PUP 4931r Lecture Notes - Lecture 71: Medicare Advantage, Managed Care, Iatrogenesis
16 May 2018
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Issues Facing Medicare:
Rapid spending growth must be slowed
Raise premiums, deductibles, copays?
Raise eligibility age
Cut physician/provider reimbursements?
Improve care efficiency?
Consumer cost consciousness must be raised
Demands for unnecessary care discouraged
More beneficiaries must become managed care enrollees
Providers’ volume-rewarding incentives must be changed
More episode-based payment must be adopted
More pay for performance for docs: MACRA implementation
Unexplained variation must be eliminated
Ineffective, harmful care must be discouraged, not paid for
Quality standards must be set & met
Care must be standardized
Medicare/Medicaid perverse incentives must be curbed
Means-testing will be broadened
High income payroll taxes may be raised further
Medicare and the ACA
Medicare Advantage Payment Cuts
Implications include terminating 10-15% of MDs
Potential increases in premiums, co-pays
Possible service reductions
Hospital Value Based Purchasing
DSH Payment Reductions
Other Payment Changes
Bundling, Readmission, Iatrogenic disorders
Donut Hole Closure & Discounts
Preventive Services
Trust Fund Balance Extension
.9% Tax on higher incomes
Part D Premiums – Income Adjusted
If ACA Repealed
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