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 11th, 2010 by Shadowfax in Better Health Network, Health Policy, Opinion, Research
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Aaron Carroll over at The Incidental Economist has been running an excellent series on healthcare spending in the U.S. and how much more we spend than the rest of the world on a per capita basis, as a percentage of GDP, and by category. It’s an excellent series and I wholly recommend it. Summary graph:
Hint: the U.S. is the lavender-ish line on top. As he says, is there anything about this graph that isn’t concerning? Read more »
*This blog post was originally published at Movin' Meat*
October 6th, 2010 by BobDoherty in Better Health Network, Health Policy, News, Opinion, True Stories
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Like most kids who grew up in the 1960s, I spent many a night watching the adventures of Fred, Wilma, Barney and Betty, the coolest cavemen ever (sorry, GEICO). It is hard to explain the appeal of the Flintstones, which [recently] celebrated the 50th anniversary of its first broadcast. Its animation was primitive, the stories campy and cliché, and it was horribly sexist — but the characters were lovable, the dialogue funny, and who couldn’t love the way it depicted “modern conveniences” (like washing machines) using only stone-age technologies (bones, stones and dino-power?)
What does Fred Flintstone have to do with healthcare? Not much, really, although Fred was the victim of a medical error. According to Answers.com: “A 1966 episode had Fred can’t stop sneezing, so he goes to the doctor for some allergy pills. The prescription gets mixed up with another package of pills which, when taken, transform Fred into an ape! Only Barney witnesses this metamorphosis, and naturally he can’t convince anyone what is happening … until a fateful family outing at the Bedrock Zoo.” (Of course, this all might have been prevented if they had e-prescribing in those days.) Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
October 3rd, 2010 by John Mandrola, M.D. in Better Health Network, Health Policy, News, Opinion
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Could understanding the tacit rules which govern play on a neighborhood playground help us explain why some aspects of implementing healthcare reform are unlikely to succeed? Recent news involving McDonald’s Corporation suggests so.
On the playground, there are some simple precepts — like the fact that older and stronger kids get to make up the game, and the rules. That’s understood and mostly okay. As if these leaders are considered modestly benevolent and the rules are workable, the game is good and all benefit. And all players on the playground know this basic tenet of fairness: That the rules of the game shouldn’t change in the midst of the competition, and, taking it one step further, if the rules have to be changed they weren’t very good in the first place. Soon, if those in power become too controlling, too conflicted, or too self-serving, kids stop showing up, and the games cease.
In enacting this, our government gave us a very complicated game, with oodles of rules. (For the record, the PPACA of 2010 is 475 pages and 393,000 words.) But then, on further consideration of the rules, important players (McDonald’s) decided that they could not play. They were pulling out of the game, and they had many friends (Home Depot, CVS, Staples, etc.) who may not have spoke outwardly, but surely felt the same way. Read more »
*This blog post was originally published at Dr John M*
September 28th, 2010 by DavidHarlow in Better Health Network, Health Policy, News, Opinion
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The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services scrapped its old self-referral voluntary disclosure program in 2009 (it dated back to 1998, and was revisited in 2008), and the Patient Protection and Affordable Care Act (PPACA) mandated that it be replaced. Just like clockwork, on the deadline for its promulgation the OIG obliged, and the new Self-Referral Disclosure Protocol is now posted and effective.
The new protocol could be clearer and offer more comfort, but it doesn’t. Makes one pine for the old policy’s clarity: In the old days, voluntary disclosure bought you a discounted fine for Stark violations — not like the new protocol’s wishy-washy, maybe-we’ll-give-you-a-discount language. The new protocol also fails to help a provider seeking to disclose past wrongs voluntarily in dealing with the Federales on a number of fronts simultaneously (e.g., for false claims violations, anti-kickback violations, etc., all arising from the same set of facts). We can perhaps blame Congress for that failure, rather than the OIG — the OIG is just implementing the statute as written.
Keep your eyes peeled for some tinkering on this front as the OIG gains some experience working under the new regime.
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
