Medicaid work requirements can result in loss of health coverage for communities, especially in rural areas. Furthermore, the requirements can harm hospitals as they lose Medicaid revenue, see an increase in their uncompensated care costs, and a reduction in hospital operating margin. Dobson | DaVanzo examined the impact of imposing work requirements on Medicaid enrollees through Section 1115 waivers in 16 states that have implemented the waiver or are scheduled to do so after approval. To find out how your state might fare under the policy, download the fact sheets from The Commonwealth Fund.
Dobson | DaVanzo is pleased to welcome Stephanie Demian to our team of Research Analysts. Stephanie brings valuable health policy and management experience from prior roles as the Assistant Director of Quality and Regulatory Affairs at the American Academy of Child and Adolescent Psychiatry and also served as the Implementation Manager for a quality improvement project under contract with the Centers for Medicare and Medicaid Services.
Dobson| DaVanzo has long-standing experience in conducting feasibility studies. These studies assess whether Medicare claims can be used to demonstrate the value proposition of medical technologies, procedures and policy changes. Our knowledge of publicly available and proprietary claims and financial datasets combined with our thorough understanding of clinical treatment pathways enables us to paint a picture of a medical product’s utilization and payment over time as the technology diffuses. We help ascertain the way forward for new technologies by determining whether there is an adequate sample size in the data, both to create the treatment group as well as the best matched comparison group. We also determine the best outcome variables to be used to demonstrate value in healthcare and economic outcomes. These analyses help clients to truly understand the use of their technology in specific situations. A feasibility study demonstrating a sufficient sample size is generally followed by a health economics and outcomes study that provides vital information on demographics and comparative cost outcomes. These studies can also take the form of market analyses, enabling our clients to make a plausible case for new technologies and their pay
As the world confronts an emerging global pandemic of coronavirus outbreak, Dobson | DaVanzo is developing a business continuity plan that ensures our ongoing support for our clients. With an internal team of staff trained in public health, our onsite infectious disease prevention plan is designed to keep our staff healthy and productive.
Our business continuity plan is also designed to permit Dobson | DaVanzo to continue operations and avoid significant business disruption. This business continuity plan addresses: data back‐up and recovery, all critical IT systems, financial and operational assessments; communications with our clients and employees; alternate physical location of employees. All of this is directed at assuring our clients prompt and continued access to our services.
Joan DaVanzo will serve on the second roundtable panel of thought leaders addressing Social Determinants of Health (SDoH), sponsored by Tivity Health, Healthcare Leadership Council, and Aetna. This discussion will follow-up on the four areas of success identified in an earlier meeting – coordinating healthcare and social services, bridging incentives across health services, improving data strategies, and integrating the voice of patients – and will seek to make actionable recommendations on the same for policymakers as well as legislative officials.
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.