Competitive pricing and the challenge of cost control in medicare

Journal of Health Politics, Policy and Law

Volumn 36, Issue 4, 2011, Pages 649-689

  Coulam, Robert F ^a   Feldman, Roger D ^b   Dowd, Bryan E ^b  

^a SIMMONS COLLEGE   (United States)

^b UNIVERSITY OF MINNESOTA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COST; COST CONTROL; ECONOMIC ASPECT; ECONOMICS; HUMAN; LEGAL ASPECT; MEDICARE; POLITICS; UNITED STATES;

COST CONTROL; COSTS AND COST ANALYSIS; ECONOMIC COMPETITION; HUMANS; MEDICARE; POLITICS; UNITED STATES;

EID: 80055104102     PISSN: 03616878     EISSN: 15271927     Source Type: Journal    
DOI: 10.1215/03616878-1334677     Document Type: Article

References (71)

1. Antos, J. R. 2005. Ensuring Access to Affordable Drug Coverage in Medicare. Health Care Financing Review 27:103-112.
2. Apolskis, M. 2008. U.S. District Court Stops Clinical Laboratory Competitive Bidding Demonstration. Medicare Update: Medicare Compliance, Reimbursement, and Enforcement Resource. Blog entry, April 12. medicareupdate.typepad.com/ medicare_update/2008/04/on-april-8-2008.html.
3. Areeda, P., and D. F. Turner. 1975. Predatory Pricing and Related Practices under Section 2 of the Sherman Act. Harvard Law Review 88:697-733.
4. Banks, J. S., and B. R. Weingast. 1992. The Political Control of Bureaucracies under Asymmetric Information. American Journal of Political Science 36:509-524.
5. Barnes, J. 2005. Managed Care Litigation. Washington, DC: Bureau of National Affairs.
6. Berenson, R. A., L. M. Nichols, and T. Emswiler. 2010. Reforming Medicare's Governance to Enhance Value-Based Purchasing. In Making Medicare Sustainable, ed. L. M. Nichols and R. A. Berenson, 21-58. Washington, DC: New America Foundation.
7. Bodenheimer, T., R. A. Berenson, and P. Rudolf. 2007. The Primary Care-Specialty Income Gap: Why It Matters. Annals of Internal Medicine 146:301-306.
8. Campbell, A. L. 2003. How Policies Make Citizens: Senior Political Activism and the American Welfare State. Princeton, NJ: Princeton University Press.
9. Carpenter, D. 2010. Reputation and Power: Organizational Image and Pharmaceutical Regulation at the FDA. Princeton, NJ: Princeton University Press.
10. Cawley, J. H., and A. B. Whitford. 2007. Improving the Design of Competitive Bidding in Medicare Advantage. Journal of Health Politics, Policy and Law 32:317-347.
11. Chiles, L. 1998. Letter to Nancy-Ann Min DeParle, administrator of the Health Care Financing Administration, from the governor of Florida. May 22.
12. Christianson, J. B. 1987. Competitive Bidding for Home Care under the Channeling Demonstration. Health Care Financing Review 8:73-86.
13. College of American Pathologists. 2010. Competitive Bidding Data Documents Destroyed. Statline: Federal and State News Briefs, August 19. www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2F portlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPt lt{actionForm.contentReference}=statline%2Fstat081910.html&_state=ma ximized&_pageLabel=cntvwr#Story5.
14. Cooper, B., and B. C. Vladeck. 2000. Bringing Competitive Pricing to Medicare. Health Affairs 19 (5): 49-56.
15. Coulam, R., 1995. Contracting for Health Care Services: The Administrative Problem. Unpublished paper, Abt Associates, Cambridge, MA.
16. Coulam, R., R. Feldman, and B. Dowd. 2009. Bring Market Prices to Medicare! Essential Reform at a Time of Fiscal Crisis. Washington, DC: AEI.
17. Coulam, R., and G. Gaumer. 1991. Medicare's Prospective Payment System: A Critical Appraisal. Health Care Financing Review, 1991 annual supplement, 45-77.
18. Coulam, R., K. Quinn, L. Reardon, A. White, R. Schmitz, N. Burstein, A. Baker, and C. Robinson. 1997. Evaluation of the Effectiveness of the Operation Restore Trust Demonstration: Final Report. Report submitted to the Health Care Financing Administration pursuant to contract no. 500-92-0014, September 29.
19. Coulam, R., and L. Reardon. 1990. Review of Reimbursement Methods of Other Payors for Durable Medical Equipment. Report to the Health Care Financing Administration pursuant to contract no. 500-85-0050, December 24. Cambridge, MA: Abt Associates.
20. Coulam, R., L. Reardon, W. Marder, K. Calore, and D. Reck. 1990. Final Report: Options for Medicare Reimbursement of Durable Medical Equipment. Report submitted by Abt Associates to the Health Care Financing Administration pursuant to contract no. 500-85-0050, December 24.
21. Dowd, B., R. Coulam, and R. Feldman. 2000. A Tale of Four Cities: Medicare Reform and Competitive Pricing. Health Affairs 19 (5): 9-29.
22. Dowd, B., R. Feldman, and J. Christianson. 1996. Competitive Pricing for Medicare. Washington, DC: American Enterprise Institute.
23. Duhigg, C. 2007. Golden Opportunities: Oxygen Suppliers Fight to Keep a Medicare Boon. New York Times, November 30.
24. Families USA. 2007. No Bargain: Medicare Drug Plans Deliver High Prices. Publication no. 07-101. January. Washington, DC: Families USA. www.familiesusa.org/assets/pdfs/no-bargain-medicare-drug.pdf.
25. Frank, R. 2004. Perspective: Election 2004 - Prescription-Drug Prices. New England Journal of Medicine 351:1375-1377.
26. Frank, R., and J. P. Newhouse. 2008. Should Drug Prices Be Negotiated under Part D of Medicare? And If So, How? Health Affairs 27:33-43.
27. Frank, R. G., and R. J. Zeckhauser. 2009. Health Insurance Exchanges: Making the Markets Work. New England Journal of Medicine 361:1135.
28. Freudenheim, M. 2003. Medicare Plan for Competition Faces Hurdles. New York Times, November 28.
29. Graham, B. 1998. Graham Medicare Legislation Takes Root in Polk County. News release, U.S. Senate Office (D-FL), May 29.
30. Gray, T. 1999. Competitive Bidding Takes Off. Homecare, November 1. homecaremag.com/mag/medical_competitive_bidding_takes.
31. Hacker, J. S., and P. Pierson. 2010. Winner-Take-All Politics: Public Policy, Political Organization, and the Precipitous Rise of Top Incomes in the United States. Politics and Society 38:152-204.
32. Hoerger, T., and A. Meadow. 1997. Developing Medicare Competitive Bidding: A Study of Clinical Laboratories. Health Care Financing Review 19:59-86.
33. Hoerger, T., R. Lindrooth, and J. Eggleston. 1998. Medicare's Demonstration of Competitive Bidding for Clinical Laboratory Services: What It Means for Clinical Laboratories. Clinical Chemistry 44:1728-1734.
34. HomeCare Magazine. 2011. H.R. 1041 at Seventy-Five and Climbing. April 11. homecaremag.com/topics/competitive-bidding/hr1041-at-75-climbing-2011041 1.
35. Kaiser Family Foundation. 2010. Fact Sheet: Medicare Spending and Financing. August. www.kff.org/medicare/upload/7305-05.pdf (accessed December 19, 2010).
36. Karon, S., K. Jewell, T. Hoerger, S. Bernard, E. Finkelstein, K. Tate, R. Lindrooth, and T. Waters. 2002. Evaluation of Medicare's Competitive Bidding Demonstration for DMEPOS: Second-Year Annual Evaluation Report. CMS Contract No. 500-95-0061/T.O. #3. April. Research Triangle Park, NC: RTI International. www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/2rtc_Appendix.pdf (accessed August 3, 2009).
37. Klevorick, A. K. 1993. The Current State of the Law and Economics of Predatory Pricing. American Economic Review 83:162-167.
38. Lawlor, E. F. 2003. Redesigning the Medicare Contract: Politics, Markets, and Agency. Chicago: University of Chicago.
39. Levit, K., C. Cowan, H. Lazenby, A. Sensenig, P. McDonnell, J. Stiller, A. Martin, and the Health Accounts Team. 2000. Health Spending in 1998: Signals of Change. Health Affairs 19 (1): 125-132.
40. Lillis, M. 2010. Battle Continues over Medicare Competitive Bidding Program. The Hill's Healthcare Blog, July 2. thehill.com/blogs/healthwatch/medicare/107001-battle-continues-over-medi care-competitive-bidding-program.
41. Mathews, A. W. 2008. Lawmakers Question Medicare Bidding Plan. Wall Street Journal, May 6.
42. Mayes, R., and R. A. Berenson. 2006. Medicare Prospective Payment and the Shaping of U.S. Health Care. Baltimore: Johns Hopkins University Press.
43. Medicare Payment Advisory Commission (MedPAC). 1999. Report to the Congress: Selected Medicare Issues. June. Washington, DC: MedPAC. www.medpac.gov/documents/Jun99%20Entire%20report.pdf (accessed August 3, 2009).
44. Medicare Payment Advisory Commission (MedPAC). 2003. Report to the Congress: Variation and Innovation in Medicare. June. Washington, DC: MedPAC. www.medpac.gov/documents/June03_Entire_Report.pdf (accessed August 3, 2009).
45. Medicare Payment Advisory Commission (MedPAC). 2008. Payment Basics: Part D Payment System. Revised October. Washington, DC: MedPAC. www.medpac.gov/documents/MedPAC_Payment_Basics_08_PartD.pdf (accessed August 3, 2009).
46. Mutti, A. 2003. Experience with Market Competition in Fee-for-Service Medicare. Statement before a meeting of the Medicare Payment Advisory Commission. March 23. medpac.gov/transcripts/0321_feeforservice_AM_transc.pdf.
47. Nichols, L. M., and R. D. Reischauer. 2000. Who Really Wants Price Competition in Medicare Managed Care? Health Affairs 19 (5): 30-43.
48. Oberlander, J. 2007. Through the Looking Glass: The Politics of the Medicare Prescription Drug, Improvement, and Modernization Act. Journal of Health Politics, Policy and Law 32:187-219.
49. Perlmutter, R. M. 2007. Interim Measures and Civil Litigation: Introduction. Suffolk Transnational Law Review 31:1-12.
50. Reuters. 2008. Court Issues an Injunction in San Diego Clinical Laboratory Bidding Case. April 8. www.reuters.com/article/pressRelease/idUS13811+09-Apr-2008+BW20080409.
51. Richard Beveridge and Associates. 2001. Medicare Participating Centers of Excellence Demonstration for Cardiovascular Health Care Facilities Expanding in 2001. Unpublished paper. Electronic file in authors' possession.
52. Sipkoff, M. 2007. What's Good for the VHA Is Not So Good for Medicare. Managed Care, February. www.managedcaremag.com/archives/0702/0702.medmgmt.html.
53. U.S. Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. 2008. 2008 Annual Report. March 25. Washington, DC: Boards of Trustees. www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2008.pdf.
54. Sipkoff, M. 2009. 2009 Annual Report. May 12. Washington, DC: Boards of Trustees. www.cms.gov/ReportsTrustFunds/downloads/tr2009.pdf.
55. U.S. Centers for Medicare and Medicaid Services (CMS). 2008a. Competitive Acquisition for Part B Drugs and Biologicals: Overview. September 15. Washington, DC: CMS. www.cms.hhs.gov/CompetitiveAcquisforBios.
56. U.S. Centers for Medicare and Medicaid Services (CMS). 2008b. Lower Medicare Part D Costs than Expected in 2009. August 14. Washington, DC: CMS. www.cms.hhs.gov/apps/media/press/release.asp?Counter=3240&intNumPerP age=10&checkDate=&checkKey=2&srchType=2&numDays=0&sr chOpt=0&srchData=part+d&keywordType=All&chkNewsType=1%2C+2%2 C+3%2C+4%2C+5&intPage=&showAll=1&pYear=&year=0&desc= &cboOrder=date.
57. U.S. Centers for Medicare and Medicaid Services (CMS). 2010a. Annual Release of Part D National Average Bid Amount and other Part C and D Bid Related Information. August 18. Washington, DC: CMS www.cms.gov/MedicareAdvtgSpecRateStats/Downloads/PartDandMABenchmarks201 1.pdf.
58. U.S. Centers for Medicare and Medicaid Services (CMS). 2010b. The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program: A Better Way for Medicare to Pay for Medical Equipment. February. www.cms.gov/MLNProducts/downloads/DMEPOSCompBidProg.pdf.
59. U.S. Centers for Medicare and Medicaid Services (CMS). 2010c. Medicare Fact Sheet: New Program Reduces Costs for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. July 1. Washington, DC: CMS. news.khca.org/khca/downloads/070110DMEPOcompbidfactsheet.pdf.
60. U.S. Department of Health and Human Services (HHS). 2004. Final Report to Congress: Evaluation of Medicare's Competitive Bidding Demonstration for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. Washington, DC: HHS. www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/CMS_rtc.pdf (accessed August 3, 2009).
61. U.S. General Accounting Office (GAO). 1972. Need for Legislation to Authorize More Economical Ways of Providing Durable Medical Equipment Under Medicare: Report to the Congress by the Comptroller General of the United States No. B-164031(4). May 12. Washington, DC: GAO. archive.gao.gov/f0302/096573.pdf.
62. U.S. General Accounting Office (GAO). 1997. Medicare HMOs: Setting Payment Rates Through Competitive Bidding. GAO/HEHS-97-154R. June 12. Washington, DC: GAO. archive.gao.gov/paprpdf1/158828.pdf.
63. U.S. Government Accountability Office (GAO). 2004. Past Experience Can Guide Future Competitive Bidding for Medical Equipment and Supplies. GAO-04-765. September. Washington, DC: GAO. www.gao.gov/new.items/d04765.pdf (accessed August 3, 2009).
64. U.S. Government Accountability Office (GAO). 2005. Report to the Committees on Armed Services, U.S. Senate and House of Representatives: Implementation Issues for New TRICARE Contracts and Regional Structure. GAO 05-773. July. Washington, DC: GAO. www.gao.gov/new.items/d05773.pdf (accessed August 3, 2009).
65. U.S. Government Accountability Office (GAO). 2008. Medicare: Competitive Bidding for Medical Equipment and Supplies Could Reduce Program Payments, but Adequate Oversight Is Critical. Highlights of GAO-08-767T, Testimony before the Subcommittee on Health, Committee on Ways and Means, House of Representatives, May 6. Washington, DC: GAO. gao.gov/highlights/d08767thigh.pdf.
66. U.S. House of Representatives, Committee on Energy and Commerce. 2010. Medicare's Competitive Bidding Program for Durable Medical Equipment: Implications for Quality, Cost, and Access. Briefing Memorandum for Members of the Subcommittee on Health. 111th Congress, 2d Session. September 13. Washington, DC: House of Representatives. energycommerce.house.gov/documents/20100913/Health.2010.9.13.pdf.
67. U.S. House of Representatives, Committee on Small Businesses. 2007. Hearing on Competitive Bidding for Clinical Lab Services: Where Is It Heading and What Small Businesses Can Expect. Statement of Timothy Love, director of ORDI, Centers for Medicare and Medicaid Services. 110th Cong., 1st Sess. July 25. Transcript in press release from CMS Office of Public Affairs. Washington, DC: House of Representatives. www.cms.hhs.gov/apps/media/press/testimony.asp?Counter=2370&intNumPe rPage=10&checkDate=&checkKey=&srchType=1&numDays=3500 &srchOpt=0&srchData=&keywordType=All&chkNewsType=7&intP age=&showAll=&pYear=&year=&desc=&cboOrder=date.
68. Wayne, A. 2008. Once Bid, Twice Shy on Medicare Equipment Program. Congressional Quarterly Weekly Online. June 23, 1674-1674. library.cqpress.com/cqweekly/weeklyreport110-000002902840.
69. Weissman, J. S., M. Wachterman, and D. Blumenthal. 2005. When Methods Meet Politics: How Risk Adjustment Became Part of Medicare Managed Care. Journal of Health Politics, Policy and Law 30:475-504.
70. Whitford, A. 2007. Designing Markets: Why Competitive Bidding and Auctions in Government Often Fail to Deliver. Policy Studies Journal 35:61-85.
71. Young, J. 2008. Business and Lobbying: Prescribing a Price Fix. The Hill, May 6. thehill.com/business-a-lobbying/3578-k-street-in-brief.