Primer: The Medicare Advantage Star Rating System

For years, policymakers and health insurers have looked for ways to simultaneously reduce federal health care expenditures and ensure better quality care for patients. For both hospital services (Part A) and physician services (Part B), the Centers for Medicare and Medicaid Services (CMS) has implemented multiple programs to track providers’ performance on various metrics and adjust payments accordingly—similar to efforts being imposed by private insurers. For Medicare Advantage (MA or Part C), CMS operates the Star Rating System. This system provides a relative quality score to Medicare Advantage Organizations (MAOs) on a 5-star scale based on their plans’ performance on selected criteria, and is now used to determine whether or not an MAO will receive bonus payments and/or rebates for their enrollees.

Pioneer ACOs: Not Exactly a Success

This week several news outlets published stories about the great successes of the Pioneer Accountable Care Organization (ACO) demonstration project, a managed care approach explained in depth here, and the potential positive implications for Medicare.  While it is understandable that many are desperate to find any sign of success deriving from the health reform law, wishful thinking doesn’t actually make the Pioneer ACO program a success. The hype surrounding the $400 million savings is overblown, and the stability of the Pioneer model should be seriously questioned before more Medicare funds are committed to a relatively untested and largely unsuccessful program.

Prescription Drug Follies

At exactly the same time that a bipartisan bill is making a great stride forward for Medicare in the House of Representatives, the Senate is poised to vote on a great step backward. Specifically, Senator Jack Reed is offering an amendment to the Senate budget resolution with the purpose of “making prescription drugs more affordable for seniors and for tax-payers by requiring the Secretary of Health and Human Services to negotiate prescription drug costs under the Medicare program.”

 

Merits of the Proposed SGR Repeal

Congress has the chance to eliminate an annual legislative nightmare, fix the reimbursement of doctors under Medicare, introduce substantive, structural changes to an entitlement program, and ensure the continued insurance coverage of needy children – all without raising a dime of taxes. Reports indicate that there is a bipartisan, bicameral leadership agreement for Congress to repeal the Sustainable Growth Rate (SGR) mechanism, as well as extend for two years the Children’s Health Insurance Program (CHIP) and numerous other health provisions. The legislation isn’t perfect – more on that below – but it is an important step forward.

The Daily Dish

When the U.S. housing bubble burst the aftershocks were at the heart of the financial crisis and Great Recession, so you might think that policymakers would avoid at all costs the kinds of policies that fed the housing bubble. Enter the Federal Housing Administration (FHA), which yesterday put into effect a 0.50 percent (50 basis points) reduction in the premiums borrowers must pay for taxpayer-backed FHA mortgage insurance.

The Daily Dish

The Trustees of the Social Security and Medicare programs released their annual reports yesterday. Read the coverage and claims contained therein carefully, with an eye for two key moments of spin: (1) the fiscal news is good and the programs are fine, and (2) Obamacare has improved the outlook for Medicare. Instead, remember this: (3) both programs are fiscal toast and need immediate reforms to continue to provide future seniors with an appropriate safety net.

Six Questions for HHS Secretary Nominee Sylvia Matthews Burwell

Senate confirmation hearings begin this week for Sylvia Matthews Burwell–currently the Director of the Office of Management and Budget, and the President’s pick to run the Department of Health and Human Services (HHS). Burwell would replace outgoing HHS Secretary Kathleen Sebelius, who has held the office since April 2009. Ms. Burwell should move to make HHS a more transparent, accountable organization under her leadership.

CMS Rulemaking and Medicare Part D: Stifling Innovation, Limiting Access, and Decreasing Quality

In January the Center for Medicare and Medicaid Services (CMS) proposed new regulations for Medicare Part D that would limit plan options, restrict competition, and interfere with plans’ negotiations. Under the guise of ordinary rulemaking, the proposed regulations are a fundamental contravention of the policy principles that have made Part D a popular, low-cost, and innovative program. If implemented, the taxpayer will face higher budget costs, millions of seniors will lose their preferred plans, benefits will diminish, and premiums will rise.

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