By Jordan Kiszla & Rachel Nuzum – HHS issued a proposed rule to implement MACRA. Congress passed this bipartisan legislation last year to replace the sustainable growth rate formula (SGR)—which tied the growth of Medicare physician payments to growth in the economy—with an approach that rewards high-performing providers and supports alternative payment models.
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By Susan Jaffe – Despite interventions by Medicare officials, the number of appeals from health care providers and patients challenging denied claims continues to spiral, increasing the backlog of cases and delaying many decisions well beyond the timeframes set by law, according to a government study released on June 9th.
Fewer than a quarter of U.S. hospitals are on track to hit the Obama Administration’s 2018 goal of providing at least half their patient care through so-called “value-based” arrangements – structures that tie reimbursement from Medicare to the quality of care patients receive.
By Susan Jaffe – Looking for ways to save money and improve care, Medicare officials are returning to an old-fashioned idea: house calls. But the experiment, called Independence at Home, is more than a nostalgic throwback to the way medicine was practiced decades ago when the doctor arrived at the patient’s door carrying a big black bag.
By Jordan Rau – The federal government paid bonuses to 231 hospitals with subpar quality because their patients tend to be less expensive for Medicare, new research shows. The bonuses are small, generally a fraction of a percent of their Medicare payments. Nonetheless, rewarding hospitals of mediocre quality was hardly the stated goal…
By Karen B. DeSalvo MD & Andy Slavitt – Seven years ago, Congress passed a law to spur the country to digitize the health care experience for Americans and connect doctor’s practices and hospitals, thereby modernizing patient care through the Electronic Health Records (EHRs) Incentive Programs, also known as “Meaningful Use.”
By Mary Agnes Carey – As the health law turned six, federal officials proposed the expansion of a Medicare diabetes prevention program funded by the landmark measure. The pilot program, developed and administered by the YMCA…
By Patrick Conway – The launch of the Comprehensive Care for Joint Replacement Model (CJR) on April 1 is a major step toward transforming care delivery in Medicare. Why? Because this model looks to improve care and quality for the most common procedures that Medicare beneficiaries have, hip and knee replacements.
By Johanna Legaspi – Hierarchical Condition Categories were mandated in 1997 by CMS and have been the basis for reimbursement for Medicare Advantage plans since 2004. HCCs use data to prospectively estimate predicted costs for enrolled members during the next year of coverage.