ABSTRACT
This study estimates the association between Medicare eligibility and support for recent proposals to expand program participation and benefits.
Subject(s)
Eligibility Determination , Medicare , Aged , Humans , Insurance Benefits , Medicare/legislation & jurisprudence , United States , Insurance Coverage/legislation & jurisprudenceSubject(s)
Antineoplastic Agents , Drug Costs , Drug Development , Medicare , Neoplasms , Aged , Humans , Antineoplastic Agents/economics , Antineoplastic Agents/therapeutic use , Drug Costs/legislation & jurisprudence , Medicare/economics , Medicare/legislation & jurisprudence , Negotiating , Neoplasms/drug therapy , United States , Drug Development/economics , Drug Development/legislation & jurisprudence , Time FactorsABSTRACT
In this Viewpoint, Kesselheim and coauthors discuss 2 bills in Congress that would curtail Medicare's ability to decline, limit, or conditionally cover medical products that lack robust evidence and argue that officials should distinguish between better and worse therapies when determining reimbursement.
Subject(s)
Medicare , Therapies, Investigational , Aged , Humans , Medicare/economics , Medicare/legislation & jurisprudence , United States , Therapies, Investigational/economicsABSTRACT
This Viewpoint discusses how limited-supply agreements (introduction of generic products in reduced volumes) might thwart efforts to negotiate lower prices on prescription drugs in the US.
Subject(s)
Drug Costs , Drug Industry , Medicare , Negotiating , Pharmaceutical Preparations , Aged , Humans , Drug Costs/statistics & numerical data , Drugs, Generic/economics , Drugs, Generic/supply & distribution , Medicare/economics , Medicare/legislation & jurisprudence , Medicare/statistics & numerical data , United States/epidemiology , Drug Industry/economics , Drug Industry/legislation & jurisprudence , Drug Industry/statistics & numerical data , Commerce/economics , Commerce/legislation & jurisprudence , Commerce/statistics & numerical data , Pharmaceutical Preparations/economics , Pharmaceutical Preparations/supply & distributionABSTRACT
This Viewpoint evaluates the legal claims and policy implications of historic drug price negotiations possible with the Inflation Reduction Act of 2022.
Subject(s)
Drug Costs , Medicare , Prescription Drugs , Drug Costs/legislation & jurisprudence , Medicare/economics , Medicare/legislation & jurisprudence , Negotiating , Prescription Drugs/economics , Prescriptions , United StatesSubject(s)
Colorectal Neoplasms , Early Detection of Cancer , Health Policy , Medicare , Aged , Humans , Colonoscopy , Colorectal Neoplasms/diagnosis , Early Detection of Cancer/methods , Early Detection of Cancer/standards , Early Detection of Cancer/trends , Mass Screening , Medicare/legislation & jurisprudence , United States , Health Policy/legislation & jurisprudenceABSTRACT
One of the heroes in American history, Associate Supreme Court Justice Thurgood Marshall (1908-1993) sought legal remedies against racial discrimination in education and health care. As director of the Legal Defense Fund (LDF) of NAACP from 1940 to 1961, his success in integrating law schools in Texas led to the first black medical student admitted to a state medical school in the South. Representing doctors and dentists needing a facility to perform surgery, the LDF brought cases before the courts in North Carolina that moved the country toward justice in health care. His ultimate legal victory came in 1954, Brown v. Board of Education of Topeka, the decision that declared racial segregation in public schools unconstitutional. In 1964, the LDF under Jack Greenberg, Marshall's successor as director, won Simkins v. Moses H. Cone Memorial Hospital, a decision that held that hospitals accepting federal funds had to admit black patients. The two decisions laid the judicial foundation for the laws and administrative acts that changed America's racial history, the Civil Rights Act of 1964 and the Social Security Act Amendments of 1965 that established Medicare and Medicaid. His achievements came during the hottest period of the American civil rights movement of the 1950s and 1960s. Well past the middle of the twentieth century, black Americans were denied access to the full resources of American medicine, locked in a "separate-but-equal" system woefully inadequate in every respect. In abolishing segregation, Marshall initiated the long overdue remedy of the unjust legacies of slavery and Jim Crow.
Subject(s)
Black or African American , Delivery of Health Care , Education , Human Rights , Lawyers , Supreme Court Decisions , Aged , Humans , Black or African American/education , Black or African American/history , Black or African American/legislation & jurisprudence , Civil Rights/history , Civil Rights/legislation & jurisprudence , Delivery of Health Care/ethnology , Delivery of Health Care/legislation & jurisprudence , Education/history , Education/legislation & jurisprudence , Education, Medical/history , Education, Medical/legislation & jurisprudence , Educational Status , History, 20th Century , Human Rights/history , Human Rights/legislation & jurisprudence , Medicare/history , Medicare/legislation & jurisprudence , Racial Groups , Supreme Court Decisions/history , United States , Lawyers/historySubject(s)
Drug Industry , Fee-for-Service Plans , Health Expenditures , Inflation, Economic , Medicare , Aged , Humans , Fee-for-Service Plans/economics , Fee-for-Service Plans/legislation & jurisprudence , Health Expenditures/legislation & jurisprudence , Inflation, Economic/legislation & jurisprudence , Medicare/economics , Medicare/legislation & jurisprudence , Pharmaceutical Preparations/economics , United States , Drug Industry/economics , Drug Industry/legislation & jurisprudenceSubject(s)
Health Expenditures , Insurance Benefits , Medicare , Patient Protection and Affordable Care Act , Aged , Humans , Health Expenditures/legislation & jurisprudence , Medicare/legislation & jurisprudence , Patient Protection and Affordable Care Act/legislation & jurisprudence , United States , Inflation, Economic/legislation & jurisprudence , Insurance Benefits/legislation & jurisprudence , Insurance Benefits/trendsSubject(s)
Cardiac Surgical Procedures/economics , Centers for Medicare and Medicaid Services, U.S./economics , Fee Schedules/economics , Insurance, Health, Reimbursement/economics , International Classification of Diseases/economics , Medicare/economics , Postoperative Care/economics , Surgeons/economics , Budgets , Cardiac Surgical Procedures/legislation & jurisprudence , Centers for Medicare and Medicaid Services, U.S./legislation & jurisprudence , Fee Schedules/legislation & jurisprudence , Health Care Reform/economics , Health Expenditures , Hospital Charges , Hospital Costs , Humans , Insurance, Health, Reimbursement/legislation & jurisprudence , Medicare/legislation & jurisprudence , Policy Making , Postoperative Care/legislation & jurisprudence , Relative Value Scales , Surgeons/legislation & jurisprudence , United StatesSubject(s)
Alzheimer Disease/drug therapy , Antibodies, Monoclonal, Humanized/economics , Budgets , Drug Costs , Drug Industry/economics , Insurance Coverage/economics , Medicare/economics , Reimbursement Mechanisms/economics , State Government , Antibodies, Monoclonal, Humanized/therapeutic use , Centers for Medicare and Medicaid Services, U.S. , Humans , Insurance Coverage/legislation & jurisprudence , Medicaid/legislation & jurisprudence , Medicare/legislation & jurisprudence , Reimbursement Mechanisms/legislation & jurisprudence , United StatesSubject(s)
Drug Costs/legislation & jurisprudence , Drug Development/economics , Drug Industry/economics , Medicare/legislation & jurisprudence , Prescription Drugs/economics , Financing, Government , Medicare/economics , National Institutes of Health (U.S.) , Research Support as Topic , Standard of Care/economics , United StatesABSTRACT
The current policy environment for rehabilitation in skilled nursing facilities (SNFs) is complex and dynamic, and SNFs are facing the dual challenges of recent Medicare payment policy change that disproportionately impacts rehabilitation for older adults and the COVID-19 pandemic. This article introduces an adapted framework based on Donabedian's model for evaluating quality of care and applies it to decades of Medicare payment policy to provide a historical view of how payment policy changes have impacted rehabilitation processes and patient outcomes for Medicare beneficiaries in SNFs. This review demonstrates how SNF responses to Medicare payment policy have historically varied based on organizational factors, highlighting the importance of considering such organizational factors in monitoring policy response and patient outcomes. This historical perspective underscores the mixed success of previous Medicare policies impacting rehabilitation and patient outcomes for older adults receiving care in SNFs and can help in predicting SNF industry response to current and future Medicare policy changes.
Subject(s)
Medicare/statistics & numerical data , Prospective Payment System/legislation & jurisprudence , Rehabilitation/economics , Skilled Nursing Facilities/economics , Skilled Nursing Facilities/organization & administration , Aged , COVID-19 , Humans , Medicare/legislation & jurisprudence , Pandemics , SARS-CoV-2 , United StatesSubject(s)
Hearing , Insurance, Dental/legislation & jurisprudence , Insurance, Vision/legislation & jurisprudence , Medicare/legislation & jurisprudence , Health Care Costs , Humans , Insurance, Dental/economics , Insurance, Vision/economics , Medicare/economics , Medicare/organization & administration , Medicare Part C/economics , Needs Assessment , United StatesABSTRACT
Background Evidence suggests intracerebral hemorrhage survivors have earlier recovery compared with ischemic stroke survivors. The Centers for Medicare and Medicaid Services prospective payment system instituted documentation rules for inpatient rehabilitation facilities (IRFs) in 2010, with the goal of optimizing patient selection. We investigated whether these requirements limited IRF and increased skilled nursing facility (SNF) use compared with home discharge. Methods and Results Intracerebral hemorrhage discharges to IRF, SNF, or home were estimated using GWTG (Get With The Guidelines) Stroke registry data between January 1, 2008, and December 31, 2015 (n=265 444). Binary hierarchical models determined associations between the 2010 Rule and discharge setting; subgroup analyses evaluated age, geographic region, and hospital type. From January 1, 2008, to December 31, 2009, 45.5% of patients with intracerebral hemorrhage had home discharge, 22.2% went to SNF, and 32.3% went to IRF. After January 1, 2010, there was a 1.06% absolute increase in home discharge, a 0.46% increase in SNF, and a 1.52% decline in IRF. The adjusted odds of IRF versus home discharge decreased 3% after 2010 (adjusted odds ratio [aOR], 0.97; 95% CI, 0.95-1.00). Lower odds of IRF versus home discharge were observed in people aged <65 years (aOR, 0.92; 95% CI, 0.89-0.96), Western states (aOR, 0.89; 95% CI, 0.84-0.95), and nonteaching hospitals (aOR, 0.90; 95% CI, 0.86-0.95). Adjusted odds of SNF versus home discharge increased 14% after 2010 (aOR, 1.14; 95% CI, 1.11-1.18); there were significant associations in all age groups, the Northeast, the South, the Midwest, and teaching hospitals. Conclusions The Centers for Medicare and Medicaid Services 2010 IRF prospective payment system Rule resulted in fewer discharges to IRF and more discharges to SNF in patients with intracerebral hemorrhage. Health policy changes potentially affect access to intensive postacute rehabilitation.
Subject(s)
Cerebral Hemorrhage/rehabilitation , Health Care Reform , Medicare , Outcome and Process Assessment, Health Care/trends , Patient Discharge/trends , Prospective Payment System , Rehabilitation Centers/trends , Skilled Nursing Facilities/trends , Adult , Aged , Aged, 80 and over , Female , Health Care Reform/economics , Health Care Reform/legislation & jurisprudence , Health Services Accessibility/trends , Humans , Inpatients , Male , Medicare/economics , Medicare/legislation & jurisprudence , Middle Aged , Outcome and Process Assessment, Health Care/economics , Outcome and Process Assessment, Health Care/legislation & jurisprudence , Patient Discharge/economics , Patient Discharge/legislation & jurisprudence , Policy Making , Prospective Payment System/economics , Prospective Payment System/legislation & jurisprudence , Registries , Rehabilitation Centers/economics , Rehabilitation Centers/legislation & jurisprudence , Skilled Nursing Facilities/economics , Skilled Nursing Facilities/legislation & jurisprudence , Time Factors , Treatment Outcome , United StatesABSTRACT
BACKGROUND: Lumbar Spine MRI Use for Low Back Pain (OP-8) is calculated by dividing the number of patients who received lumbar magnetic resonance imaging (MRI-L) before receiving alternative treatments (e.g., physical therapy) by the total number of patients receiving MRI-L in the outpatient setting at a given institution. Since the passage of the Post-Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), OP-8 scores became tied to hospital finances. This study aims to determine how MACRA has impacted OP-8 scores since its implementation. We also aim to investigate how regional designation, profit status (for-profit, government, and nonprofit), and hospital setting (critical access, non-critical access) affect OP-8 scores. METHODS: Data from the Centers for Medicare and Medicaid Services Hospital Compare database were used to extract information on the national trends in OP-8 scores from 2014 to 2020. A multivariable linear regression model was fit to isolate the impact of hospital characteristics on OP-8 scores. RESULTS: After a decrease from 2015 to 2016, the mean national OP-8 score plateaued, staying around 40% from 2017 through 2020. A critical access setting increased OP-8 scores by 5.41 (95% confidence interval, 3.51-6.77; P ≤ 0.001), compared with a non-critical access setting. Governmental status increased scores by 1.27 (95% confidence interval, 0.28-2.27; P = 0.012), compared with a nonprofit status. CONCLUSIONS: The implementation of MACRA seems to have been unsuccessful in altering practice patterns, given the minimal change in OP-8 scores over the last 4 years. Furthermore, institutional factors are clearly correlated with a lack of adherence to magnetic resonance imaging guidelines. Given these findings, there is a need to modify health policies.