Last month was just ideological climate terrorism, hopefully this month is back to some semblance of actual research. The themes are price transparency and Medicare and Medicaid.
Price transparency is supposed to require that providers–hospitals, physicians and others–disclose the prices they charge various payers so that consumers and employers can make decisions about where to go based at least in part on price. It is a good idea in theory, but almost impossible in practice, as detailed by some of the articles. Many health services have complex components and pricing out those components is difficult. Coding systems are used to try to identify components, but providers don’t use consistent systems or approaches. And providers are often not paid on a fee per service basis, they might be paid on a per person per month basis or get bundled payments. What would be most useful is being forced to post and stick to a self-pay price–if the patient were paying, what would you charge them?
Medicare pays hospitals partly based on data about labor costs. Guess what? Hospitals game the data and get exceptions that are driving what Medicare pays up.
Private equity firms have been increasingly buying medical providers, including primary care practices. A study suggests that after acquisition, the practices see more patients and provide more services to them. That could be just boosting costs or it could partly be improving access and quality. Similarly there are firms working to put together and manage Accountable Care Organizations, which were one way Medicare was trying to improve care coordination and lessen costs. But these “conveners” of the ACOs appear to drive up costs without quality improvements.
Dual eligibles, who enroll in both Medicare and Medicaid, are driving up state costs. The obvious solution has been to have Medicare be the sole source of coverage for low-income beneficiaries and reduce their cost-sharing burdens. Another study finds that Medicaid enrollees who smoke fail to take advantage of treatment options. Anyone who smokes, drinks excessively or uses illegal drugs should either get treated and quit or be disenrolled from Medicaid. The taxpayers should not be paying for irresponsible behavior. Immigrants are having a hard time getting Medicaid says another study, but one criteria for being admitted to the US is you must have a job and have health benefits. We simply cannot afford Medicaid costs.
Rhode Island’s limits on hospital costs led to reduced staffing with uncertain quality implications. I will bet they didn’t result in reductions in executive pay.
Medicare is in deep shit, expected to run out of trust fund money in about 6 years. It is experimenting with prior authorization for some services. In some pilot states, pre-claim review of home health services appears to reduce spending.
