Medicare Advantage vs. FFS

Austin Frakt summarizes some recent research presented at AcademyHealth. There are three principle MA plan types: HMOs, PPOs, and private fee for service (PFFS) plans. It’s HMOs that are lowest in cost, because they tend to offer the most restrictive networks. As Biles et al. report, based on 2012 data, HMOs have costs 7 percent…

Health in Baltimore

Baltimore is in the news, and not for the best reasons.  The arrest and eventual death of Freddie Gray have unleashed a series of protests and riots.  One conference where the Healthcare Economist had a poster presentation–the American Heart Association (AHA) Quality of Care and Outcomes Research (QCOR) Scientific Sessions (conference) was cancelled this week due…

Medicare starts using prior authorization

Included within the many changes to physician payment in HR2, is one provision that may surprise people; a subset of Medicare physicians will be required to receive prior authorization to conduct imaging services. Beginning with 2017, and in consultation with stakeholders, the Secretary will identify ordering professionals with low adherence to applicable [appropriate use criteria]…