In December, 2011, Washington State's Health Care Authority announced its intention to stop paying for emergency department (ED) visits by Medicaid beneficiaries “when those visits are not necessary for that place of service.”¹ To identify unnecessary ...

Since the spending targets in Medicare's new accountable care organization (ACO) programs are being set on the basis of national, rather than local, rates of spending growth, ACOs could gain or lose financially without altering their delivery of care.

Although the media and the U.S. public focused primarily on the minimum-coverage requirement, or individual mandate, during the recent oral arguments in the challenges to the Affordable Care Act (ACA) before the Supreme Court, the most important issue ...

In October, U.S. acute care hospitals will begin to be “paid for performance” under the Medicare Hospital Value-Based Purchasing program. But accumulating evidence raises doubts about whether the program will in fact improve value. What can be done to redirect the policy?

Disparate voices are advocating changes to Medicare's investment in graduate medical education (GME) — now $9.5 billion annually. Prescriptions include reducing federal support, developing performance measures, and assessing programs' governance and financing.

Under the Affordable Care Act, hospitals with “worse than expected” 30-day readmission rates will be penalized by Medicare. But though a focus on readmissions may have good face validity, the policy attention to 30-day readmissions may be misguided.

The Affordable Care Act's financial penalty for “excessive” readmissions may be too weak to overcome the substantial counterincentives currently at work. But a “warranty” payment would provide a stronger business case for hospitals to get with the program.

In the Douglas case, health care providers and Medicaid patients attacked California laws reducing Medicaid payments, arguing that they violated federal standards and jeopardized patients' health. The Supreme Court punted, sending the case back for further development.

Policymakers may be overlooking the lessons of Medicare Advantage. Though current policy guarantees greater government spending on private Medicare Advantage plans than on traditional Medicare, the plans are developing low-cost ways of delivering attractive benefits.

One proposed solution to the problem of high and rising Medicare costs is to expand the use of private plans and market competition. What lessons for current Medicare policy can be gleaned from the history of Medicare Advantage plans?

Although meaningful Medicare reform is not likely to occur until after the 2012 elections, some Republicans and Democrats appear to be in substantial agreement about some changes that might make Medicare more efficient, effective, and fiscally sustainable.

There are indications that the unsustainably rapid growth in Medicare spending has recently slowed — and that this slowdown is not a fluke, but rather the result of tighter Medicare payment policies whose effects will only be bolstered by the Affordable Care Act.

In late March, the Supreme Court will examine the constitutionality of the Affordable Care Act, potentially producing a landmark decision. The Court will determine whether, in crafting the ACA's individual mandate and Medicaid expansion, Congress exceeded its powers.

The idea of a premium-support system for Medicare dates from 1995, but current proposals do not contain appropriate safeguards, and the circumstances of the U.S. health care system have changed in ways that would make the approach unwise today.

Under the Wyden–Ryan proposal, instead of guaranteeing to pay for services as they are rendered, Medicare would give beneficiaries a subsidy to purchase coverage from one of multiple health plans, which would compete by providing necessary services cost-effectively.

An alternative approach to improving the quality of care — especially for patients with multiple conditions, severe disability, or short life expectancy — is to determine whether patients' individual health goals (e.g., for symptoms and functional status) are being met.

Since U.S. kidney-transplant recipients don't benefit from a coherent funding policy for immunosuppressive drugs, thousands of them are at risk for allograft failure and premature death. Ensuring lifetime access to these medications would save lives and money.

In appealing to the Supreme Court, 26 states are arguing that the Affordable Care Act unconstitutionally coerces them into expanding their Medicaid programs. But although states may face a hard choice about participating in Medicaid, that's not a constitutional matter.