medicare

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February 17, 2012 | 8:06 AM | By

Why Is Health Care Expensive? It’s the Prices, Stupid.

Sometimes the simplest answer is the right one.

At least that’s the thesis here, in this concise analysis by Matthew Yglesias in Slate, who argues that the real reason health care is so expensive in the U.S. is laughably clear: prices are high.

That sounds almost tautological at first, but it’s genuinely not. And you can see it in a variety of ways. One is the comparison of Medicare to private health insurance. Medicare is a very expensive government program, but it’s actually cheaper than private health insurance. Liberals sometimes point to administrative efficiencies and lack of advertising and executive compensation as the reason for this, but the main reason is simply that the prices are lower. Medicare is a bulk purchaser of health care services, and offers providers an offer they can’t refuse—perform medicine relatively cheaply, or get locked out of the Medicare client base. Continue reading →

FILED UNDER: Insurance, Money, cost, medicare
February 10, 2012 | 9:17 AM | By

Cartoon Solves Health Care Puzzler: What The Heck Is An ACO?

Ladies and gentlemen! Announcing a whole new film genre: Wonk Cinema!! And what we hope will be the first in a series of CommonHealth cartoons dedicated to helping people stay awake as they learn about important health care changes that affect their lives.

Our first topic: “What the heck is an Accountable Care Organization?” Five minutes, just five minutes, to unravel one of the great mysteries of the universe! Explain the inexplicable! Destultify the stultifying! Also, to cast much-needed light on a health care phenomenon that is sweeping the state and the country…

We’re taking requests for other topics so soporific and esoteric they can only be explained tolerably in a cartoon video. What should we do next? Tiered health insurance? Payment reform? Please lodge your suggestion in the Comments section below.

And deepest thanks to former Boston Globe health care reporter Jeffrey Krasner, now president of Krasner Health Strategies, for lending his deep knowledge and rapier wit to this project. Continue reading →

FILED UNDER: Insurance, Medicine/Science, Personal Health, accountable care organizations, ACO, ACOs, medicaid, medicare
December 19, 2011 | 3:30 PM | By

What Boston’s Pioneer ACOs Will Mean For Patients


As we reported last week, five Boston area hospitals and physician groups will have a dominant role in a federal experiment that could transform Medicare. All Medicare patients who see doctors through Atrius Health, Partners HealthCare, Beth Israel Deaconess Medical Center, Mount Auburn Hospital or any of the Steward Health hospitals will be affected.  The question is how?

The Centers for Medicare and Medicaid Services (CMS) today announced 32 organizations that will “Pioneer” the move to accountable care organizations (ACOs). Greater Boston, with five of the 32, will have a large concentration of doctors and patients testing ways to coordinate care and reduce costs.

Medicare rules become the standard for payments and care at most hospitals.  So when these major groups in Boston start doing more preventive care or requiring more interaction among all a Medicare patient’s doctors, the same practices will likely apply — eventually — to patients of all ages.

This pilot will not restrict where patients go for care. Hospitals and doctors will be rewarded for beating their prior spending thresholds and for showing patient care improvements. These groups could lose money if patients need more care than they have in the past or if they get a lot of expensive care that isn’t coordinated.

CMS says this experiment could save $1.1 billion over the next five years.  That’s a lot of money, but keep in mind that the Medicare budget this year is $468 billion.

We asked leaders of each Boston area organization to answer this question: How will joining this pilot project affect the way you care for Medicare patients? Continue reading →

FILED UNDER: Insurance, Politics, ACOs, atrius, BIDPO, medicare, mount auburn hospital, partners healthcare
December 8, 2011 | 11:09 AM | By

Better Doctor-Shopping Is On The Way — But Will You Use It?

The federal government has just announced that it will let more light shine on a great trove of Medicare data — medical claims records from its 47 million patients. And in particular, it will let employers, consumer groups and insurance companies mine those mountains of claims to help them rate the performance of individual doctors.

So does this mean that something on the scale of TripAdvisor.com — or Rotten Tomatoes! — is coming to American medicine? Not any time soon.

What does it mean? I asked Dr. Tara Lagu, a research scientist at Baystate Medical Center and an assistant professor at Tufts University School of Medicine, who studies the effects of making health quality data public.

Dr. Tara Lagu


Her bottom line: Probably within a couple of years, patients will be able to determine a given doctor’s volume — how many cases like theirs the doctor treats every year — and possibly quite a bit about how well those cases have gone. But quality ratings themselves are likely to remain contentious, and the big question is whether patients will be able to take advantage of the newly available data.

Our conversation, lightly edited: 

My main take on this new Medicare announcement has to do with how patients will digest the data. The great potential of this could be lost if it’s not presented to patients in the right way. We really could be missing an opportunity to help patients participate in the quality improvement process.

What exactly is the data that will be released?

Every time a Medicare patient receives health care, the place where they got that service files a claim with Medicare, and Medicare puts it into a big database. So it’s a set of billing records. It doesn’t have things like lab results; it doesn’t have a lot of clinical data. So the first thing patients should know is that their clinical data is not going to be available. All this is, is documentation of interaction with the health care system. Medicare aggregates it on a very big scale: How many patients in Boston saw Dr. X or went to hospital Y?

‘Only 6% of patients are aware that the data exist.’

Medicare also collects quality data, mostly through chart review. For example, how many patients who had a heart attack got a beta blocker? Most of that information is available at the hospital level and presented on the Hospital Compare Website. So part of the data is actually not a new thing — that’s been available for some time. But only 6% of patients are aware that it exists, and probably even fewer are able to see the information and comprehend it. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, baystate medical center, massachusetts health quality partners, medicare
December 6, 2011 | 10:58 AM | By

Dr. Berwick Exits Washington, Optimistic About Health Reform Law

Dr. Donald Berwick served as Medicare chief for 17 months

Despite his messy, politically-tinged ouster as the administrator of the Centers for Medicare and Medicaid Services, Dr. Donald Berwick remains persistently optimistic about the future of health reform.

This morning, Berwick spoke to WBUR’s Tom Ashbrook and continually brought the conversation back to the huge potential of the nation’s health reform law, which he called “majestic.”

Berwick said the reason he lost his job in Washington boils down to this: “An absence of authentic dialogue on what’s needed in health care.”

Still, he said: “It’s a thrilling time in health care…major improvements are possible if we can buckle down in this country and get health care to perform how we want it to…We have to cross the bridge from fear to optimism.” Continue reading →

FILED UNDER: Insurance, Medicine/Science, Politics, donald berwick, health law, medicaid, medicare
November 24, 2011 | 7:00 AM | By

Despite Respect, Berwick Falls Victim To Politics

(CMS)Dr. Donald Berwick

The Associated Press reports:

“WASHINGTON — The point man for carrying out President Obama’s health care law will be stepping down after Republicans succeeded in blocking his confirmation by the Senate, the White House announced Wednesday.

Medicare chief Don Berwick, a Harvard professor widely respected for his ideas on how to improve the health care system, became the most prominent casualty of the political wars over a health care overhaul whose constitutionality will be now decided by the Supreme Court.”

The AP report includes an eloquent excerpt from an email Dr. Berwick sent to his staff, describing his “bittersweet emotions”:

“Our work has been challenging, and the journey is not complete, but we are now well on our way to achieving a whole new level of security and quality for health care in America, helping not just the millions of Americans affected directly by our programs, but truly health care as a whole in our nation,” Berwick wrote.

Dr. Berwick’s exit was long expected, as we reported here, here and here. Will he return to the Cambridge institution whence he came, the Institute for Healthcare Improvement? Please stay tuned.

FILED UNDER: Politics, donald berwick, medicare
November 10, 2011 | 9:52 AM | By

Local Hospitals Fear Super Committee Cuts

Lynn Nicholas, President of the Mass. Hospital Association, whose members are fretting about looming cuts to Medicare

WBUR’s Martha Bebinger reports that Massachusetts hospitals, some of the state’s largest employers, are preparing for the worst as the federal deficit super committee looks to make cuts in Medicare. The local hospitals say the cuts could hurt doctor training programs, among others.

The Massachusetts Hospital Association is out with a new analysis that shows that one year cuts in the program could reach hundreds of millions of dollars. Over 10 years, that number could reach into the billions.

Bebinger spoke with Bob Oakes this morning on the topic, and their conversation is here:

Bob: All the possible cuts we’re talking about this morning would be in Medicare, the federal health care program for the elderly. Why are hospitals so dependent on Medicare?

Martha: It pays doctors to care for many of their sickest patients, the elderly and disabled and several proposals would affect how much or the way doctors are paid. But the biggest worry right now Bob is possible cuts to graduate medical education. Medicare pays part of the cost of training doctors, that’s salaries and equipment and services. And if the super committee reduced medicare spending here, the Massachusetts Hospital Association say members would lose between $100 and $300 million a year or one to $3.2 billion over ten years.

Bob: There are about 5,000 doctors in training in Massachusetts at any given time. How many men and women would this affect?

Martha: We don’t have exact numbers, but one estimate says hospitals would have to eliminate several hundred student or resident slots. Continue reading →

FILED UNDER: Insurance, Money, Politics, hospitals, medical training, medicare
November 8, 2011 | 11:15 AM | By

Price Of Surgery Varies Widely Among Hospitals, Study Finds

The bottom line of this new study on price variations in surgery mirrors what we already know: there is absolutely no consistency in the cost of medical care.

Consider the findings of the new report, published in the journal Health Affairs:

Medicare payments for four common types of inpatient surgery–hip replacement, coronary artery bypass grafting, back surgery, and colon removal– and their follow-up care can vary among hospitals by 49 percent to 130 percent. The result is that payments to the highest-cost hospitals exceed those to the lowest-cost facilities by up to $2,549 for colon removal surgery and $7,759 for back surgery.

The research provides a strong argument for “bundled” payments to try to make the pricing system more rational, but authors concede it may not work for everyone: Continue reading →

FILED UNDER: Insurance, Medicine/Science, Money, cost, medicare, surgery
November 3, 2011 | 12:09 PM | By

Herald: Co-Pay Nightmare With Cost Hike From $42 To $600 For Meds

When your co-pay for a critical medication jumps from $42 to $600 a month, you know something’s gone wrong.

That’s the sad fate of retired pressmann Ken Helgeson, as told by Margery Eagan in today’s Boston Herald. Helgeson is just a regular guy trying to care for his daughter and paraplegic wife. He “could be you” Eagan writes, “simply another man who played by the rules, and now faces a nightmare.”

In what he calls “a sellout,” Helgeson says Medicare has changed its deal for covering the prescription drug that kept him working for 10 years with increasingly severe rheumatoid arthritis. Enbrel used to cost him a $42 per month co-pay. Now it costs him $600 a month. He can’t afford it. So he stopped taking Enbrel four months ago.

“Six hundred a month is an awful lot of money on a fixed income,” he said. “I just can’t pay.” Continue reading →

FILED UNDER: Insurance, Money, Personal Health, cost, medicare, prescription drugs
October 31, 2011 | 1:48 PM | By

‘The American Prospect’ On Medicare’s Fatal Flaws

Medicare has created a large bloc of voters who do not realize how great a public subsidy they receive and who think that other people shouldn’t expect government to help pay for their health care.

Ah, such a succinct description of a pernicious political effect of Medicare, the government health insurance program for seniors. Hat-tip to Jeff Levin-Scherz’s Managing Healthcare Costs blog for summarizing and analyzing sociologist Paul Starr’s long piece on ‘The Medicare Bind,’ just out in the November issue of the left-leaning American Prospect magazine. Bottom line: The whole idea of creating a separate health insurance plan for America’s elderly was a mistake from the get-go, Paul Starr writes, and major fixes are now needed:

We need to recognize that establishing a separate health-insurance program for seniors was not a good idea in the first place, and the fairest and most effective way to control Medicare’s costs will be to bring health insurance for seniors under the same rules and policies that govern health insurance for everyone else.

A couple other favorite excerpts from Jeff’s excellent summary (yes, Cliff Notes to the Cliff Notes:) Continue reading →

FILED UNDER: Insurance, Politics, costs of care, medicare