Health affairs
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Since the inception of the Medicare Rural Hospital Flexibility Program in 1997, over 1,300 rural hospitals have converted to critical-access hospitals, which entitles them to Medicare cost-based reimbursement instead of reimbursement based on the hospital prospective payment system (PPS). Several changes to eligibility for critical-access status have recently been proposed. ⋯ Returning to the PPS would have considerable negative impacts on critical-access hospitals that are located near another hospital. We conclude that establishing a minimum-distance requirement would generate modest cost savings for Medicare but would likely be disruptive to the communities that depend on these hospitals for their health care.
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Congress is again attempting to repeal the Sustainable Growth Rate (SGR) formula. The formula is a failed mechanism intended to constrain Medicare Part B physician spending by adjusting annual physician fee updates. ⋯ Current congressional deliberations appear focused on how to pay for the fix, with wide consensus that the 2014 legislation should remain the basic model for reform. We describe key features of the 2014 SGR fix, place it in the context of both past and ongoing Medicare health policy, assess its strengths and weaknesses as a mechanism to foster improved care and lower costs in Medicare, and suggest further actions to ensure success in meeting these goals.
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During a time when cancer drug prices are increasing at an unprecedented rate, a debate has emerged as to whether these drugs continue to provide good value. In this article I argue that this debate is irrelevant because under today's highly distorted market, prices will not be set with value considerations in mind. ⋯ More important than these issues, however, is the revolution that is occurring in molecular biology and its impact on scientists' ability to detect changes in the cancer genome. The lowered cost of discovery is driving more competitors into the market, which under distorted pricing paradoxically encourages drug makers to charge ever higher prices for their products.