Insurance

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.

The downward trend in preventable hospital readmissions that began in 2012 has continued well into this year, according to data published Friday on the CMS' blog. Quality experts were impressed but had questions.

A bicameral effort is quickly gaining traction in an effort that would forever change the sustainable growth rate (SGR) and Medicare reimbursement model.

Medicare has agreed to allow specialist medical societies to determine the quality measures physicians will report when the new reporting system goes into effect on Jan. 1.

By all accounts, the shopping experience on HealthCare.gov has improved significantly. That means customers can routinely access information about what health plans and subsidies are available and select the product of their choice.

As the CMS begins the second year of a penalty program for preventable hospital readmissions required by the healthcare reform law, new research indicates that hospitals fare better when they focus on patient care more generally rather than targeting specific conditions, such heart failure, or specific timeframes, such as 30 days post-discharge.

Dr. Farzad Mostashari, former National Coordinator of Health IT, serves as guest editor of a special issue of AJMC, which covers the breadth of issues concerning how technology is affecting healthcare delivery, quality of care, and payment reform.