Dobson | DaVanzo staff are gearing up to provide research and analytic assistance to our clients in preparing their public comments to federal agencies as part of the annual proposed rulemaking cycle. Over the years, D|D has provided support to “both” sides. As a contractor to the Centers for Medicare and Medicaid Services (CMS), D|D provided a variety of services including compiling, summarizing and providing recommendations for finalizing Disproportionate Share Hospital (DSH) payment methodology. From the perspective gained from this eight-year experience, we have improved our ability to assist stakeholders in the regulatory process.
As a consultant to private sector clients, we utilize our insights on the federal rulemaking process, as well as our vast Medicare claims data and payment system knowledge and models to undertake analyses that provide critical information enabling our clients to not only understand the impact of proposed rules but also to prepare data-driven actionable comments for consideration by Federal agencies.
Allen Dobson, Ph.D. recently served as the plaintiff’s expert witness in the Connecticut Department of Social Services Medicaid rate appeals. In these appeals, a number of hospitals in Connecticut collectively challenged Medicaid inpatient and outpatient hospital payment rates between 2012 and 2016. As expert witness, Dr. Dobson demonstrated the inadequacy of Connecticut Medicaid payment rates during this period and explained how this inadequacy has impacted Connecticut hospitals’ financial health. Dr. Dobson was supported by a team of analysts at Dobson | DaVanzo throughout the legal process.
These appeals were part of a broader set of legal claims that Connecticut hospitals, under the Connecticut Hospital Association, filed against the State challenging the hospital user fee. Involved parties have recently disclosed that they have reached a settlement agreement covering all pending legal claims in which hospitals will receive one-time retroactive Medicaid payments and Medicaid hospital rates will be increased by approximately two percent per year over the next seven years. The agreement also reduces the hospital user fee and increases supplemental payments over the same time . The settlement agreement must still be approved by the U.S. Centers for Medicare and Medicaid Services before it can be finalized.
Dobson | DaVanzo presented a critique of efforts to build a unified post-acute care (PAC) prospective payment system (PPS) at the annual board meeting of a major PAC trade association in December 2019. In light of current reforms to PAC PPS affecting institutional health settings, e.g. skilled nursing facilities (SNFs) and long-term acute care (LTAC) facilities, our team commented on the practicality of the timelines for the development of unified PPS embodied in Improving Medicare Post-Acute Care Transformation (IMPACT) Act.
Dobson | DaVanzo’s latest evaluation of Medicare Shared Savings Program Accountable Care Organizations (ACOs) found greater savings than the Centers for Medicare and Medicaid Services (CMS) benchmark savings estimate. The Dobson | DaVanzo study found positive net savings of $755 million for performance years (PY) 2013-2017 using a difference-in-differences analysis while the CMS benchmark calculations resulted in negative net savings of $70 million for PY2013-PY2017. Our study uses standard evaluation techniques typically employed by CMS in its evaluations of the Next Generation ACO (NGACO) model, Pioneer ACOs, and other programs that do not rely on the benchmark method to estimate program effects. View the full report and NAACOS press release.
Vincent Agboto, Ph.D, M.S., has joined Dobson | DaVanzo as a Scientist Statistician. He will enhance Dobson | DaVanzo’s statistical capabilities and in turn, augment our provision of cutting-edge scientific methods in the analyses of Medicare and Medicaid administrative claims data as well as commercial claims data. With our corporate mission of expanding the power of claims data in developing healthcare practice and policy, he will bring innovation to our analytical capabilities and produce powerful insights into our analyses with social determinants of health and clinical information. He will also explore the integration of clinical records data with administrative claims data to produce more actionable results for our clients.
Dr. Agboto is the author of two statistical textbooks - including a Bayesian statistics textbook - which are used in graduate programs for future business leaders across the country. Currently, he serves as a member of Meharry Translational Research Center Scientific Review Committee. Prior to joining Dobson | DaVanzo, Dr. Agboto worked as the Senior Statistical Principal Scientist at Allina Health where he led their research program and data analytics initiatives to apply high quality statistical methodology with demonstrated understanding of the particular disease, scientific premise, or functional area involved. Dr. Agboto also served as the Director of Research at Health Partners where he led the translation of research from the Critical Care Research Center to clinical practice. He received his Ph.D in Statistics from University of Minnesota and was the recipient of a Fulbright Scholarship in 2010.
In September, Dobson | DaVanzo was re-awarded the Medicare DSH Support Contract with CMS. Under this five-year contract, Dobson | DaVanzo will assist CMS with Inpatient Prospective Payment System (IPPS) rulemaking activities related to Medicare DSH. This will include conducting analyses to inform and implement Section 1886(r) of the Social Security Act during the development of the annual IPPS rulemaking; developing technical documentation for making policy proposals; conducting impact analyses for policy proposals and alternatives; and reviewing and summarizing all public comments received to the IPPS notice of proposed rulemaking. Dobson | DaVanzo has served as the contractor on this project since October 2011.
Dobson | DaVanzo’s Alex Hartzman and Kimberly Rhodes presented at NALTH’s Fall meeting on Friday, October 25th. The presentation focused on the recent and expected shifts in Medicare post-acute care (PAC) payment policy and the resulting outlook for Long Term Care Hospitals (LTCHs).
RAND Cited Al Dobson and Joan DaVanzo's 2006 Study on Cost-Shifting in Healthcare
A recent RAND report titled “Prices Paid to Hospitals by Private Health Plans Are High Relative to Medicare and Vary Widely” (May 2019) is a considered examination of hospital payments in 25 states. The authors examined hospital payments across payers and found that there is a wide variation in prices paid by private health plans as compared to Medicare. To discuss these large gaps in prices, RAND posited two different interpretations, citing Al Dobson, Joan DaVanzo, and a former colleague’s (Namrata Sen) 2006 cost-shifting article’s conclusion as one possible theory to explain that as Medicare severely underpays hospitals, “hospitals are compelled to charge higher prices to their privately insured patients merely to stay afloat”.
The Medicare Payment and Advisory Commission (MedPAC) has cited the Dobson | DaVanzo evaluation of Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) (funded by NAACOS) in its June 2019 report. Within the report, MedPAC corroborates the overall savings level described in our report. MedPAC carefully describes and compares a variety of recent evaluations from the literature, including those from Harvard, University of Michigan, the National Institutes of Health, NORC, and Dobson | DaVanzo.
As noted in our study of MSSP and elsewhere in the literature, ACO programs are fiendishly difficult to evaluate. This is part of the nature of voluntary provider-driven programs: they are in some part driven by an inherent bias of providers deciding to be in the program. This, coupled with retrospective patient assignment rules and rapidly shifting ACO provider rolls, can make for a program where almost every measurable aspect shifts over time (chiefly which providers and patients are included).
We look forward to continuing the public discussion of the impact of this important program and contributing further to the literature.
Dobson | DaVanzo has joined the national effort in determining the real costs associated with the opioid epidemic. While considering the economic burden of the crisis associated with addiction and overdose, we will also attempt to quantify total societal costs such as the impact on newborns, education, criminal justice, and the health insurance sector, to name a few.
The Commonwealth Fund has awarded a grant to Dobson | DaVanzo to expand upon our work that shows how Medicaid work requirements could affect hospital finances. Previous issue brief prepared by Dobson | DaVanzo estimated the number of Medicaid enrollees that would lose coverage and in turn impact hospitals’ Medicaid revenues, uncompensated care costs, and operating margins, in 13 states who had either approved or had pending Medicaid waivers to impose work requirements for certain eligibility groups. The upcoming work will expand upon our prior brief by including 5 additional states that have requested Medicaid work requirement waivers.
Dobson | DaVanzo was awarded a $4.7 million five-year contract to perform Part D claims analyses. Together with our subcontractor Acumen, LLC, the firm will be conducting data analyses of prescription drug event (PDE) data and other available CMS data to support CMS’s ongoing monitoring of the Medicare Part D program.
Al Dobson attended the Princeton Conference, a longstanding initiative of The Council on Health Care Economics and Policy, organized by the Brandeis University’s Heller School of Social Policy and Management. Held from May 21-23, 2019, this conference was focused on whether federalism could improve the U.S. healthcare system. These conferences serve as a national platform for health policy experts to debate key issues that help shape healthcare policy and regulation in the U.S.
Dobson | DaVanzo analyzed the National Health Expenditure (NHE) data published by CMS along with data collected from a survey of healthcare providers that use group purchasing organization (GPO) services to show substantial savings for the entire healthcare industry. In particular, the analysis showed that GPOs are projected to reduce total health care spending for hospital and nursing homes by up to $456.6 billion over the next ten years (2017-2026). Medicare is estimated to account for over 25 percent (or $116.3 billion) and Medicaid for approximately 20 percent (or $90.2 billion) of these cost savings.
To view the report in its entirety, please follow this link.
Joan DaVanzo attended a half-day meeting addressing Social Determinants of Health (SDoH), sponsored on May 17, 2019 by Tivity Health, Healthcare Leadership Council, and Aetna. The meeting, which brought approximately 60 stakeholders together, was designed to ensure a common understanding of the importance of SDoH. This discussion also identified barriers and private and government sector solutions to address SDoH.