Dr. Allen Dobson presented “Medicare Payment Bundling: Is it Inevitable?” at the Squire, Sanders & Dempsey Health Care Reform Task Force Seminar in Phoenix, Arizona on October 28, 2010. The presentation covered the Patient Protection and Affordable Care Act, how to define care coordination, what a bundle is, and what issues need to be resolved before Medicare payments can be bundled.
Dobson|DaVanzo published its full report, entitled “The Risks to Medicare Beneficiaries of DMEPOS Competitive Bidding Considerations for the Round 1 Re-bid and Beyond,” examining the potential impact on patients of the competitive bidding program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). The report discusses potential consequences for Medicare’s most vulnerable beneficiaries who may experience a decline in choice, access, and quality in their DMEPOS benefit.
Drs. Joan DaVanzo and Allen Dobson, and Audrey El-Gamil, along with Namrata Sen from The Lewin Group, published an article in the September 2010 edition of Ostomy Wound Management. Their article, entitled “A Retrospective Comparison of Clinical Outcomes & Medicare Expenditures in Skilled Nursing Facility Residents with Chronic Wounds,” discusses health care expenditures for Medicare patients with wounds treated with and without a comprehensive wound care protocol.
Dobson|DaVanzo released an issue brief in August evaluating the potential impact on patients of the competitive bidding program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). The study, entitled “Issue Brief on the Risks to Medicare Beneficiaries of DMEPOS Competitive Bidding,” considers the difficulties beneficiaries may experience in terms of choice, access to, and quality of DMEPOS, if the competitive bidding program leads to poor quality equipment and a reduction of services.
Dr. Allen Dobson presented a paper, entitled “Post-Acute Care and Long-Term Care: A Complex Relationship,” at the AcademyHealth Long Term Care Interest Group Colloquium on June 29, 2010. The presentation examines issues that should be considered in designing a post-acute care payment bundle and the implications of bundling on long-term care as health care reform is implemented.
Dr. Allen Dobson presented at the Infocast Cancer Centers of Excellence Summit on May 4, 2010. His presentation, entitled “Cancer Centers of Excellence Under a Medicare Bundled Payment System,” discusses what a payment bundle is, what issues need to be resolved before payments can be bundled, what the role of the Stark III Law and anti-kickback statutes are, how overall payment amounts are set, and what the implications and incentives of bundled payments are.
The study was commissioned by the National Association of Psychiatric Health Systems (NAPHS) to estimate the economic contribution of inpatient psychiatric hospitals and residential treatment centers to each state economy and the national economy in terms of output, employment, and taxes. Mark Covall, President and CEO of NAPHS, said in a press release that, "investing in inpatient behavioral healthcare is a win-win situation for those who so desperately need this care and for the economy where job creation is a top priority." Al Dobson presented the study at the NAPHS 2010 Annual Meeting on March 9, 2010.
Dobson | DaVanzo received a 2010 APEX Award of Excellence for this publication.
Their expertise on and long standing experience working with the hospital industry made them an essential asset to understanding the current state and future of hospital markets the meeting included simulation of future policy scenarios.
The methodology involved conducting a series of confidential interviews with health policy leaders to determine if and how PAF information can be used by organizations in various sectors of the health care industry. The goal of this study was to investigate the perceived analytic and economic value of these data to potential health care stakeholders, and identify potential data-related products and services of greatest interest to them. PAF will be launching its new Data Products Division in the coming year.
The study explored the range of services community health centers currently need from supporting organizations in order to fulfill their mission as safety net providers. Our goal in this study was to examine the benefits and drawbacks of different organizational approaches to the issue, and found that Primary Care Associations (PCA), “sister” corporations, and other independent stakeholders each play a unique role in supporting community health centers. The study was commissioned by the California HealthCare Foundation (CHCF).
The presentation was delivered to the Northeast Home Health Leadership Summit in Boston on January 20, 2010. The presentation considers who the winners and losers might be in the post-acute care (PAC) industry under a bundled payment system, and examines the possibilities for adapting elements of existing prospective payment systems (PPS) to develop a PAC payment bundle. This speech also examines the financial implications of PAC bundling and ways PAC providers might evolve under a changing payment system.
The paper entitled, ‘"Must Have' Provisions under Health Care Reform," analyzed the potential impact of remedying three significant problems in the health insurance market and evaluated several publically available cost estimates for the proposed legislation. Our analysis focused on three solutions to insurance market failure: eliminating pre-existing conditions, waiting periods and cancellations; limiting out-of-pocket expenses; and eliminating annual and lifetime coverage limits. This white paper was delivered to every member of the Congress.
WASHINGTON, D.C. – Introducing a government-run health insurance plan could cause hospitals to shift a new financial burden onto patients with private insurance, raising premiums for those who already have coverage.
According to a new study by Dobson DaVanzo & Associates, LLC – published today on the Health Affairs Web site – implementing a public plan could place a variety of financial pressures on hospital management, resulting in sharply raised private insurance premiums if hospitals prove unable to curtail costs under a new system.
When public programs pay less than costs for the services their patients receive, hospitals attempt to shift costs to private payers in order to cover their expenses, modernize, and stay current with emerging technology. A health care system with a public plan could increase hospital pressures to shift costs.
"This paper supports the contention that a government-run plan that is aggressively implemented to include large proportions of the privately insured could test the U.S. health care financing system," write Allen Dobson and Joan DaVanzo, lead authors of the study. "Rising hospital private-payer payment-to-cost ratios could be followed by rising private insurance premiums. The result could be the antithesis of what advocates say is the advantage of a public plan: to curtail cost growth for the average citizen."
A large influx of individuals to a new public health care program could place tremendous strain on the nation's health care financing system, even if payments are set at Medicare rates plus 10 percent. While some hospitals may be able to absorb the initial costs imposed by a government-run plan, some degree of cost shifting could occur to pay for the new, and likely underfunded, public program.
Based on hospital financial data from the California Office of Statewide Health Planning and Development (OSHPD), the study was designed to show the effect of various reallocation scenarios on hospital patient revenue margins and private payer payment-to-cost ratios. The study indicates that a high level of enrollment of the uninsured would initially bolster hospital finances. However, when the privately insured begin to move from the private sector into the public plan, this positive effect is reversed and hospital patient revenue margins decrease. The mass reallocation of the privately insured to the government-run plan could lead to an increase in private insurance premiums to defray hospital costs, unintentionally forcing private plan enrollees to bear a portion of the costs of health insurance reform.
Article: "How A New 'Public Plan' Could Affect Hospitals' Finances And Private Insurance Premiums," Allen Dobson, Ph.D., Joan DaVanzo, Ph.D., M.S.W., Audrey El-Gamil, and Gregory Berger, Dobson DaVanzo & Associates, LLC, Vienna, Virginia; Health Affairs, September 15, 2009.
(Full text of the article is available at HealthAffairs.org.)
Dobson DaVanzo & Associates, LLC is a health care consulting firm based in the Washington, D.C. metropolitan area. The work of the firm's principals has influenced numerous public policy decisions, and appears in legislation and regulation.