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The cost impact to Medicare of shifting treatment of worsening heart failure from inpatient to outpatient management settings23 January 2019 - By John F. Mohr and Joseph J. Medicis and William S. Weintraub and Kathryn V. Fitch and Tyler Engel - Article

This study estimates the cost impact to the Medicare fee-for-service population associated with shifting the treatment of a portion of worsening heart failure cases from the inpatient hospital setting to outpatient settings.

Pathways to Success MSSP final rule: Faster movement to downside risk increases focus on reducing population costs04 January 2019 - By Kathryn V. Fitch and Adam Laurin and Michele M. Berrios - Article

Under the new Medicare Shared Savings Program’s new rule, there will be a more urgent need for accountable care organizations to reduce population costs.

Preference-sensitive surgical procedures for preference-sensitive conditions24 September 2018 - By Kathryn V. Fitch and Carol Bazell and Sumudu Dehipawala - Article

This paper focuses on 15 preference-sensitive surgical procedures that may be performed to treat certain preference-sensitive conditions that have surgical treatment options.

Why accurate claims coding for MSSP ACOs has become increasingly important26 June 2018 - By Jonah Broulette and Noah Champagne and Kathryn V. Fitch - Article

This brief explains how benchmark year 3 risk scores affect the benchmark calculation for Medicare Shared Savings Program (MSSP) renewals, presents an overview of the prior and new MSSP benchmark calculations, and illustrates how the change can affect an accountable care organization’s benchmark under various scenarios.

The exclusion of some nursing facility visits from MSSP assignment has potential unintended consequences16 April 2018 - By Kathryn V. Fitch and Cory Gusland - Article

This article describes the changes in the historical benchmarks and performance expenditures for a number of Medicare Shared Savings Program accountable care organizations and also explains the possible impact of these changes.

The cost burden of worsening heart failure in the Medicare fee for service population: An actuarial analysis03 April 2017 - By Kathryn V. Fitch and Tyler Engel - Article

This report identifies the rate and costs of heart failure (HF) admissions, the costs in the 30 days after HF admissions, and the percentage of HF admissions that are readmissions.

Real-world insights and economic considerations in type 2 diabetes27 March 2017 - By Kathryn V. Fitch and Tyler Engel and Bruce S. Pyenson - Article

This paper presents patterns of hemoglobin A1c levels and diabetes medication adherence among people with type 2 diabetes mellitus based on real-world data from 2012 to 2014.

Open vs. minimally invasive hysterectomy: Commercially insured costs and readmissions22 August 2016 - By Warner Huh and Andrew Bochner and Kathryn V. Fitch - Article

This paper analyzes commercial payer differences in the average costs and readmission rates between inpatient open hysterectomies and three types of outpatient hysterectomies: laparoscopic, laparoscopic assisted, and vaginal.

Cardiovascular event incidence and cost in type 2 diabetes: A commercial and Medicare claim based actuarial analysis10 August 2016 - By Kathryn V. Fitch and Tyler Engel - Article

An analysis to identify the annual rate and cost of cardiovascular (CV) events in patients with type 2 diabetes mellitus (T2DM) and the contribution of these CV events to both T2DM annual costs as well as total Medicare fee-for-service and commercially insured population annual costs.

Cost differences between open and minimally invasive surgery06 August 2016 - By Andrew Bochner and Kathryn V. Fitch and Tyler Engel - Article

This study analyzes the difference in payer costs between minimally invasive surgery and open surgery in a commercial population for four commonly performed elective surgical procedures.

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