Browsing by Subject "Medicare"
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Item The cost of dying in America(2023-06-09) Terauchi, StephanieItem Ethical implications of public disclosure of Medicare payments to individual physicians(2015-03-10) Steinbrook, RobertIn the spring of 2014, the Centers for Medicare & Medicaid Services, in response to a court decision and the requirements of the Freedom of Information Act, began to publicly disclose the amounts and reasons for Medicare payments to individual physicians. The disclosures have attracted broad interest in the news media and shone a bright light on patterns of physician billing and utilization that were previously hidden from public view. The disclosures, however, have also raised questions about what the data means, how useful they will be to patients, and how the data can best be used to improve the quality and values of medical care. This grand rounds will discuss salient examples from the first year of the new policy that highlight the ethical implications of the public disclosure of physician payment data.Item Home based primary care: an economic(2018-07-27) Jamshed, NamirahItem Potential Impact of the Site-Neutral Payment Policy on Regions and Hospitals with Differential LTAC Utilization: A National Study of Medicare Beneficiaries(2018-01-23) Kirby, Benjamin; Nguyen, Oanh; Miller, Michael; Xuan, Lei; Halm, Ethan; Makam, AnilBACKGROUND: Long-term acute care hospitals (LTAC) are the fastest growing and most expensive post-acute care provider. Due to rising LTAC use, beginning in 2018 the site-neutral payment (SNP) policy will reduce reimbursement for Medicare beneficiaries without prolonged mechanical ventilation or ICU stay prior to transfer because these patients are considered less likely to require this level of care. Since half of the variation in LTAC use is explained by differences between regions and hospitals, we sought to examine whether regions and hospitals with more LTAC use transfer patients with lower severity and complexity of illness and how they may be affected by SNP policy. METHODS: We conducted a retrospective cohort study using 5% national Medicare data. We included adults ?65 years with Medicare parts A and B who were transferred from an acute care hospital to an LTAC in 2012. We compared characteristics of patients transferred to LTACs by tertile of regional LTAC supply (beds per 100,000 residents) and by propensity-score matched hospitals with low (< median of 1.26%) versus high (? 1.26%) historical LTAC transfer rates. RESULTS: We included 3,898 and 1,673 older adults transferred to an LTAC for our regional and hospital-level analyses respectively. For both comparisons, patient demographics, prior healthcare utilization, comorbidities, and functional impairment were similar. Compared to regions with the lowest LTAC supply, patients in the highest supply regions had shorter hospital length of stay (5 fewer days), lower intensity diagnoses (DRG weight of 1.91 vs 3.06), fewer intensive therapies (11% vs 27% for tracheostomy), and were more likely to meet SNP criteria (47% vs. 30%; p<0.01 for all comparisons). Similarly, patients from high LTAC transfer hospitals were less sick compared to patients from matched low transfer hospitals. However, the magnitudes of the differences were smaller than those between regions (i.e. length of stay difference of 2 days; 14% vs 22% for tracheostomy; 43% vs. 36% for SNP). Patients who meet SNP criteria were otherwise similar between regions and hospitals with different LTAC supply and use. CONCLUSION: High regional LTAC supply and LTAC transfer hospitals were associated with greater LTAC care for patients with lower severity and complexity of illness. The SNP policy will impact LTACs in high supply regions more than those accepting patients from high transfer hospitals, however nearly a third of patients in low supply regions and from low transfer hospitals will also be affected. Further research is warranted to study the impact of SNP policy on LTAC access and how this relates to patient outcomes, recovery, and costs.Item Profit over professionalism: the case of the Medicare Physician Fee Schedule(2024-04-09) Berenson, Robert A.The Centers for Medicare & Medicaid Services (CMS) sets fees for 8000+ service codes that comprise the Medicare Physician Fee Schedule based largely on recommendations by the American Medical Association's Relative Value Update Committee (RUC) through notice-and-comment rulemaking. Under RUC supervision, medical specialty societies and other professional organizations ask members to estimate clinical time and "work" for codes. The RUC process eschews reliance on empirical data but rather relies almost entirely on the estimates from the surveys. Various ethical concerns about this process have arisen: physicians completing the survey may have biased judgments because they and their specialty colleagues directly benefit financially from their judgments and therefore inflate time and work estimates; some physicians describing the actual clinical activities comprising work to inform RUC members from other specialties exaggerate or invent work that they do not actually perform; and the AMA/RUC routinely misrepresents the performance of the RUC in determining accurate RVUs, while keeping much of their work protected from public scrutiny. This presentation describes the fee-setting process and elaborates on the ethical concerns that result in distorted fees, which in turn negatively affects access, quality, and spending for Medicare beneficiaries and the public at large.