A study published in the Archives of Internal Medicine found that 88 percent of physicians accepted new privately insured patients in 2008, down from 93 percent in 2005.  The authors cited low reimbursement rates and significant administrative burdens as possible reasons for the decline.  The study also notes that rate of acceptance declined less for Medicare beneficiaries, dropping from 96 to 93 percent between 2005 and 2008.

Bishop, Tara F. et. al. (2011). Declines in physician acceptance of Medicare and private Coverage. Archives of Internal Medicine, 171 (12): 1117 - 1119. doi:10.1001/archinternmed.2011.251. http://archinte.ama-assn.org/cgi/content/short/171/12/1117

Authors: Tara F. Bishop, Alex D. Federman and Salomeh Keyhani.

Health Affairs has released a study finding that hospitals in areas with robust hospital competition tend to address shortfalls between Medicare payments and projected costs primarily by reducing hospital costs.  Conversely, the authors found that hospitals in areas where hospital care is concentrated among a limited number of providers respond by raising the prices they charge private insurers, in a practice known as “cost shifting”.  The authors argue that their findings necessitate a policy discussion about whether increased provider integration will interfere with the national health care reform law’s goal of reducing Medicare spending, as increased integration could reduce market competition and, in turn, increase the use of cost shifting.

Robinson, James. (2011). Hospitals respond to Medicare payment shortfalls by both shifting costs and cutting them, based on market concentration. Health Affairs, 30 (7): 1265-1271. doi: 10.1377/hlthaff.2011.0220. http://content.healthaffairs.org/content/30/7/1265.abstract

Author: James Robinson.

Mathematica Policy Research has released a brief examining managed long-term care.  Focusing on options for New York State, the brief also offers general options available to all states.  The authors also offer options for improving dual eligibles' care.

From the report:

The Federal Coordinated Health Care Office (renamed the Medicare-Medicaid Coordination Office) and the Center for Medicare and Medicaid Innovation are partnering to help states develop integrated care programs for dual eligibles.  CMS selected 15 states on April 14, 2011 to receive contracts of up to $1 million each to help them plan dual eligible demonstration projects.  States selected were CA, CO, CT, MA, MI, MN, NY, NC, OK, OR, SC, TN, VT, WA, and WI.  Planning contracts will be for 18 months, and demonstrations will start in 2012.

Full report: Managed Long Term Care: Options for New York and Examples From Other States (PDF | 197.47 KB)

Mathematica Policy Research.  (2011).  Managed long term care: options for New York and examples from other states.  Verdier, J.

Health Services Research has published a study examining whether medication adherence lowers Medicare spending among beneficiaries with diabetes.  The authors found that adherence does lower Medicare costs, and offered strategies to improve medication adherence and lower costs.

Stuart, B., et. al.  (2011).  Does medication adherence lower Medicare spending among beneficiaries with diabetes?  Health Services Research, 46 (4): 1180-1999.  doi: 10.1111/j.1475-6773.2011.01250.x.  http://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2011.01250.x/abstract;jsessionid=BB6A0465FAAD18988396BD81997BF844.d03t04

Authors: Bruce Stuart, Amy Davidoff, Ruth Lopert, Thomas Shaffer, J. Samantha Shoemaker and Jennifer Lloyd.

The Kaiser Family Foundation has released a brief examining the effect of raising the Medicare eligibility age to 67.  An update of a March 2011 study, the July version accounts for additional aspects of the national health care reform law.  The authors estimate that raising the eligibility age to 67 in 2014 would generate $5.7 billion in federal savings.  However, the brief also projects that doing so would increse 65 and 66 year olds' out-of-pocket (OOP) costs by $3.7 billion, and employers' retiree health costs by $4.5 billion.

From the report:

As the debate over the federal deficit takes hold, some are proposing to raise the age of Medicare eligibility beyond age 65 as one among many options to reduce entitlement spending. Previous studies, conducted prior to the enactment of the 2010 health reform law, show that an increase in the age of Medicare eligibility would be expected to reduce Medicare spending, but also increase the number of uninsured 65 and 66 year olds, many of whom would be expected to have difficulty finding comparable coverage on their own, either because of prohibitively expensive premiums or coverage limitations imposed on those with pre-existing conditions. Our analysis differs from prior analyses of raising the age of Medicare eligibility primarily because it takes into account key provisions in the 2010 health reform law, which provides new avenues to public and private health insurance coverage for those under age 65, including expanded Medicaid eligibility and a new health insurance exchange.

Full report: Raising the Age of Medicare Eligibility: A Fresh Look Following Implementation of Health Reform (PDF | 840.34 KB)

Kaiser Family Foundation.  (2011).  Raising the age of Medicare eligibility: a fresh look following implementation of health reform.  Neuman, T., Cubanski, J., Waldo, D., Eppig, F. and Mays, J.

The Commonwealth Fund has released a brief examining private sector accountable care organizations’ (ACO) experiences implementing shared payer-provider risk payment models.  Noting that the national health care reform law implements such a model under the Medicare Shared Savings Program, the brief posits that providers currently lack the necessary infrastructure to successfully assume and manage risk.  The authors conclude that providers need improved data and analytic capabilities to negotiate appropriate risk-sharing arrangements with payers and adequately manage risk for affected patient population.

From the report: 

The Medicare Shared Savings Program, a component of the Patient Protection and Affordable Care Act, has accelerated the creation of accountable care organizations (ACOs), payer–provider alliances meant to deliver lower-cost but still high-quality health care via new payment models, particularly ones that reward efficiency. This paper describes and reports on the implementation of eight private ACOs that use, or are planning to deploy, a shared payer–provider risk payment model. Still in an early developmental phase, these payment models vary not only in their design and in how they define shared risk. The authors note that providers currently lack the infrastructure required to take on and manage risk successfully, though some payers are providing such support. Providers will need more data and analytic capabilities to manage the patient populations for which they take on financial risk and to negotiate appropriate risk-sharing arrangements with payers.

Full report: Promising Payment Reform: Risk-Sharing with Accountable Care Organizations (PDF | 568.48 KB)

Commonwealth Fund.  (2011).  Promising payment reform: risk-sharing with accountable care organizations.  Delbanco, S.