Insurance

While Medicare is ready to pay for an annual spiral CT scan for long-term smokers, some doctors think it's an unnecessary procedure that might do more harm than good.

Cancer patients without insurance can be paying up to 43 times what Medicare pays for the same chemotherapy drugs, according to a new study published in Health Affairs from the University of North Carolina at Chapel Hill.

A new coalition of consumers, healthcare providers, and industry launched the Clear Choices Campaign on April 9 to advocate for more transparent, accountable, and consumer-friendly health markets.

UPMC is threatening to lock Highmark's Medicare Advantage customers out of its hospitals, a move Governor Tom Wolf calls "unacceptable."

In Montana, 13 Republicans helped give a Medicaid expansion bill a solid majority to send it back to the Senate for reconciliation. A bill signing could come by next week. In Florida, Governor Rick Scott appeared to reverse his 2013 position that he could not deny the uninsured access to care.

The study's lead author said delays in melanoma surgery were more common than expected, and the team at Yale School of Medicine is looking into explanations. Right now, there is no "gold standard" for how long it should take between a diagnosis and excision.

Instead of the original 0.95% rate cut for the Medicare Advantage (MA) program proposed in February, CMS announced on Monday that the MA pay rate for 2016 would be a 1.25% increase.

Medicare Advantage has the potential to be the most powerful part of the solution for American healthcare, but the government needs to create reimbursement stability in order for that to happen, said Kent Thiry, chief executive officer of DaVita Healthcare Partners Inc.

Physicians were accepting nearly equal amounts of new Medicare and privately insured patients in 2013, but much fewer were accepting new Medicaid patients, according to a new report from the CDC's National Center for Health Statistics.

Long before patient-centered care and value-based models were the order of the day, Geisinger was focused on delivery care that was not focused on figuring out who would pay the bill.

The failure of federal agencies to implement 25 sets of "significant" recommendations from the HHS Office of Inspector General has cost US taxpayers and beneficiaries some $24 billion.

The overhaul would fix the Medicare reimbursement system and align payment with CMS' current efforts to reward value-based care. For the first time, the wealthiest seniors would be asked to pay higher premiums.

Links between cardiorespiratory fitness and cardiovascular events are well-established. More recently, researchers are turning their attention to the connections between fitness and certain cancers.

The Health Care Payment Learning and Action Network kicked off with its inaugural meeting bringing together public and private sector actors to discuss efforts to move healthcare toward a system that pays based on quality rather than quantity.

In a show of solidarity, state oncology societies from across the United States today joined the American Society of Clinical Oncology in its call on Congress to repeal Medicare's Sustainable Growth Rate formula before the current payment patch expires at the end of the month.

More than $3 billion was returned to the Medicare Trust Fund in 2014 from individuals and companies attempting to defraud federal health programs, according to an announcement by HHS.

A one-minute look at managed care news during the week of March 16, 2015, including bills from Congress to fix the sustainable growth rate formula and anticipation over the PCSK9 inhibitors.

A bipartisan coalition in the House and Senate introduced identical bills that repeal Medicare's notorious formula for setting physician pay and, have implications for health information technology.

CMS released its proposed rules for Stage 3 meaningful use for the Medicare and Medicaid Electronic Health Records Incentive Programs. The proposed rules will include greater flexibility and drive interoperability, according to HHS.

Increasing adherence to inhaled corticosteroids for Medicaid-enrolled children with asthma could cost-effectively decrease both Medicaid spending and adverse clinical outcomes.

"It's so ironic that CMMI, the innovation arm of CMS, is trying to sell us on implementing a new payment model for oncology while community oncology practices are struggling financially to keep their doors open because of CMS payment cuts," said Ted Okon, executive director, Community Oncology Alliance.

The agreement would put an end to 17 straight fixes to the sustainable growth rate that have not found a permanent solution for addressing the Medicare cost cuts envisioned in the original legislation.

Providers' perspectives point to key considerations for policy makers as they seek to broaden participation in the Bundled Payments for Care Improvement Initiative.

The ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, launched a little over a year ago to give stakeholders focused on accountable care opportunities to share ideas on how to move from volume- to value-based models. The Coalition's most recent Web-based session shows how meetings have evolved to highly detailed discussions of how organizations are making those transitions.

Public comments on the first ever update to the Medicare Shared Savings Program are in. Conceptually, there is an astounding level of consensus, but it is the details that can make or break an ACO.

For the last 17 years Congress has passed temporary 1-year fixes to prevent the Sustainable Growth Rate from enacting steep cuts to Medicare payments. This year, Congress is again flirting with the possibility of creating a permanent fix.

The fine is a result of the company falsifying sales price data to Medicare. In addition to the fine, Sandoz has to provide evidence that it has established a government pricing compliance program.

A study that combined socioeconomic data and hospital-level data on quality care after myocardial infarction showed that hospitals that serve the poorest Americans adhere to high standards, but patient outcomes do not always reflect that high-quality acute care.

The study, published in the Annals of Emergency Medicine found that patient-centered medical homes (PCMHs) saw slower growth in emergency department (ED) visits and lower payment per beneficiary. However, only 32% of PCMHs agreed to share their data, and those medical homes treated "healthier patients" who may have been less likely to need ED visits, the authors acknowledge.