Implications Of MIPS Scoring On Clinician Engagement In Value-Based Payments
[Reposted: Joshua M. Liao and Amol S.
MIPS APMs In The Quality Payment Program
[Reposted: Joshua M. Liao and Amol S.
The Real Opportunities of MIPS Payment Adjustments
[Reposted: Joshua M. Liao, Anders Chen, and Amol S.
The Current State of Evidence on Bundled Payments
A review of the evidence shows that bundled payments for surgical procedures can generate savings without adversely affecting patient outcomes. Less is known about the effect of bundled payments for chronic medical conditions, but early evidence suggests that cost and quality improvements may be small or non-existent. There is little evidence that bundles reduce access and equity, but continued monitoring is required.
Making Value-Based Payment Work in Medicaid
If value-based payment models can work in Medicare, can they also work in Medicaid? Not without significant changes, according to LDI Senior Fellows Joshua Liao and Amol Navathe and colleague Benjamin Sommers in a NEJM Perspective.
Physician Perspectives Towards Medicare’s New Payment Program
In a study in Health Affairs, LDI Senior Fellow Joshua Liao and colleagues report on what physicians think about Medicare’s new payment program, the Merit-based Incentive Payment System (MIPS).
Preferred Pharmacy Networks and Drug Costs
Amanda Starc, Ashley Swanson
ABSTRACT [FROM JOURNAL]
Selective contracting is an increasingly popular tool for reducing health care costs, but these savings must be weighed against consumer surplus losses from restricted access. In both public and private prescription drug insurance plans, issuers utilize preferred pharmacy networks to reduce drug prices. We show that, in the Medicare Part D program, drug plans with more restrictive preferred pharmacy networks, and plans with fewer enrollees who are insensitive to preferred pharmacy discounts on copays, pay lower retail drug prices. We then use estimates of...
Addressing Out-Of-Pocket Specialty Drug Costs In Medicare Part D: The Good, The Bad, The Ugly, And The Ignored
[Reposted: Jalpa A. Doshi, Amy R. Pettit, and Pengxiang Li. Addressing Out-Of-Pocket Specialty Drug Costs In Medicare Part D: The Good, The Bad, The Ugly, And The Ignored, Health Affairs Blog, July 25, 2018. https://www.healthaffairs.org/do/10.1377/hblog20180724.734269/full/: Copyright ©2018 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.]
SUMR 2018 Attends AHRQ National Research Service Awards Conference
Modernizing Medicare Funding for Nurse Education
With policies rooted in the 1960s, it’s time to change how Medicare pays for nurse education. In a New England Journal of Medicine Perspective, LDI Senior Fellow Linda Aiken and colleagues present a compelling case for funding a new consortium model that trains nurse practitioners (NPs) in the community settings where they are a crucial source of primary care.
Comparison Of Hospitals Participating In Medicare’s Voluntary And Mandatory Orthopedic Bundle Programs
Amol S. Navathe, Joshua M. Liao, Daniel Polsky, Yash...
Abstract [from journal]
We analyzed data from Medicare and the American Hospital Association Annual Survey to compare characteristics and baseline performance among hospitals in Medicare’s voluntary (Bundled Payments for Care Improvement initiative, or BPCI) and mandatory (Comprehensive Care for Joint Replacement Model, or CJR) joint replacement bundled payment programs. BPCI hospitals had higher mean patient volume and were larger and more teaching intensive than were CJR hospitals, but the two groups had similar risk exposure and baseline episode quality and cost. BPCI hospitals...
Looking Ahead at Medicaid: Work Requirements and Other Big Changes
Trends in hospital-SNF relationships in the care of Medicare beneficiaries
Joshua M. Liao, R. Tamara Konetzka, Rachel M. Werner
Abstract [from journal]
Improving the value of post-acute care at skilled nursing facilities (SNFs) has become a Medicare policy priority. Anecdotally, hospitals have responded by formally acquiring or pursuing tighter informal connections with SNFs. We evaluated the trend in connections between US acute care hospitals and Medicare-certified SNFs between 2000 and 2013 using vertical integration and two novel network-based measures (number of SNF partners, and...
Rates of Hospital Readmission Among Medicare Beneficiaries With Gastrointestinal Bleeding Vary Based on Etiology and Comorbidities
Abstract [from journal]
Background & Aims: Gastrointestinal bleeding results in significant morbidity, mortality, and healthcare costs in the United States. The Center for Medicare and Medicaid Services' payment reform programs assess quality and value based on rates of hospital readmission for patients with gastrointestinal bleeding, but they identify these patients using Medicare Severity Diagnosis Related Groups (MS-DRGs), which include many types of gastrointestinal bleeding and do not account for the clinical heterogeneity among these patients. We aimed...
Where Patients Go After Hospital Discharge: Trends in Post-Acute Care
As the largest single source of health care spending, hospitals have drawn considerable attention from policymakers. Efforts to reduce costs have led to decreased lengths of hospital stays, but far less attention has been paid to where those patients go immediately after discharge. Medicare payment reforms implemented in the wake of the Affordable Care Act, such as hospital readmissions penalties and bundled payments, have made hospitals accountable for care beyond their walls, including institutional post-acute care.