scholarly journals VOLUNTARY Regulation: Evidence from Medicare Payment Reform

2021 ◽  
Author(s):  
Liran Einav ◽  
Amy Finkelstein ◽  
Yunan Ji ◽  
Neale Mahoney
Keyword(s):  
Healthcare Services ◽  
Medical Provider ◽  
Medicare Payment ◽  
Payment Reform ◽  
Design Elements ◽  
Bundled Payment ◽  
Voluntary Regulation ◽  
Market Participants ◽  
Level Data ◽  
Mandatory Participation

Abstract Government programs are often offered on an optional basis to market participants. We explore the economics of such voluntary regulation in the context of a Medicare payment reform, in which one medical provider receives a single, predetermined payment for a sequence of related healthcare services, instead of separate service-specific payments. This “bundled payment” program was originally implemented as a five-year randomized trial, with mandatory participation by hospitals assigned to the new payment model; however, after two years, participation was made voluntary for half of these hospitals. Using detailed claim-level data, we document that voluntary participation is more likely for hospitals that can increase revenue without changing behavior (“selection on levels”) and for hospitals that had large changes in behavior when participation was mandatory (“selection on slopes”). To assess outcomes under counterfactual regimes, we estimate a stylized model of responsiveness to and selection into the program. We find that the current voluntary regime generates inefficient transfers to hospitals, and that alternative (feasible) designs could reduce these inefficient transfers and raise welfare. Our analysis highlights key design elements to consider under voluntary regulation.

scholarly journals Voluntary Regulation: Evidence from Medicare Payment Reform

2020 ◽  
Author(s):  
Liran Einav ◽  
Amy Finkelstein ◽  
Yunan Ji ◽  
Neale Mahoney
Keyword(s):  
Medicare Payment ◽  
Payment Reform ◽  
Voluntary Regulation

Medicare Payment Reform: Aligning Incentives for Better Care

2015 ◽  
Author(s):  
Gerard F. Anderson Anderson ◽  
Karen Davis Davis ◽  
Stuart Guterman Guterman
Keyword(s):  
Medicare Payment ◽  
Payment Reform

scholarly journals Effects of Medicare Payment Reform: Evidence from the Home Health Interim and Prospective Payment Systems

2012 ◽  
Author(s):  
Peter J. Huckfeldt ◽  
Neeraj Sood ◽  
Jose Escarce ◽  
David C. Grabowski ◽  
Joseph P. Newhouse
Keyword(s):  
Home Health ◽  
Prospective Payment ◽  
Payment Systems ◽  
Medicare Payment ◽  
Payment Reform

Disease risk and its moderating effect on the e-consultation market offline and online signals

2019 ◽  
Vol 32 (4) ◽  
pp. 1065-1084 ◽  
Author(s):  
Jia Li ◽  
Jie Tang ◽  
David C. Yen ◽  
Xuan Liu
Keyword(s):  
Health Care ◽  
Disease Risk ◽  
Positive Impact ◽  
Healthcare Services ◽  
Moderating Effect ◽  
Health Care Market ◽  
Content Type ◽  
Design Elements ◽  
Market Signals ◽  
Online Reputation

PurposeThe purpose of this paper is to investigate the moderating effect of disease risk in terms of the major signals (i.e. status, reputation and self-representation) on the e-consultation platforms.Design/methodology/approachIn this study, the proposed research hypotheses are tested using the transaction data collected from xywy.com (in Need of Therapy). In fact, xywy.com is one the leading e-consultation service websites in China that provides a platform for the interactions between the physicians and patients (Yu et al., 2016; Peng et al., 2015). Generally speaking, it has all the needed design elements and in other words, a standard e-consultation website should have such items/components as physician homepage, physician review, free consultation, paid consultation and recommendation systems.FindingsThe obtained results reveal that all attributes including status, reputation and self-representation have a positive impact on physician’s online order volume. Moreover, there is a positive moderating effect of disease risk onto the online reputation, indicating a higher effect exists for the diseases with high risk. However, the effect of offline status and online self-representation is not moderated by the disease risk, indicating market signals (online reputation) may have a stronger predictive power than seller signals (offline status and online self- representation), and therefore market signals are more effective when/if the disease risk is high.Originality/valueE-consultation has gradually become a significant trend to provide the healthcare services, in the emerging economy such as China because of shortage of medical resources but having an adequate access in internet usage. The impacts of signals on the health care market have been validated by previous studies. However, the research focusing on the moderating effect of signaling environment in the health care industry is still lacking. As a result, the value of this research helps to bridge the aforementioned research gap.

scholarly journals Costs and effects of on-demand treatment of hereditary angioedema in Italy: a prospective cohort study of 167 patients

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e022291 ◽  
Author(s):  
Carlo Federici ◽  
Francesca Perego ◽  
Ludovica Borsoi ◽  
Valentina Crosta ◽  
Andrea Zanichelli ◽  
...  
Keyword(s):  
Hereditary Angioedema ◽  
Healthcare Services ◽  
Routine Practice ◽  
C1 Inhibitor Deficiency ◽  
On Demand ◽  
Reference Centre ◽  
Level Data ◽  
Reported Data ◽  
Current Guidelines ◽  
Observation Period

ObjectivesTo explore treatment behaviours in a cohort of Italian patients with hereditary angioedema due to complement C1-inhibitor deficiency (C1-INH-HAE), and to estimate how effects and costs of treating attacks in routine practice differed across available on-demand treatments.DesignCost analyses and survival analyses using attack-level data collected prospectively for 1 year.SettingNational reference centre for C1-INH-HAE.Participants167 patients with proved diagnosis of C1-INH-HAE, who reported data on angioedema attacks, including severity, localisation and duration, treatment received, and use of other healthcare services.InterventionsAttacks were treated with either icatibant, plasma-derived C1-INH (pdC1-INH) or just supportive care.Main outcome measuresTreatment efficacy in reducing attack duration and the direct costs of acute attacks.ResultsOverall, 133 of 167 patients (79.6%) reported 1508 attacks during the study period, with mean incidence of 11 attacks per patient per year. Only 78.9% of attacks were treated in contrast to current guidelines. Both icatibant and pdC1-INH significantly reduced attack duration compared with no treatment (median times from onset 7, 10 and 47 hours, respectively), but remission rates with icatibant were 31% faster compared with pdC1-INH (HR 1.31, 95% CI 1.14 to 1.51). However, observed treatment behaviours suggest patterns of suboptimal dosing for pdC1-INH. The average cost per attack was €1183 (SD €789) resulting in €1.58 million healthcare costs during the observation period (€11 912 per patient per year). Icatibant was 54% more expensive than pdC1-INH, whereas age, sex and prophylactic treatment were not associated to higher or lower costs.ConclusionsBoth icatibant and pdC1-INH significantly reduced attack duration compared with no treatment, however, icatibant was more effective but also more expensive. Treatment behaviours and suboptimal dosing of pdC1-INH may account for the differences, but further research is needed to define their role.

scholarly journals Long-acting injectable antipsychotic (LAI) prescribing trends during COVID-19 restrictions in Canada: a retrospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kyle A. McKee ◽  
Candice E. Crocker ◽  
Philip G. Tibbo
Keyword(s):  
Psychotic Disorders ◽  
Public Awareness ◽  
Healthcare Services ◽  
Prescribing Practices ◽  
Patient Level ◽  
Level Data ◽  
Gender And Age ◽  
Prescribing Trends ◽  
Concomitant Medications ◽  
Long Acting

Abstract Background The COVID-19 pandemic has had significant impacts on how mental health services are delivered to patients throughout Canada. The reduction of in-person healthcare services have created unique challenges for individuals with psychotic disorders that require regular clinic visits to administer and monitor long-acting injectable antipsychotic medications. Methods To better understand how LAI usage was impacted, national and provincial patient-level longitudinal prescribing data from Canadian retail pharmacies were used to examine LAI prescribing practices during the pandemic. Prescribing data on new starts of medication, discontinuations of medications, switches between medications, antipsychotic name, concomitant medications, payer plan, gender and age were collected from January 2019 to December 2020 for individuals ≥18-years of age, and examined by month, as well as by distinct pandemic related epochs characterized by varying degrees of public awareness, incidence of COVID-19 infections and public health restrictions. Results National, and provincial level data revealed that rates of LAI prescribing including new starts, discontinuations and switches between LAI products remained highly stable (i.e., no statistically significant differences) throughout the study period. Conclusions Equal numbers of LAI new starts and discontinuations prior to and during the pandemic suggests prescribing of LAI antipsychotics, for those already in care, continued unchanged throughout the pandemic. The observed consistency of LAI prescribing contrasts with other areas of healthcare, such as cardiovascular and diabetes care, which experienced decreases in medication prescribing during the COVID-19 pandemic.

scholarly journals Trends in antineoplastic receipt after medicare payment reform: Implications for future oncology payment design

2018 ◽  
Vol 17 ◽  
pp. 51-58 ◽  
Author(s):  
Helen M. Parsons ◽  
Susanne Schmidt ◽  
Laura L. Tenner ◽  
Amy J. Davidoff
Keyword(s):  
Medicare Payment ◽  
Payment Reform

How payment reform drives innovation in interventional oncology.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 276-276
Author(s):  
Joseph Rodgers Steele ◽  
Ryan Kristopher Clarke ◽  
Elizabeth Priya Ninan ◽  
Armeen Mahvash
Keyword(s):  
Cost Savings ◽  
Standard Of Care ◽  
Prospective Payment System ◽  
Balloon Occlusion ◽  
Payment System ◽  
Fee For Service ◽  
Payment Reform ◽  
Similar Clinical Outcome ◽  
Bundled Payment ◽  
Group Purchasing Organization

276 Background: Innovation has transformed healthcare; however, our current fee-for-service payment system can actually stifle creativity. When procedures are streamlined, fewer CPT codes may be charged, resulting in lower total reimbursement. Payment reform is necessary not only to control costs, but also to support constructive innovation. We describe how an innovative, lower reimbursed, technique of catheter-directed cancer therapy failed widespread acceptance in spite of being faster, safer and cheaper than the standard of care. Methods: Retrospective patient review was performed using the radiology information system and electronic health record. Medicare Part A and Part B payments were obtained from the Hospital Outpatient Prospective Payment System (HOPPS) for Harris County, Texas, and disposable supply costs were obtained from Premier Group Purchasing Organization. Results: From May 2008 to May 2013, 292 Yttrium-90 hepatic radioembolization procedures were performed for primary and metastatic disease. Eighty patients received the innovated balloon occlusion technique. This technique resulted in less fluoroscopy dose to the patient, faster procedure times, similar clinical outcome and a disposable cost savings of $1,138.72. However, because numerous procedure steps were avoided, the total average per-patient reimbursement was decreased by $8,044.05. Conclusions: Innovation that simplifies a procedure frequently obviates process steps that correspond to specific CPT codes. Hence, in a fee-for-service payment system, a faster, safer and cheaper option may result in fewer CPT codes and lower reimbursement, a disincentive that slows adoption. Our experience resulted in lost profit of over $8,000 per case for a total exceeding $640,000. Not surprisingly, this technique has not been widely embraced since we described it nearly two years ago. Conversely, a bundled payment model would have resulted in better aligned incentives, increased profit, and cost savings shared by patients, providers, and payers.

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