Bedside bureaucrats: Why medicare reform hasn't worked

Georgetown Law Journal

Volumn 101, Issue 3, 2013, Pages 519-580

  Bagley, Nicholas ^a  

^a UNIVERSITY OF MICHIGAN LAW SCHOOL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 84878748245     PISSN: 00168092     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (215)

1. MICHAEL LIPSKY, STREET-LEVEL BUREAUCRACY: DILEMMAS OF THE INDIVIDUAL IN PUBLIC SERVICES 13, 16-18 (2d ed. 2010).
2. K. N. LLEWELLYN, THE BRAMBLE BUSH: SOME LECTURES ON LAW AND ITS STUDY 3 (1930).
3. JERRY L. MASHAW, BUREAUCRATIC JUSTICE: MANAGING SOCIAL SECURITY CLAIMS (1983).
4. Joseph P. Newhouse, Assessing Health Reform's Impact on Four Key Groups of Americans, 29 HEALTH AFF. 1714, 1720 (2010).
5. ADVERSE EVENTS IN HOSPITALS: NATIONAL INCIDENCE AMONG MEDICARE BENEFICIARIES, at ii (2010), available at http://www.oig.hhs.gov/oei/reports/ oei-06-09-00090.pdf.
6. INST. OF MED., TO ERR IS HUMAN: BUILDING A SAFER HEALTH SYSTEM 1 (1999).
7. David C. Classen et al., 'Global Trigger Tool' Shows that Adverse Events in Hospitals May Be Ten Times Greater than Previously Measured, 30 HEALTH AFF. 581, 584 (2011).
8. THEODORE R. MARMOR, THE POLITICS OF MEDICARE 185-86 (2d ed. 2000).
9. Katherine Baicker & Michael E. Chernew, The Economics of Financing Medicare, NEW ENG. J. MED., July 28, 2011, at e7(1).
10. JOHN E. WENNBERG, TRACKING MEDICINE: A RESEARCHER'S QUEST TO UNDERSTAND HEALTH CARE 156-69 (2010).
11. Katherine Baicker & Amitabh Chandra, Medicare Spending, the Physician Workforce, and Beneficiaries' Quality of Care, 7 HEALTH AFF. 184 (2004).
12. Jerry L. Mashaw, Federal Administration and Administrative Law in the Gilded Age, 119 YALE L.J. 1362, 1470 (2010).
13. Timothy Stoltzfus Jost, Governing Medicare, 51 ADMIN. L. REV. 39, 41 (1999).
14. David M. Frankford, The Medicare DRGs: Efficiency and Organizational Rationality, 10 YALE J. ON REG. 273 (1993).
15. Eleanor D. Kinney, National Coverage Policy Under the Medicare Program: Problems and Proposals for Change, 32 ST. LOUIS U. L.J. 869 (1988).
16. Jacqueline Fox, Medicare Should, but Cannot, Consider Cost: Legal Impediments to a Sound Policy, 53 BUFF. L. REV. 577 (2005).
17. Jerry L. Mashaw, Recovering American Administrative Law: Federalist Foundations, 1787- 1801, 115 YALE L.J. 1256, 1263-64 (2006).
18. DAVID A. HYMAN, MEDICARE MEETS MEPHISTOPHELES (2006).
19. Sallyanne Payton, Professionalism as Third-Party Governance: The Function and Dysfunction of Medicare, in MAKING GOVERNMENT MANAGEABLE 112 (Thomas H. Stanton & Benjamin Ginsberg eds., 2004).
20. BRUCE WYMAN, THE PRINCIPLES OF THE ADMINISTRATIVE LAW GOVERNING THE RELATIONS OF PUBLIC OFFICERS 15 (1903).
21. FRANK J. GOODNOW, THE PRINCIPLES OF THE ADMINISTRATIVE LAW OF THE UNITED STATES 371 (1905).
22. GOVERNMENT BY CONTRACT: OUTSOURCING AND AMERICAN DEMOCRACY (Jody Freeman & Martha Minow eds., 2009).
23. Jody Freeman, The Private Role in Public Governance, 75 N.Y.U. L. REV. 543 (2000).
24. David A. Super, Privatization, Policy Paralysis, and the Poor, 96 CALIF. L. REV. 393 (2008).
25. Jody Freeman & Martha Minow, Introduction: Reframing the Outsourcing Debates, in GOVERNMENT BY CONTRACT: OUTSOURCING AND AMERICAN DEMOCRACY, supra note 17, at 2.
26. THE TOOLS OF GOVERNMENT: A GUIDE TO THE NEW GOVERNANCE 603-05 (Lester M. Salamon ed., 2002).
27. KIMBERLY J. MORGAN & ANDREA LOUISE CAMPBELL, THE DELEGATED WELFARE STATE: MEDICARE, MARKETS, AND THE GOVERNANCE OF SOCIAL POLICY 144-67 (2011).
28. RICK MAYES & ROBERT A. BERENSON, MEDICARE PROSPECTIVE PAYMENT AND THE SHAPING OF U.S. HEALTH CARE 17 (2006) (quoting Cohen).
29. PAUL STARR, THE SOCIAL TRANSFORMATION OF AMERICAN MEDICINE 178 (1982).
30. SYLVIA A. LAW, BLUE CROSS: WHAT WENT WRONG? 34 (2d ed. 1976).
31. Larry DeWitt, The Medicare Program as a Capstone to the Great Society-Recent Revelations in the LBJ White House Tapes (May 2003) (unpublished manuscript) (on file with author).
32. PHILLIP LONGMAN, BEST CARE ANYWHERE: WHY VA HEALTH CARE IS BETTER THAN YOURS (2d ed. 2010).
33. Sallyanne Payton, Professionalism as Third-Party Governance: The Function and Dysfunction of Medicare, in MAKING GOVERNMENT MANAGEABLE 112 (Thomas H. Stanton & Benjamin Ginsberg eds., 2004)., supra note 15, at 119.
34. C. Eugene Steuerle & Eric C. Twombly, Vouchers, in THE TOOLS OF GOVERNMENT: A GUIDE TO THE NEW GOVERNANCE, supra note 19, at 445-46.
35. MARILYN MOON, MEDICARE: A POLICY PRIMER 5-6 (2006).
36. JAMES Q. WILSON, BUREAUCRACY: WHAT GOVERNMENT AGENCIES DO AND WHY THEY DO IT 355 (1989).
37. JOHN E. WENNBERG, TRACKING MEDICINE: A RESEARCHER'S QUEST TO UNDERSTAND HEALTH CARE (2010). supra note 12, at 7-8.
38. Carl E. Schneider & Mark A. Hall, The Patient Life: Can Consumers Direct Health Care?, 35 AM. J.L. & MED. 7 (2009).
39. Stan Soloway & Alan Chvotkin, Federal Contracting in Context: What Drives It, How To Improve It, in GOVERNMENT BY CONTRACT: OUTSOURCING AND AMERICAN DEMOCRACY, supra note 17, at 192.
40. John D. Donahue, The Transformation of Government Work: Causes, Consequences, and Distortions, in GOVERNMENT BY CONTRACT: OUTSOURCING AND AMERICAN DEMOCRACY, supra note 17, at 41-42.
41. Christopher Drew, Costliest Jet, Years in Making, Sees the Enemy: Budget Cuts, N.Y. TIMES, Nov. 28, 2012, http://www.nytimes.com/2012/11/29/us/in- federal-budget-cutting-f-35-fighter-jetis-at-risk.html.
42. David Super, Indiana Court Autopsies Welfare Privatization Effort, BALKINIZATION (Aug. 3, 2012, 6:30 AM), http://balkin.blogspot.com/2012/08/ indiana-court-autopsies-welfare.html.
43. Total Professionally Active Physicians, November 2012, KAISER FAMILY FOUND., http://www.statehealthfacts.org/comparemaptable.jsp?ind-934&cat-8 (last visited Jan. 8, 2013).
44. KAISER FAMILY FOUND., MEDICARE CHARTBOOK 28 (4th ed. 2010).
45. Steven L. Schooner, Fear of Oversight: The Fundamental Failure of Businesslike Government, 50 AM. U. L. REV. 627, 640 (2001).
46. Jody Freeman, Extending Public Law Norms Through Privatization, 116 HARV. L. REV. 1285, 1343 (2003).
47. David A. Super, Privatization, Policy Paralysis, and the Poor, 96 CALIF. L. REV. 393 (2008)., supra note 17, at 403.
48. Martha Minow, Public and Private Partnerships: Accounting for the New Religion, 116 HARV. L. REV. 1229, 1259 (2003).
49. Jody Freeman & Martha Minow, Introduction: Reframing the Outsourcing Debates, in GOVERNMENT BY CONTRACT: OUTSOURCING AND AMERICAN DEMOCRACY, supra note 18, at 1.
50. JERRY L. MASHAW, BUREAUCRATIC JUSTICE: MANAGING SOCIAL SECURITY CLAIMS (1983), supra note 7, at 32.
51. Paul Pierson, Increasing Returns, Path Dependence, and the Study of Politics, 94 AM. POL. SCI. REV. 251, 259 (2000).
52. Steven L. Schooner, Fear of Oversight: The Fundamental Failure of Businesslike Government, 50 AM. U. L. REV. 627, (2001), supra note 52, at 676-77.
53. Lester M. Salamon, The New Governance and the Tools of Public Action: An Introduction, 28 FORDHAM URB. L.J. 1611, 1656 (2000).
54. Paul L. Posner, Accountability Challenges of Third-Party Government, in THE TOOLS OF GOVERNMENT: A GUIDE TO THE NEW GOVERNANCE, supra note 19, at 523, 540 (cataloging various examples).
55. Donald F. Kettl, Managing Indirect Government, in THE TOOLS OF GOVERNMENT: A GUIDE TO THE NEW GOVERNANCE, supra note 19, at 490-91.
56. CONG. BUDGET OFFICE, THE EFFECT OF PSROS ON HEALTH CARE COSTS: CURRENT FINDINGS AND FUTURE EVALUATIONS, at x (1979), available at http://www.cbo.gov/ sites/default/files/cbofiles/ftpdocs/91xx/doc9178/79doc659.pdf.
57. Spencer Rich, Who Should Police Hospitals and Doctors?, WASH. POST, Nov. 29, 1983, at A15.
58. BETH C. FUCHS, CONG. RESEARCH SERV., 90-273 EPW, MEDICARE'S PEER REVIEW ORGANIZATIONS 10 (1990).
59. MEDICARE'S QUALITY IMPROVEMENT ORGANIZATION PROGRAM: MAXIMIZING POTENTIAL 41 (2006).
60. Stephen F. Jencks & Gail R. Wilensky, The Health Care Quality Improvement Initiative: A New Approach to Quality Assurance in Medicare, 268 J. AM. MED. ASS'N 900, 900 (1992).
61. INST. OF MED., MEDICARE: A STRATEGY FOR QUALITY ASSURANCE 2-4 (Kathleen N. Lohr ed., 1990).
62. U.S. GOV'T ACCOUNTABILITY OFFICE, GAO-11-116R, MEDICARE: CMS NEEDS TO COLLECT CONSISTENT INFORMATION FROM QUALITY IMPROVEMENT ORGANIZATIONS TO STRENGTHEN ITS ESTABLISHMENT OF BUDGETS FOR QUALITY OF CARE REVIEWS 2 (2010).
63. Haya R. Rubin et al., Watching the Doctor-Watchers: How Well Do Peer Review Organization Methods Detect Health Care Quality Problems?, 267 J. AM. MED. ASS'N 2349, 2350 (1992).
64. Clark C. Havighurst & James F. Blumstein, Coping with Quality/Cost Trade-Offs in Medical Care: The Role of PSROs, 70 NW. U. L. REV. 6, 32 (1975).
65. OFFICE OF INSPECTOR GEN., DEP'T OF HEALTH & HUMAN SERVS., OEI-01-06-00170, QUALITY CONCERNS IDENTIFIED THROUGH QUALITY IMPROVEMENT ORGANIZATION MEDICAL RECORD REVIEWS, at ii (2007).
66. U.S. GEN. ACCOUNTING OFFICE, MEDICARE: BETTER CONTROLS NEEDED FOR PEER REVIEW ORGANIZATIONS' EVALUATIONS 4 (1987) (same).
67. CTRS. FOR MEDICARE & MEDICAID SERVS., REPORT TO CONGRESS ON THE EVALUATION OF THE QUALITY IMPROVEMENT ORGANIZATION (QIO) PROGRAM FOR MEDICARE BENEFICIARIES FOR FISCAL YEAR 2006, at 5 (2009).
68. INST. OF MED., MEDICARE: A STRATEGY FOR QUALITY ASSURANCE (Kathleen N. Lohr ed., 1990), supra note 72, at 183.
69. Haya R. Rubin et al., Watching the Doctor-Watchers: How Well Do Peer Review Organization Methods Detect Health Care Quality Problems?, 267 J. AM. MED. ASS'N 2349, (1992). supra note 77, at 2353.
70. INST. OF MED., MEDICARE'S QUALITY IMPROVEMENT ORGANIZATION PROGRAM: MAXIMIZING POTENTIAL (2006). supra note 71, at 234.
71. Claire Snyder & Gerard Anderson, Do Quality Improvement Organizations Improve the Quality of Hospital Care for Medicare Beneficiaries?, 293 J. AM. MED. ASS'N 2900, 2900 (2005) (same).
72. Stephen F. Jencks et al., Change in the Quality of Care Delivered to Medicare Beneficiaries, 1998-1999 to 2000-2001, 289 J. AM. MED. ASS'N 305, 305 (2003)
73. Thomas A. Marciniak et al., Improving the Quality of Care for Medicare Patients with Acute Myocardial Infarction: Results from the Cooperative Cardiovascular Project, 279 J. AM. MED. ASS'N 1351 (1998).
74. William Rollow et al., Assessment of the Medicare Quality Improvement Organization Program, 145 ANNALS INTERNAL MED. 342 (2006) (reporting similar results).
75. TROYEN A. BRENNAN & DONALD M. BERWICK, NEW RULES: REGULATION, MARKETS, AND THE QUALITY OF AMERICAN HEALTH CARE 320 (1996).
76. Elizabeth H. Bradley et al., From Adversary to Partner: Have Quality Improvement Organizations Made the Transition?, 40 HEALTH SERVS. RES. 459, 471 (2005) (internal quotations omitted).
77. NURSING HOMES: FEDERALACTIONS NEEDED TO IMPROVE TARGETING AND EVALUATION OF ASSISTANCE BY QUALITY IMPROVEMENT ORGANIZATIONS 4-5 (2007).
78. JOHN E. WENNBERG, TRACKING MEDICINE: A RESEARCHER'S QUEST TO UNDERSTAND HEALTH CARE (2010), supra note 12, at 220.
79. Mark B. McClellan, Medicare Reimbursement and Hospital Cost Growth, in ADVANCES IN THE ECONOMICS OF AGING 149, 159 (David A.Wise ed. 1996).
80. RICK MAYES & ROBERT A. BERENSON, MEDICARE PROSPECTIVE PAYMENT AND THE SHAPING OF U.S. HEALTH CARE 17 (2006) (quoting Cohen), supra note 22, at 83.
81. RICK MAYES & ROBERT A. BERENSON, MEDICARE PROSPECTIVE PAYMENT AND THE SHAPING OF U.S. HEALTH CARE 17 (2006), supra note 22, at 87.
82. Bruce C. Vladeck, Fixing Medicare's Physician Payment System, 362 NEW ENG. J. MED. 1955, 1955 (2010).
83. Mark B. McClellan, Medicare Reimbursement and Hospital Cost Growth, in ADVANCES IN THE ECONOMICS OF AGING 149, (David A.Wise ed. 1996). supra note 97, at 155.
84. RICK MAYES & ROBERT A. BERENSON, MEDICARE PROSPECTIVE PAYMENT AND THE SHAPING OF U.S. HEALTH CARE 17 (2006), supra note 22, at 53.
85. Bruce C. Vladeck, Hospital Prospective Payment and the Quality of Care, 319 NEW ENG. J. MED. 1411, 1411-12 (1988).
86. David C. Hsia et al., Accuracy of Diagnostic Coding for Medicare Patients Under the Prospective-Payment System, 318 NEW ENG. J. MED. 352 (1988).
87. Einer Elhauge, The Limited Regulatory Potential of Medical Technology Assessment, 82 VA. L. REV. 1525, 1558 (1996).
88. PHYSICIAN PAYMENT REVIEW COMM'N, ANNUAL REPORT TO CONGRESS 208 (1989).
89. RICK MAYES & ROBERT A. BERENSON, MEDICARE PROSPECTIVE PAYMENT AND THE SHAPING OF U.S. HEALTH CARE 17 (2006) supra note 22, at 92.
90. Miriam J. Laugesen et al., In Setting Doctors' Medicare Fees, CMS Almost Always Accepts the Relative Value Update Panel's Advice on Work Values, 31 HEALTH AFF. 965, 965 (2012).
91. Uwe E. Reinhardt, The Little-Known Decision-Makers for Medicare Physicians Fees, N.Y. TIMES ECONOMIX BLOG (Dec. 10, 2010, 6:00 AM), http://economix.blogs.nytimes.com/2010/12/10/thelittle-known-decision-makers- for-medicare-physicans-fees/.
92. Bruce C. Vladeck, Fixing Medicare's Physician Payment System, 362 NEW ENG. J. MED. 1955, (2010), supra note 103, at 1956.
93. Chantal Worzala et al., Challenges and Opportunities for Medicare's Original Prospective Payment System, 22 HEALTH AFF. 175, 177-78 (2003).
94. MEDICARE PAYMENT ADVISORY COMM'N, REPORT TO THE CONGRESS: MEDICARE AND THE HEALTH CARE DELIVERY SYSTEM 16 (2011).
95. David M. Cutler, The Incidence of Adverse Medical Outcomes Under Prospective Payment, 63 ECONOMETRICA 29, 29 (1995).
96. John F. Fitzgerald et al., The Care of Elderly Patients with Hip Fracture: Changes Since Implementation of the Prospective Payment System, 319 NEW ENG. J. MED. 1392, 1396 (1988).
97. Lisa V. Rubenstein et al., Changes in Quality of Care for Five Diseases Measured by Implicit Review, 1981 to 1986, 264 J. AM. MED. ASS'N 1974, 1977 (1990).
98. DAVID C. GOODMAN ET AL., AFTER HOSPITALIZATION: A DARTMOUTH ATLAS REPORT ON POSTACUTE CARE FOR MEDICARE BENEFICIARIES (2011) (documenting wide variation in readmission rates).
99. Jacqueline Kosecoff et al., Prospective Payment System and Impairment at Discharge: The Quicker-and-Sicker Story Revisited, 264 J. AM. MED. ASS'N 1980, 1982 (1990).
100. See INST. OF MED., KEEPING PATIENTS SAFE: TRANSFORMING THE WORK ENVIRONMENT OF NURSES 171 (2004).
101. Jonathan Gruber & Samuel A. Kleiner, Do Strikes Kill? Evidence from New York State, 4 AM. ECON. J. 127, 128 (2012).
102. MEDICARE PAYMENT ADVISORY COMM'N, REPORT TO THE CONGRESS: MEDICARE AND THE HEALTH CARE DELIVERY SYSTEM (2011). supra note 121, at 35-36.
103. David J. Brenner & Eric. J. Hall, Computed Tomography-An Increasing Source of Radiation Exposure, 357 NEW ENG. J. MED. 2277, 2281-82 (2007).
104. TIMOTHY STOLTZFUS JOST, DISENTITLEMENT? THE THREATS FACING OUR PUBLIC HEALTH-CARE PROGRAMS AND A RIGHTS-BASED RESPONSE 114-15 (2003).
105. Robert A. Berenson, Medicare Disadvantaged and the Search for the Elusive 'Level Playing Field, ' 15 HEALTH AFF. 572, 574 (2004).
106. MEDICARE PAYMENT ADVISORY COMM'N, REPORT TO THE CONGRESS: MEDICARE PAYMENT POLICY 291 (2011).
107. CTRS. FOR MEDICARE & MEDICAID SERVS., TIP SHEET: UNDERSTANDING MEDICARE ENROLLMENT PERIODS 7, 11 (2011), available at http://www.medicare.gov/ Pubs/pdf/11219.pdf.
108. HHS FAQ, U.S. DEP'T OF HEALTH & HUMAN SERVS., http://answers.hhs.gov/ questions/3006 (last visited Sept. 30, 2012).
109. TIMOTHY STOLTZFUS JOST, DISENTITLEMENT? THE THREATS FACING OUR PUBLIC HEALTH-CARE PROGRAMS AND A RIGHTS-BASED RESPONSE (2003), supra note 132, at 119-20.
110. NAT'L ACAD. OF SOC. INS., FINAL REPORT OF THE STUDY PANEL ON MEDICARE AND MARKETS: THE ROLE OF PRIVATE HEALTH PLANS IN MEDICARE: LESSONS FROM THE PAST, LOOKING TO THE FUTURE 46 (Kathleen M. King & Mark Schlesinger eds., 2003).
111. James C. Robinson, The End of Managed Care, 285 J. AM. MED. ASS'N 2622, 2627 (2001).
112. Robert A. Berenson, Beyond Competition, 16 HEALTH AFF. 171, 174 (1997).
113. Michael A. Morrisey et al., Favorable Selection, Risk Adjustment, and the Medicare Advantage Program, 48 HEALTH SERVS. RES. (forthcoming 2013).
114. Richard Kronick, Medicare and HMOs-The Search for Accountability, 360 NEW ENG. J. MED. 2048, 2050 (2009).
115. OFFICE OF INSPECTOR GEN., DEP'T OF HEALTH & HUMAN SERVS., OEI-01-96-00191, MEDICARE'S OVERSIGHT OF MANAGED CARE: IMPLICATIONS FOR REGIONAL STAFFING, at i-ii (1998).
116. U.S. GEN. ACCOUNTING OFFICE, GAO/T-HEHS-00-108, MEDICARE: 21ST CENTURY CHALLENGES PROMPT FRESH THINKING ABOUT PROGRAM'S ADMINISTRATIVE STRUCTURE 8 (2000).
117. NAT'L ACAD. OF SOC. INS., FINAL REPORT OF THE STUDY PANEL ON MEDICARE AND MARKETS: THE ROLE OF PRIVATE HEALTH PLANS IN MEDICARE: LESSONS FROM THE PAST, LOOKING TO THE FUTURE 46 (Kathleen M. King & Mark Schlesinger eds., 2003) supra note 144, at 15.
118. Jonathan B. Oberlander, Managed Care and Medicare Reform, 22 J. HEALTH POL. POL'Y & L. 595, 623 (1997).
119. Sean R. Tunis, Why Medicare Has Not Established Criteria for Coverage Decisions, 350 NEW ENG. J. MED. 2196, 2196 (2004).
120. Susan Bartlett Foote, Why Medicare Cannot Promulgate a National Coverage Rule: A Case of Regula Mortis, 27 J. HEALTH POL. POL'Y & L. 707, 713-20 (2002).
121. Jacqueline Fox, The Hidden Role of Cost: Medicare Decisions, Transparency, and the Public Trust, 79 U. CIN. L. REV. 1, 5 (2010).
122. Alan M. Garber, Commentary, The Impact of Medicare Coverage Policies on Health Care Utilization, 43 HEALTH SERVS. RES. 1302, 1303 (2008).
123. Susan Bartlett Foote et al., The Impact of Medicare Coverage Policies on Health Care Utilization, 43 HEALTH SERVS. RES. 1285, 1287 (2008).
124. Peter J. Neumann et al., Medicare's National Coverage Decisions for Technologies, 1999-2007, 27 HEALTH AFF. 1620, 1621 (2008).
125. Medicare Coverage Database, CTRS. FOR MEDICARE&MEDICAID SERVS., http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx (last visited Sept. 7, 2012).
126. David. M. Cutler, Technology, Health Costs, and the NIH 9 (Sept. 1995) (unpublished manuscript prepared for the National Institutes of Health and Economics Roundtable on Biomedical Research), available at http://www.economics. harvard.edu/files/faculty/13-Technology, %20Health%20Costs%20and%20the%20NIH. pdf.
127. Sheila Smith et al., Income, Insurance, and Technology: Why Does Health Spending Outpace Economic Growth?, 28 HEALTH AFF. 1276, 1276, 1281 (2009).
128. Alan M. Garber, Commentary, The Impact of Medicare Coverage Policies on Health Care Utilization, 43 HEALTH SERVS. RES. (2008), supra note 163, at 1305.
129. Susan Bartlett Foote et al., The Impact of Medicare Coverage Policies on Health Care Utilization, 43 HEALTH SERVS. RES. 1285, (2008). supra note 164, at 1300.
130. Redacted Benchmark Metric Reports, CTRS. FOR MEDICARE & MEDICAID SERVS., http://www.cms.gov/Medicare/Medicare-Contracting/ MedicareContractingReform/RedactedBenchmarkMetricReports.html (last visited Aug. 9, 2011) (providing spreadsheets of contracting benchmarks, none of which mention LCDs).
131. Susan Bartlett Foote et al., The Impact of Medicare Coverage Policies on Health Care Utilization, 43 HEALTH SERVS. RES. 1285, (2008). supra note 164, at 1299.
132. James S. Goodwin et al., Overuse of Screening Colonoscopy in the Medicare Population, 171 ARCHIVES INTERNALMED. 1335, 1342 (2011).
133. Jacqueline Fox, Medicare Should, but Cannot, Consider Cost: Legal Impediments to a Sound Policy, 53 BUFF. L. REV. (2005)., supra note 13, at 593-94.
134. Cass R. Sunstein, Chevron Step Zero, 92 VA. L. REV. 187, 236-42 (2006).
135. Einer Elhauge, Allocating Health Care Morally, 82 CALIF. L. REV. 1449, 1471 (1994).
136. DANIEL CARPENTER, REPUTATION AND POWER: ORGANIZATIONAL IMAGE AND PHARMACEUTICAL REGULATION AT THE FDA (2010).
137. Peter J. Neumann et al., Medicare's National Coverage Decisions for Technologies, 1999-2007, 27 HEALTH AFF. 1620, (2008). supra note 167, at 1623.
138. U.S. CONGRESS, OFFICE OF TECH. ASSESSMENT, OTA-H-608, IDENTIFYING HEALTH TECHNOLOGIES THATWORK: SEARCHING FOR EVIDENCE 21 (1994).
139. ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT (OECD), HEALTH AT A GLANCE 2011, at 9, 104-28 (2011), available at http://www.oecd.org/health/ healthpoliciesanddata/49105858.pdf.
140. Richard B. Stewart, Administrative Law in the Twenty-First Century, 78 N.Y.U. L. REV. 437, 448-49 (2003).
141. TROYEN A. BRENNAN & DONALD M. BERWICK, NEW RULES: REGULATION, MARKETS, AND THE QUALITY OF AMERICAN HEALTH CARE 320 (1996), supra note 90, at 28.
142. Donald F. Kettl, Managing Indirect Government, in THE TOOLS OF GOVERNMENT: A GUIDE TO THE NEW GOVERNANCE, supra note 63, at 493.
143. Jon D. Michaels, Privatization's Pretensions, 77 U. CHI. L. REV. 717, 719 (2010).
144. Einer Elhauge, Why We Should Care About Health Care Fragmentation, in THE FRAGMENTATION OF U.S. HEALTH CARE: CAUSES AND SOLUTIONS 7 (Einer Elhauge ed., 2010).
145. David Leonhardt, Making Health Care Better, N.Y. TIMES MAG. Nov. 3, 2009, at MM31.
146. Peter Pronovost et al., An Intervention To Decrease Catheter-Related Bloodstream Infections in the ICU, 355 NEW ENG. J. MED. 2725, 2726-31 (2006).
147. Thomas H. Lee et al., How Geisinger Structures Its Physicians' Compensation To Support Improvements in Quality, Efficiency, and Volume, 31 HEALTH AFF. 2068, 2068 (2012).
148. SHANNON BROWNLEE, OVERTREATED: WHY TOO MUCH MEDICINE IS MAKING US SICKER AND POORER 245 (2007).
149. Alain Enthoven, Curing Fragmentation with Integrated Delivery Systems, in THE FRAGMENTATION OF U.S. HEALTH CARE: CAUSES AND SOLUTIONS, supra note 199, at 61.
150. Austin B. Frakt & Rick Mayes, Beyond Capitation: How New Payment Experiments Seek To Find the 'Sweet Spot' in Amount of Risk Providers and Payers Bear, 31 HEALTH AFF. 1951, 1955 (2012).
151. KIMBERLY J. MORGAN & ANDREA LOUISE CAMPBELL, THE DELEGATED WELFARE STATE: MEDICARE, MARKETS, AND THE GOVERNANCE OF SOCIAL POLICY (2011). supra note 20, at 159.
152. Gardiner Harris, More Doctors Giving Up Private Practices, N.Y. TIMES, Mar. 25, 2010, http://www.nytimes.com/2010/03/26/health/policy/26docs.html.
153. Ezekiel J. Emanuel, Saving by the Bundle, N.Y. TIMES, Nov. 16, 2011, http://opinionator.blogs.nytimes.com/2011/11/16/saving-by-the-bundle/(endorsing bundled payments).
154. MEDICARE PAYMENT ADVISORY COMM'N, REPORT TO THE CONGRESS: VARIATION AND INNOVATION IN MEDICARE 140 (2003).
155. R.H. COASE, THE FIRM, THE MARKET, AND THE LAW 33-55 (1988).
156. JAMES ROBINSON, THE CORPORATE PRACTICE OF MEDICINE 106 (1999).
157. Theodore W. Ruger, Plural Constitutionalism and the Pathologies of American Health Care, 120 YALE L.J. ONLINE 347, 364 (2011), http:// yalelawjournal.org/the-yale-law-journal-pocket-part/legislation/ plural-constitutionalism-and-the-pathologies-of-american-health-care/.
158. ROBERT BERENSON ET AL., WHAT IF ALL PHYSICIAN SERVICES WERE PAID UNDER THE MEDICARE FEE SCHEDULE? AN ANALYSIS USING MEDICAL GROUPMANAGEMENTASSOCIATION DATA 13-14 (2010).
159. INST. OF MED., REWARDING PROVIDER PERFORMANCE: ALIGNING INCENTIVES IN MEDICARE (2007) (embracing pay-for-performance initiatives).
160. DAVID M. CUTLER, YOUR MONEY OR YOUR LIFE 100-13 (2004) (same).
161. Meredith B. Rosenthal, Beyond Pay for Performance-Emerging Models of Provider- Payment Reform, 359 NEW ENG. J. MED. 1197, 1197 (2008).
162. Grace M. Lee et al., Effect of Nonpayment for Preventable Infections in U.S. Hospitals, 367 NEW ENG. J. MED. 1428, 1434 (2012).
163. Karen Milgate & Sharon Bee Cheng, Pay-For-Performance: The MedPAC Perspective, 25 HEALTH AFF. 413, 416-17 (2006).
164. Andrew Ryan & Jan Blustein, Making the Best of Hospital Pay for Performance, 366 NEW ENG. J. MED. 1557, 1559 (2012).
165. DAVID A. HYMAN, MEDICARE MEETS MEPHISTOPHELES (2006)., supra note 15, at 22.
166. Robert F. Coulam et al., Competitive Pricing and the Challenge of Cost Control in Medicare, 36 J. HEALTH POL. POL'Y & L. 649, 657 (2011).
167. Amitabh Chandra & Jonathan S. Skinner, Technology Growth and Expenditure Growth in Health Care 28 (Nat'l Bureau of Econ. Research, Working Paper No. 16953, 2011), available at http://www.nber.org/papers/w16953.
168. Einer Elhauge, The Limited Regulatory Potential of Medical Technology Assessment, 82 VA. L. REV. 1525, (1996), supra note 112, at 1526.
169. HENRY J. AARON, WILLIAM B. SCHWARTZ & MELISSA COX, CAN WE SAY NO? THE CHALLENGE OF RATIONING HEALTH CARE 19-20 (2005).
170. Lester M. Salamon, The Tools Approach and the New Governance: Conclusion and Implications, in THE TOOLS OF GOVERNMENT: A GUIDE TO THE NEW GOVERNANCE, supra note 19, at 602.
171. Stuart H. Altman, The Lessons of Medicare's Prospective Payment System Show that the Bundled Payment Program Faces Challenges, 31 HEALTH. AFF. 1923, 1926 (2012).
172. MEDICARE PAYMENTADVISORY COMM'N, ALIGNING INCENTIVES IN MEDICARE 6 (2010).
173. John K. Iglehart, Doing More with Less: A Conversation with Kerry Weems, 28 HEALTH AFF. w688, w694 (2009).
174. LYNN ETHEREDGE, REENGINEERING MEDICARE: FROM BILL-PAYING INSURER TO ACCOUNTABLE PURCHASER 7 (1995).
175. Robert A. Berenson & Dean M. Harris, Using Managed Care Tools in Traditional Medicare-Should We? Could We?, 65 LAW & CONTEMP. PROBS. 139, 147-49 (2002).
176. U.S. GOV'T ACCOUNTABILITY OFFICE, GAO-07-307, MEDICARE: FOCUS ON PHYSICIAN PRACTICE PATTERNS CAN LEAD TO GREATER PROGRAM EFFICIENCY 21 (2007).
177. KIMBERLY J. MORGAN & ANDREA LOUISE CAMPBELL, THE DELEGATED WELFARE STATE: MEDICARE, MARKETS, AND THE GOVERNANCE OF SOCIAL POLICY (2011). supra note 20, at 226-27.
178. U.S. OFFICE OF PERS. MGMT., FEDERAL EMPLOYMENT STATISTICS, at tbl.2, available at http://www.opm.gov/feddata/html/2008/may/table2.asp.
179. Stuart M. Butler et al., Crisis Facing HCFA & Millions of Americans, 18 HEALTH AFF. 8, 8 (1999).
180. Paul Krugman, Messing with Medicare, N.Y. TIMES, July 24, 2011, http://www.nytimes.com/2011/07/25/opinion/25krugman.html.
181. Mark A. Hall, Law, Medicine, and Trust, 55 STAN. L. REV. 463, 473 (2002).
182. Kevin Sack, Unintended Consequence for Dialysis Patients as Drug Rule Changes, N.Y. TIMES, May 11, 2012, http://www.nytimes.com/2012/05/11/health/ policy/dialysis-rule-changes-followedby-transfusion-increases.html.
183. Mark A. Hall, Making Sense of Referral Fee Statutes, 13 J. HEALTH POL. POL'Y & L. 623, 624 (1988).
184. CNTRS. FOR MEDICARE & MEDICAID SERVS., ORAL HISTORY PROJECT 178, available at http://www.cms.gov/About-CMS/Agency-Information/History/downloads/ cmsoralhistory.pdf;.
185. JAMES C. SCOTT, SEEING LIKE A STATE: HOW CERTAIN SCHEMES TO IMPROVE THE HUMAN CONDITION HAVE FAILED 11 (1998).
186. U.S. GEN. ACCOUNTING OFFICE, GAO/T-HEHS-99-58, HCFA MANAGEMENT: AGENCY FACES MULTIPLE CHALLENGES IN MANAGING ITS TRANSITION TO THE 21ST CENTURY 10 (1999). 264.
187. Robert Pear, Fraud in Medicare Increasingly Tied to Claims Payers, N.Y. TIMES, Sept. 20, 1999, http://www.nytimes.com/1999/09/20/us/fraud-in-medicare- increasingly-tied-to-claims-payers.html.
188. NAT'L BIPARTISAN COMM'N ON THE FUTURE OF MEDICARE, BUILDING A BETTER MEDICARE FOR TODAY AND TOMORROW (1999), available at http://rs9.loc.gov/ medicare/bbmtt31599.html.
189. David Cutler, How Health Care Reform Must Bend the Cost Curve, 29 HEALTH AFF. 1131, 1133 (2010).
190. Peter R. Orszag & Ezekiel J. Emanuel, Health Care Reform and Cost Control, 363 NEW ENG. J. MED. 601, 603 (2010).
191. Brian Beutler, GOP Sens Threaten To Block Key Element of Health Care Law-and They Can, TALKING POINTS MEMO (May 24, 2011), http://tpmdc. talkingpointsmemo.com/2011/05/republicansthreaten-to-squash-democrats-most- promising-debt-reduction-tool.php.
192. Transcript of the First Presidential Debate, N.Y. TIMES, Oct. 3, 2012, http://www.nytimes.com/2012/10/03/us/politics/transcript-of-the-first- presidential-debate-in-denver.html.
193. Timothy Stolzfus Jost, The Independent Medicare Advisory Board, 11 YALE J. HEALTH POL'Y L. & ETHICS 21, 30 (2011).
194. DAVID G. SMITH, PAYING FOR MEDICARE 28-31 (1992).
195. Timothy Stoltzfus Jost, The Real Constitutional Problem with the Affordable Care Act, 36 J. HEALTH POL. POL'Y & L. 501, 503-06 (2011).
196. CTRS. FOR MEDICARE & MEDICAID SERVS., DEP'T OF HEALTH & HUMAN SERVS., BUNDLED PAYMENTS FOR CARE IMPROVEMENT INITIATIVE (Aug. 23, 2011), available at http://www.cms.gov/apps/media/fact-sheets.asp.
197. Jonathan Oberlander, Throwing Darts: Americans' Elusive Search for Health Care Cost Control, 36 J. HEALTH POL. POL'Y & L. 477, 480-81 (2011) (reaching a similar conclusion).
198. Kavita Patel, Health Reform's Tortuous Route to the Patient-Centered Outcomes Research Institute, 29 HEALTH AFF. 1777, 1778-79 (2010).
199. Elliot S. Fisher et al., Creating Accountable Care Organizations: The Extended Hospital Medical Staff, 26 HEALTH AFF. w44, w48-49 (2006).
200. Donald M. Berwick, Making Good on ACOs' Promise-The Final Rule for the Medicare Shared Savings Program, 365 NEW ENG. J. MED. 1753, 1754 (2011).
201. Harris Meyer, Now Departed from the Centers for Medicare and Medicaid Services, Berwick Receives High Marks for His Tenure at Agency, 30 HEALTH AFF. 2277, 2284 (2011).
202. Francis J. Crosson, The Accountable Care Organization: Whatever Its Growing Pains, the Concept is Too Vitally Important to Fail, 30 HEALTH AFF. 1250, 1253 (2011).
203. Harris Meyer, Accountable Care Organization Prototypes: Winners and Losers?, 30 HEALTH AFF. 1227, 1230 (2011).
204. Gail R. Wilensky, Lessons from the Physician Group Practice Demonstration-A Sobering Reflection, 365 NEW ENG. J. MED. PERSPECTIVES 1659, 1660 (2011).
205. DEP'T OF HEALTH & HUMAN SERVS., REPORT TO CONGRESS: PHYSICIAN GROUP PRACTICE DEMONSTRATION EVALUATION 18 (2009).
206. Robert A. Berenson, Shared Savings Program for Accountable Care Organizations: A Bridge to Nowhere?, 16 AM. J. MANAGED CARE 721, 725 (2010).
207. OFFICE OF MGMT. & BUDGET, EXEC. OFFICE OF THE PRESIDENT, LIVING WITHIN OUR MEANS AND INVESTING IN THE FUTURE: THE PRESIDENT'S PLAN FOR ECONOMIC GROWTH AND DEFICIT REDUCTION 35-40 (2011).
208. OFFICE OF MGMT. & BUDGET, EXEC. OFFICE OF THE PRESIDENT, FISCAL YEAR 2013 BUDGET OF THE U.S. GOVERNMENT 107-15 (2012).
209. NAT'L COMM'N ON FISCAL RESP. & REFORM, THE MOMENT OF TRUTH 37-39 (2011).
210. RON WYDEN & PAUL RYAN, GUARANTEED CHOICES TO STRENGTHEN MEDICARE AND HEALTH SECURITY FOR ALL: BIPARTISAN OPTIONS FOR THE FUTURE 7-11 (2011).
211. Living Independently for Elders, GEISINGER, http://www.lifegeisinger.org (last visited Oct. 24, 2012).
212. Medicare Plans, SHARP, http://www.sharp.com/seniors/medicare-plans.cfm (last visited Oct. 24, 2012).
213. Jerry L. Mashaw, Federal Administration and Administrative Law in the Gilded Age, 119 YALE L.J. 1362, (2010), supra note 13, at 1428.
214. NICHOLAS R. PARRILLO, AGAINST THE PROFIT MOTIVE: THE SALARY REVOLUTION IN AMERICAN GOVERNMENT, 1780-1940, ch. 4 (forthcoming 2013).
215. Jerry L. Mashaw, Federal Administration and Administrative Law in the Gilded Age, 119 YALE L.J. 1362, (2010), supra note 13, at 1432.