Insurance

Oncology clinical pathways have helped health plans deliver quality care while keeping an eye on costs. The lack of standardization in pathways can be cumbersome on a busy oncology practice. If Medicare adopts a pathways model, it could offer a framework for broader use.

Current reform efforts seek to tie providers' pay with performance, yet a recent finding suggests that less than 15% of internal medicine residency programs provide education that focuses on such training.

The American Medical Association pledged its full support for legislation repealing the Medicare sustainable growth-rate physician payment formula.

Susan Fox, director, business and product development, US Script, Inc, says the prescription benefit provides a unique opportunity to attract, attain, serve, and retain members in exchange insurance plans

Earning Too Little for Health-Law Subsidies but Ineligible for Benefits Under Existing Medicaid Programs

The CMS is extending the deadline for physicians and other eligible professionals to attest to meaningful use for the Medicare EHR incentive program for the 2013 reporting year and is offering some hospitals a second chance at receiving payment-as well as possible relief from the program's 2015 penalties for failing to comply in 2013.

With hospitals vehemently opposed to more Medicare cuts to fund the bipartisan legislation unveiled Thursday that would permanently end the annual charade around physician pay cuts, Congress may have to enact some form of payment or tax reform if it expects to get the job done this year.

A bipartisan agreement has been reached regarding the sustainable growth rate (SGR) and Medicare reimbursement model.

As out-of-pocket medical costs grow for many Americans, the insurance industry is offering a way to help and, at the same time, expand its business: by selling supplemental policies that may fill the gaps for consumers.

Healthcare providers say Medicare is going to short-change them on patients who spend fewer than two nights in the hospital, and delaying implementation of a new payment policy until October won't change that.

The Obama administration on Thursday reported what it called encouraging results from efforts to reduce healthcare costs and improve the quality of care for more than 5 million Medicare beneficiaries under Obamacare

Nearly half of the organizations in the CMS' largest test of accountable care slowed Medicare spending, but just 29 of 114 ACOs saved enough to receive bonus payments, the agency said.

It sounds like an oxymoron -- semi-permanent repeal -- but some former Medicare administrators are suggesting it as a solution to permanently repealing Medicare's much-hated sustainable growth rate (SGR) payment formula.

There is a radical and bipartisan bill making its way to Congress that could change the future of Medicare.

Conference Coverage: Diabetes Innovation

Cost transparency could change how providers, payers, and patients think about healthcare.

As healthcare providers start to bear more financial risk for managing population health, they're making larger investments in commercial insurance assets to build their actuarial expertise.

The weak correlation between Medicare and commercial insurance spending is due to negative correlations between each sector's price and the other sector's volume.

As policymakers consider ways to slow the growth in Medicare spending as part of broader efforts to reduce the federal debt or offset the cost of other spending priorities, some have proposed to increase beneficiary contributions through higher Medicare premiums.

The CMS has moved quickly to replace two recently departed senior executives. The experience levels of the announced replacements should allay concerns that the mini-exodus, which some saw as fallout from launch issues with HealthCare.gov, would hurt agency operations, former CMS insiders agreed.

Patients at high risk - including those with cancer, diabetes, and cardiovascular disease - will be covered under the Pre-Existing Condition Insurance Plan (PCIP) until March 31, thanks to a decision this week from the Department of Health and Human Services.

The Department of Health and Human Services (HHS) announced its intention to release Medicare payment data of individual physicians on a case-by-case basis. The agency seeks to publicly impart the information following a 2013 federal court decision that overturned an injunction previously barring the release of physicians' Medicare payments.

The American Medical Association is warning that the Obama administration could violate physicians' privacy rights if it poorly implements its new policy for informing the public how much money Medicare pays to individual doctors. But other groups say the administration did not go far enough in making payment data broadly accessible.

Analyses of national trends indicate that a considerable proportion of new specialist visits among both Medicare and private insurance beneficiaries are self-referred.

The promise of the Affordable Care Act is right there in its title: Affordable. Yet, anti-poverty agencies across the country fear that even with the federal financial assistance available under the law, health insurance will remain unaffordable for significant numbers of low-income Americans.

Maryland could set a precedent as the Centers for Medicare & Medicaid Services gives approval for a plan that would allow the state to continue setting hospital reimbursement rates for Medicare beneficiaries.

The U.S. Chamber of Commerce has accepted that the Patient Protection and Affordable Care Act is here to stay and, rather than continue calling for its complete repeal, will work this year to change what it sees as flaws in the 2010 law, the business group's president and CEO said Wednesday.

Restaurants know customers eat more at fixed-price buffets than when they pay À la carte. Economists have been saying for years that the same kind of behavior goes on in the federal Medicare program for seniors and the disabled.