large impact on advertising expenditures. Our results have implications for a key feature of the Affordable Care Act that will reduce reimbursement to MA plans by $156 billion from 2013 to 2022.