Dobson DaVanzo under commission and in collaboration with Adventist HealthCare (Montgomery County, MD) developed a conceptual model of healthcare financial relationships to relieve a myriad of concerns about today’s healthcare billing system, including surprise balance billing. This conceptual piece called “Consumer Protection Realignment: Shifting Consumer Billing from Providers to Health Plans” was published in the Health Affairs Blog dated May 1, 2020.
The Consumer Protection Realignment (CPR) model is a novel approach that refocuses attention on the financial interaction of patients, providers and health plans. Today’s healthcare billing system frustrates consumers and it is nearly impossible for consumers to anticipate and understand out-of-pocket medical costs, even when receiving simple procedures. Healthcare providers struggle to recoup and manage the complexity of a health insurance market that is facing market pressures that have led to higher out-of-pockets costs in order to control healthcare expenses and premiums. This dynamic has produced a system that is unfavorable to consumers, as they bear the brunt of unaffordable costs, an increased presence of surprise balance billing, a lack of price transparency and a multitude of often complex and unexpected bills.
To solve this issue, the CPR model realigns the billing and collection of deductibles, coinsurance and copayments from health care providers to health insurance plans via proposed federal legislation requiring all providers, whether in- or out-of- network, to bill patient out-of-pocket costs through the insurer. While CPR is an overarching reform approach, the system uses operational mechanisms currently in place. Health plans would still negotiate rates with providers, but would take on the added responsibility and risk of billing patients. In turn, providers would be required to return the resulting savings to plans in the form of reduced charges for services. In so doing, CPR creates a system where consumers enjoy increased price transparency, protection from surprise balance billing, consolidated and simpler billing, and, in the long-term, more progressive and integrated healthcare delivery mechanisms. To read more about CPR visit the Health Affairs blog.
In their March 2020 Report to the Congress: Medicare Payment Policy, MedPAC addressed the question of whether 340B drug discounts create incentives for hospitals to choose more expensive products. As part of their analysis, MedPAC cited Dobson | DaVanzo’s 2017 report entitled Financial Challenges Faced by 340B Disproportionate Share Hospitals In Treating Low-Income Patients, written by Al Dobson, Kennan Murray and Joan DaVanzo. MedPAC wrote that “Dobson and colleagues found that 340B DSH hospitals incur higher drug spending compared to non-340B hospitals due to the type of patients they treat and the characteristics of the facilities they operate. Accounting for differing patient and facility characteristics using propensity score matching (that matched 340B hospitals to non-340B hospitals based on patients’ and hospitals’ characteristics), Part B spending per beneficiary in 2013 was 15 percent greater at 340B DSH hospitals than at non-340B hospitals ($3,204 versus $2,794). However, because 58 percent of the 340B DSH hospitals that could not be matched to non-340B hospitals were therefore excluded from the analysis, a limitation of this study is that it may not be generalized to all 340B DSH hospitals.”
The National Association for Home Care and Hospice (NAHC) has commissioned Dobson | DaVanzo to conduct analyses assessing the impact of potential regulatory payment and policy changes that may be under consideration by the Medicare Payment Advisory Commission (MedPAC) and Centers for Medicare and Medicaid Services (CMS). Payment policy changes could adversely affect the fairness and accuracy of Medicare Fee for Service payments for hospice services if not carefully conceptualized and implemented; current considerations seem to have little to do with differences in patient mix, but rather have more to do with provider characteristics. In this preliminary study, Dobson | DaVanzo will be preparing descriptive statistics and preliminary analyses to eventually develop and understand what a hospice-specific case-mix system that predicts Medicare hospice expenditures might look like
As the coronavirus situation evolves, the Dobson | DaVanzo team remains fully operational as we continue to work remotely, ensuring a safe environment for all our employees, colleagues, and clients. Our proactive business continuity plan that was put into place early on, has enabled us to continue operations without business disruption, and to allow our clients the prompt and continued access to our services, as they so deserve. As the world changes from day to day, we are closely monitoring the situation, following the CDC rules and recommendations, and paying close attention to what the rest of our country, as well as the entire world, are doing in these difficult and uncertain times. Although the virus has driven certain segments of the economy to a stand-still, Dobson | DaVanzo has continued our momentum coming out from our best year to date into the first quarter of 2020. We remain dedicated to taking care of both our employees and clients and are here to serve the needs of health care organizations as they navigate this time of crisis. As we continue to grow, we are pleased to inform you that we intend to increase our workforce by as much as 10% in the upcoming months. Our robust backlog and strong portfolio of liquid assets allows Dobson | DaVanzo to continue to invest in our organization and in our client products. We are uniquely positioned to further help our customers with more complex and challenging assignments so we, collectively, can make it through these very real and difficult times.
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.