{"id":15834,"date":"2013-08-13T00:02:55","date_gmt":"2013-08-13T04:02:55","guid":{"rendered":"https:\/\/nationalcenter.org\/?p=15834"},"modified":"2017-09-20T15:43:36","modified_gmt":"2017-09-20T19:43:36","slug":"orszag-and-medicare-grand-claims-scant-evidence","status":"publish","type":"post","link":"https:\/\/nationalcenter.org\/ncppr\/2013\/08\/13\/orszag-and-medicare-grand-claims-scant-evidence\/","title":{"rendered":"Orszag and Medicare: Grand Claims, Scant Evidence"},"content":{"rendered":"

Peter Orszag is at it again, defending<\/a> the death panel Independent Payment Advisory Board against an attack by, of all people, Howard Dean<\/a>. \u00a0However, what\u2019s most interesting about the article is Orszag\u2019s contention about the causes of the recent slowdown, to 2.7%, of the growth in Medicare this year:<\/p>\n

One reason costs have been rising so slowly is that systems for paying hospitals and doctors are changing. We\u2019re moving away from the old fee-for-service plan and toward paying for value in health care \u2014 and we\u2019re making the shift more rapidly than expected.<\/p><\/blockquote>\n

It\u2019s not entirely clear what Orszag\u00a0means by \u201cpaying for value\u201d although presumably he means the \u201cMedicare experiments with accountable care organizations [ACOs], bundled payments and other new strategies\u201d that he mentions later on. \u00a0I emailed him for an explanation last week and for the data to back up those claims. \u00a0Thus far, no response. \u00a0So, for the sake of argument, let\u2019s assume he does mean ACOs and bundled payments.<\/p>\n

That\u2019s odd because so far those efforts are a tiny portion of Medicare\u2019s operations. \u00a0At the beginning of the year, about 1.6 million Medicare beneficiaries were enrolled<\/a> in ACOs, which amounts to about 3% of all Medicare beneficiaries. \u00a0What impact such a small number of enrollees would have on costs is debatable. \u00a0That assumes, of course, that ACOs will reduce costs. \u00a0Looking at early evidence, such as the Pioneer ACO model, shows mixed results<\/a> at best on cost saving. \u00a0Only 18 of the 32 organization involved in the demonstration saved money. \u00a0Of those, only 13 saved enough money to share some of the savings with Medicare.<\/p>\n

\"\"An article in Modern Health Care notes that nine organizations will no longer continue<\/a> in the program. \u00a0It also notes the savings to Medicare from the ACOs that reduced costs was about $33 million. \u00a0Medicare spent about $572 billion in 2012, which means that the $33 million saved by the ACOs are responsible for about .006% of the slowdown in Medicare spending.<\/p>\n

Regarding bundled payments, Medicare\u2019s\u00a0four<\/a> bundled<\/a> payment<\/a> experiments<\/a> only began this year, and as of yet we have no data on whether they are saving costs. \u00a0And even if they were, the effect on the entire system would be small, since only 114 organizations serving Medicare beneficiaries are involved.<\/p>\n

Then there is the Advance Primary Care Practice Demonstration<\/a> which has been going on since 2011. \u00a0However, with only 195,000 Medicare beneficiaries enrolled, it\u2019s doubtful it is having much impact on costs either.<\/p>\n

It would sure be nice if\u00a0Orszag would back up the grand claims he makes for Medicare\u2019s new delivery methods with some actual evidence. \u00a0But then, maybe there isn\u2019t much evidence for those claims.<\/p>\n","protected":false},"excerpt":{"rendered":"

Peter Orszag is at it again, defending the death panel Independent Payment Advisory Board against an attack by, of all people, Howard Dean. \u00a0However, what\u2019s most interesting about the article is Orszag\u2019s contention about the causes of the recent slowdown, to 2.7%, of the growth…<\/p>\n","protected":false},"author":15,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[74],"tags":[77],"yoast_head":"\nOrszag and Medicare: Grand Claims, Scant Evidence - The National Center<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/nationalcenter.org\/ncppr\/2013\/08\/13\/orszag-and-medicare-grand-claims-scant-evidence\/\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"David Hogberg\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/nationalcenter.org\/ncppr\/2013\/08\/13\/orszag-and-medicare-grand-claims-scant-evidence\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/nationalcenter.org\/ncppr\/2013\/08\/13\/orszag-and-medicare-grand-claims-scant-evidence\/\"},\"author\":{\"name\":\"David Hogberg\",\"@id\":\"https:\/\/nationalcenter.org\/#\/schema\/person\/cca707c3813b36233b7ecbebd8f785c2\"},\"headline\":\"Orszag and Medicare: Grand Claims, Scant Evidence\",\"datePublished\":\"2013-08-13T04:02:55+00:00\",\"dateModified\":\"2017-09-20T19:43:36+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/nationalcenter.org\/ncppr\/2013\/08\/13\/orszag-and-medicare-grand-claims-scant-evidence\/\"},\"wordCount\":451,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\/\/nationalcenter.org\/#organization\"},\"image\":{\"@id\":\"https:\/\/nationalcenter.org\/ncppr\/2013\/08\/13\/orszag-and-medicare-grand-claims-scant-evidence\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/nationalcenter.org\/wp-content\/uploads\/2017\/09\/DropBucket2-200x300.jpg\",\"keywords\":[\"ConservativeBlog.org\"],\"articleSection\":[\"Blog\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/nationalcenter.org\/ncppr\/2013\/08\/13\/orszag-and-medicare-grand-claims-scant-evidence\/\",\"url\":\"https:\/\/nationalcenter.org\/ncppr\/2013\/08\/13\/orszag-and-medicare-grand-claims-scant-evidence\/\",\"name\":\"Orszag and Medicare: Grand Claims, Scant Evidence - 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