Potential “Savings” of Medicare: The Analysis of Medicare Advantage and Accountable Care Organizations

Medicare faces significant financial challenges because of rising health care costs. In response, Medicare reform efforts have been testing various payment and service delivery models, including accountable care organizations (ACOs), aiming to reduce expenditures while preserving or enhancing the coordination of quality care. The idea behind ACOs is to form an organizational network to coordinate all care for Medicare beneficiaries and in so doing, at least theoretically, improve quality of care and hopefully reduce medical costs. The purpose of this research is to apply Data Envelopment Analysis (DEA) to assess the potential savings of Medicare obtainable through optimally efficient implementation of ACOs and Medicare Advantage plans. DEA comparisons across plans achieve this purpose by identifying which Medicare plans operate relatively more efficiently and which are inefficient, and additionally, for inefficient plans, the DEA analysis generates target levels of “inputs” and “outputs” required to bring the plan into efficient operation. Knowing sources of inefficiency can also provide insights into Medicare reform, such as Medicare privatization and innovation models. Our results show that Medicare Advantage plans are more efficient in reducing health expenditures but incur higher administrative costs. Health expenditure savings can also be achievable by promoting government-sponsored managed Medicare such as ACOs. Finally, compared to the profit efficiency of Medicaid managed care plans, Medicare Advantage should have the potential for more Medicare market penetration from the supply (insurer) side.     

The U.S. small business bankruptcy amendments: A global model for reform?

On February 19, 2020, the Small Business Reorganization Act of 2019 went into effect in the United States. This statute was intended to make the rescue regime of Chapter 11 of the United States Bankruptcy Code more effective for smaller businesses that would not otherwise have the financial wherewithal to complete a traditional Chapter 11 reorganization. This article describes the central innovations of the new statute, and considers whether they might be adaptable by other countries.     

The Financial Accountability of Australia's Medicare System: A Generational Accounting Analysis

The financial sustainability of publicly funded health care systems is sensitive to the demographics of ageing populations, which have a significant bearing on their financial management, accountability and reporting of their financial performance. This paper examines historical and current trends in demographic structure of Australia's population that are likely to impact on the financial management and accountability practices affecting Australia'suniversal public health care system ('Medicare'). The pay-as-you-go financed funding status of Medicare as represented under both currently required, cash-based accounting principles and proposed accrual-based accounting principles are criticised for not recognising the obligations of the Australian government under Medicare. An alternative system of generational accounting is proposed that projects the financial management costs of Medicare. Data are taken from both historical trends in expenditure and ageing as well as projected demographics. The analysis implies that there is significant intergenerational-inequity in the funding of Medicare, which is not recognised under accrual-based accounting principles that are now being used to evaluate the financial accountability and performance of government entities.     

HMOS--independent medical review--preemption. Rush Prudential HMO,Inc. v. Moran

A state statute can require an HMO to provide for an independent medical review of a denial of a request for a particular treatment as not medically necessary and to provide the treatment if the reviewing physician determines the covered service is reasonably necessary. The statute is exempt from ERISA preemption as a law that regulates insurance.     

Medicare--substitute HMOs--reimbursement from other insurance. Care Choices HMO v. Engstrom

The federal statute that permits Medicare-substitute HMOs to seek reimbursement from other insurers does not provide the HMOs with a private federal remedy for reimbursement. It permits Medicare-substitute HMOs to provide in their policies that they are entitled to reimbursement in cases where other insurance, such as the third-party liability insurance of a party responsible for causing an injury, is available. The HMO must sue in state court for its contractual right to reimbursement. It may not sue in federal court under the federal statute that merely allows it to provide for reimbursement in their policies.     

Does competition under Medicare Prospective Payment selectively reduce expenditures on high-cost patients?

Competition and prospective payment have been widely used to control health care costs but may together provide incentives to selectively reduce expenditures on high-cost relative to low-cost patients. We use patient discharge and hospital financial data from California to examine the effects of competition on costs for high- and low-cost admissions in the 12 largest Diagnosis-Related Groups before and after the Medicare Prospective Payment System (PPS). We find that competition increased costs before PPS, but that this effect decreased afterward, especially inpatients with the highest costs.We conclude that competition and PPS selectively reduced spending among the most expensive patients and that careful assessment of these patients' outcomes is important.     

The Medicare hospice benefit: the effectiveness of price incentives in health care policy

This article examines the implications of fixed-price reimbursement of providers for access to hospice care by Medicare beneficiaries. Hospices that are offered higher reimbursement rates by Medicare are found to be more likely to become certified to provide care under the Medicare Hospice Benefit program. Each $1.00 increase in the daily routine home care rate raises the probability of certification by 1.7%. In turn, the Hospice Benefit increases access to hospice care by enabling Medicare-certified facilities to serve more patients than they would if they were noncertified. However, care must be taken to set reimbursement rates appropriately. Failure to correctly adjust reimbursement rates for the real costs of certification across different parts of the country leads to disparities in hospice certification and differential access to hospice care for Medicare beneficiaries.     

Uncertainty, Real Options, and Cost Behavior: Evidence from Washington State Hospitals

This study tests an implication of the real‐options theory of investment, that uncertainty leads firms to prefer technologies with low fixed and high variable costs. In 1983, a change in Medicare reimbursement increased the uncertainty of revenues for hospitals. Using a sample of 831 departments in 59 Washington State hospitals over the 1977–1994 period, we find that the ratio of variable to total costs increased after 1983. This increase is not attributable to a gradual increase in the ratio over time: We estimate a significant increase after 1983 even after controlling for a time trend. Further, we find a greater increase in the variable‐to‐total cost ratio for hospitals that had higher percentages of Medicare patients, increasing our confidence in the conclusion that the change in cost behavior is attributable to Medicare's change in reimbursement.     

金融审判中风险防范的适法困境与选择

金融资管业务往往通过民事合同的安排来达到降低交易成本、规避金融监管的目的。为了防范金融风险,金融监管机构通过《资管新规》等一系列监管政策加强对金融市场的"穿透式"监管。金融商事审判机关在制定法没有明确规定的情况下,如何针对违反监管政策的金融交易合同做出公允的裁判是亟须解决的问题。本文分析了合同法第53条3、4、5款的适用空间为何,以及金融商事审判如何在现行法的框架内防范实现风险防范的目的。     

Vergleich der Fahrkostenübernahme durch die Gesetzliche Krankenversicherung in Deutschland und Frankreich

The payment of transportation costs according to German health insurance law in § 60 IV SGB V depends on the legal provisions concerning rescue services in the Bundesländer: Transportation has to be awarded in kind if the prices are agreed upon in a contract between the health insurers and the transportation enterprises. On the other hand, if these prices are fixed in a municipal or Länder statute, the health insurers are entitled to limit their payment obligations up to a fixed amount (?Festbetrag“). In this case, the reimbursement of the accrued transportation costs is the only feasible method. The French health insurance is based upon the principle of reimbursement which is valid for transportation costs as well. Under certain conditions the insured persons can be exempted from their personal contribution as well as the advance payment. The difference to the principle of benefits in kind becomes thus ?invisible“. According to § 60 IV SGB V, the statutory German health insurance does not bear the costs for transports from abroad. People who are insured in the French Assurance Maladie, however, are entitled to reimbursement of these costs if the transport was medically indicated. The reimbursable amount is reduced by the costs that would have to be paid for the return journey had the accident or illness not occurred. According to the standard that has been set up by the ECJ in their rulings in Kohll and Decker, the German provision in § 60 IV SGB V is contrary to both the freedom of movement within the EU of the insured persons, art. 39 EC, and the freedom of services of the transportation enterprises, art. 49 EC. National law has to be interpreted in conformity with the EC-law provisions, therefore transportation costs have to be borne if the next possible treatment is available only after crossing the border to Germany.     

Medicare on the critical list. Understanding the etiology of the disease will help in the search for a cure.

Medicare, and its companion program Medicaid, came into being as part of Lyndon Johnson's Great Society. Their purpose was to provide the elderly with equal access to high-quality medical care. Though the goals were laudable, the magnitude of the costs and of the effects was unforeseen. As the two programs made medical care available to a large segment of the population, the demand grew. At the same time, private industry became more generous with its health insurance plans. Because of their emphasis on hospital care, the governmental and private industry plans helped push hospital prices up. Now that both sectors are finding the cost of medical care unacceptably high, Congress is proposing remedial legislation and corporations are trying alternative health care plans. These authors explore how well the maladies of Medicare may respond to the various cures that are being proposed.     

The clock is ticking on readmission penalties

Hospital leaders who are considering initiatives to reduce readmissions by improving discharge processes and postdischarge care should begin with five action steps: Ascertain the hospital's Medicare 30-day readmission rates from July 1, 2011, to June 30, 2012. Based on these numbers, estimate the potential readmission penalties the organization may face. Identify a clear strategy or program for the organization to reduce 30-day readmissions and avoid Medicare penalties. Determine the overall direct and indirect costs of this strategy or program. Calculate the potential ROI of the initiative.     

Public plans--Americans with Disabilities Act--discrimination-disparate treatment of mental disabilities. Rogers v. Department of Health and Environmental Control, 174 F.3d 431 (4th Cir.1999)

Title II of the Americans with Disabilities Act of 1990 (ADA), which prohibits discrimination in the services, programs or activities of public entities, does not require a state's long-term disability plan to provide the same level of benefits for mental and physical disabilities. By placing mental disabilities in different risk classifications from physical disabilities, South Carolina's long-term disability plan did not violate a South Carolina statute that prohibits discrimination "between insureds of the same class and risk involving the same hazards."     

Medicare+Choice--cost and funding issues for Medicare risk plans.

The Balanced Budget Act of 1997 contained the most important changes in Medicare since its inception in 1965. The most notable changes include Medicare+Choice, which includes existing Medicare risk programs. The author offers a brief summary of the history of Medicare and the changes that will impact employer/union service providers. Areas of discussion include typical Medicare risk benefit packages, a financial analysis of Medicare risk contractors and changes to risk contracting under the new law.     

Opening a dialog: communicating with retirees about Medicare+Choice.

In October 1998, the Health Care Financing Administration sent information to 38 million Medicare beneficiaries in five pilot states, consisting of a comprehensive handbook entitled Medicare and You. The purpose of the handbook is to clarify new options under Medicare+Choice to participants. Such clarification is bound to initiate contact by Medicare beneficiaries to former employers/unions. This article addresses employers' need to develop a communication strategy for beneficiaries and suggests a methodology and possible questions that may arise.     

Cost and effectiveness of physician peer review in reducing medicare overutilization

There has been concern that some physicians within the U.S. Medicare program may be rendering medical attention unecessarily. To help curb this possible overutilization, peer review committees have been formed in certain areas. These committees of practicing physicians examine utilization practices of doctors.The objective of this study is to determine the cost and effectiveness of the peer review process. In order to do this, we compare the costs and benefits resulting from peer review. The benefits are two types. One type is recoverable overpayments, which peer review has established as amounts that were paid for unnecessary medical attention. The other type is the deterrent to physicians against overutilization, due to the presence of peer review.The findings of this study are that each of the benefits of peer review substantially outweigh its costs, and that the benefits due to the deterrent effect of peer review are evident in all review areas considered.     

The Evolution of Standard Costing in the U.K. and U.S.: From Decision Making to Control

Decision making and control are two fundamental components of industrial management that are aided by accounting information. This article traces the evolution of standard costing in the U.K. and U.S. and describes how it has served these two purposes over time. At the start of the industrial revolution, standard costing, in the form of past actual costs, aided managers in make-or-buy, pricing, outsourcing and other routine and special decisions. In the late nineteenth century, as the mass production of homogeneous products became more common, predetermined, norm-based standard costs were promoted as the means to control operations and reduce waste. The use of predetermined costs was recommended by both academic and professional branches well into the twentieth century. Since the mid-1980s, norm-based standards have come under fire for not providing appropriate strategic signals in an era of global competition, continuous improvement and perpetual cost reduction.
This article compares the nature of standard costing practices in the British Industrial Revolution with those that evolved in the U.S. under scientific management. The enquiry is not limited to double-entry systems and, like Miller and Napier (1993), the domain is broadened to include other forms of cost-keeping practices. We utilize primary and secondary sources to argue that the environment and rationales for standard costs have changed fundamentally over time. It is speculated that in the future standard costing will be used far less for individual accountability or operational control, but will return to its decision-making roots in the form of long-run cost targets that benchmark the success of continuous cost-reduction efforts.     

敦煌会计文书的史料价值研究

敦煌会计文书中含有大量丰富的信息资料,不仅为会计研究,而且为经济、社会关系、契约制度、户籍制度、佛寺关系等研究领域提供了重要的历史资料参考和文献依据.敦煌会计文书重要的史料价值形成与唐五代时期发达的商业经济、繁荣的东西文化交流、寺院特殊的社会地位和高度发达的单式记账方法是分不开的,体现了科学与原始、历史与现实的融舍统一.