Insurance

Almost all pharmacy and therapeutic committees have a unique process for evidence-based formulary decision making, said Steven Pearson, MD, founder & president, Institute for Clinical and Economic Review.

Edmund J. Pezalla, MD, MPH, national medical director, Aetna Pharmacy Management, suggest that the healthcare industry will continue to move in the direction of providing patients incentives to make use of health risk assessment tools and screenings.

Joseph Antos, the Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute, says the federal Medicare program not only has a spending problem, but a delivery system problem that the fee-for-service model has not solved.

Hospitals spend less on operations-largely by squeezing labor costs-to make up for lost revenue when Medicare cuts hospital prices, according to a study.

In five markets around the country, accountable care organizations were providing care to more than half the Medicare patients in the traditional fee-for-service program, a new study found. In addition, ACOs were more likely to be found in markets with greater consolidation by hospitals and doctors.

In the past few years, efforts to lower costs and improve care have proliferated.

There's a Medicare prescription-drug coverage abyss that is playfully referred to as the "doughnut hole," though there is nothing sweet or amusing about it.

As the government shutdown drags on, patients and providers are feeling the strain.

Barry Singer, MD, director, MS Center for Innovations in Care, St. Louis, MO, said that the Affordable Care Act could cause challenges in terms of coverage.

Hospitals will be paid nearly the same rates by health plans sold through new state insurance exchanges as by plans sold to employers outside them, say analysts and hospital system executives.

Medicare officials announced Thursday that they will delay enforcement of controversial new rules that define when hospital patients should receive observation care, rather than being admitted, a distinction that makes beneficiaries ineligible for follow-up nursing home coverage.

Melanie Bella, director, Medicare-Medicaid Coordination Office, Centers for Medicare & Medicaid Services, says the sole focus of the Medicare-Medicaid Coordination Office is to increase coordination and access to services from many fronts.

The sweeping federal health care law making its major public debut next month was meant for people like Juanita Stonebraker, 63, from Oakland, Md., who retired from her job in a hospital billing office a year and a half ago.

Federally qualified health centers would receive higher Medicare reimbursements starting next year, under a proposed rule issued by the CMS.

Associations between out-of-pocket costs and prescription reversals, as well as impact of reversals on rehospitalizations and healthcare costs, were examined among patients prescribed oral linezolid.

MedPAC, the Congressional advisory committee on Medicare, discussed how to get patients more involved in their health decisions.

Federal officials for more than a decade have let hospitals charge Medicare varying rates for certain emergency department overhead and staffing costs called facility fees-a controversial policy some critics believe invites overcharges.

Hospitals and healthcare systems nationwide are increasingly buying more physician practices as health reform requires care delivery to move toward a more quality-based care model instead of a fee-for-service one. The reactions are mixed.

Bargaining leverage, not the cost of providing complex care, is the main reason why some hospitals can demand prices twice as high as their competitors' and still get contracts to treat privately insured patients, according to a new study.

A new poll conducted by the American College of Physician Executives has found that doctors are almost evenly divided on whether or not Medicare payment data should be made public.

Darius Lakdawalla, PhD, addresses the value of diabetes patients' adherence in this clip.

The U.S. health care bureaucracy is expanding; both dramatically (e.g. the implementation of the Affordable Care Act) and gradually. A recent decision proposed by the Centers for Medicare & Medicaid Services (CMS) exemplifies the dangers to medical innovation and patients represented by the gradual expansion of the health care bureaucracy.

Debated and despised, the Medicare physician payment formula may finally be on the way out at least that's what AMA President Ardis Hoven believes.

Amitabh Chandra, PhD, says health reform affects patient-centered diabetes care through two different interventions.

Only 6 states across the country are currently receiving funds through the Affordable Care Act (ACA) provision intended to increase Medicaid managed-care payments to meet Medicare payment levels.

Medicare may enjoy the fruits of the growing and varied work among private payers and providers to boost value in healthcare, though the benefits will come sooner to costs than quality, a study suggests.

A new study from The American Journal of Pharmacy Benefits finds that physicians who treat cancer patients may be influenced by the reimbursement policies of the Medicare claim processors that pay them.

Could Medicare payment models impact a physician's decision to prescribe cancer drug supplements? A recent study from The American Journal of Pharmacy Benefits published new findings that say they can.

Facing anticipated reductions in funding and regulatory changes under the health care reform law, several of the nation's largest health insurers have indicated plans to scale back their Medicare Advantage programs.