In its April 2020 report, the Medicare Board of Trustees projects that the Hospital Insurance (HI) Trust Fund – basically, funding for Part A – will be depleted by 2026; Medicare will only be able to pay out 90 percent of benefits available under current law in that year. With financial circumstances likely to worsen as a result of COVID-19, Congress will be looking for ways to extend the solvency of the Medicare program over the next few years.
One approach favored by some would be to accelerate the growth of Medicare Advantage (MA), which would shift financial risk from the Federal Government to the private insurers that offer an MA plan. In 2020, approximately 36 percent of Medicare beneficiaries are enrolled in an MA plan, which receives a fixed fee per enrollee, adjusted for clinical characteristics. Most beneficiaries are in Traditional Medicare (TM), but the Medicare Trustees project MA enrollment to continue to grow and reach 43.3 percent by 2030.
Because MA plans receive fixed payments for their enrollees, they have an incentive to control healthcare use, including use of post-acute care (PAC), i.e., home health agencies (HHAs), skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and […]
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Lane Koenig is President and Founder of KNG Health Consulting and Director of the Healthcare Reform and Payment Innovation Practice. He is a healthcare economist with over 20 years’ experience in the public and private sectors. As President of KNG Health Consulting, Dr. Koenig has overall responsibility for the quality and direction of KNG Health’s research. He serves as Project Director and Principal Investigator for many studies, particularly those related to healthcare reform proposals, healthcare provider payments, value-based purchasing, and delivery system innovations. With expertise on hospital and post-acute care payment and quality issues, his work regularly assesses the potential impact on hospitals and other providers of proposed legislation or regulations. He has assisted both industry and Federal and state governments in the development and assessment of healthcare provider payment policies and value-base purchasing initiatives. Prior to founding KNG Health in 2007, Dr. Koenig was the senior economist in the Office of Policy at the Centers for Medicare & Medicaid Services (CMS). Before joining CMS, Dr. Koenig was a Senior Scientist in the healthcare finance practice at The Lewin Group. Dr. Koenig has led over 100 quantitative and qualitative health policy and health economic studies and has published over 20 peer-reviewed studies in journals, such as Health Affairs, Health Services Research, and Medical Care. He graduated with Honors from the University of Florida, Gainesville and earned his PhD in Economics from the University of Maryland, College Park. |
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Jing Xu is a Senior Research Associate in the Healthcare Reform and Payment Innovation practice at KNG Health. Dr. Xu has expertise in aging policy and healthcare related issues. She has extensive experience in conducting data analysis and policy evaluation to inform healthcare payment reform. Using claims and survey data, her research examines healthcare payments, costs, quality, and utilization. Examples of her work include: an analysis on quality and market performance of claims-based measures of the Post-Acute Care (PAC) Long-term Care Hospital (LTCH) Quality Reporting Program; a study of healthcare utilization among chronically critically ill Medicare beneficiaries, comparing between Fee-for-Service (FFS) enrollees and Medicare Advantage enrollees; an examination of the characteristics of Medicare FFS beneficiaries by PAC discharges and conditions; and an estimation of the payment impacts on LTCHs associated with legislative and regulatory developments. Prior to joining KNG Health, Dr. Xu worked as a Graduate Research Assistant at the Hilltop Institute where she evaluated Maryland Medicaid programs. She conducted pharmaceutical health services research among Medicare Part D enrollees when she was a Graduate Research Assistant at the University of Maryland, Baltimore. She gained first-hand experience about the policy and practical challenges of end-of-life care as a Graduate Intern at Vidant Medical Center. Dr. Xu earned her PhD in Gerontology (Policy) from the joint program at the University of Maryland, Baltimore and Baltimore County, her MA in Anthropology at East Carolina University, and her BS degree in Biotechnology at Fudan University. |
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Berna Demiralp is a Principal Research Associate at KNG Health Consulting and Director of the Evaluation and Health Economics practice. She is an applied micro-economist with expertise in health, labor and demographic economics. She specializes in designing and implementing impact evaluations with particular emphasis in quasi-experimental designs. Dr. Demiralp evaluates Medicare programs and alternative payment models; analyzes cost, utilization, and patient outcomes associated with acute and post-acute care; and assesses cost-effectiveness of treatment alternatives. She evaluated the direct and spillover effects of Medicare’s Hospital Readmissions Reduction Program on hospital readmissions using an interrupted time series design. She served as project director on KNG Health’s evaluation of the effects of participation in Accountable Care Organizations on care quality and Medicare payments for high-cost populations, using propensity score matching and difference-in-difference estimation. She conducted a comparative effectiveness study of long-term care hospitals in caring for critically ill patients, using an instrumental variable approach. She is currently leading the KNG Health team’s task in monitoring the performance of the State Innovation Model (SIM) initiative, including Maryland’s new All-Payer model, applying trend analysis and statistical process control to identify changes in cost and utilization in acute and post-acute care settings. Prior to joining KNG Health, Dr. Demiralp held positions in consulting and academia. As Senior Research Associate at Optimal Solutions Group and later at Summit Consulting, Dr. Demiralp served as Project Director and Lead Analyst for projects funded by the Centers for Medicare and Medicaid Services (CMS), the Department of Labor, and the Small Business Administration. She has extensive experience in designing and implementing mixed-method, rapid-cycle evaluations, including the evaluations of SBA’s Regional Clusters Initiative and CMS’ Graduate Nurse Education Demonstration. Dr. Demiralp also worked as an Assistant Professor in the Department of Economics at Old Dominion University and as an Associate Economist at RTI International. Dr. Demiralp has published in peer-reviewed journals including Medical Care, Health Services Research, European Economic Review, Journal of Macroeconomics, Eastern Economic Review and Journal of Economics and Finance. She received her PhD in economics from Johns Hopkins University and her BA from Davidson College. |