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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.

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

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.

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

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

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

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

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

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

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

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

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