What is Medicare / Medicaid? - Eligibility - Payment - Reference
Medicaid / Medicare are different governmental programs that provide medical and health-related services to specific groups of people in U.S. and managed by Centers for Medicare and Medicaid Services.
Medicaid / Medicare are different governmental programs that provide medical and health-related services to specific groups of people in U.S. and managed by Centers for Medicare and Medicaid Services.
Background: Several initiatives have focused on defining low-value health care services. Measuring overuse of such services may be helpful to characterize the potential extent of wasteful care and inform policies to address low-value practices.
How the Study Was Conducted: The authors developed 26 claims-based measures of low-value services and used 2009 claims from more than 1.3 million Medicare beneficiaries to assess the proportion of beneficiaries receiving these services, average per-beneficiary service use and the proportion of total spending connected with these services. The 26 measures included cervical cancer screening for women 65 years and older, CT scanning of the sinuses for uncomplicated acute rhinosinusitis (inflammation of the sinuses), preoperative stress testing and back imaging for patients with low back pain.
Study Suggests Regional Variation in Medicare Imaging Utilization is Considerably Less Than Variation in Imaging Costs
A variety of issues relating to clinical practice, practice management, health services and policy, and radiology education and training are highlighted in the January issue.
A variety of issues relating to clinical practice, practice management, health services and policy, and radiology education and training are highlighted in the January issue.
Discussion: "Despite their imperfections, claims-based measures of low-value care could be useful for tracking overuse and evaluating programs to reduce it. However, many direct claims-based measures of overuse may be insufficiently accurate to support targeted coverage or payment policies that have a meaningful effect on use without resulting in unintended consequences. Boarder payment reforms, such as global or bundled payment models, could allow greater provider discretion in defining and identifying low-value services while incentivizing their elimination."
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Less Hispanic Participation in Medicare Drug Benefit may Point to Barriers
Despite the existence of the Medicare Prescription Drug Plan – also known as Part D – and the availability of assistance to help pay insurance premiums, hispanic seniors are 35 percent less likely to have prescription drug coverage.
Despite the existence of the Medicare Prescription Drug Plan – also known as Part D – and the availability of assistance to help pay insurance premiums, hispanic seniors are 35 percent less likely to have prescription drug coverage.
In a related editor's note, JAMA Internal Medicine deputy editor Mitchell H. Katz, M.D., and colleagues write: "This article highlights the opportunity for eliminating unnecessary care, and we hope that others will use and improve the methods developed by the authors. Most important, we hope that development of better measures of low-value care will ultimately spur development of interventions to reduce unnecessary care."
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Patterns of Patient Care Examined in Medicare Accountable Care Organizations: Study
Bottom Line: About one third of Medicare beneficiaries that were assigned to accountable care organizations (ACOs) in 2010 or 2011, were not assigned to the same ACO in both the years.
Bottom Line: About one third of Medicare beneficiaries that were assigned to accountable care organizations (ACOs) in 2010 or 2011, were not assigned to the same ACO in both the years.
