Unbiased Analysis of Today's Healthcare Issues

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] […]

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What is MIPS?

Yesterday I posted about MIPS, the new Medicare physician reimbursement program set to begin in 2019.  The Health Affairs blog provides a nice summary of some of the changes. First and probably most importantly, the formulaic approach to setting base payment rates is gone, replaced with automatic increases for all doctors from 2015 through 2019. For […]

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Medicaid Expansion and States’ bottom line

A recent RWJF Issue Brief notes that states that expanded Medicaid received more revenue from the federal government and had less state-level spending on programs that support the uninsured. In examining Medicaid expansion across eight states—Arkansas, Colorado, Kentucky, Michigan, New Mexico, Oregon, Washington and West Virginia—it is clear that states are realizing savings and revenue […]

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Transitioning to Alternative Payment Models

CMS has stated that they want 30% of all fee-for-service payments to be transitioned to alternative payment models–such as pay for performance–in the upcoming years.  A future where all providers are paid capitation or based on some measure of value is not here yet.  And in the interim, providers are dealing with a complex system […]

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5 Trends 5 years after by ACA

From a PwC report on “Five trends to watch as the Affordable Care Act turns five“: Risk Shift: Raising the stakes for all healthcare players. The ACA added force to new payment models that reward outcomes and penalize poor performance such as high rates of readmission and hospital-acquired conditions. Primary care: Back to basics. Experimentation […]

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Medicaid Expansion States

Which states have decided to receive additional federal funds to expand the share of people they cover under Medicaid?  The Kaiser Family Foundation has the answer. Alabama Not Moving Forward at this Time Alaska  Not Moving Forward at this Time Arizona Implementing the Medicaid Expansion  Arkansas Implementing the Medicaid Expansion California  Implementing the Medicaid Expansion Colorado Implementing the Medicaid Expansion […]

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Who will pay the Cadillac tax?

Beginning in 2018, many individuals will face the “Cadillac” tax. What is the Cadillac tax? The Cadillac tax is a tax on high-cost health insurance plans. According to a Truven report, it is calculated as “40 percent of the excess of total per employee per year (PEPY) healthcare costs above statutory threshold limits of $10,200 […]

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Will Obamacare Increase the share of Part-Time Workers?

The ACA requires large employers to provide coverage to all full-time workers. However, providing insurance is costly. Will employers avoid this requirement by hiring more part-time workers? An Urban Institute report claims that this is not the case. We find no evidence that the ACA had already started increasing part-time work before 2014. We find […]

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How did the ACA affect Employer-Sponsored Insurance?

Most people think that the Affordable Care Act (ACA) has focused on decreasing uninsurance rates by creating health insurance exchanges, providing subsidies for health insurance premiums for these exchanges, and expanding Medicaid. The ACA also has affected a number of other segments of the health care industry. Less well known is that the ACA also affected […]

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Obamacare will Increase Use of Elective Surgeries

Expanding health insurance causes moral hazard.  Patients who bear a lower share of cost will inevitably use more health care serices.  On the one hand, this increases the cost of the health care system; on the other hand, the patients who receive the additional care likely have better health outcomes. However, which services will patients who are newly […]

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