California: Mandatory Enrollment of Seniors and the Disabled into Managed Care

In 2010, CMS approved California’s “Bridge to Reform” waiver request that authorized the state to expand its mandatory managed care to seniors and people with disabilities covered by Medi-Cal.  Authorized under a Section 1115 waiver, the policy affected nearly 400,000 Medi-Cal enrollees, including 240,000 who were moved from fee-for-service into managed care between June 2011…

Excellence

“We are what we repeatedly do. Excellence, then, is not an act, but a habit.” ~ Aristotle “For me, pushing myself is way more about ‘It’s hard to make something that’s interesting.’ It’s really, really hard, and I’m sure we don’t succeed with every story on every show. Basically, anything that anyone makes…It’s like a…

Effect of Outpatient PPS on Medicare Volume

Implemented on August 1, 2000, Medicare’s Outpatient Prospective Payment System (OPPS) classifies hospital outpatient services into approximately 800 ambulatory payment classifications (APCs) based on clinical and cost similarity. Medicare reimburses the hospital the same amount for each APC–with adjustments for local labor costs, certain hospitals, and outlier cases–regardless of the mix of services provided. How…