Advisory Commission Research Articles

Impact of Site-Neutral Payments for Commercial and Employer-Sponsored Plans.

Site-neutral payment is a policy created by federal rule making and implemented by the Centers for Medicare and Medicaid Services (CMS) that aims to reduce healthcare costs by aligning payment rates for certain services provided in multiple care settings. Site-neutral payments are intended to eliminate the incentive for providers to acquire facilities, such as physician offices or ambulatory surgical centers (ASCs), that Medicare reimburses at the lower non-facility rate and convert those settings into hospital outpatient departments (HOPDs), where Medicare reimburses at the higher facility rate. Although initiated by Congress to address payment disparities in Medicare, similar payment discrepancies can be seen in the commercial market where individual and employer-sponsored health plans often pay more for certain outpatient services depending on their location. This analysis presents a simulation of the impact of applying site-neutral payments to the commercial market with respect to overall potential savings for consumers, health plans and the federal government. To conduct the analysis, we use an all-payer claims data base generalizable to the United States. The analysis focused on a select group of outpatient services identified by the Medicare Payment Advisory Commission (MedPAC). We mapped the MedPAC identified 68 Ambulatory Payment Classifications (APCs), the codes Medicare uses to reimburse facilities for outpatient services, to the relevant CPT4/HCPCS codes, which the commercial market uses for billing. The potential cost savings of applying the site-neutral payment policy to the commercial insurance market to be $58 billion for year 2022. We estimate the 10-year total (2024-2033) employer market premium reduction ranges from 5.35% to 5.0% and found that those premium reductions would result in employer-sponsored insurance (ESI) tax subsidy savings of $140 billion to the federal government over a 10-year period (2024-2033).

A Mediator Between Sharia and State Law: Aḥmad al-Khamlīshī’s Legal Thinking and Contribution to Reforms

With the 2004 reforms on the Moroccan Personal Status Law, the Moroccan Family Code (Mudawwanah) is considered one of the most egalitarian codes in the Muslim World. The reforms was a product of long-lasting public debates for decades in Morocco. Aḥmad al-Khamlīshī has been actively involved in the debate since the beginning of the 1980s and explained that the Personal Status Law is man-made law open to interpretation, revision of which should be undertaken through ijtihād. Shortly after ascending to the throne, in 2001, the King Mohammed VI appointed the Royal Advisory Commission in charge to reform the Moroccan Personal Status Code. The King charged the commission for making a substantial change in the Code by respecting the main objectives of Sharia (maqāsid al-Sharia) and also responding to the necessities of the time and society by means of exercising ijtihād. He encouraged members of the commission to consider the public interest and to strive for consensus and moderation in any proposed changes. The commission worked for around two and a half years on the proposed changes, but could not reach a consensus on many issues. Everyone on the commission has, more or less, had some leaning towards either of the two main groups, namely, the reformists and traditionalists. Aḥmad al-Khamlīshī was one of the members of the Royal Advisory Commission. He was a person who shared views of the reformist group, but also used the language of the traditionalists. He became a reference point for reformist groups with his critical but moderate views that remain within the Islamic legal framework. In this paper, I argue that al-Khamlīshī was the mastermind behind the reforms of 2004. By applying data analysis method, this study primarly uses al-Khamlīshī’s writings, his interviews and speeches. To reveal the difference and similarities of his understanding, the literature was consulted and comparisons were made. Following a brief background, this paper will discuss al-Khamlīshī’s mediating role between text and context, his influence on the debate of family law reforms, and thus his stance on Sharia-state relations. This paper will then focus on his understanding of ijtihād with reference to his views on the concept of the closure of the gate of ijtihād, qualifications of mujtahid (one who is capable to deduce legal rulings from the revealed texts), and his suggestion on collective type of ijtihād (ijtihād jamā’iʻ); as it was exercised by the Advisory Commission. Al-Khamlīshī’s methods of legal reasoning will be examined with regard to family law.

Analysis of work with citizen complaints in Ukraine and their levels of control

Complaints of citizens are a form of direct management of state affairs and one of the ways of controlling state administration. Through the appeal, a «dialogue» takes place between the state and citizens, in which the interests of the complainant, as well as other citizens or society as a whole, can be reflected. The demands of citizens are, above all, a source of information and a necessary force for solving current or prospective problems of the development of a modern country. Most appeals consist of complaints and statements, and these concepts hide exactly the rights that have been violated or not implemented, which are formally enshrined in Ukrainian legislation.Of course, the government cannot consider everyone's appeals, but their number on the same problem can force it not just to make a decision to eliminate a specific violation, and to correct a specific deficiency, but to pay attention to the problem on a national scale.The purpose of the study is to analyze the organization of work with citizens' appeals and to define the main levels of their control.Material and methods. Statistical and medical-epidemiological methods were used in the study. An analysis of the database with appeals from citizens of the Ministry of Health of Ukraine for 10 years (2013-2022) was carried out.Results and discussion. It was established that during the study period in Ukraine, the number of appeals from citizens regarding the provision of medical assistance increased significantly. The number of appeals for 2022 compared to 2013 increased by 24,0%. The main issues addressed by citizens concern the provision of medical assistance (23,4%), personnel issues (14,6%); issues of referral to the medical and sanitary expert commission and medical advisory commission (12,9%) and illegal actions of medical workers (7,7%).The obtained results confirmed the need for the development and implementation of scientific preventive technologies in order to improve the organization of work with citizens' appeals at the regional level with further implementation in the work of medical institutions.Conclusions. It was found that optimizing work with appeals requires implementing a new model for organizing work with citizens regarding their appeals. Such a model will ensure consideration of appeals on merit, with entry into a single register of appeals, taking into account feedback and monitoring of patient satisfaction.

‘A Supremely Good Chinovik’: William Strang, Europe, and the Role of the Official, 1919–1949

ABSTRACT Sir William Strang was the Permanent Under-Secretary of the Foreign Office from 1949 to 1953, he was the most senior Foreign Office official at an important period in British foreign policy. Prior to this appointment, he enjoyed a Foreign Office career that spanned some three decades, where he was involved in notable episodes such as the Munich Agreement, the Moscow Conference (1939), the workings of the European Advisory Commission, and the post-war occupation of Germany. Strang’s career, however, has been subject to little scholarly attention. He is often regarded as a competent, yet singularly dull individual lacking the intellect or the original thinking of his contemporaries, such as Robert Vansittart, Alexander Cadogan, Orme Sargent, or Gladwyn Jebb. This article challenges this interpretation, arguing that while Strang has a clearly identifiable worldview, this was intrinsically tied to his view of the proper function of a Foreign Office official. For Strang, it was not the role of the official to sway a minister’s mind with well-argued memoranda, but to make vast quantities of information and arguments comprehensible to allow a minister to make as informed a decision as possible. This fundamental tenet of Strang’s worldview must be understood when examining his career prior to his appointment as Permanent Under-Secretary of the Foreign Office.

Health care policy that relies on poor measurement is ineffective: Lessons from the hospital readmissions reduction program.

Health care policy that relies on poor measurement is ineffective: Lessons from the hospital readmissions reduction program.

Contextual Vulnerability Should Guide Fair Subject Selection in Xenotransplantation Clinical Trials

Contextual Vulnerability Should Guide Fair Subject Selection in Xenotransplantation Clinical Trials

The influence of expert groups: a citation analysis

ABSTRACT Decision-makers rely extensively on expert groups and commissions for policy advice. Many see in this a growing technocracy or expertization of decision-making. Yet, we know little about the actual influence of these expert bodies in policy-making. When does expert group advice shape policy-making rather than being brushed aside? The article goes beyond existing research by measuring and explaining variation in expert group influence. Using the number of citations to expert group reports in government white papers and later expert group reports as measures of influence, the article analyzes citations to 1545 Norwegian advisory commission reports published 1972–2017. It concentrates on three dimensions of the organization of expert groups as potential determinants of influence: member composition, appointing ministry and resources. The results suggest that expert groups have greater influence when they include more politicians and have a bigger secretariat. The article contributes empirically and methodologically to research on expertise and policy-making.

Paying for Nursing Home Quality: An Elusive But Important Goal.

Paying for Nursing Home Quality: An Elusive But Important Goal.

The US Supreme Court and Future of Financing Dialysis Care.

The US Supreme Court and Future of Financing Dialysis Care.

HOME HEALTHCARE ACCESS AND UTILIZATION AMONG VULNERABLE POPULATIONS IN THE US AND PUERTO RICO

Abstract Home health (HH) care utilization among Medicare beneficiaries has exploded, serving over 3.3 million users (The Medicare Payment Advisory Commission, 2021). With the aging of the population and the preference for Home- and Community-Based Services and/or person-centered care delivered in the home, HH care use is expected to continue increasing. Prior research has highlighted inequitable access and use of HH rooted in structural and social determinants of health (Fashaw-Walters et al., 2022). However, more research is needed about disparities in timely access to quality of care and outcomes among racial and ethnic and rural populations. Furthermore, the literature regarding post-acute care has often excluded Puerto Rico HH beneficiaries (Rivera-Hernandez et al., 2020). Given the need to ensure equity of care post-pandemic, there is a pressing need to understand disparities in care and outcomes, specifically using representative data. This symposium will feature four presentations that provide novel insight regarding HH care utilization and outcomes among vulnerable populations. Individual presentations will describe 1) Home health care services utilization among Medicare beneficiaries in Puerto Rico; 2) Public reporting role in exacerbating disparities in access; 3) Differences in home healthcare latency following hospitalization for ADRD patients by race/ethnicity and rural and urban locations; 4) Racial disparity in the start of home healthcare in high-risk ADRD patients by the quality of home health and impact on rehospitalization. In addition, studies in this panel will discuss policy and clinical implications, as well as directions for future research regarding equitable access and health outcomes among HH users.

The Tennessee Advisory Commission on Intergovernmental Relations: Building Consensus Through Collaboration

The Tennessee Advisory Commission on Intergovernmental Relations serves as a model for bringing policymakers and stakeholders together, more clearly defining public policy problems, and reaching consensus on how to address those problems.

Asian American, Native Hawaiian, and Pacific Islander Health.

Asian American, Native Hawaiian, and Pacific Islander Health.

Fireside Chat on the Asian American, Native Hawaiian, and Pacific Islander Special Edition of the Health Equity Journal Featuring Authors.

Fireside Chat on the Asian American, Native Hawaiian, and Pacific Islander Special Edition of the Health Equity Journal Featuring Authors.

Germany's Use Of Reference Pricing For Biologics: Lessons For The US.

A redesign of consumer cost sharing in the United States is important to accelerate the adoption of biosimilars and price reductions for biologics. This article analyzes therapeutic reference pricing for anti-inflammatory biosimilars in Germany and its implications for the United States. The German experience demonstrates that a redesign of consumer cost sharing can achieve savings for payers without creating onerous financial barriers for patients. In contrast, the dominant coinsurance structure of cost sharing in the US creates strong incentives for patients to abandon treatment, especially for serious illnesses treated by complex biologics, and only weak incentives to compare prices among therapeutically equivalent products. The Medicare Payment Advisory Commission (MedPAC) has advocated that the Centers for Medicare and Medicaid Services adopt a variant of reference prices for biologics, their related biosimilars, and therapeutically similar branded alternatives by assigning them the same billing code or by paying a similar rate for all the products. The German experience demonstrates that the proposed MedPAC approach is technically feasible and would generate savings for payers without imposing access obstacles on patients.

Aspects of termination of pregnancy at more than 22 weeks in the presence of anomalies of fetus development

The article presents an analysis of the legal aspects of the abortion procedure application for more than 22 weeks due to fetal malformations (CM) in the context of a clinical case of patient dissatisfaction with the decision of the medical advisory commission to refuse to terminate the pregnancy. Fetal CM is a significant problem leading to perinatal, neonatal, infant mortality and disability. Approximately 3-4% of newborns have significant congenital malformations and in 50% of all malformations, the exact cause cannot be determined. The approaches the right of a woman to terminate a pregnancy when the fetus is diagnosed with congenital malformations of different countries, signs an informed consent and an application for the first stage of the fetocide procedure (intrauterine death of the fetus). A clinical case of a woman’s dissatisfaction with the decision of the ICC, on the example of which the psychological and bioethical aspects for the mother are described.. The authors made conclusions about the legal risks of using fetocide and allowing termination before 22 weeks, the necessity of introducing the official term “fetocide” into the legislation and revising the clinical recommendations on safe abortion for the third trimester and the regulation of fetal elimination.

The Explosive Growth of Telehealth Throughout the COVID-19 Pandemic and Beyond

The Explosive Growth of Telehealth Throughout the COVID-19 Pandemic and Beyond

THE INFLUENCE OF THE EMPLOYEES’ COMPETENCE AND WORK DISCIPLINE ON PUBLIC SERVICES AT THE DUNGALIYO SUB-DISTRICT OFFICE GORONTALO REGENCY

ABSTRACT
 
 Susanty Rusdin Lasena. The Influence of The Employees’ Competence and Work Discipline on Public Services at the Dungaliyo Sub-District Office, Gorontalo Regency (Advisory Commission by Dr. Hj. Ellys Rachman, S.Sos, M.Si and Dr. H Zuchri Abdussamad, S.I.K, M.Si).
 This study aims to determine and analyze the influence of The Employees’ Competence and Work Discipline on Public Services at the Dungaliyo Sub-District Office, Gorontalo Regency. The method used in this research is quantitative data analysis by using multiple linear regression analysis model and primary data sources. The population in this study were all employees at the Dungaliyo Sub-District Office, Gorontalo Regency, consist of 24 employees. By using a total sampling, 24 respondents were obtained and the community was directly represented by 20 people. Overall population or research respondents are 44 people.
 The results of the study indicate that competence and work discipline can improve public services. The better the competence and work disciplinewill affect the public services. Based on the analysis results show that the variables of competence and work discipline simultaneously have a significant effect on public services. The variable that has the dominant influence on public services is work discipline. This shows that the higher of the motivation carried out by employees, the higher of the performance showed by them.

Surveying Knowledge Gaps for a Post-Acute Care (PAC) Curriculum Taught by Geriatrics-trained Core Internal Medicine Program Faculty for Internal Medicine and Family Medicine Residents Learners

Preventable errors in care transitions for the elderly are responsible for up to one third of costly hospital readmissions. The 2009 Institute of Medicine sentinel report outlined a critical need to expand geriatrics competencies in residencies caring for the vulnerable elders. While the 2010 published set of core competencies for geriatrics aligns with the Medicare Payment Advisory Commission directives, training in geriatrics competencies during residency is still lacking. We surveyed our IM/FM residents (Internal Medicine/Family Medicine residents) to help formulate a customized geriatrics curriculum with dedicated clinical exposure and emphasis on teaching communication across care transitions, health care systems, discharge destinations, and their level of care for the hospitalized elderly.

Current Controversies in Radiology on Cost, Reimbursement, and Price Transparency: AJR Expert Panel Narrative Review.

Many believe that fundamental reform of the U.S. health care system is overdue and necessary given rising national health care expenditures, poor performance on key population health metrics, meaningful health disparities, concerns about potential financial toxicity of care, inadequate price transparency, pending insolvency of Medicare Part A, increasing commercial insurance premiums, and large uninsured and underinsured populations. The Medicare Payment Advisory Commission, an independent congressional agency, believes that part of this reform includes redistribution of reimbursements away from specialties such as radiology. Thus, despite an increase in the Medicare population and spending, Medicare payments for medical imaging have been decreasing for years. Further, the No Surprises Act, a federal law intended to curb the problem of surprise medical billing, was repurposed in federal rulemaking to reduce reimbursement from commercial payers to certain specialties, including radiology. In this article, we examine challenges facing the U.S. health care system, focusing on cost, reimbursement, and price transparency and the role of radiology in addressing such challenges. Medical imaging is a minor contributor to national health care expenditures but has an outsized impact on patient care. The radiology community should work together to reinforce the value of medical imaging and reduce inappropriate utilization of low-value care.

Effects of an out-of-pocket maximum in Medicare Part D.

Three different out-of-pocket (OOP) maximums in Medicare Part D have been proposed: $2000 by the House of Representatives, $3100 by the Senate Finance Committee, and the beginning of catastrophic coverage by the Medicare Payment Advisory Commission. However, little is known about how beneficiaries would be affected. We estimated multivariate linear regression models to determine which beneficiary characteristics were associated with the greatest savings under each proposed OOP maximum and simulated a potential behavioral response by beneficiaries. Using Part D 2017 claims data for beneficiaries in stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug (MA-PD) plans, we estimated the number of beneficiaries affected, their demographic characteristics, and their drug utilization patterns. We then simulated a potential behavioral response by beneficiaries. Under the $2000 OOP proposed threshold, only 7% of PDP and 4% of MA-PD plan beneficiaries would have spending high enough to reach the OOP maximum. Annual mean (SD) savings would be $1301 ($1849) for PDP beneficiaries and $1363 ($1888) for MA-PD plan beneficiaries, concentrated among beneficiaries taking specialty drugs. As the threshold increases, fewer beneficiaries would accrue savings, but savings would increase. For the highest proposed OOP maximum, mean (SD) savings would be $2720 ($3465) and $2473 ($2805) for PDP and MA-PD plan beneficiaries, respectively. In our simulations, we estimated that the number of beneficiaries affected by an OOP maximum could increase by 2% to 11%, depending on the magnitude of response, but changes in savings would be minimal. As currently drafted, proposed OOP maximums would reduce OOP spending for a small population of Part D beneficiaries, with savings concentrated among beneficiaries with the very highest costs who are taking specialty medications.