The Pricing of Care Under Medicare for All

Song, Zirui

doi:10.1001/jama.2019.8245

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…Moreover, physicians and hospitals would face a reduction in prices for services previously reimbursed at commercial insurer rates that would be reimbursed at Medicare rates. To the extent that the price reduction induces clinician behavioral responses—such as changes in quantity of services, coding intensity, site of care, or patient selection (analogous to potential responses to a Medicare-for-All approach)—the fiscal outcome would be affected . Such responses would be important to anticipate and monitor from a quality-of-care perspective as well.…”

Section: Overall What Would Be the Net Fiscal Implications Of Lowerin...mentioning

confidence: 99%

“…To the extent that the price reduction induces clinician behavioral responses-such as changes in quantity of services, coding intensity, site of care, or patient selection (analogous to potential responses to a Medicare-for-All approach)-the fiscal outcome would be affected. 7 Such responses would be important to anticipate and monitor from a qualityof-care perspective as well.…”

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confidence: 99%

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Potential Implications of Lowering the Medicare Eligibility Age to 60

Song

2020

JAMA

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On April 9, 2020, former Vice President Joe Biden announced a proposal to lower the Medicare eligibility age from 65 to 60 years. The presumptive Democratic nominee for president stated that this policy would protect older workers whose jobs may be disrupted by the coronavirus disease 2019 (COVID-19) pandemic, which has sharply increased unemployment nationwide. 1 Proposals to expand the Medicare program have garnered broader public support in recent years. 2 In a 2019 Kaiser Family Foundation tracking poll of 1190 adults, 77% favored allowing people aged 50 to 64 years to buy into Medicare, and 56% supported a Medicarefor-All program that in essence lowers the Medicare eligibility age to zero. 3

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Section: Overall What Would Be the Net Fiscal Implications Of Lowerin...mentioning

confidence: 99%

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confidence: 99%

Potential Implications of Lowering the Medicare Eligibility Age to 60

Song

2020

JAMA

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“…Little is currently known about how VA payment reforms may have affected payments to community providers, provider behavior (16)(17)(18), quality of care, and patient outcomes. It is possible that the payment reductions under the new policies' preset and nonvariable contracted payments may have diminished the appeal for community providers, particularly higher-quality providers, to accept serving veterans under the VA Community Care program.…”

Section: Introductionmentioning

confidence: 99%

Association of VA Payment Reform for Dialysis with Spending, Access to Care, and Outcomes for Veterans with ESKD

Wang

Swaminathan

Corneau

et al. 2020

CJASN

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Background and objectivesBecause of the limited capacity of its own dialysis facilities, the Department of Veterans Affairs (VA) Veterans Health Administration routinely outsources dialysis care to community providers. Prior to 2011—when the VA implemented a process of standardizing payments and establishing national contracts for community-based dialysis care—payments to community providers were largely unregulated. This study examined the association of changes in the Department of Veterans Affairs payment policy for community dialysis with temporal trends in VA spending and veterans’ access to dialysis care and mortality.Design, setting, participants, & measurementsAn interrupted time series design and VA, Medicare, and US Renal Data System data were used to identify veterans who received VA–financed dialysis in community-based dialysis facilities before (2006–2008), during (2009–2010), and after the enactment of VA policies to standardize dialysis payments (2011–2016). We used multivariable, differential trend/intercept shift regression models to examine trends in average reimbursement for community-based dialysis, access to quality care (veterans’ distance to community dialysis, number of community dialysis providers, and dialysis facility quality indicators), and 1-year mortality over this time period.ResultsBefore payment reform, the unadjusted average per-treatment reimbursement for non–VA dialysis care varied widely ($47–$1575). After payment reform, there was a 44% reduction ($44–$250) in the adjusted price per dialysis session (P<0.001) and less variation in payments for dialysis ($73–$663). Over the same time period, there was an increase in the number of community dialysis facilities contracting with VA to deliver care to veterans with ESKD from 19 to 37 facilities (per VA hospital), and there were no changes in either the quality of community dialysis facilities or crude 1-year mortality rate of veterans (12% versus 11%).ConclusionsVA policies to standardize payment and establish national dialysis contracts increased the value of VA–financed community dialysis care by reducing reimbursement without compromising access to care or survival.

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