Was struck today that I have heard very little about the role of Medigap in the current health insurance debate…despite massive discussion of Medicare, Medicare Advantage, payment reform…etc. In addition, it highlights how difficult it is to sort through the tangled web of money and influence…not sure how much I believe it, but its certainly food for thought.
This thought was triggered by Michelle Milkin’s post on AARP’s dependance on royalties from selling sponsored insurance plans:
A Hill source summed it up for me this way: “AARP has endorsed a huge reduction in funding of Medicare Advantage, which touches over 10 million middle-lower income seniors. If Medicare Advantage funding is reduced, and seniors are forced out of the program, they become potential buyers of the heavily-promoted and very profitable Medicare Supplement program sponsored by AARP (MediGap is 70% of AARP’s annual income). Medicare Supplement is a huge source of revenue to AARP. At a minimum, AARP should be required to disclose this every time they discuss Medicare Advantage.
When I was a kid, I hit my head a fair bit, including getting knocked out once at football practice. Initial care involved an evaluation, but scans weren’t the norm. Now that they’ve become increasingly common in the evaluation of head injuries in youth, have we gained much?
The Value of CT Scans in Youths Is Questioned in this study in the Lancet (article in NYTimes). continue reading »
Gold Plated Wheelchairs
Does low administrative cost or pooled purchasing lead you to the best values? When it comes to government purchasing, the results are surprisingly bad– the Medicare fee schedule rate for medical supplies can multiples higher than the cash price an individual can command. HHS’s Inspector General, Daniel Levinson, gives us the shocking details in his report on Power Wheelchair Acquisition Costs for the Medicare program (via CNN.com)
The Executive Summary is a fascinating rebuke of Congress’ ability to remove pork from the Medicare program, driving up costs for both taxpayers and beneficiaries. It also is a cry for help for a Medicare Administrator to take the steps required to appropriately run the government’s payor– we’ve missed the leadership a Mark McClellan can provide in the role (there hasn’t been a Senate-confirmed Medicare head since 2006). Is this the future of a govenment plan focused on minimizing administration?
Medicare’s fee schedule amounts are based on manufacturer-suggested retail prices. They include reimbursement for the power wheelchair acquisition cost and services performed in conjunction with providing the wheelchair, such as assembling and delivering it and educating the beneficiary about its use. Prior Office of Inspector General (OIG) reviews have found that consumers can buy power wheelchairs for lower prices than Medicare and its beneficiaries. In May 2006, the Centers for Medicare & Medicaid Services (CMS) proposed a revised methodology for setting new fee schedule amounts that would not rely upon manufacturer-suggested retail prices and is responsive to the market. As of May 2009, CMS had not finalized this proposal.
I keep hearing about Comparative Effectiveness and how evidence needs to used in medical practice. Then I remember my days in the clinic/hospital, where complex patients presented in ways that didn’t fit textbook definitions and whose multitude of issues offered contradictory readings from the literature.
So how are we to move forward? I’m a strong believer that the best evidence needs to be used in clinical decision-making…the issue is in making this evidence usable in the field in a way that doctors can trust will be relevant to the person in front of them (as opposed to 300 carefully selected and studied patients in Finland).
So what will the new paradigm look like? My sense is the RCT will fade as consumer-focused care comes into play. If the best of science is directed to the patient sitting in front of a doctor, the goal will be to combine the information of others just like them (across multiple segments and disease phases) to predict both the natural course as well as the potential options for improvement (and their predicted results).
From Medicine to McKinsey to Main St