Insurance

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.

In an effort to save $1.3 billion over five years and curb the abuse of prescription drugs that Medicare pays for, the CMS is proposing an array of changes to Medicare's Part D and Advantage programs.

Across the country, Medicaid expansion varies among states. Some experts worried about whether that variation would drive Americans to relocate to other states so that they could obtain better medical coverage. However, those concerns are likely to prove unfounded, according to a recent study from Harvard.

Hospitals across the nation delivered $45.9 billion in uncompensated care during 2012, according to an annual study of the American Hospital Association.

January 2014 has arrived, and with that Affordable Care Act coverage begins. Over the next 12 months, the administration will thoroughly consider the ways in which it can control the rising costs of healthcare in the United States. This is especially true for the nation's Medicare program.

Low-income and disabled people who are dually eligible for Medicare and Medicaid and belong to Medicare Advantage plans consistently score worse than other Medicare Advantage enrollees on the performance measures that determine plan eligibility for bonus payments from the CMS.

Healthcare reform is already presenting new challenges and opportunities for endocrinology, a specialty that is under significant stress in the United States. A critical workforce shortage has drained the pool of practicing endocrinologists, just as the Affordable Care Act (ACA) is expected to send millions of newly insured people into the system.

Starting in January, there will officially be an additional 123 accountable care organizations (ACOs) in the Medicare Shared Savings Program. As providers and hospitals transition to this emerging care model, there is mixed opinion over its longevity.

The coming year will be one for those who have beaten cancer to develop survivorship plans, with the Commission on Cancer to require planning by treatment centers starting in 2015.

HHS announced the latest round of accountable care contracts in the Medicare Shared Savings Program, adding 123 additional ACOs and reaching about 1.5 million more Medicare beneficiaries.

The Centers for Medicare & Medicaid Services announced Friday that it is seeking a second round of applicants to the Pioneer ACO Model. It is also soliciting suggestions for new accountable care organization models that encourage greater provider integration and financial accountability.

Cancer drug prices have doubled in the past decade, from an average of $5,000 per month to more than $10,000.

This study shows that generic initiation improves adherence to antidepressant therapy among Medicare patients and mitigates the negative effects of the Part D coverage gap.

During the first eight months of this year, fewer than 18 percent of Medicare patients ended up back in the hospital within a month of discharge, the lowest rate in years, the government reported Friday.

Moving healthcare reimbursement from fee-for-service to a system that rewards quality care is easier said than done, but tools are emerging to help the cause. Three expert commentators featured in the inaugural issue of The American Journal of Accountable Care examined the challenges providers face, as they are being ask to share risk under new contracts with accountable care organizations, or ACOs.

Since 1992 Medicare has reimbursed physicians on a fee-for-service basis. In 1997, as medical costs escalated, Congress began using a Sustainable Growth Rate (SGR) formula to reduce reimbursements if overall physician spending exceeded the growth in the economy.

Access is an important component of the Triple Aim (cost, quality, access), and it has also been stressed as a significant factor in health reform initiatives. As the influx of uninsured increasingly seeks care, and if the number of providers available to provide primary care decreases as projected, achieving access to quality and cost-effective care may become more problematic.

The House of Representatives passed a 3-month patch late Thursday to stabilize physicians' Medicare payments -- delaying dramatic cuts scheduled for 2014 -- while Congress works on a permanent repeal of Medicare's sustainable growth rate (SGR) payment formula.

The Centers for Medicare & Medicaid Services (CMS) recently announced that Stage 2 of the EHR Meaningful Use program would be extended through 2016, especially as many healthcare CIOs continue to struggle with health IT tool vendors. This also means that Stage 3 will be delayed until 2017.

The bipartisan budget deal reached this week could drag out efforts to overhaul Medicare's payment formula for physicians as lawmakers pursue a short-term fix and attempt to extend and make other tweaks to Medicare provisions, including significant changes to reimbursement for long-term acute care.

Congress' work to reshape physician payments under Medicare and repeal the sustainable growth rate (SGR) payment formula took several pivotal steps this week.

Thousands of hospitals, large and small, are girding for cuts to their Medicare payments in 2014, as federal pay-for-performance programs aimed at boosting clinical quality, improving patient experience and preventing unnecessary hospital readmissions roll into their second year.