Corpus ID: 21410310

Improving the Quality and Efficiency of the Medicare Program Through Coverage Policy Timely Analysis of Immediate Health Policy Issues August 2011

  title={Improving the Quality and Efficiency of the Medicare Program Through Coverage Policy Timely Analysis of Immediate Health Policy Issues August 2011},
  author={Sean R Tunis and Robert A. Berenson and Steve E. Phurrough and Penny E. Mohr},
In the face of large and growing budget deficits, finding ways to bend the health care cost curve and improve the efficiency of the Medicare program has been a central focus of budget policy. Medicare spends more than $500 billion annually for more than 46 million senior and disabled beneficiaries, and research suggests new medical technologies such as drugs, devices, diagnostics and surgical techniques are a major driver of increasing costs. For example, some novel anti-cancer drugs now cost… Expand
3 Citations
Synchronization of coverage, benefits, and payment to drive innovation.
If related policies do not evolve to align with payment reform, those entities contracted to receive new bundled payments, such as hospitals or physician groups, will only be able to redesign care to the extent that care meets the myriad of related payment policy requirements. Expand
Medicare's enduring struggle to define "reasonable and necessary" care.
In today's fiscal environment, "reasonable and necessary" warrants a closer look. Expand
The taxing power and the public's health.
The Supreme Court opened the door for Congress to use its taxing power to achieve myriad policy objectives, including to pursue public health goals. Expand


How Medicare could use comparative effectiveness research in deciding on new coverage and reimbursement.
A payment model incorporating comparative effectiveness research to encourage Medicare to pay equally for services that provide comparable patient outcomes is proposed, which would include higher payments for services demonstrated by adequate evidence to provide superior health benefits compared to alternative options. Expand
Using Managed Care Tools in Traditional Medicare — Should We? Could We?
Since the early 1990s, policy analysts seeking important opportunities for reform in the Medicare program have looked at the experience of private markets and managed care in the private sector.Expand
Medicare coverage for technological innovations--time for new criteria?
  • M. Gillick
  • Medicine
  • The New England journal of medicine
  • 2004
It is argued that explicit criteria should be developed to guide Medicare's decisions about which procedures it will cover and how much it should pay for them. Expand
The role of costs in comparative effectiveness research.
It is argued that providing information bearing on the use and costs of health care interventions is necessary to decision makers who are attempting to raise the quality of care while reining in health spending. Expand
Medicare's national coverage decisions for technologies, 1999-2007.
An analysis of Medicare national coverage decisions (NCDs) from 1999 through 2007 reveals that the Centers for Medicare and Medicaid Services (CMS) considers the available evidence as no better thanExpand
Why Medicare has not established criteria for coverage decisions.
  • S. Tunis
  • Medicine
  • The New England journal of medicine
  • 2004
Decisions about medical coverage by Medicare specify the forms of technology and services that the program will pay for on behalf of its 42 million beneficiaries. These decisions often haveExpand
Variation in Medicare's local coverage policies: content analysis of local medical review policies.
Variation in the content of Medicare's local medical review policies is assessed to reflect the nature of and reasons for policy variation as suggested by the findings of this research. Expand
Why Medicare Cannot Promulgate a National Coverage Rule: A Case of Regula Mortis
  • S. Foote
  • Economics, Medicine
  • Journal of health politics, policy and law
  • 2002
The article diagnoses the condition of regula mortis, explains its effects in the Medicare case, and draws on principles of administrative law to propose remedies to break the logjam. Expand
Medicare and cost-effectiveness analysis: time to ask the taxpayers.
It is suggested that given the opportunity to weigh in on ethical and normative issues that surround CEA, members of the public are appropriate parties to engage in shaping Medicare's broadest resource allocation questions. Expand
Implementing evidence-based medicine through medicare coverage decisions.
This paper identifies the sizable barriers to implementation of evidence-based medicine in Medicare and proposes policy solutions to address them. Expand