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The latest news from HCCI

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Nov
05

Comparing Average Rates for Select Anesthesiology, Emergency Medicine, and Radiology Services by Local Areas

When a person unknowingly receives health care services from a provider that is outside of their insurer's network, it gives rise to the potential for a "surprise bill". Congress continues to consider legislation aimed at reducing the financial burden of "surprise bills" for patients. The approach approved by committees in both the House and Senate is to set a benchmark for the amount that can be ...
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May
15

Examining the adoption of a new Medicare billing code for cognitive assessments: a slow but steady uptake

  On January 1, 2017, the Medicare program started reimbursing providers for a new procedure code for clinical visits for cognitive assessments and care planning services (CPT code G0505). This newly-billable service is intended to improve the care of patients with Alzheimer's disease and related dementias and hopefully increase early detection and diagnosis. A G0505 visit includes a complete...
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Apr
01

Health Care Spending and Utilization in Public and Private Medicare

Abstract: We compare health care spending in public and private Medicare using newly available claims data from Medicare Advantage (MA) insurers. MA insurer revenues are 30 percent higher than their health care spending. Adjusting for enrollee mix, health care spending per enrollee in MA is 9 to 30 percent lower than in Traditional Medicare (TM), depending on the way we define "comparable" enrolle...
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Jun
11

INQUIRY The Journal of Health Care Organization, Provision, and Financing: How do the Hospital Prices Paid by Medicare Advantage Plans and Commercial Plans Compare with Medicare Fee-for-Service Prices?

ABSTRACT The prices that private insurers pay hospitals have received considerable attention in recent years, but most of that literature has focused on the commercially insured population. Although nearly one-third of Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan, little is known about the prices paid to hospitals by the private insurers that administer such plans. More in...
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Aug
07

New York Times: Medicare Advantage Spends Less on Care, So Why Is It Costing So Much?

By: Austin Frakt   The Medicare Advantage program was supposed to save taxpayers money by allowing insurers to offer older Americans private alternatives to Medicare. The plans now cover 19 million people, a third of all those who qualify for Medicare. Enrollee satisfaction is generally high, and studies show that plans offer higher quality than traditional Medicare. But the government p...
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Aug
01

Health Affairs: Medicare Competitive Bidding Program Realized Price Savings For Durable Medical Equipment Purchases

ABSTRACT: From the inception of the Medicare program there have been questions regarding whether and how to pay for durable medical equipment, prosthetics, orthotics, and supplies. In 2011 the Centers for Medicare and Medicaid Services (CMS) implemented a competitive bidding program to reduce spending on durable medical equipment and similar items. Previously, CMS had used prices in an administrat...
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Apr
04

Congressional Budget Office Working Paper Series: An Analysis of Private-Sector Prices for Hospital Admissions

ABSTRACT: Prices for hospital admissions have received considerable attention in recent years, both because they are an important component of health care spending and because they can vary widely. In this paper, we use 2013 claims data from three large insurers to examine the hospital payment rates of those insurers in their commercial plans and their Medicare Advantage plans and compare them wit...
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Feb
19

Health Services Research: Payer Type and Low‐Value Care: Comparing Choosing Wisely Services across Commercial and Medicare Populations

ABSTRACT Objective: To compare low‐value health service use among commercially insured and Medicare populations and explore the influence of payer type on the provision of low‐value care.​ Data Sources: 2009–2011 national Medicare and commercial insurance administrative data. Design: We created claims‐based algorithms to measure seven Choosing Wisely‐identified low‐value services and examined the ...
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Jan
01

NBER Working Paper: Healthcare Spending and Utilization in Public and Private Medicare

ABSTRACT: We compare healthcare spending in public and private Medicare using newly available claims data from Medicare Advantage (MA) insurers. MA insurer revenues are 30 percent higher than their healthcare spending. Healthcare spending is 25 percent lower for MA enrollees than for enrollees in traditional Medicare (TM) in the same county with the same risk score. Spending differences between MA...
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Aug
01

Health Affairs: Medicare Advantage Plans Pay Hospitals Less Than Traditional Medicare Pays

ABSTRACT There is ongoing debate about how prices paid to providers by Medicare Advantage plans compare to prices paid by fee-for-service Medicare. We used data from Medicare and the Health Care Cost Institute to identify the prices paid for hospital services by fee-for-service (FFS) Medicare, Medicare Advantage plans, and commercial insurers in 2009 and 2012. We calculated the average price per a...
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