Content by Keyword: Medicare

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Medicare Part D: Competition and Generic Drug

Medicare Part D: Competition and Generic Drug Prices, 2007-2018

The United States relies on the interactions of private entities – drug manufacturers, health plans and pharmaceutical benefit managers (PBMs) - to achieve value by negotiating prices, operating formularies and implementing other benefit management strategies.
  • Medicare Part D: Competition and Generic Drug Prices
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Medicare: Opportunities for Market-Based Policies

Medicare: Opportunities for Market-Based Policies

Market-based payment policies such as competitive bidding, reference pricing, centers of excellence and tiered provider networks have been implemented both in Medicare and across the private sector, as described in this report required by Executive Order 13890.
  • Medicare: Opportunities for Market-Based Policies
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Medicare FFS Part B and International Drug Prices

Medicare FFS Part B and International Drug Prices: A Comparison of the Top 50 Drugs

The September 13, 2020 Executive Order on Lowering Drug Prices by Putting America First declared, “It is the policy of the United States that the Medicare program should not pay more for costly Part B or Part D prescription drugs or biological products than the most-favored-nation price.”
  • Medicare FFS Part B and International Drug Prices
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ASPE Issue Brief: Medicare Beneficiary Use of

ASPE Issue Brief: Medicare Beneficiary Use of Telehealth Visits: Early Data From the Start of the COVID-19 Pandemic

This ASPE issue brief examines changes in Medicare fee-for-service primary care visits and use of telehealth at the start of the COVID-19 public health emergency (PHE). This brief seeks to address the issue of how and whether the Medicare telehealth flexibilities introduced to address the COVID-19 pandemic may have helped maintain access to primar
  • ASPE Issue Brief: Medicare Beneficiary Use of Telehealth Visits: Early Data From the Start of the COVID-19 Pandemic
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Second Report to Congress on Social Risk and

Second Report to Congress on Social Risk and Medicare's Value-Based Purchasing Programs

As required by the IMPACT Act, the second Report to Congress examines the effect of individuals’ social risk factors on quality measures, resource use, and other measures under the Medicare program, as well as analyses of the effects of Medicare’s current value-based payment programs on providers serving socially at-risk beneficiaries and simu
  • Social Risk and Medicare's Value-Based Purchasing Programs Second Report to Congress - Executive Summary
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  • Social Risk and Medicare's Value-Based Purchasing Programs Second Report to Congress
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  • Social Risk and Medicare's Value-Based Purchasing Programs Second Report to Congress - Three Page Summary
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  • Social Risk and Medicare's Value-Based Purchasing Programs Second Report to Congress - Appendix
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Perspectives of Physicians in Small Rural

Perspectives of Physicians in Small Rural Practices on the Medicare Quality Payment Program

The objectives of this research effort were to collect feedback through interviews with physicians in small rural practices on the initial implementation of Medicare’s Quality Payment Program in 2017, a new value-based purchasing program for Medicare physicians. RAND's findings suggest that small rural practices are struggling to participate in
  • MIPS_SmallRuralPhysicianPerspectives.pdf
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Appendix E. Federal Support for Uncompensated

Analysis of the Joint Distribution of Disproportionate Share Hospital Payments. Appendix E. Federal Support for Uncompensated Care Costs Incurred by Ambulatory Care Providers

Overview
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Appendix D. Simulation Results from Three State

Analysis of the Joint Distribution of Disproportionate Share Hospital Payments. Appendix D. Simulation Results from Three State Analysis

 
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Appendix C Summary of Financial Indicators by

Analysis of the Joint Distribution of Disproportionate Share Hospital Payments. Appendix C. Summary of Financial Indicators by Hospital Class

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Appendix B. Additional Tables on the Current

Analysis of the Joint Distribution of Disproportionate Share Hospital Payments. Appendix B. Additional Tables on the Current Distribution of DSH Payments

   
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Appendix A. Technical Documentation for

Analysis of the Joint Distribution of Disproportionate Share Hospital Payments. Appendix A. Technical Documentation for Estimating DSH Payments

Data Sources Used to Estimate Medicare Payments
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Appendices

Analysis of the Joint Distribution of Disproportionate Share Hospital Payments. Appendices

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Are Homeless Families Connected to the Social

Are Homeless Families Connected to the Social Safety Net?

New analysis of data from HUD's Family Options Study of families' experiences in shelter and 20 months later shows that families experiencing homelessness are generally connected to public benefits at similar rates to other families in deep poverty. This non-experimental analysis finds that homeless families receive TANF, publicly funded health i
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Health Care Spending Growth and Federal Policy

Health Care Spending Growth and Federal Policy

In this Issue Brief, we examine spending growth through 2014, the first year the Affordable Care Act’s coverage provisions were in effect, and 2015, where possible. We provide detailed cost growth trends for Medicare and the private insurance market. We also estimate the effect of recently introduced specialty drugs on current and future spendin
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MEDICARE PART B DRUGS: PRICING AND INCENTIVES

Medicare Part B Drugs: Pricing and Incentives

Medicare Part B covers infusible and injectable drugs and biologics administered in physician offices and hospital outpatient departments; as well as certain other drugs required by law provided by suppliers such as pharmacies The Part B payment method provides weak incentives for physicians to consider value – that is choose the lowest cost the
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Footnotes

Examining Post Acute Care Relationships in an Integrated Hospital System. Footnotes

1 Medicare Benefit Policy Manual, Chapter 3 Duration of Covered Inpatient Services. 2 Medicare Benefit Policy Manual, Chapter 7 Home Health Services. 3 An index hospitalization is an acute hospitalization with a prior 60-day clean period. In the prior 60 days, no acute or post-acute (IRF, LTCH, SNF, HHA, outpatient therapy) services were
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Appendix B

Examining Post Acute Care Relationships in an Integrated Hospital System. Appendix B

Table B-1. Utilization 1 and Payment, by Claim Type, by DRG and APR-DRG Severity Index 2 , for Live Discharges, 2005 APR-DRG Severity of Illness Level DRG   N % with Claim Mean Use Mean Payment N
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Appendix A

Examining Post Acute Care Relationships in an Integrated Hospital System. Appendix A

HHC Label HCC1 HIV/AIDS HCC2 Septicemia/Shock HCC5 Opportunistic Infections HCC7 Metastatic Cancer and Acute Leukemia HCC8 Lung, Upper Digestive Tract, and Other Severe Cancers
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5. References

Examining Post Acute Care Relationships in an Integrated Hospital System. 5. References

Berenson, R. 2004. The Medicare Chronic Improvement Program. Retrieved August 2008 from http://www.urban.org/publications/900714.html Buntin MB, AD Garten, S Paddock, D Saliba, M Totten, and JJ Escarce. 2005. How much is postacute care use affected by its availability? Health Serv. Res., 40(2): 413-34. CDC (Centers for Disease Control and P
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4.2 Next Steps

Examining Post Acute Care Relationships in an Integrated Hospital System. 4.2 Next Steps

The results of the current work will feed directly in to work we will be completing as part of a contract modification. The additional work will include use of the CCW data to identify the presence of chronic conditions in beneficiaries in our 2006 episode file. Similar to some of the analyses presented in this report, we will look at the patterns

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