Publications

A Study of Hospital Charge Setting Practices

December 2005

The Medicare Payment Advisory Commission has expressed concerns about the accuracy and fairness of the current Medicare hospital inpatient and outpatient prospective payment system. Payment rates for these systems are based, to varying degrees, on hospital charges. In order to better understand hospital charge setting practices and the nature of hospital mark-ups across service lines, MedPAC engaged The Lewin Group to conduct a nationwide study of hospital charge practices. This report reviews the charge practices of a purposive sample of hospitals and hospital systems around the U.S.

Client Area: Federal Government
Expertise Area: Medicare

Medication Therapy Management Services: A Critical Review: Executive Summary Report

May 2005

The American Pharmacists Association (APhA) commissioned The Lewin Group to develop a report examining the range of Medication Therapy Management (MTM) programs and practices, and how they are currently being reimbursed. In the final rule implementing the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), the Centers for Medicare and Medicaid Services (CMS) said that MTMS must "evolve and become a cornerstone of the Medicare Prescription Drug Benefit." The purpose of this report was to identify existing MTMS programs, standards of practice, and compensation models, and to develop a model for payers to consider in compensating pharmacists for MTMS. This report is intended to serve as a resource for pharmacists, health plans, and PDP sponsors charged with designing and implementing a Medicare MTM program.

Client Area: Associations
Expertise Area: Medicare

Low-Income Medicare Beneficiary Savings Still Available in the Medicare Drug Discount Card Program: A Nine State Assessment

March 2005

On December 8, 2003, President Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The law modernizes Medicare so that, beginning in January 2006, seniors and people with disabilities can have coverage for prescription drugs that have become an important part of quality medical care. This new benefit improves access to prescription drugs and provides important financial protections to Medicare beneficiaries. The MMA specified that for the years 2004 and 2005, prior to implementation of the full prescription drug benefit, Medicare beneficiaries would have access to Medicare-approved discount cards, and beneficiaries meeting the low-income thresholds would have access to an additional $600 in annual cash assistance. In 2002, The Lewin Group conducted a study commissioned by the Healthcare Leadership Council that examined the potential savings to beneficiaries from using Medicare-approved discount cards. The Pharmaceutical Research and Manufacturers of America (PhRMA), engaged The Lewin Group to build upon this prior work to estimate the potential savings forgone for low-income beneficiaries who do not sign up for Medicare-approved discount cards in 2005 since these persons have the most to lose by not enrolling in the program.

Client Area: Associations
Expertise Area: Medicare

Assessment of Beneficiary Savings in the Medicare Drug Discount Card Program

August 2004

The Healthcare Leadership Council commissioned The Lewin Group to examine the savings available to Medicare beneficiaries who elect to participate in the Medicare-endorsed drug discount card program. The study analyzes the 150 drugs most frequently used by seniors and determines the range of savings available to seniors on those medications using their drug discount cards. The study presents estimated average savings for beneficiaries who shop at retail pharmacies using the drug discount card, including the value of the $600 federal credit available to qualifying low-income beneficiaries. It also provides estimates of aggregate savings based on the number of beneficiaries projected to use the discount cards by the Centers for Medicare and Medicaid Services.

Client Area: Associations
Expertise Area: Medicare

Business Opportunities in the Medicare Modernization Act for Community Affiliated Health Plans

April 2004

The Medicare Modernization Act of 2003 (MMA) has important consequences for dual eligible beneficiaries as well as Medicaid managed care plans. ACAP commissioned this report to provide member health plans with a better understanding of the Act's implications for their current Medicaid business -- as well as a roadmap to explore the possibility of expanding into Medicare managed care.

Client Area: Associations
Expertise Area: Medicaid and CHIP, Medicare

Impact of Financial Uncertainty on Capital Formation for the Nursing Facility Industry

August 2002

This study builds on an earlier analysis prepared by The Lewin Group that assessed the implications of the expiration of Medicare add-ons for nursing facility margins. It examines the magnitude and implications of reduced Medicare revenue on the industry's ability to generate and access capital in the future.

Client Area: Associations
Expertise Area: Medicare

Results from the SSA Medicare Part B Buy-in Demonstration: Final Report

October 2001

Over the past two years, the Social Security Administration conducted a demonstration to increase enrollment in the Medicare Part-B Buy-in program, using a variety of outreach methods. This is the final report that evaluates these efforts to increase participation. This report presents key findings that indicate that outreach letters significantly increased enrollment. In addition, it examines whether the outreach made a difference if interested beneficiaries were referred to Medicaid agencies or SSA became actively involved in the application process. Finally, it examines the effect of other means of outreach, such as public service announcements and grass roots information dissemination.

Client Area: Federal Government
Expertise Area: Medicare

Results from Three of the Initial Models of the SSA Medicare Part B Buy-in Demonstration

September 2001

SSA was mandated to conduct a demonstration to test outreach and application methods for enrollment in the Medicare Part B Buy-In program. In March 1999, SSA implemented four models in 11 sites around the country and the state of Massachusetts that involve different levels of SSA involvement. This report describes the demonstration, documents the implementation of the four models, and presents findings of the impact of each model on enrollment.

Client Area: Federal Government
Expertise Area: Medicare

Initial Results from the Peer Assistance, Decision Making, and Widow(er)s Models of the SSA Medicare Part B Buy-in Demonstration

August 2001

SSA was mandated to conduct a demonstration to test outreach and application methods for enrollment in the Medicare Part B Buy-in program. This report provides information on the implementation and early outcomes of three of the six models implemented during fiscal year 2000. This report describes the demonstration, documents its implementation, and presents descriptive analyses of individuals targeted for the program.

Client Area: Federal Government
Expertise Area: Medicare

Initial Results and Evaluation Design for the SSA Medicare Part B Buy-in Demonstration

June 2000

SSA was mandated to conduct a demonstration to test outreach and application methods for enrollment in Medicare Part B Buy-in programs in which state Medicaid programs pay for Medicare Part B premiums and possibly Medicare copayments and deductibles for low income beneficiaries. The demonstration included mailing letters to all potentially eligible individuals in eleven sites in six states informing them of the benefits and asking them to contact SSA. Of the nearly 240,000 letters mailed, approximately six percent responded and 61 percent appeared to meet the required income and asset limits. Depending upon the site, one of the three models for application referral and intake were employed: 1) Screening Only, where potential eligibles were made an appointment with the local Medicaid or welfare office; 2) Co-location, where a state Medicaid or welfare worker was onsite at the SSA office; and 3) Application, where SSA staff filled out state application forms and forwarded them to the state for processing. This report describes the demonstration, documents its implementation, presents descriptive analyses of individuals targeted for the program, and discusses our plans for assessing the effectiveness of the models. The key process lessons include the need for clear communication among all parties involved in the demonstration; a well-defined liaison role to resolve implementation problems efficiently; accountability on the part of the central office and the field offices participating in the demonstration; adequate training; local flexibility in implementation strategy; and commitment from major players.

Client Area: Federal Government
Expertise Area: Medicare