Medicare

Cancer Outcomes Influenced by Health Insurance Status

  • Two studies published in Cancer reveal that uninsured and Medicaid-insured patients have worse outcomes than patients with private insurance.
  • In these 2 studies, patients with private insurance had a clear survival advantage
  • Based on SEER data on glioblastoma multiforme outcomes, researchers found that an uninsured patient was 14% more likely to have a shorter survival time than a patient who carried private insurance.
  • A patient insured through Medicaid was 10% more likely to have a shorter survival time.
  • In a study of the outcomes of men diagnosed with testicular cancer, compared with men with private insurance, uninsured men were 88% more likely to die.
  • Men insured through Medicaid were 51% more likely to die of the disease.

Meaningful Use to End in 2016; will Morph into MACRA, MIPS

  • The Meaningful Use program will end in 2016 and will transition to the Medicare and CHIP Reauthorization Act of 2015 (MACRA) and the Merit-Based Incentive Payment System (MIPS) by 2019.
  • The specifics of the new programs will be revealed in early 2016.
  • Meaningful Use has successfully resulted in the widespread implementation and use of healthcare information technology (HIT) and systems.
  • MACRA and MIPS will focus on the use of HIT to improve clinical outcomes and patient experience.

Improved HIV/AIDS Care Could Save Billions

  • HIV screening programs are associated with increased costs.
  • Increased care engagement among patients could save billions.
  • A variety of programs can increase patient care compliance.
  • Improved compliance is linked to improved outcomes and decreased costs.

Millions of Americans Will Pay Higher Medicare Premiums

  • A portion of Medicare recipients could see a significant increase in premiums in 2016.
  • Premium increases will affect Medicare Part B.
  • Coincidentally, there will be no Social Security cost of living increase in 2016.
  • Patients will likely make fewer office visits and will spend less on healthcare.

New Antivirals Revolutionize HCV Treatment Value Proposition

  • In 2015, 80% of all Medicare spending will be on new, frequently curative treatments of hepatitis C (HCV) infection.
  • Medicare spent about $7 million/y on older HCV drugs; will spend about $9 billion on new DAAs in 2015.
  • Newer HCV drugs will be accompanied by high cost in the first few years of their use. A precipitous drop in spending is expected once the HCV epidemic is stemmed.
  • HCV-related costs will drop sharply in the coming years, to below $2 billion by 2020, and to just $14 million by 2030.
  • New DAAs are one of the greatest value propositions in the history of medicine; a fantastic value at a high up-front cost.

What is an Accountable Care Organization?


  • Accountable care organizations (ACOs) embody performance-based medicine.
  • An ACO is a network of healthcare providers and hospitals that shares responsibility for providing all types of healthcare to ≥5000 Medicare beneficiaries at a period of at least three years.
  • These providers and organizations must be able demonstrate that they can reduce costs while improving outcomes.
  • Studies have shown that ACOs do effectively achieve these improved results.

Why You’re Seeing Fewer Workers’ Comp Cases

  • Since 2003, legislators in 33 states have passed workers’ comp laws that reduce benefits or make it more difficult for those with certain injuries and diseases to qualify for them.
  • In 37 states, workers can’t pick their own doctor or are restricted to a list provided by their employers.
  • For those patients who are able to access workers’ comp benefits, the amounts have been reduced by as much as 65%.

Pressure Ulcers Are Painful, Dangerous, Costly, and Preventable


  • Pressure ulcers are common throughout the world.
  • Many different types of pressure wounds and treatments exist.
  • The annual cost of pressure ulcers in the U.S. is about $11 billion.
  • Pressure ulcers are easily prevented.
  • Prevention is much less costly than treatment.

Studies Show Wild Variations in Healthcare Spending, Pricing

  • Cost of an orthopedic procedure can vary from $16,000 to $60,000 depending on the geographic location of the surgery.
  • Per-veteran spending within the VA system ranges from $25,000 per year in Boston to less than $6500 per patient on Cape Cod.
  • Hospital procedure pricing is seen as largely fictitious and unrelated to actual local financial conditions.
  • Blue Cross Blue Shield and the Centers for Medicare and Medicaid Services have published tools to help patients learn the cost of a procedure in advance.

Can Feeling Younger Help Your Patients Live Longer?

  • Self-perception of young was linked to lower mortality rates among older adults.
  • Can you teach your patients to feel younger and live longer?
  • Help your patients feel younger and they’ll live longer.
  • Teach your patients the value of youthful active.

Physicians Being Excluded from Narrow ACA Networks


  • Twenty percent of surveyed practices reported having been excluded from narrow-network ACA plans in which they would have liked to participate.
  • The percentage of insurers offering narrow-network plans has increased steadily since 2007.
  • Insurers use narrow-network plans to increase revenues but docs are blamed by angry patients.

JAMA Study Finds Cochlear Implants Improve Cognition in Elderly Patients

  • Elderly patients aged 65 to 94 years experienced improved speech perception.
  • Study included 94 patients, 81% of whom showed improved cognitive abilities following implantation.
  • Benefits were observable beginning at six months postop.

Not All of Your Older Patients Will Spend More at Your Office


  • By 2050, the U.S. will have four times as many people over age 90.
  • Spending on physicians and outpatient services will rise steadily until patients reach age 83.
  • Home-health and skilled nursing facility spending will likely increase steadily until patients are in their late 90s.

JAMA Study Shows that Bariatric Surgery Saves Lives

  • Obese patients who undergo bariatric surgery are 40% less likely to die at five and 10 years postop.
  • Bariatric surgery significantly extends the lives of obese patients, even among older men with multiple comorbidities.
  • Of the 10,000 patients studied, 74% were male and the average body mass index (BMI) among surgical patients was 47 compared to an average of 46 in nonsurgical patients.

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