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Robert Berenson joined Urban as an Institute fellow in 2003. In this position he conducts research and provides policy analysis primarily on health care delivery issues, particularly related to Medicare payment policy, pricing power in commercial insurance markets, and new forms of health delivery based on reinvigorated primary care practices. In 2012, Berenson completed a three-year term on the Medicare Payment Advisory Commission, the last
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.
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
Senior fellow Robert Berenson, testifying before the House Ways and Means Health Subcommittee on physician payment reform options in Medicare, argued that long-term approaches need to include bundled payments as an alternative to traditional fee-for-service payments, especially for primary care physicians caring for patients with chronic conditions. Because these reforms are operationally challenging and will require
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
Medicare and other insurers generally ignore the importance of established chronic illnesses in generating demands on the health care system and escalating costs, Institute Fellow Robert Berenson told the House Ways and Means Committee. At the same time, delivery system reforms are likely to fail unless immediate steps are taken to address the likely collapse of the primary care physician workforce in many parts of the country.
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.
There seems to be broad support for shifting from reliance on volume-based provider payments to value-based payments. The term value-based payment connotes assessment of performance and making payments commensurate with that assessment. However, most of the actual payment models specified in the Affordable Care Act for testing actually are not based on performance assessments but rather primarily alter payment incentives, with
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
In testimony before the Senate Finance Committee, Robert Berenson, M.D. explores possible reasons that integrated care organizations that include multispecialty group practices have not become a major feature of the U.S. health system despite prominent success stories. These organizations are often penalized financially for undertaking activities that reduce costs because the benefits of efficiency are not internalized to the
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
In a testimony presented to the U.S. Senate Special Committee on Aging, Robert Berenson argues that the proposed Financial Alignment Initiative is much too ambitious and represents not a series of demonstration but rather the equivalent of Medicaid waivers that would produce permanent programmatic change for duals. Given that 80 percent of Medicare and Medicaid dollars represent federal dollars, Berenson further argues that
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
Although political rhetoric suggests major differences between the Presidential candidates on health policy, particularly over the Affordable Care Act and the future of Medicare, the political process does not readily permit adoption of campaign pledges. In this commentary, Robert Berenson reviews why the 2012 Election will largely continue on it current trajectory, no matter who wins the Presidency. That trajectory includes the
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
In this Perspective, Robert Berenson reviews the likely impact of the Patient Protection and Affordable Care Act on the Medicare program. Medicare savings made up more than half of the price tag for the ACA's insurance coverage expansions and extended the solvency of the Part A trust fund by 12 years, to 2029. The article reviews the likelihood that these payment reductions are sustainable and discusses other important
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
Accountable care organizations have emerged as the newest big thing in health care. ACOs receive prominent attention in the Affordable Care Act, yet, the ACA's shared savings payment approach to encouraging ACO formation, based on the Medicare Physician Group Practice demonstration, may not be represent enough change from usual fee-for-service to produce organizational behavior change. Indeed, despite some assertions that the
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
Health care costs in Massachusetts have been rising at high, possibly unsustainable rates. Three kinds of cost containment opportunities are associated with the Roadmap. The first type is inherent in the design of the building blocks. The second type is optional but is facilitated by the presence of changes made as part of the Roadmap. The third type includes a number of additional steps that could be undertaken without the
A panel of health care market experts outlined practical strategies to bring US health care prices down
Debate over whether to place federal caps on non-economic damages in cases of medical malpractice is over two versions of a failed system of compensation and deterrence. In addition, by promoting a lack of transparency between doctors and patients, the adversarial legal system in which malpractice cases are brought harms the doctor-patient relationship. By recounting how patients, their families, and physicians have faced a wall
Despite growing documentation that the conditions needed to support competition in health care do not exist, consumer-directed health care has been offered as the new market-based solution to cost inflation. Yet typical consumer-based insurance products undermine the very logic of expecting consumers to make good health care decisions by making preventive services--the category of services about which consumers are best able to
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
Prices are the major driver of why the United States spends so much more on health care than other countries do. The pricing power that hospitals have garnered recently has resulted from consolidated delivery systems and concentrated markets. New payment and delivery models being pioneered in Medicare, especially those built around accountable care organizations (ACOs), offer an opportunity to reduce pricing power, but only if
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