Reforming Medicare to protect the health of an aging and vulnerable population is a pressing policy concern. To share some perspective, Dr. Mary Naylor led a panel entitled “Shaping the Future of Medicare” at Penn LDI’s 50th Anniversary Symposium.
The panelists addressed several core themes, including cost-effective personal care in the home, end-of-life care, Medicare payment reforms, and reimagining care for families of an aging population.
September 22, 2017 [cross-posted from the Health Cents blog on philly.com]
Association Between Hospital Participation in a Medicare Bundled Payment Initiative and Payments and Quality Outcomes for Lower Extremity Joint Replacement Episodes
In JAMA, Laura Dummit and colleagues, including Matthew Press, evaluate whether a Centers for Medicare and Medicaid Services (CMS) bundled payment pilot program is associated with a reduction in Medicare payments. Specifically, the authors assess if Bundled Payments for Care Improvement (BPCI) reduced Medicare payments and maintained quality in lower extremity joint replacement. This CMS program was launched in 2013 to test whether linking payments for services provided during an episode of care can reduce Medicare payments and maintain quality. The authors used a difference-in-...
This brief reviews the evidence on how key ACA provisions have affected the growth of health care costs. Coverage expansions produced a predictable jump in health care spending, amidst a slowdown that began a decade ago. Although we have not returned to the double-digit increases of the past, the authors find little evidence that ACA cost containment provisions produced changes necessary to “bend the cost curve.” Cost control will likely play a prominent role in the next round of health reform and will be critical to sustaining coverage gains in the long term.
This is the way it is supposed to work. You develop policy and processes to drive innovation. You design and test innovative ideas in a small, efficient way. You learn and adapt. Successful innovation drives new policy. Rinse and repeat.
And this is the way it appears to have worked, in the case of Medicare bundled payment. Start small with a pilot. Expand in reach and scope if promising. Scale up if successful.
Evidence on the effects of bundled payment is more important than ever, while hospitals already in Medicare bundled payment programs need guidance in redesigning care. This observational study looks at whether bundled payment for joint replacement affected quality, hospital costs and post-acute care spending in a health system that was an early adopter of the model. Did the bundles save money, and if so, what produced those savings?
Comparing the contributions of acute and post acute care facility characteristics to outcomes after hospitalization for hip fracture
In Medical Care, LDI Senior Fellows Mark Neuman, Jeffrey Silber and Rachel Werner and colleagues quantify the contribution of acute versus post acute care factors to survival and functional outcomes after hip fracture. This retrospective cohort study was conducted using Medicare data from previously ambulatory nursing home residents hospitalized for hip fracture between 2005 and 2009. The authors measured the associations of hospital and nursing home factors with functional and survival outcomes at 30 and 180 days among patients discharged to a nursing facility,...
In the Journal of Health Economics, Abby Alpert examines anticipation effects of Medicare Part D, which went into effect two years after it was signed into law. This potentially gave forward-looking individuals time to change their drug consumption behavior in anticipation of future subsidized drug coverage. This approach contrasts with prior studies of Part D, which do not take the possibility of behavioral responses to the announcement into consideration, thus...
The projected growth, and widespread variation, in the cost of joint replacement surgeries prompted Medicare to introduce a bundled payment plan for these procedures. In a new JAMA Viewpoint, Said Ibrahim, a LDI Senior Fellow and Co-Director of the VA’s Center for Health Equity Research and Promotion, and co-authors Hyunjee Kim and K.
In Health Affairs, Jalpa Doshi and colleagues, including Pengxiang Lee, Andrea Troxel and Kevin Volpp, evaluate whether renewing all medications at the same time from the same pharmacy improves adherence to medication regimens. Synchronizing medication refills is an increasingly popular strategy, but there has been little research regarding its effectiveness. The authors looked at a pilot refill synchronization program implemented by Humana, a large national insurer, and analyzed patients’ adherence before and after participation in the program, compared to a control group. The...