- Last year CMS received 41,136 complaints about the marketing of Medicare Advantage plans. (WSJ, gated)
- Do breaks from surgery improve the performance of orthopedic surgeons? Yes. HT: Tyler
- Can a dead person fly? Not before the TSA pats her down.
- CDC’s latest message: You don’t have to do anything about COVID, except please go get your booster urgently.
- A summary of Fauci flip flops. (NYT, gated)
Category: Doctors & Hospitals
Stat News: Medicare’s Bundled Payment Initiative for Joint Replacement a Rigged Game
The price Medicare pays for joint replacement had hardy changed in two decades when the Centers for Medicare and Medicaid Services (CMS) began an experimental program to pay bundled payments for a full 90-day episode of care. The program was designed to save Medicare money while rewarding surgeons who keep costs down and penalizing those whose costs are higher.
Surgeons whose patients cost Medicare less than the lump sum over 90 days get a portion of their savings as a reward. Surgeons who don’t save Medicare money face penalties large enough to bankrupt them.
When Hospitals Misquote Prices They’re Not Held Accountable
I often write about how the U.S. health care industry is predicated on maximizing revenue against third party payers, primarily employer plans. Health insurers negotiate prices with providers but about half of people in private health insurance are covered by self-insured employer plans. That means an insurer is often managing the plan but not taking on any risk. Some benefits brokers have told me insurers frequently profit off third-party claims due to spread pricing. That is, charging the employer plan slightly more for a procedure than what the insurer paid the provider. That is problematic because the party negotiating the prices (insurers) profits every time they spend (someone else’s) money. That is not a very strong incentive to hold prices down, or steer enrollees to the cheapest options.
Tuesday Links
- What Noble Laureate gene editors don’t seem to want to talk about: can they change the evolution of the human race?
- Eye hospital travels from place to place – inside an airplane.
- How could Pickleball (a wimpy sport in my view) be sending so many people to the ER?
- Your pharmacist can now prescribe Paxlovid. But does Paxlovid work if you have already been vaccinated? and How did the FDA get the power to decide who can prescribe?
- Monkeypox: Trump secured the right to 13 million vaccine doses and ordered 1.4 million for emergency use in 2020. So why are all those doses being stockpiled in Washington?