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Journal of Women's Health (2002) Jan 2013
Topics: Early Detection of Cancer; Female; Humans; Mammography; Mass Screening; Medicare; Vaginal Smears
PubMed: 23276187
DOI: 10.1089/jwh.2012.4129 -
Journal of Health Politics, Policy and... Aug 2015Many problems facing the Affordable Care Act would disappear if the nation were instead implementing Medicare for All - the extension of Medicare to every age group....
Many problems facing the Affordable Care Act would disappear if the nation were instead implementing Medicare for All - the extension of Medicare to every age group. Every American would be automatically covered for life. Premiums would be replaced with a set of Medicare taxes. There would be no patient cost sharing. Individuals would have free choice of doctors. Medicare's single-payer bargaining power would slow price increases and reduce medical cost as a percentage of gross domestic product (GDP). Taxes as a percentage of GDP would rise from below average to average for economically advanced nations. Medicare for All would be phased in by age.
Topics: Humans; Medicare; Patient Protection and Affordable Care Act; Private Sector; Public Sector; Single-Payer System; Taxes; United States
PubMed: 26124300
DOI: 10.1215/03616878-3150160 -
The Journal of Arthroplasty Sep 2015A pilot study was undertaken to examine the impact of Medicare's 3-day rule on length of stay (LOS). One hundred consecutive patients who underwent primary total joint...
A pilot study was undertaken to examine the impact of Medicare's 3-day rule on length of stay (LOS). One hundred consecutive patients who underwent primary total joint arthroplasty and were discharged to extended care facilities were retrospectively reviewed. Based on readiness for discharge criteria, delaying discharge until the third postoperative day increased LOS by 1.1 days (P<0.001). 60.6% of patients were ready for discharge by the second postoperative day, none of whom required re-admission within 30 days of discharge. There were no rehabilitation gains by staying an additional hospital day beyond readiness for discharge (P=0.092). This pilot study calls into question the value of Medicare's 3-day rule and demonstrates the feasibility and need for further research to address this seemingly antiquated policy.
Topics: Adult; Aged; Aged, 80 and over; Female; Health Policy; Humans; Length of Stay; Male; Medicare; Middle Aged; Outcome Assessment, Health Care; Patient Discharge; Pilot Projects; Postoperative Period; Retrospective Studies; Skilled Nursing Facilities; Time Factors; United States
PubMed: 25922314
DOI: 10.1016/j.arth.2015.03.038 -
Health Affairs (Project Hope) 2005In 1998 Medicare amended its procedures for making national coverage decisions for new technologies in an attempt to make the process more transparent and evidence...
In 1998 Medicare amended its procedures for making national coverage decisions for new technologies in an attempt to make the process more transparent and evidence based. We examined the quality of evidence for sixty-nine technologies reviewed by Medicare since then. Determinations by the Centers for Medicare and Medicaid Services (CMS) have generally been consistent with the strength of evidence. Good clinical evidence from rigorous studies is usually lacking for the technologies Medicare considers, although in most cases the CMS covers with conditions if there is at least fair evidence that benefits outweigh harms. Decisions referred to the external Medicare Coverage Advisory Committee (MCAC) have averaged eight months longer than non-MCAC decisions.
Topics: Centers for Medicare and Medicaid Services, U.S.; Evidence-Based Medicine; Insurance Coverage; Medicare; United States
PubMed: 15647237
DOI: 10.1377/hlthaff.24.1.243 -
JAMA Jun 2016
Topics: Centers for Medicare and Medicaid Services, U.S.; Delivery of Health Care; Health Expenditures; Humans; Medicare; Patient-Centered Care; Primary Health Care; Reimbursement, Incentive; United States
PubMed: 27065435
DOI: 10.1001/jama.2016.4472 -
The Journal of Behavioral Health... Jul 2010While Medicare's discriminatory copayments for mental and physical health care are being eliminated, much remains to be done to achieve true parity within Medicare....
While Medicare's discriminatory copayments for mental and physical health care are being eliminated, much remains to be done to achieve true parity within Medicare. Medicare needs to recognize and pay for such critical mental health services as case management, psychiatric rehabilitation, and assertive community treatment. Medicare must cover payments for all behavioral health professionals. Also the 190-day lifetime limit on inpatient psychiatric hospital days under Medicare must be removed. We envision a time-in the not too distant future-when Medicare provides a mental health benefit that includes vital community services.
Topics: Case Management; Community Mental Health Services; Humans; Medicare; Mental Disorders; United States
PubMed: 20480245
DOI: 10.1007/s11414-010-9218-7 -
The American Journal of Managed Care Sep 2012To conduct the first empirical study of competitive bidding in Medicare.
OBJECTIVES
To conduct the first empirical study of competitive bidding in Medicare.
STUDY DESIGN AND METHODS
We analyzed 2006-2010 Medicare Advantage data from the Centers for Medicare and Medicaid Services using longitudinal models adjusted for market and plan characteristics.
RESULTS
A $1 increase in Medicare's payment to health maintenance organization (HMO) plans led to a $0.49 (P <.001) increase in plan bids, with $0.34 (P <.001) going to beneficiaries in the form of extra benefits or lower cost sharing. With preferred provider organization and private fee-for-service plans included, higher Medicare payments increased bids less ($0.33 per dollar), suggesting more competition among these latter plans.
CONCLUSIONS
As a market-based alternative to cost control through administrative pricing, competitive bidding relies on private insurance plans proposing prices they are willing to accept for insuring a beneficiary. However, competition is imperfect in the Medicare bidding market. As much as half of every dollar in increased plan payment went to higher bids rather than to beneficiaries. While having more insurers in a market lowered bids, the design of any bidding system for Medicare should recognize this shortcoming of competition.
Topics: Benchmarking; Competitive Behavior; Cost Savings; Empirical Research; Health Care Costs; Health Maintenance Organizations; Humans; Longitudinal Studies; Medicare; Models, Economic; Multivariate Analysis; United States
PubMed: 23009305
DOI: No ID Found -
The New England Journal of Medicine Feb 2013
Topics: Aftercare; Centers for Medicare and Medicaid Services, U.S.; Fee-for-Service Plans; Humans; Medicare; Patient-Centered Care; Primary Health Care; Reimbursement Mechanisms; United States
PubMed: 23425161
DOI: 10.1056/NEJMp1214122 -
JAMA Jan 2016
Topics: Accountable Care Organizations; Centers for Medicare and Medicaid Services, U.S.; Episode of Care; Medicare; Reimbursement, Incentive; United States
PubMed: 26720889
DOI: 10.1001/jama.2015.18161 -
JAMA Jun 2016
Topics: Accountable Care Organizations; Episode of Care; Medicare; Reimbursement, Incentive
PubMed: 27299629
DOI: 10.1001/jama.2016.3815