Medicare (21 - 30 of 214 items)
Private Health Insurance: Geographic Variation in Spending for Certain High-Cost Procedures Driven by Inpatient Prices
GAO-15-214: Published: Dec 29, 2014. Publicly Released: Jan 28, 2015.
Spending for an episode of care in the private sector varied across metropolitan statistical areas (MSA) for coronary stent placement, laparoscopic appendectomy, and total hip replacement, even after GAO adjusted for geographic differences in the cost of doing business and differences in enrollee demographics and health status. MSAs in the highest-spending quintile had average adjusted episode spe...
Health Care Transparency: Actions Needed to Improve Cost and Quality Information for Consumers
GAO-15-11: Published: Oct 20, 2014. Publicly Released: Nov 18, 2014.
Results obtained from two selected private consumer transparency tools GAO reviewed—websites with health cost or quality information comparing different health care providers—show that some providers are paid thousands of dollars more than others for the same service in the same geographic area, regardless of the quality of such services. For example, the cost for maternity care at selected ac...
Compounded Drugs: Payment Practices Vary across Public Programs and Private Insurers, and Medicare Part B Policy Should Be Clarified
GAO-15-85: Published: Oct 10, 2014. Publicly Released: Nov 10, 2014.
Medicare, Medicaid, and private health insurers have varying payment practices for compounded drugs, depending upon whether compounded drugs and their ingredients can be identified on health insurance claims, and Medicare's Part B payment policy for these drugs is unclear.For drugs dispensed in pharmacy settings, claims contain sufficient information for public programs and private insurers to ide...
Medicare Imaging Accreditation: Effect on Access to Advanced Diagnostic Imaging Is Unclear amid Other Policy Changes
GAO-14-378: Published: Apr 18, 2014. Publicly Released: Apr 18, 2014.
GAO found that the number of advanced diagnostic imaging (ADI) services provided to Medicare beneficiaries in the office setting—an indicator of access to those services—began declining before and continued declining after the accreditation requirement went into effect on January 1, 2012. In particular, the rate of decline from 2009 to 2010 was similar to the rate from 2011 to 2012 for magneti...
Medicare: Certain Physician Feedback Reporting Practices of Private Entities Could Improve CMS's Efforts
GAO-14-279: Published: Mar 26, 2014. Publicly Released: Mar 26, 2014.
Private entities GAO reviewed for this study selected a range of measures and benchmarks to assess physician group performance, and provided feedback reports to physicians more than once a year. Private entities almost exclusively focused their feedback efforts on primary care physician groups participating in medical homes and accountable care organizations, which hold physicians responsible for...
Medicare: Nurse Anesthetists Billed for Few Chronic Pain Procedures; Implementation of CMS Payment Policy Inconsistent
GAO-14-153: Published: Feb 7, 2014. Publicly Released: Mar 10, 2014.
From 2009 through 2012, certified registered nurse anesthetists (CRNA)—a type of advanced-practice nurse specializing in anesthesia care—billed Medicare fee-for-service (FFS) for a minimal share of selected chronic pain procedures, less than ½ of 1 percent of these procedures in each year. Physicians without board certification in pain medicine billed for the majority of selected procedures e...
Electronic Health Record Programs: Participation Has Increased, but Action Needed to Achieve Goals, Including Improved Quality of Care
GAO-14-207: Published: Mar 6, 2014. Publicly Released: Mar 6, 2014.
Based on the number of providers awarded incentive payments, participation in the Department of Health and Human Services' (HHS) Medicare and Medicaid Electronic Health Record (EHR) programs increased substantially from their first year in 2011 to 2012. For hospitals, participation increased from 45 percent of those eligible for 2011 to 64 percent of those eligible for 2012. For professionals, suc...
Medicare: Continuous Insurance before Enrollment Associated with Better Health and Lower Program Spending
GAO-14-53: Published: Dec 17, 2013. Publicly Released: Jan 16, 2014.
Beneficiaries with continuous health insurance coverage for approximately 6 years before enrolling in Medicare were more likely than those without prior continuous insurance to report being in good health or better during the first 6 years in Medicare. In particular, having prior continuous insurance raised the predicted probability that a beneficiary reported being in good health or better by nea...
Clinical Data Registries: HHS Could Improve Medicare Quality and Efficiency through Key Requirements and Oversight
GAO-14-75: Published: Dec 16, 2013. Publicly Released: Dec 16, 2013.
Clinical data registries (CDR) have demonstrated a particular strength in assessing physician performance through their capacity to track and interpret trends in health care quality over time. Studies examining results reported by several long-established CDRs demonstrate the utility of CDR data sets for analyzing trends in both outcomes and treatments. CDR efforts to improve outcomes typically in...
Electronic Health Records: Number and Characteristics of Providers Awarded Medicare Incentive Payments for 2011-2012
GAO-14-21R: Published: Oct 24, 2013. Publicly Released: Oct 24, 2013.
Hospitals and health care professionals, such as physicians, were awarded a total of approximately $6.3 billion in Medicare electronic health records (EHR) incentive payments for 2012, which is more than twice the $2.3 billion awarded to hospitals and professionals for 2011. Almost half of eligible hospitals and less than a third of eligible professionals received Medicare EHR incentive payments f...