Insurance

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.

Hagop Kantarjian, MD, from MD Anderson is at it again. A special publication online, written in collaboration with S. Vincent Kumar, MD, from the Mayo Clinic, highlights the dismal state of the economics behind high oncology drug costs and recommends solutions.

Cardiologists treat patients who are older, sicker, and more reliant on Medicare. That means they must pay attention to new payment models from CMS that reduce reliance on fee-for-service and increase the presence of accountable care organizations.

Momentum is building in Congress for a proposal that would abolish Medicare cuts, top Republicans said Thursday, despite the emerging battle over the $174 billion price tag.

Until recently, it's been unclear whether accountable care organizations can live up to the hype or are just a passing healthcare reform fad.

Congress came close to adopting a value-based payment formula for physicians last year, but the problem of funding the SGR, which has grown to $175 billion, prevents a solution.

One of the criticisms, which came from ASCO, points to the absence of consideration for patient heterogeneity that can result in physicians being penalized for providing patient-centered treatment.

CMS has proposed several possible changes to the Medicare Shared Savings Program in an effort to attract new participants and to encourage current participants to continue with the program beyond their initial 3-year commitment.

New proposals from Congress would decrease Medicare payments to hospital outpatient departments, which traditionally serve patients who are more likely to be minority, poorer, and have more severe chronic conditions compared with patients treated in physician offices.

Under the Affordable Care Act, CMS is charged with evaluating how well accepted quality measures are working to help meet a National Quality Strategy.

Awareness of chronic kidney disease remains low in the United States, yet the prevalence of the disease will rise over the next 15 years, according to a model developed by RTI.

Federal investigators say they have found evidence of widespread overuse of psychiatric drugs by older Americans with Alzheimer's disease, and are recommending that Medicare officials take immediate action to reduce unnecessary prescriptions.