October 18th, 2010 by BobDoherty in Better Health Network, Health Policy, News, Opinion, Research
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From its inception, Medicare has been agnostic about the effectiveness of different treatments when it sets payment rates. Once a treatment is found to be “reasonable and necessary,” Medicare establishes a payment rate that takes into account complexity and other “inputs” that go into delivering the service. But it is prohibited by law from varying payments based on how well an intervention works.
This would change under a “dynamic pricing” approach proposed by two experts in this month’s issue of Health Affairs. The article itself is available only to Health Affairs subscribers, but the Wall Street Journal health blog has a good summary.
The researchers propose that Medicare pay more for therapies with “superior” results and the same for two therapies with comparable effectiveness. A new service without any evidence on its relative effectiveness would be reimbursed in the usual way for the first three years, during which research would be conducted on its comparative effectiveness. If such research found that the service was less effective than other interventions, Medicare would have the authority to reduce payments. If it was found to be more effective, Medicare could pay more than for other available interventions. The WSJ blog gives an example of how this would work. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
October 3rd, 2010 by DrRob in Better Health Network, Health Policy, Opinion
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“It will never happen.”
“They know better than to do it.”
“They realize the disaster it would be if they let it pass.”
That’s what I hear. I hear that the upcoming SGR adjustment, the one that will cut Medicare reimbursement by 23 percent, won’t go through.
In case you missed it, the SGR is a formula coming from the Balanced Budget Act of 1997 that does automatic cuts to Medicare reimbursement. This year we witnessed a legislative game of chicken in congress, with both sides agreeing that it was a bad idea to screw physicians in a time that they are trying to fix healthcare. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
June 14th, 2010 by RyanDuBosar in Better Health Network, Health Policy, News
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Senators visited their districts Friday and again today, so the earliest they could vote on the doc fix is tomorrow (6/15) — the day the 21.3 percent reimbursement cut takes effect.
Slowing down the process are the numerous amendments. For example, the duration of the fix is still being negotiated. And there are amendments such as redefining what makes up a rural health district. In California, some rural areas are seeing urban levels of patient demand, but giving more money to these counties is being seen as a kickback akin to others that were proposed during healthcare reform. (Part B News, The Hill)
*This blog post was originally published at ACP Internist*