Association of high cost sharing and targeted therapy initiation among elderly Medicare patients with metastatic renal cell carcinoma
In Cancer Medicine, Pengxiang (Alex) Li and colleagues, including Jalpa Doshi, explore whether high out-of-pocket costs limit access to oral therapies for Medicare patients newly diagnosed with metastatic renal cell carcinoma. Using 2011–2013 Medicare claims, the investigators identified 1,721 patients newly diagnosed with metastases in the liver, lung, or bone. They compared low-income Medicare Part D beneficiaries (who had low out-of-pocket costs due to...
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...