Insurance

For the last 17 years Congress has passed temporary 1-year fixes to prevent the Sustainable Growth Rate from enacting steep cuts to Medicare payments. This year, Congress is again flirting with the possibility of creating a permanent fix.

The fine is a result of the company falsifying sales price data to Medicare. In addition to the fine, Sandoz has to provide evidence that it has established a government pricing compliance program.

A study that combined socioeconomic data and hospital-level data on quality care after myocardial infarction showed that hospitals that serve the poorest Americans adhere to high standards, but patient outcomes do not always reflect that high-quality acute care.

The study, published in the Annals of Emergency Medicine found that patient-centered medical homes (PCMHs) saw slower growth in emergency department (ED) visits and lower payment per beneficiary. However, only 32% of PCMHs agreed to share their data, and those medical homes treated "healthier patients" who may have been less likely to need ED visits, the authors acknowledge.

Hagop Kantarjian, MD, from MD Anderson is at it again. A special publication online, written in collaboration with S. Vincent Kumar, MD, from the Mayo Clinic, highlights the dismal state of the economics behind high oncology drug costs and recommends solutions.

Cardiologists treat patients who are older, sicker, and more reliant on Medicare. That means they must pay attention to new payment models from CMS that reduce reliance on fee-for-service and increase the presence of accountable care organizations.

Momentum is building in Congress for a proposal that would abolish Medicare cuts, top Republicans said Thursday, despite the emerging battle over the $174 billion price tag.

Until recently, it's been unclear whether accountable care organizations can live up to the hype or are just a passing healthcare reform fad.

Congress came close to adopting a value-based payment formula for physicians last year, but the problem of funding the SGR, which has grown to $175 billion, prevents a solution.

One of the criticisms, which came from ASCO, points to the absence of consideration for patient heterogeneity that can result in physicians being penalized for providing patient-centered treatment.

CMS has proposed several possible changes to the Medicare Shared Savings Program in an effort to attract new participants and to encourage current participants to continue with the program beyond their initial 3-year commitment.

New proposals from Congress would decrease Medicare payments to hospital outpatient departments, which traditionally serve patients who are more likely to be minority, poorer, and have more severe chronic conditions compared with patients treated in physician offices.

Under the Affordable Care Act, CMS is charged with evaluating how well accepted quality measures are working to help meet a National Quality Strategy.

Awareness of chronic kidney disease remains low in the United States, yet the prevalence of the disease will rise over the next 15 years, according to a model developed by RTI.

Federal investigators say they have found evidence of widespread overuse of psychiatric drugs by older Americans with Alzheimer's disease, and are recommending that Medicare officials take immediate action to reduce unnecessary prescriptions.

A recent survey indicates healthcare providers are eager to adopt a chronic care management platform that would qualify them for newly available Medicare reimbursements.

Proposed payment cuts to Medicare Advantage (MA) could cause many beneficiaries to lose access to MA plans and cause great disruption to the market, according to a new report by Oliver Wyman for America's Health Insurance Plans.

Budget cuts mean county health clinics will be unable to fill hundreds of jobs, leaving smaller staffs to serve low-income people in state that declined to expand Medicaid despite pleas from its hospitals and business leaders.

CMS has released proposed changes for the Medicare Advantage and Part D Prescription Drug Programs that help build a better, smarter healthcare system and move the Medicare program toward paying providers based on quality of care.

For decades, hospital executives across the country have justified expensive renovation and expansion projects by saying they will lead to better patient reviews and recommendations.

A study published today in JAMA suggests that former long-term smokers who have quit for more than 15 years would benefit from access to the lung cancer screening recently approved for coverage by Medicare; however, these smokers no longer meet the criteria.

The Medicare prescription-drug benefit introduced in 2006 saved an estimated 19,000 to 27,000 lives in its first year by expanding access to medications that treat cardiovascular killers like strokes and heart disease.

According to a healthcare consultant, hospitals that handle high patient volume tend to receive lower patient satisfaction scores than the smaller, specialty hospitals. The discrepancy in the patient demographic and the kind of procedures being conducted need to be considered when evaluating hospitals, experts think.

Hospital super utilizers in Pennsylvania account for $761 million of the state's Medicare and Medicaid expenditures for inpatient stays, according to a new report from the Pennsylvania Health Care Cost Containment Council.

A Wall Street Journal analysis found many long-term hospitals discharge a disproportionate share of patients during the time when hospitals stand to make the most.

Published in the Journal of Nuclear Medicine, the authors show that a fourth and subsequent follow-up PET/CT scan in lung cancer patients was associated with treatment change.

Two PCSK9 inhibitors under development-one by Amgen and the other jointly by Sanofi and Regeneron-could eventually cost the US healthcare system $150 billion per year. William Shrank, the chief scientific officer of CVS thinks these costs would be unsustainable for the healthcare industry that is already rattled by the burgeoning cost of specialty medications.