The Rundown | Week of 11.18.2019

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Majority Beneficiaries Choosing No-Premium MA Plans

According to an analysis by eHealth, 83 percent of Medicare Advantage (MA) plans chosen during 2020 open enrollment have no premiums. Though numbers may shift before the December 7 deadline, the average monthly MA premium is only $5.47, 43 percent lower than last year. This contrasts with the Centers for Medicare & Medicaid Services’ (CMS) prediction in September that the average monthly premium would be $23.Similarly, “Part D plan premiums are down year over year,” researchers note. However, Medicare Supplement premiums saw an 8 percent increase over last year.
>> Read More: Medicare Snapshot: Open Enrollment Costs and Trends

Hospital Costs Vary Even When Outcomes Don’t

A new study in JAMA Network Open found that hospital costs varied widely among Medicare beneficiaries, although mortality and other health outcomes were similar. Researchers studied more than 2,323 patients with heart failure or pneumonia who were admitted for the same condition in either a high-cost or low-cost hospital. “The same patients admitted with the same diagnosis to hospitals in the highest Medicare payment quartile had higher costs than when they were admitted to hospitals in the lowest quartile,” researchers discovered. This indicates that “hospitals operate at different cost levels independent of their patients” and “non-time-varying patient characteristics.”
>> Read More: Association of Hospital Payment Profiles With Variation in 30-Day Medicare Cost for Inpatients With Heart Failure or Pneumonia

Study: Patients Seeking Mental Health More Out-of-Network

A recent study from Milliman indicates that “out-of-network utilization rates for behavioral healthcare providers were higher than for medical/surgical procedures.” Patients are five times more likely to see an out-of-network — and, therefore, more costly — provider for a behavioral health condition. Furthermore, the disparities extended to reimbursements to providers; “Average in-network reimbursement rates for behavioral health office visits are lower than for medical/surgical office visits (each as a percentage of Medicare-allowed amounts), and the disparity increased … Primary care reimbursements were 23.8% higher than behavioral reimbursements.” Researchers advised that “health plans should carefully review their processes in order to ensure compliance” with the Mental Health Parity and Addiction Equity Act
>> Read More: Addiction and Mental Health vs. Physical Health: Widening Disparities in Network Use and Provider Reimbursement

Medicare Fee-For-Service Improper Payments Lowest Since 2010

Improper payments under Medicare have fallen to the lowest level since 2010, CMS announced. These results exemplify the agency’s “commitment to strengthening Medicare and ensuring that tax dollars are spent appropriately,” the report noted. Estimates show that recent “efforts to detect and prevent fraud, waste and abuse and more aggressively ensure the integrity of the federal healthcare programs” saved approximately $7 billion. “CMS has taken a multifaceted approach that includes provider enrollment and screening standards to keep bad actors out of the program, enforcement against bad actors, provider education on our rules and requirements, and advanced data analytics to stop improper payments before they happen,” said CMS Administrator Seema Verma.
>> Read More: Fiscal Year (FY) 2019 Medicare Fee-for-Service Improper Payment Rate Is Lowest Since 2010 While Data Points to Concerns With Medicaid Eligibility

AHA Addresses E-Cig, Which Study Suggests May Be Less Harmful

The American Heart Association (AHA) recently announced “an aggressive, three-pronged initiative involving research, policy advocacy and youth activation intended to urgently address the epidemic of youth e-cigarette use.” The initiative will receive $20 million and focus on “long-term health effects in youth.” This news follows a recent study that found e-cigarettes are less harmful than traditional cigarettes, according to the American College of Cardiology. “Smokers, particularly females, demonstrate significant improvement in vascular health within one month of switching,” researchers concluded, adding: “Switching from [cigarettes] to [e-cigarettes] may be considered a harms reduction measure.”
>> Read More: Cardiovascular Effects of Switching From Tobacco Cigarettes to Electronic Cigarettes

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