While large geographic variation in Medicare costs is widely recognized, the size and source of the variation has been subject to debate. This study examined and compared alternative approaches to case-mix adjustment to inform geographic variation estimates and draw policy inferences.
An article in the Los Angeles Times reports on the decision by Blue Shield of California to stop covering proton beam therapy for early-stage prostate cancer. In an ongoing HCFO-funded study, Jack Hadley, Ph.D., George Mason University, is examining factors that may influence the type of prostate cancer treatment received by Medicare beneficiaries...
- The Effect of Palliative Care on Patient Functioning October 2013
Palliative care has typically been viewed as a care option that is offered primarily to patients very near the end of life. The aim of this study was to determine if increased use of palliative care earlier in a patient's disease trajectory is associated with increased patient functioning.
- Medical Group Practice Characteristics Influencing Inappropriate Emergency Department and Avoidable Hospitalization Rates October/December 2013
The use of an emergency department for a nonemergent condition contributes rising costs in the health care system. Using a national sample of 212 medical group practices, this study identified hospital characteristics that influence the rates of inappropriate use of emergency department and ambulatory care sensitive hospital admissions.
In the lead up to the launch of insurance marketplaces on October 1, many state insurance regulators poured over premium rates; among them members of Connecticut’s Insurance Department. In a recent article in The Courant, Matthew Sturdevant explained that before insurers could sell products on Connecticut’s health insurance exchange, they needed the department’s approval of those premiums across the four metal levels, bronze, silver, gold and platinum
The Affordable Care Act gradually reduces Medicare provider payments in an attempt to rein in spending; however, these cuts may cause providers to increase the volume of Medicare services they provide to make up for the lower per service price. This study used data from ten states from 1995–2009 to examine the market-level relationship between Medicare prices and inpatient hospital volume and found that Medicare price cuts may lead to a reduction in volume.
There is a growing demand for primary care as provisions of the Affordable Care Act seek to expand accessibility of health services. This study examined the relationship between utilization of a retail clinic and primary care relationships and found that patients who visited a retail clinic were less likely to seek care from a primary care physician in the future.
For millions of uninsured Americans, hospital emergency departments (EDs) are one of the few options for medical care, both urgent and non-urgent. Yet this care may come at a significant price. Unlike their insured counterparts, uninsured and other “self-pay” patients receive hospital bills based on “billed charges.”
Medicare is reducing its payments to hospitals by one percent as part of the Hospital Value-based Purchasing (HVBP) Program, a provision of the Affordable Care Act. However, hospitals are given the incentive to earn back those reimbursements if they are able to demonstrate they have met benchmarks for clinical standards and patient satisfaction.
- Private Insurers’ Payments For Routine Physician Office Visits Vary Substantially Across The United States September 2013
Anecdotal reports suggest that substantial variation exists in private insurers’ payments for physician services, but systematic evidence is lacking. Using a retrospective analysis of insurance claims, this study examines variations in private payments to physicians and the extent to which variation is explained by patients’ and physicians’ characteristics and by geographic region.