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Senior fellow Robert Berenson discussed physicians providing care outside of the insurance system at a hearing of the Joint Economic Committee. He concluded that physicians' business practices are actually contributing to rising service use and, as a result, hindering cost containment efforts, the combination of which could exacerbate current problems with access to services for the uninsured and underinsured.

In a July 25th Health Affairs web exclusive, Bob Berenson, Tom Bodenheimer and Mai Pham tracked the emergence of specialty-service lines as the primary basis for competition among health care providers. The authors describe the emerging practice of hospitals and physicians to organize and market services based on specific diseases, organ systems, and population and find that competition for control of these specialty services is

Maryland embarked on an ambitious plan in 2014 to transform its all-payer rate setting system for hospitals under the authority of a new Medicare demonstration. The five-year demonstration will test all-payer global budgets for hospitals while attempting to use hospital payments to shift to population-based payments for most health care services. To learn about this approach, experience to date, and challenges faced, Robert

While Medicare spending varies widely across the country, increased local spending apparently does not produce differences in quality, access, or even patient satisfaction. Yet policy analysts tend to minimize the importance that as much as 30% of Medicare spending in particular high-spending areas might be excessive and unnecessary. Under most visions of the future of Medicare, there is an imperative to transform the

Statement of Robert A. Berenson, M.D. before a hearing of the House Ways and Means Committee's Subcommittee on Health. Berenson addresses the Medicare Chronic Care Improvement Program and the challenges of better serving the growing number of Medicare beneficiaries with multiple and complex chronic conditions, such as chronic obstructive pulmonary disease, congestive heart failure, diabetes mellitus, and other diseases.

On February 14, 2013, Urban Institute Fellow Robert Berenson testified before the House of Representatives Committee on Energy and Commerce on ways to improve the Medicare physician payment system. While everyone agrees that paying for value and not volume is important, Dr. Berenson argues value should be derived from how well particular services are performed as well as the mix of services beneficiaries receive. The current

This report reintroduces state-based hospital rate setting as an approach to addressing increasing prices and hospital market power. It details what rate setting is and how it works, discusses the record of rate setting in the states that operated rate setting programs , examines in depth the programs that have persisted in West Virginia and Maryland, discusses the lessons learned from these systems, and describes the ambitious

There is bipartisan agreement on the need to move from volume-based to value-based payment for health care providers. Rather than paying for activity, the aspirational goal is to pay for outcomes that take into account quality and costs. The Affordable Care Act (ACA) created the physician "value-based payment modifier," a pay-for-performance approach that, by 2017, will reward or penalize physicians based on the calculated value

Somewhere along its tortuous path to enactment, health care reform turned into health insurance reform. Although providing coverage to more than 30 million uninsured Americans and eliminating the unsavory practices of the insurance industry are major achievements, the Affordable Care Act does not do much at least in the short term to change the care most Americans receive or to slow the growth in health care costs. In this

This issue brief describes the mispricing of services in the Medicare Physician Fee Schedule resulting from the flawed specialty society-driven process for setting and updating the relative value scale that forms the basis for fees. The paper advocates moving to an altered process using objective data for the core component of time spent providing a service. The paper also emphasizes the various reasons why even new payment

Seven case studies of provider organizations implementing innovative approaches to care coordination and disease management of patients with one or more serious chronic conditions and to the homebound frail elderly demonstrate a range of issues that need to be addressed to produce rapid dissemination of these approaches throughout the health care system. Study participants all describe perverse incentives within fee-for-service

A panel of health care market experts outlined practical strategies to bring US health care prices down