Late last month we wrote about criticism leveled at the federal government’s latest bundled payment proposal.
Since then, other experts have come forward to criticize not only the Comprehensive Care for Joint Replacement (CCJR) proposal announced last month, but also the Bundled Payments for Care Initiative (BPCI) program that began in April 2013. Both programs come from the federal Centers for Medicare & Medicaid Services.
You can find detailed criticism of CCJR from Harold Miller, president of the Center for Healthcare Quality and Payment Reform, on the CHQPR’s blog, and from Suzanne Delbanco, executive director of Catalyst for Payment Reform, and Francois de Brantes, executive director of the Health Care Incentives Improvement Institute (HCI3), on the Health Affairs blog. For an explanation of how CMS can improve the BPCI program, see this HCI3 blog post from de Brantes. Continue reading
Vox’s Sarah Kliff, who has an AHCJ Reporting Fellowship on Health Care Performance, is writing a series about fatal, preventable medical errors.
Not the inevitable tragic things that can happen to a patient – but the ones that we know how to avoid, the lives that should not be at risk. Kliff spent several months on one story – actually a story and accompanying video and graphics – that combined insights about how hospitals think central line infections and a gripping narrative about the death of a 3-year-old girl. You can find the story here.
Kliff wrote a “How I did It” essay for AHCJ that addresses a lot of the nuts and bolts of a vast project like this. She outlines how she reached out to patients/families, how she organized the voluminous – initially not searchable – medical records, how she found researchers who could elucidate things she did not fully understand in those records.
And she talks about the power of a good analogy to both organize a 5000-word narrative and give readers an accessible entry point to her work. Read about how she did it.
Quality measures are good, right? We all want our doctors and hospitals to follow best practices and be held to them.
It’s not so simple.
Put aside for the moment whether the measure is accurate – we don’t always know or agree on what the best thing is in health care (Exhibit A: mammograms).
There’s another quality problem.
There too many quality measures. Oodles and oodles of quality measures. Continue reading
The Center for Medicare & Medicaid Innovation, created by the Affordable Care Act, is trying new ways of delivering health care and testing new incentives and payment models. Some ideas are likely, even expected, to fail. Others may lead to new ways of delivering higher quality care for less money.
CMMI also is supposed to help spread new ideas so they’ll take root in the real world. The U.S. Department of Health and Human Services has the authority to expand approaches that reduce spending – and halt those that do not. This is a more flexible approach than officials had with “demonstration projects” prior to the ACA.
The agency’s website is a goldmine of health care innovation. Read more about what CMMI is tasked with doing, how it will do it and how the success or failures of its projects will be determined in this new tip sheet.
Here is an article that stood out amid the tidal wave of media coverage of Medicare and Medicaid’s 50th anniversary this year. It’s a piece about why Medicaid matters, posted on the Health Affairs blog.
As you read, keep in mind that the article is written by two people who strongly support the program: former Denver Health Chief Executive Patricia Gabow, who serves on the Medicaid and CHIP Payment and Access Commission and on the National Governors’ Association Health Advisory Board, and former Senate Democratic Leader Tom Daschle. It is not, by and large, a critique. Continue reading
When drafting the Affordable Care Act in 2010, Congress wanted to foster competition among health insurers. So it offered loans to nonprofit organizations that wanted to start health insurance consumer oriented and operated plans (called co-ops) in the states.
In theory, the co-ops are a great idea to increase competition and consumer choice. Congress included $2.4 billion in the ACA to establish these member-operated health insurance plans. The co-ops are particularly important today because five of the largest health insurers could soon be reduced to three if Anthem acquires Cigna and Aetna merges with Humana. Continue reading
The uninsured rate among all Americans in the first quarter of this year dropped to 9.2 percent, according to the latest report from the Centers for Disease Control and Prevention’s National Center for Health Statistics, released Wednesday.
This is estimated to be the lowest rate of all uninsured Americans, of all ages, since 1972, when the center began reporting on that data from the National Health Interview Survey, Reena Flores reported for CBS News. Continue reading
We’ve all written a lot about the “Medicaid gap” – the low-income people who can’t get coverage under the Affordable Care Act because their states have opted out of Medicaid expansion. The Kaiser Family Foundation has estimated that 4 million people fall in this gap.
According to Moody’s Investors Service, nonprofit hospitals in expansion states have seen their bad debt from unpaid bills drop an average of 13 percent as they treated more patients who have coverage. In non-expansion states, bad debt rose.
Reuters’ Robin Respaut recently looked at how the Medicaid gap has affected two iconic urban safety net hospitals who treat a lot of low income people – Cook County in Chicago and Grady Memorial in Atlanta. Continue reading
We’ve told you over and over again on this blog that the Affordable Care Act isn’t just about coverage. It’s also about changing how health care is delivered, moving away from fee-for-service to a more value- and quality-based system. Medicare is aiming to have half of its payments under alternative payment models by 2018.
That means hospitals have to change. But not all of them want to.
Fee-for-service is the preferred business model for many. Why should those hospitals want to go through considerable expense and upheaval to switch to a new system that demands more – and may well pay less? Continue reading
Source: 19th Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care. © Towers Watson 2014.
For the purpose of this blog post, let’s leave aside the decade-plus ideological fight about whether health savings accounts (HSAs) are a good or bad idea.
Let’s just look at what happens to people who have them, at least according to this recent article by Michael Fletcher, a national economics correspondent for The Washington Post. His argument is that people could save money on health care – if they knew how to use their HSAs. Continue reading