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Pharma Pays $825 Million to Doctors and Hospitals, ACA’s Sunshine Act Reveals

November 24, 2014 Comments off

Pharma Pays $825 Million to Doctors and Hospitals, ACA’s Sunshine Act Reveals
Source: Brookings Institution

A not so well-known provision of the Affordable Care Act is the Sunshine Act. The purpose of this act is to increase the transparency in the health care market by requiring doctors, hospitals, pharmaceutical companies, and medical device manufacturers to disclose their financial relationships. Mandated by the Sunshine Act, on September 30th, Centers for Medicare and Medicaid Services (CMS) publicly released the first set of data, under the Open Payments title. This data includes $3.5 billion paid to over half a million doctors and teaching hospitals in the last five months of 2013.

A subset of Open Payments data that is individually identifiable includes two categories of payments. The first category are the payments that are made for other reasons such as travel reimbursement, royalties, speaking and consulting fees and the second are payments which are made as research grants. These datasets together include more than 2.3 million financial transactions which amount to a total of more than $825 million.

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The U.S. Health Workforce: State Profiles

November 20, 2014 Comments off

The U.S. Health Workforce: State Profiles
Source: U.S. Department of Health and Human Services, Health Resources and Services Administration

The State Profiles provide data on 35 types of health workers – from physicians, nurses, and dentists to counselors, physical therapists, laboratory technicians, nursing assistants, and others.

They are companion documents to the U.S. Health Workforce Chartbook and were developed to make data on the U.S. health workforce more readily available to diverse users.

Distribution of U.S. Health Care Providers Residing in Rural and Urban Areas

November 19, 2014 Comments off

Distribution of U.S. Health Care Providers Residing in Rural and Urban Areas (PDF)
Source: U.S. Department of Health and Human Services, Health Resources and Services Administration

Key Findings

  • Among rural residents, there are proportionately more providers in occupations that require fewer years of education and training. Among urban residents, there are proportionately more providers in occupations that require greater years of education and training.
  • Some sectors of the health care workforce have proportionately fewer providers living in rural areas, regardless of amounts of education and training.

Foreign Nurse Importation to the United States and the Supply of Native Registered Nurses

November 19, 2014 Comments off

Foreign Nurse Importation to the United States and the Supply of Native Registered Nurses (PDF)
Source: Federal Reserve Bank of Boston

Importing foreign nurses has been used as a strategy to ease nursing shortages in the United States. The effectiveness of this policy critically depends on the long-run response of native-born nurses. We examine how the immigration of foreign-born registered nurses (RNs) affects the occupational choice and long-run employment decisions of native RNs. Using a variety of empirical strategies that exploit the geographical distribution of immigrant nurses across U.S. cities, we find evidence of large displacement effects—over a 10-year period, for every foreign nurse that migrates to a city, between one and two fewer native nurses are employed in that city. We find similar results at the state level using data on individuals taking the nursing board exam—an increase in the flow of foreign nurses significantly reduces the number of natives sitting for licensure exams in the states that are more dependent on foreign-born nurses compared to those states that are less dependent on foreign nurses. Using data on self-reported workplace satisfaction among a sample of California nurses, we find evidence suggesting that some of the displacement effects could be driven by a decline in the perceived quality of the workplace environment.

CBO — Medicare’s Payment to Physicians

November 17, 2014 Comments off

Medicare’s Payment to Physicians
Source: Congressional Budget Office

On October 31, 2014, the Centers for Medicare and Medicaid Services (CMS) issued a final rule in which CMS announced the update to the conversion factor update for the Physician Fee Schedule (PFS) under Medicare will be a reduction of 21.2 percent for services furnished during calendar year 2015.

Following long-standing practice, CBO will incorporate that information in its next regular baseline update. It will also immediately take that information into account when analyzing legislation being considered by the Congress.

The table, Medicare’s Payment to Physicians: the Budgetary Effects of Alternative Policies, includes estimates for several replacement and short-term alternatives to the current rules for setting Medicare’s payment rates for physicians’ services. The starting date for all of these alternative policies would be April 1, 2015.

Designing Smarter Pay-for-Performance Programs

November 14, 2014 Comments off

Designing Smarter Pay-for-Performance Programs
Source: Journal of the American Medical Association

Over the past decade, public and private payers have experimented with the use of financial incentives to motivate physicians to achieve quality and efficiency. The idea behind pay for performance is simple. Because individuals and organizations respond to incentives, physicians whose patients achieve desirable outcomes should be paid more as an incentive to improve their performance. Yet the results of pay-for-performance programs have been largely disappointing. One argument is that neither the right set of incentives nor the right set of metrics has been identified. Another explanation, which has received far less attention, is that the right set of patients has not been identified for targeted efforts.

Do Doctors Practice Defensive Medicine? Revisited

November 14, 2014 Comments off

Do Doctors Practice Defensive Medicine? Revisited
Source: Cato Institute

Tort reform that limits medical malpractice (“med mal”) suits can affect healthcare spending in two distinct ways. Tort reform can directly lower health care spending by lowering the cost of med mal insurance, which covers indemnity payouts on claims plus defense costs. However, these direct costs account for only about 0.3 percent of healthcare spending. Thus, any decline in med mal premiums will have a minor impact on overall spending.

Tort reform can also affect healthcare spending indirectly, by changing providers’ incentives. In particular, if med mal risk falls, providers might engage in less “defensive medicine” — the practice of ordering tests and other procedures that do not benefit patients (or lack sufficient benefit to justify their costs), to reduce the risk of a med mal lawsuit. If tort reform leads to fewer lawsuits, it may also lead to less defensive medicine. Policymakers have long seen the elimination of defensive medicine as a source of major savings in healthcare costs (e.g., more than a hundred billion dollars).

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