- 100% of large health insurers cover telemedicine for mental health and other behavioral health problems. (gated)
- However, more therapists are refusing to accept private insurance. (WSJ)
- Israeli study: Paxlovid (for Covid) lowered hospitalization rates in 65-year-olds and older by about 75%, but people ages 40-64 who took the drug shortly after infection saw little to no benefit.
- Kaiser: Most Medicare beneficiaries will soon get their coverage through Medicare Advantage.
- A liberal critiques Biden: He needs advisers who think like economists. A good read if you are an Yglesias subscriber.
Category: Health Economics & Costs
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.
Thursday Links
- The chronically ill have trouble paying their bills.
- Survey: 43 percent in the 19-30 age group has used cannabis 20 or more times over the previous year.
- How to earn $139,000 a year as a nurse.
- What a black hole sounds like.
- 40% of US births are out of wedlock. But internationally we are in the middle of the pack. In Iceland it is 71%.
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.