Insurance

The bipartisan budget deal reached this week could drag out efforts to overhaul Medicare's payment formula for physicians as lawmakers pursue a short-term fix and attempt to extend and make other tweaks to Medicare provisions, including significant changes to reimbursement for long-term acute care.

Congress' work to reshape physician payments under Medicare and repeal the sustainable growth rate (SGR) payment formula took several pivotal steps this week.

Thousands of hospitals, large and small, are girding for cuts to their Medicare payments in 2014, as federal pay-for-performance programs aimed at boosting clinical quality, improving patient experience and preventing unnecessary hospital readmissions roll into their second year.

The downward trend in preventable hospital readmissions that began in 2012 has continued well into this year, according to data published Friday on the CMS' blog. Quality experts were impressed but had questions.

A bicameral effort is quickly gaining traction in an effort that would forever change the sustainable growth rate (SGR) and Medicare reimbursement model.

Medicare has agreed to allow specialist medical societies to determine the quality measures physicians will report when the new reporting system goes into effect on Jan. 1.

By all accounts, the shopping experience on HealthCare.gov has improved significantly. That means customers can routinely access information about what health plans and subsidies are available and select the product of their choice.

As the CMS begins the second year of a penalty program for preventable hospital readmissions required by the healthcare reform law, new research indicates that hospitals fare better when they focus on patient care more generally rather than targeting specific conditions, such heart failure, or specific timeframes, such as 30 days post-discharge.

Dr. Farzad Mostashari, former National Coordinator of Health IT, serves as guest editor of a special issue of AJMC, which covers the breadth of issues concerning how technology is affecting healthcare delivery, quality of care, and payment reform.

In what is likely to be a relief to dialysis providers, the CMS decided to phase in the controversial payment cut to dialysis providers over a three- to four-year period.

Electronic health records are changing the way your family doctor does business, with most now able to view lab results or send a prescription online, a change that advocates say will improve efficiency and lead to fewer medical errors.

New case management model achieves success in reducing readmissions and is easily duplicated across the Baptist Health System, Inc.

The administration was warned last spring that its website didn't meet key requirements for a successful rollout, including relying too heavily on outside contractors, according to a copy of a Red Team report.

More than 200 participants gathered in Baltimore for "Patient-Centered Oncology: Real-World Perspectives," which covered genetic testing, how to engage patients in decision-making, and how the "culture of medicine" continues to drive up costs despite calls to abandon the fee-for-service payment model.

Medicare payment reforms require valid measures of high-quality healthcare. Different types of administrative wait time measures predicted glycated hemoglobin levels for new and returning patients.

Finding a health plan on the Medicare website could be troublesome for some seniors.

More hospitals are receiving penalties than bonuses in the second year of Medicare's quality incentive program, and the average penalty is steeper than it was last year, government records show.

Researchers who want to study population health using the vast stores of Medicare and Medicaid data will no longer have to order it and wait for the federal government to ship them encrypted data files.

CMS Administrator Touted HealthCare.gov on Eve of Troubled Rollout

The American Journal of Managed Care recently sat with Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services (CMS), as she discussed CMS's role in the new, evolving healthcare landscape. This special AJMCtv interview highlights just some of the initiatives CMS has implemented, as well as some of the challenges that remain for the organization.

For all the current focus on Obamacare lurching into its infancy, 50-year-old Medicare is also undergoing profound and disruptive change as Congress struggles with soaring medical bills and a growing senior population.

The Senate Finance Committee and House Ways and Means Committee jointly released their draft legislation to reform physician payment under Medicare on October 30.

The premiums for Medicare Part B will remain flat in 2014 and seniors have saved $8.3 billion on Part D prescriptions since the Affordable Care Act was enacted in 2010, the Department of Health and Human Services announced Monday.

Many physicians around the country are getting notices from Advantage plans that they are being cut from private insurers' networks. In addition, some insurers have announced they are reducing their Advantage plan offerings in some states, trimming extra benefits and increasing patient cost sharing.

Raising the eligibility age for enrolling in Medicare won't produce nearly the cost savings that had been assumed previously, said a new report issued Thursday.

This study identified inefficiencies in drug and medical service utilization related to pain management among Medicare members with osteoarthritis and chronic low back pain.

Convention wisdom has long held that hospitals make up for reimbursement shortfalls in government insurance and uncompensated care by shifting those costs to the privately insured.

Katherine Baicker, PhD, professor of health economics, Department of Health Policy and Management, Harvard School of Public Health, says that Medicare Advantage Plans still hold promise to deliver high-value, better-tailored care to beneficiaries.