Unbiased Analysis of Today's Healthcare Issues

Health care to comprise 20% of the US economy by 2025

That is the conclusion reacted by CMS’ Office of the Actuary.  As published in a recent Health Affairs article: Under current law, national health expenditures are projected to grow at an average annual rate of 5.6 percent for 2016–25 and represent 19.9 percent of gross domestic product by 2025. For 2016, national health expenditure growth is anticipated to […]

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VBID comes to Medicare Advantage

CMS announced last week that they are extending their value-based insurance design (VBID) program to more states and more patients.  I describe VBID and the proposed changes below. What is VBID? Value-Based Insurance Design (VBID) generally refers to health insurers’ efforts to structure enrollee cost sharing and other health plan design elements to encourage enrollees […]

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Core Quality Measures

One challenge providers have faced in the past is that quality measure reporting has been complex.  Medicare may ask for quality measures with one definition, commercial payers may define quality a second way, and Medicaid may ask for a third definition of quality.  Keeping track of these definitions and recording quality measures distracts providers from actually providing quality […]

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What is Comprehensive Care for Joint Replacement?

Bundled Payments for Care Improvement (BPCI)A helpful post from Steven A. Farmer, Meaghan George and Mark B. McClellan explains.  Comprehensive Care for Joint Replacement (CCJR) is a bundled payment structure for hip and knee replacements.  CMS notes that: 2013, there were more than 400,000 inpatient primary procedures in Medicare, costing more than $7 billion for hospitalization alone. […]

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1 in 5 dollars of the US economy to be spent on healthcare by 2023

CMS Office of the Actuary (OACT) projects that the slowdown in healthcare spending will not last. From an article in Health Affairs this month: In 2013 health spending growth is expected to have remained slow, at 3.6 percent, as a result of the sluggish economic recovery, the effects of sequestration, and continued increases in private […]

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Too much competition?

Rarely due consumers think that too much competition is a problem.  According to the Centers for Medicare and Medicaid Services (CMS), however, this is a major issue for consumers when they choose Part D prescription drug health plans.  Avalere reports that: Proposed revisions to the meaningful differences policy will restrict the market’s top sponsors from […]

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Medicare reducing reimbursement for low-quality docs

In 2015, Medicare will begin implementing a value-based purchasing (VPB) program for physicians.  Initially the program will target only certain physicians and groups of physicians, but by 2017 all physicians is participate in this program. The VBP program will evaluate physicians along two broad dimensions: quality and cost.  In the final rule: Section 1848(p) of […]

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Another Blow to Health Reform?

The head of the Centers for Medicare and Medicaid Services (CMS), Don Berwick, announced he would step down from his post on Wednesday.  Berwick was a temporary 18 month appointment who Obama hoped would stay on longer.  The San Francisco Chronicle reports “The point man for carrying out President Obama’s health care law will be stepping down […]

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Does Medicare use CPT codes for payment?

For Part B services, Medicare pays physicians based on the services they provide.  The American Medical Association (AMA) developed Current Procedural Terminology (CPT) codes to create a taxonomy of procedures that physicians perform.  Does the Centers for Medicare and Medicaid Services (CMS) use these codes for payment? The answer is yes and no.  Officially, CMS […]

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Center for Medicare and Medicaid Innovation

Medicare and Innovation in the same sentence?  Yes indeed. As part of Health Reform [i.e, Patient Protection and Affordable Care Act (PPACA)], the government mandated the creation of the Center for Medicare and Medicaid Innovation (CMI). What does CMI do?  “The stated purpose of the CMI is to test innovative payment and service delivery models […]

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