In Louisiana, Nursing Home Managed Care Fight Creates Different Battle Lines
April 23rd 2015Nursing home operators are asking legislators for a "carve out" from the state's managed care plan. The AARP says this will retain a system that keeps state funds way from caring for the elderly in their homes, which most Louisiana residents prefer.
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Kaiser Poll Finds Strong Support to Control Drug Prices
April 21st 2015The Kaiser Health Tracking Poll found Americans strongly support ensuring that those with chronic conditions like cancer, HIV, and mental illness can have access to affordable drugs, and this sentiment was shared across partisan lines.
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Florida Standoff Could Disrupt Managed Care Progress in Medicaid
April 20th 2015Governor Rick Scott's decision to sue CMS could harm an opportunity to expand a pilot program in Medicaid managed care first championed by former Republican Governor Jeb Bush, which was found to save $118 million a year. It was praised by the conservative Heritage Foundation.
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Could Missouri Be Next to Expand Medicaid Managed Care?
April 16th 2015Missouri already spends $1.2 billion on Medicaid managed care in less than half its counties. The new plan would extend managed care to all Medicaid clients except the blind, disabled, and elderly. Meanwhile, in North Carolina, the CEO of the Medical Society argued against moving Medicaid to managed care, citing problems in other states.
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USPSTF Evidence Review Could Lead to Revised Screening Guidelines
April 15th 2015Recent emphasis of identifying those with prediabetes and intervening to halt its progression is aimed at reducing the financial impact of diabetes in the United States, which was estimated in 2012 at $245 billion.
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Two Tales of Medicaid Expansion: in Montana, a Step Forward; in Florida, a Step Back
April 10th 2015In Montana, 13 Republicans helped give a Medicaid expansion bill a solid majority to send it back to the Senate for reconciliation. A bill signing could come by next week. In Florida, Governor Rick Scott appeared to reverse his 2013 position that he could not deny the uninsured access to care.
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Tying Financial Incentives to Healthy Behavior Isn't So Easy
April 9th 2015Incentives in employee wellness programs, especially penalties, can hurt morale and lead to legal action. But without incentives, there's no guarantee the employer will see healthcare savings and return on investment.
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Study Finds Delay in Melanoma Surgery for 1 in 5 Medicare Beneficiaries
April 8th 2015The study's lead author said delays in melanoma surgery were more common than expected, and the team at Yale School of Medicine is looking into explanations. Right now, there is no "gold standard" for how long it should take between a diagnosis and excision.
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Auditor's Report Reveals Challenges in Kentucky's Healthcare Success Story
April 3rd 2015A 2011 switch to Medicaid managed care, which occurred during a budget crisis, has been blamed for financial challenges at rural hospitals and declining numbers of providers. Auditor Adam Edelen said the plight of Kentucky's rural hospitals is complex but must be addressed.
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Through Partnership, Pancreatic Cancer Patients Gain Access to Personal Treatment Options
April 1st 2015The "Know Your Tumor" initiative of the Pancreatic Cancer Action network refers newly diagnosed patients to Perthera, which provides a unique service to ensure timely tissue collection, molecular diagnostic testing, and a report with recommendations for the oncologist.
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Senate Punts on SGR Reform After House Passes Value-Based Incentives
March 27th 2015The overhaul would fix the Medicare reimbursement system and align payment with CMS' current efforts to reward value-based care. For the first time, the wealthiest seniors would be asked to pay higher premiums.
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Analysis: Half of Households With ACA Subsidy to Owe Repayment, 45% to Get Refund
March 24th 2015The most common reasons for repayments or refunds are changes in income or family size. The law allows consumers to report these changes to the Marketplace throughout the year, but with the law being so new, most 2014 reconciliations will happen during tax filing.
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As ACA Nears 5-Year Mark, Opinion Still Divided But Less So
March 20th 2015Opinion on the Affordable Care Act still breaks sharply along partisan lines, making the prospects for even technical fixes unlikely, much less a major change that might be needed in the wake of a ruling in King v. Burwell that would take away premium subsidies in states without their own exchanges.
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Viewpoint Addresses Managed Care Challenge for Surgeons: Avoiding Out-of-Network Bills for Consults
March 19th 2015Patients need transparency if another surgeon will be consulting on their procedure so there are no surprises. The authors suggest payers should extend emergency provisions to intraoperative consultations when complications arise. The movement toward bundled payments will reduce the chance for out-of-network bills, as hospitals will divide payment.
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