- “Longer life with no greater proportion lived in good health equals more years in poor health—statistically, for the population at large.” Interesting throughout, with implications for research and public policy priorities.
- Obesity drugs could save Medicare $100 billion a year.
- 40% of privately insured patients receive no preventive care, despite the ACA mandate for free coverage.
- David Henderson grades the US on how far we have come toward achieving Karl Marx’s ten public policy goals.
- Monopoly matters: “in states in which the market share of the dominant health insurer exceeded 71 percent…[that] payer, on average, paid 14.7 percent less to hospitals than market-leading insurers in more competitive insurance markets.”
Category: Health Economics & Costs
Why MA Upcoding is a Thing of the Past
In the past:
When the OIG did audits on fraud for Medicare Advantage for the past several years, the literal definition of fraud in their reviews was to have a code in the RAPS payment system that was not the one in the actual medical record of the patient… [and] they estimated in a couple of reports that the fraud level using that definition … would be as much as 6 percent of the total Medicare Advantage spend.
The fee-for-service Medicare fraud level ranges from 6–7 percent, so the people looking at both numbers said that the plans and the caregivers were in the same ball park….
Tuesday Links
- George Halvorson: “The death rate for many dual eligible patients [in traditional Medicare] with some conditions runs at about 40 percent, and we know from a year-long study … that the death rate for the people who enrolled in the Medicare Advantage [special needs plans] was 3 percent.”
- More from Halvorson on fee-for-service Medicare: “the program has 10,000 billing codes for procedures and not one billing code for a cure.”
- Survey: More than 25% of pilots admitted to being untruthful on medical forms — and nearly half turned to nonprofessionals for medical advice versus seeing a doctor.
- Under the public health emergency, employers can offer stand-alone telehealth benefits to benefits-ineligible employees like part-time or seasonal workers. Hard to believe employers need the government’s permission to do this.
Monday Links
- Just 3% of all Covid vaccine doses went to Africa, which has one-fifth of the world’s population. (NYT)
- VA health record system: Errors delay medication and treatment, endangering more than 40,000 patients.
- Paul Krugman in 2006: The VA “has been able to take the lead in electronic record-keeping and other innovations that reduce costs.”
- Kaiser study: Value of the tax exemption for nonprofit hospitals: $28.1 billion. Value of charity care: $16.0 Billion.
- Dylan Matthews: against work requirements for Medicaid.