Unbiased Analysis of Today's Healthcare Issues
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…
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…
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…
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…
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…
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…
A hospital in New York City faces higher labor costs than a hospital in Billings, Montana. To take into account these cost differences, Medicare adjusts hospital payments to reflect these cost differences using a hospital wage index. As currently constructed, however, many hospitals petition to be included in labor markets where they would receive a…
“The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires the Department of Health and Human Services (DHHS) to develop a plan that will transition Medicare payments into a VBP [value based purchasing] program for physician and other professional services that is based on efficiency and the quality of services provided. The Act…
From the CMS Office of the Actuary: U.S. health care spending growth decelerated in 2008, increasing 4.4 percent compared to 6.0 percent in 2007, as spending growth slowed for nearly all health care goods and services, particularly for hospitals. Health spending growth for state and local and private sources of funds also slowed while federal…
Joe Paduda of Managed Care Matters has a two great posts on Medicare’s new payment structure. The first post reports how exactly Medicare is changing its reimbursement for medical services. “It looks like reimbursement for cognitive services – the 99xxx codes for readers expert in CPT-4s…office visits and similar services for others – will…