scholarly journals The Consequences of Health Care Privatization: Evidence from Medicare Advantage Exits

2018 ◽  
Vol 10 (1) ◽  
pp. 153-186 ◽  
Author(s):  
Mark Duggan ◽  
Jonathan Gruber ◽  
Boris Vabson
Keyword(s):  
New York ◽  
Hospital Inpatient ◽  
Fee For Service ◽  
Medicare Advantage ◽  
Exogenous Shocks ◽  
Inpatient Utilization ◽  
Medicare Program ◽  
Considerable Controversy ◽  
Health Care Privatization ◽  
Managed Care Organizations

There is considerable controversy over the use of private insurers to deliver public health insurance benefits. We investigate the consequences of patients enrolling in Medicare Advantage (MA), privately managed care organizations that compete with the traditional fee-for-service Medicare program. We use exogenous shocks to MA enrollment arising from plan exits from New York counties in the early 2000s and utilize unique data that links hospital inpatient utilization to Medicare enrollment records. We find that individuals who were forced out of MA plans due to plan exit saw very large increases in hospital utilization. These increases appear to arise through plans both limiting access to nearby hospitals and reducing elective admissions, yet they are not associated with any measurable reduction in hospital quality or patient mortality. (JEL G22, I11, I12, I13, I18)

Influence of shunt surgery on healthcare expenditures of elderly fee-for-service Medicare beneficiaries with hydrocephalus

2007 ◽  
Vol 107 (1) ◽  
pp. 21-28 ◽  
Author(s):  
Michael A. Williams ◽  
Phoebe Sharkey ◽  
Doris Van Doren ◽  
George Thomas ◽  
Daniele Rigamonti
Keyword(s):  
Skilled Nursing Facility ◽  
Health Care Expenditures ◽  
Hospital Inpatient ◽  
Fee For Service ◽  
Shunt Surgery ◽  
Medicare Beneficiaries ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Shunt Procedure ◽  
Medicare Program

Object The goal in this study was to determine the percentage of patients with hydrocephalus who were treated with shunt surgery and to assess Medicare expenditures for those with and without shunt surgery. Methods Retrospective cost analyses were performed using the Standard Analytic Files of paid claims for beneficiaries enrolled in both Parts A (Inpatient) and B (Outpatient) of the Medicare program for 1997 through 2001. The main outcome measures were 5-year total payments and 5-year payments for separate types of service; for example, acute hospital (inpatient and outpatient), skilled nursing facility, home health, and physician/supplier services. Results Of 1441 patients with hydrocephalus, 25.1% underwent shunt surgery during the study period. The effect of a shunt procedure on 5-year Medicare expenditures is a cost difference of $25,477 (p < 0.0001) less per patient, which is equal to a potential −$184.3 million difference in 5-year Medicare expenditures. The following three factors had a negative association with whether shunt surgery was performed: 1) age 80 to 84 years (odds ratio [OR] 0.619, confidence interval [CI] 0.390–0.984); 2) age 85 years or older (OR 0.201, CI 0.110–0.366); and 3) African-American race (OR 0.506, CI 0.295–0.869). The effect of age on the likelihood of shunt surgery persisted after adjusting for the propensity to die score. Conclusions Medicare expenditures for patients with hydrocephalus treated with shunt surgery are significantly lower than expenditures for untreated patients. Research to improve the diagnosis and treatment of hydrocephalus has the potential to improve outcomes and reduce health care expenditures further.

scholarly journals Quality Advantage? Provider Quality and Networks in Medicare Advantage

2020 ◽  
Vol 6 (2) ◽  
pp. 138 ◽  
Author(s):  
Simon F. Haeder
Keyword(s):  
New York ◽  
Metropolitan Areas ◽  
Artery Bypass ◽  
Insurance Coverage ◽  
Medicare Advantage ◽  
Medicare Beneficiaries ◽  
Provider Quality ◽  
Medicare Program ◽  
Network Adequacy ◽  
Cardiac Surgeons

Medicare Advantage plans have grown significantly over the past decade and the potential for their future growth seems unabated. Astonishingly, however, we know little about how Medicare beneficiaries access services, particularly whether those services are of high quality. This study explores access to cardiac surgeons for coronary artery bypass grafting (CABG) and heart valve surgery in California and New York. It is one of the first studies to analyze Medicare Advantage networks and interactions between provider networks and provider quality. Results of the study show that for large metropolitan areas, access is rather similar for traditional Medicare and Medicare Advantage beneficiaries. Limitations, however, exist for the latter. Important concerns emerge for Medicare Advantage beneficiaries outside of metropolitan areas where healthcare market challenges appear to be exacerbated by carrier restrictions. Results indicate no evidence that carriers selectively contract to improve quality. There is, however, significant diversity with regard to network breadth; and, this breadth does not stay static across distances. These results hold important implications for the future of the Medicare program, network adequacy regulations, and how consumers make choices about their insurance coverage. 

New York’s Medicare Marketplace: Examining New York’s Medicare Advantage Plan Landscape in Light of Payment Reform

2013 ◽  
Vol 14 (3) ◽  
pp. 187-196 ◽  
Keyword(s):  
New York ◽  
Performance Metrics ◽  
New York State ◽  
Cost Savings ◽  
Medicare Advantage ◽  
Medicare Beneficiaries ◽  
Payment Reform ◽  
Cost Structures ◽  
Sound Policy ◽  
And Performance

The Patient Protection and Affordable Care Act (ACA) provided for cost savings in the Medicare program, in part to underwrite coverage expansion to Medicare beneficiaries, to finance new coverage for those not eligible for Medicare, and to strengthen Medicare’s financial outlook. One cost-saving measure, a reformulation and reduction in payments to private health insurance plans that provide Medicare benefits through the Medicare Advantage (MA) program, had a sound policy basis but was criticized, particularly by opponents of the ACA, as a measure that would lead to increased costs, reductions in benefits, and diminished plan choices to Medicare beneficiaries enrolled in MA plans. Despite dire predictions to this effect, a review of a sample of MA plan offerings in New York State in 2012 shows that Medicare beneficiaries enrolled in such plans did not experience significant benefit reductions or increased costs. While the number of plan offerings decreased, the reduction was mostly caused by the elimination of duplicative plan choices in 2011. Although the MA plan executives we interviewed indicated that further reductions in plan reimbursement in future years—tempered by potential bonus payments for meeting quality and performance metrics—could impact plan costs and benefits, they believed plans will employ a number of strategies to remain in the market and maintain beneficiary benefits and cost structures. However, government regulators and consumer advocates will need to examine MA plan offerings in the coming years to determine the effect of plan reaction to the ACA payments on beneficiaries’ costs for coverage and access to care.

Abstract 21: Variation in Hospital Costs of Percutaneous Coronary Intervention

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Amit P Amin ◽  
Richard G Bach ◽  
Eric Novak ◽  
John M Lasala ◽  
Jasvindar Singh
Keyword(s):  
New York ◽  
Financial Risk ◽  
Random Effect ◽  
Hospital Costs ◽  
Large Degree ◽  
Patient Characteristics ◽  
Coronary Intervention ◽  
P Value ◽  
Fee For Service ◽  
Hospital Site

Introduction: A great emphasis exists on improving PCI outcomes and quality, but there are no data on the variation in hospitals' costs of PCI. As Payers move away from a fee-for-service model, most forms of bundled payments or gain-sharing, increasingly require hospitals to contain costs. Hospitals are at financial risk if costs exceed a specified budget. Our goal was to understand the variation in costs of PCI across hospitals, and the extent of the variation in PCI costs explained by hospitals, after controlling for patient characteristics. Methods: We identified 230,410 patients undergoing PCI at 258 hospitals (performing ≥100 PCIs), from 2007-2010 from the Healthcare Cost and Utilization Project state inpatient database (SID) from California, Florida and New York. The SID includes 97% of all discharges regardless of payers, from these states. Costs of PCI were determined by applying hospital- and year-specific Cost-to-Charge Ratios to the total charges. Variation in costs of PCI across hospitals were examined by a hierarchical linear regression model with PCI costs as the dependent variable and hospital site as a random effect, adjusting for differences in prevalence of patient and demographic characteristics by hospital site. Results: The mean cost of performing a PCI procedure was $17,543 ± $ 12767. We observed a large degree of variation in mean PCI costs across hospitals ranging from $5,823 to $38,532. Length of stay (LOS), was associated with incrementally higher PCI cost ($2,400, per day p<0.0001). After adjusting for LOS, PCI complications, and patient comorbidities, we observed a persistent 24% variation in PCI costs across hospitals. A significant interaction between hospital cost quintile and LOS (interaction P-value <0.001) was also observed, such that in the highest quintile hospital, PCI costs were higher by $1,277 per day LOS, despite adjusting for LOS and patient comorbidities and PCI complications. Conclusions: PCI costs vary tremendously across hospitals. Approximately one quarter of the variation in PCI costs is explained by hospitals, despite controlling for differences in LOS, PCI complications and patient characteristics. The same LOS costs differently across different hospitals. There is an urgent need for hospitals to examine and reduce the variation in PCI costs.

Economic Principles for Medicare Reform

2019 ◽  
Vol 686 (1) ◽  
pp. 63-92
Author(s):  
Amitabh Chandra ◽  
Craig Garthwaite
Keyword(s):  
Pay For Performance ◽  
Medicare Advantage ◽  
Short Term ◽  
Market Prices ◽  
Economic Framework ◽  
Trade Offs ◽  
Medicare Program ◽  
Commercial Market ◽  
New Treatments ◽  
Do So

In this article, we develop an economic framework for Medicare reform that highlights trade-offs that reform proposals should grapple with, but often ignore. Central to our argument is a tension in administratively set prices, which may improve short-term efficiency but do so at the expense of dynamic efficiency (slowing innovations in new treatments). The smaller the Medicare program is relative to the commercial market, the less important this is; but in a world where there are no market prices or the private sector is very small, the task of setting prices that are dynamically correct becomes more complex. Reforming Medicare should focus on greater incentives to increase competition between Medicare Advantage plans, which necessitates a role for government in ensuring competition; premium support; less use of regulated prices; and less appetite for countless “pay for performance” schemes. We apply this framework to evaluate Medicare for All proposals.

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