Health Affairs

On Tuesday, June 5, Health Affairs will hold a briefing to discuss its June 2012 issue, “Focus On The Care Span For The Elderly And Disabled.” The volume explores a wide range of topics — from avoidable hospital admissions and readmissions, to coordination of care for dual eligibles, to reforming Medicare payment for skilled nursing... Read the rest of this entry »

As Integrated Delivery Networks (IDNs) assess the financial implications of accountable care, six key variables deserve special attention. These variables are unique because they will shape both the accuracy of future financial projections and begin to set the broader strategy for the ACO. Variable 1: The Halo Effect. As IDNs shift utilization patterns of their... Read the rest of this entry »

On May 9th, William Nickerson, Senior Judge in the Southern Maryland Federal District Court, issued a 15 page ruling against the six Augusta, GA primary care physician plaintiffs who challenged HHS’ and CMS’ longstanding relationship with the American Medical Association’s Relative Value Scale Update Committee (RUC). The opinion did not weigh the substance of the... Read the rest of this entry »

On May 9, 2012, the Center for Medicare and Medicaid Services released proposed regulations to implement section 1202 of the Health Care and Education Reform Act of 2010. Section 1202 increases Medicaid payments made to primary care physicians for primary care services during the years 2013 and 2014 to Medicare payment rates, with the additional... Read the rest of this entry »

To calculate physicians’ fees under Medicare—which in turn influence private payers’ decisions on how they will pay doctors—the Centers for Medicare and Medicaid Services (CMS) relies on the recommendations of a controversial advisory panel known as the RUC (the Relative Value Update Committee), which mainly represents a broad group of national physicians’ organizations. In recent... Read the rest of this entry »

If, as suggested in the April Health Affairs article by Andrew Ryan and coauthors, the Premier/Medicare Hospital Quality Incentive Demonstration (HQID) program failed to achieve its goals, we can only hope that all subsequent demonstration projects fail so successfully. The fact is HQID showed that the combination of rewarding performance improvement and providing transparency of... Read the rest of this entry »

Whether Medicare Advantage plans should be paid more than traditional Medicare has long been an issue of debate. In the Patient Protection and Affordable Care Act of 2010, Congress voted to narrow the difference in payments between the two programs from 2012-2017, with some offsets based on quality bonuses for plans with higher quality scores.... Read the rest of this entry »

Editor’s note: In the April issue of Health Affairs, Jean Mitchell reported that “self-referring” urologists, who billed Medicare for both prostate biopsies and the associated surgical pathology services, charged Medicare for more specimens per prostate biopsy than non-self-referring urologists sent to independent pathology providers. Additionally, the regression-adjusted cancer detection rate was higher for men treated... Read the rest of this entry »

Editor’s note: In the April issue of Health Affairs, Jean Mitchell reported that “self-referring” urologists, who billed Medicare for both prostate biopsies and the associated surgical pathology services, charged Medicare for more specimens per prostate biopsy than non-self-referring urologists sent to independent pathology providers. Additionally, the regression-adjusted cancer detection rate was higher for men treated by... Read the rest of this entry »

On April 10, Charles Blahous released a paper on the fiscal consequences of the Affordable Care Act. On Friday, Health Affairs Blog offered a condensed and modified version of that paper, along with responses to the April 10 paper from Paul Van de Water and Len Nichols. Below, Blahous replies to those responses. Paul Van... Read the rest of this entry »

The latest report from Medicare’s trustees, released yesterday drives home what many already know: Medicare poses a serious long-term budgeting challenge. But a close look look at the report also suggests that, while reforms and savings are clearly needed in the Medicare program, it would also be worthwhile and realistic to look at options for... Read the rest of this entry »

There are nearly nine million people in the United States who receive both Medicare and Medicaid benefits. Recent cost estimates show that this group, known as dual eligibles, accounts for a disproportionate share of spending in both programs. Although the Medicare and Medicaid programs were never intended to work together, a provision of the Affordable... Read the rest of this entry »

Editor’s note: On April 10, Charles Blahous released a paper on the fiscal consequences of the Affordable Care Act. Below Len Nichols responds to the arguments Blahous raised in the April 10 paper and offers his own views on the ACA’s fiscal consequences. In related Health Affairs Blog posts, Paul Van de Water responds to... Read the rest of this entry »

Editor’s note: On April 10, Charles Blahous released a paper on the fiscal consequences of the Affordable Care Act. Below Paul Van de Water responds to the arguments Blahous raised in the April 10 paper and offers his own views on the ACA’s fiscal consequences. In related Health Affairs Blog posts, Len Nichols responds to... Read the rest of this entry »

Editor’s note: On April 10, Charles Blahous released a paper on the fiscal consequences of the Affordable Care Act. Below Blahous presents a condensed and modified version of that paper. In related Health Affairs Blog posts, Paul Van de Water and Len Nichols respond to the arguments Blahous raised in the April 10 paper and... Read the rest of this entry »

While Representative Paul Ryan’s (R-WI) most recent Medicare premium support proposal will be hotly debated during this charged political season, the more durable issue is what it means for the real debate on Medicare that looms after the election.  Regardless of who wins this November, the country is faced with a massive deficit, driven in... Read the rest of this entry »

Editor’s note: For more on the first round of Medicare Shared Savings Program participants and payment and delivery system reform, see Douglas Hastings’s post. On Tuesday April 10, CMS announced 27 ACOs had begun operating under the Medicare Shared Savings Program (MSSP), joining the 32 Pioneer ACOs announced in December and the 6 physician group... Read the rest of this entry »

Editor’s note: For more on the first round of Medicare Shared Savings Program participants and payment and delivery system reform, see Steven Lieberman’s post. Back in 1996, the Federal Trade Commission and Department of Justice, in providing antitrust guidance for multi-provider networks, considered financial integration and clinical integration as separate pathways for such networks to... Read the rest of this entry »

Tomorrow, Thursday April 12, Health Affairs will hold a briefing to unveil its April 2012 issue, “Issues In Cancer Care: Value, Costs & Quality.” The volume explores a range of cancer-related topics, with the centerpiece a cluster of articles on assessing the value of high-cost cancer treatments. Please join us for the briefing at the... Read the rest of this entry »

On Thursday, April 12, Health Affairs will hold a briefing to unveil its April 2012 issue, “Issues In Cancer Care: Value, Costs & Quality.” The volume explores a range of cancer-related topics, with the centerpiece a cluster of articles on assessing the value of high-cost cancer treatments.  The cluster received funding support from Bristol-Myers Squibb;... Read the rest of this entry »