Tag Archives: Provider payment

Steve Brill Interview on the Daily Show

Steve Brill, who just wrote a 36 page article for Time Magazine, conducted an informative interview on the daily show on Thursday, Feb 21, 2013. Here is the link to the unedited version. It is in three parts, and lasts about 12 minutes (including some ads). Worth watching if you have time.

http://www.thedailyshow.com/watch/thu-february-21-2013/exclusive—steven-brill-extended-interview-pt–1

Commonwealth Fund Report on Health Care Cost Control

The Commonwealth Fund has just come out with a new report outlining a strategy for containing health care costs in the US. It seems rather optimistic to me. Here is the opening two paragraphs and link.

Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System, Authored by The Commonwealth Fund Commission on a High Performance Health System
January 10, 2013

Michael Chernew (Harvard) is the only economist on the Commission, which is mostly MDs and MBAs.

“Overview

The Commonwealth Fund Commission on a High Performance Health System, to hold increases in national health expenditures to no more than long-term economic growth, recommends a set of synergistic provider payment reforms, consumer incentives, and systemwide reforms to confront costs while improving health system performance. This approach could slow spending by a cumulative $2 trillion by 2023—if begun now with public and private payers acting in concert. Payment reforms would: provide incentives to innovate and participate in accountable care systems; strengthen primary care and patient-centered teams; and spread reforms across Medicare, Medicaid, and private insurers. With better consumer information and incentives to choose wisely and lower provider administrative costs, incentives would be further aligned to improve population health at more affordable cost. Savings could be substantial for families, businesses, and government at all levels and would more than offset the costs of repealing scheduled Medicare cuts in physician fees.” from The Commonwealth Fund Report

The heart of their analysis is in the technical report by Actuarial Research Corp.

Jim Mays, Dan Waldo, Rebecca Socarras, and Monica Brenner “Technical Report: Modeling the Impact of Health Care Payment, Financing, and System Reforms” Actuarial Research Corporation, January 10, 2013

The areas they simulate are revealed in the table of content headings. Nice recent references.

Introduction ……………………………………………………………………………………………………………………………….. 1
I. Improved Provider Payment ………………………………………………………………………………………………….. 4
II. Primary Care: Medical Homes ………………………………………………………………………………………………… 7
III. High-Cost Care Management Teams …………………………………………………………………………………….. 13
IV. Bundled Payments ……………………………………………………………………………………………………………… 16
V. Modified Payment Policy for Medicare Advantage …………………………………………………………………. 22
VI. Medicare Essential Benefits Plan ………………………………………………………………………………………….. 26
VII. Private Insurance: Tightened Medical Loss Ratio Rules ……………………………………………………………. 30
VIII. Reduced Administrative Costs and Regulatory Burden ……………………………………………………………. 32
IX. Combined Estimates …………………………………………………………………………………………………………… 35
X. Setting Spending Targets …………………………………………………………………………………………………….. 37
Appendix A. Creating the “Current Policy” Baseline ……………………………………………………………………….. 40

 

2012 Handbook of Health Economics, on ScienceDirect

2012 Handbook of Health Economics (Pauly, McGuire and Barros) is free on-line. Here is the link to the pdf files.

Excellent literature reviews and new insights. I purchased the hard cover version, but this is wonderfully accessible.

http://www.sciencedirect.com/science/handbooks/15740064

Many research universities, including BU have access to ScienceDirect.

It is unusual for Elsevier to post its new material for free access in this way.

Enjoy.

FAIR Health claims data, N=125 million

Window to the marketplace

FAIR Health now delivers the industry’s primary source of out-of-network benchmarks with unprecedented transparency

“What was referred to as a “black box” in February 2008 today has become an open window to the healthcare marketplace. The industry’s privately owned database of usual-and-customary (UC) charge information is now a transparent, public information source called FAIR Health.”

http://managedhealthcareexecutive.modernmedicine.com/mhe/Executive+Profile/Window-to-the-marketplace/ArticleStandard/Article/detail/747558?contextCategoryId=47227

Data sources

“Currently, FAIR has approximately 80 different data sources nationwide, collectively contributing claims data for 125 million covered lives. Data is deidentified as to the payer source and the individual member’s identity. By aggregating claims in this way, FAIR can meet HIPAA requirements and discourage the use of information for competitive advantages among participating payers.

Gelburd says the required fields that FAIR collects from the claims data supplied by contributors include CPT codes, standard charges, date and location of service. Additional fields include ICD-9 and ICD-10 codes, provider identifiers and negotiated, in-network charges. The optional fields are particularly useful from a research perspective.”

I would welcome comments from anyone who has used this data.

Randy


High Fees Are Key: Commonwealth Fund study


Commonwealth Fund e-Alert

High Fees Seen as Main Cause of Higher Overall Spending on Physician Services in U.S.

A new study comparing fees for physician services in the United States with those in five other nations finds that U.S. physicians are paid more per service than doctors in other countries­as much as double in some cases. According to the Commonwealth Fund–supported study, which appears in the new issue of Health Affairs, U.S. primary care physicians were paid an average of 27 percent more by public payers for an office visit, and 70 percent more by private payers for an office visit, compared with the average amount paid across the other countries, which include Australia, Canada, France, Germany, and the United Kingdom. For hip replacements, the gap was even larger: U.S. physicians received 70 percent more from public payers, and 120 percent more from private payers, than the average fees paid to physicians in the other nations studied.

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