News

SGR Deal Includes Higher Premiums, Provider Pay Cuts, MA & Medigap Reforms
March 18, 2015

The latest version of a Medicare physician payment deal would partially pay for replacing the SGR formula by charging wealthier seniors higher premiums for Medicare Part B and Part D, limiting first-dollar coverage in Medigap, shifting when payments are made to Medicare Advantage plans, and cutting pay to providers, according to a summary of the… more

 

Promising findings shown for heart-related issues
March 16, 2015

Positive results supporting the use of non-invasive heart valve replacement as a potential alternative to surgery, plus evidence a new class of cholesterol-lowering drugs may also reduce the risk of cardiac events were just two of the highlights from the second day of the American College of Cardiology meeting this past weekend. One of the… more

 

Medicare Launching New ACO Program
March 10, 2015

The Centers for Medicare & Medicaid Services (CMS) is launching a “Next Generation” accountable care organization (ACO) that the agency hopes will be more attractive to Medicare providers, a CMS official said Monday. When CMS launched its Pioneer and Shared Savings ACO programs, “we started to hear from stakeholders that [said], ‘You really need a… more

 

More Doctor Groups Get Increases Than Cuts Under CMS’s Value-Based Modifier Program
February 27, 2015

Doctors who are part of large groups discovered this week whether they will receive an increase or a cut in their Medicare payments, based on the Centers for Medicare & Medicaid Services’ measure of their 2013 quality performance, the agency announced Feb. 27. Results from the first year of the value-based payment modifier (VM) program… more

 

CMS Official Says New ACO Model May Be Unveiled in March
February 26, 2015

The Centers for Medicare & Medicaid Services aims to release in March a next-generation Medicare accountable care organization model, an agency official said Feb. 26. Patrick Conway said the new ACO model would enable greater beneficiary engagement and provide a more stable financial model. Conway is the CMS’s deputy administrator for innovation and quality and… more

 

‘Doc Fix’ Dilemma Weighs on More Than Physicians
February 25, 2015

Physicians who treat Medicare patients wouldn’t be the only health professionals to feel pain if Congress fails to step in to avert scheduled payment cuts at the end of March, or permanently repeal the formula that dictates them. Any provider who is paid for services under the Medicare physician fee schedule would be affected by the reductions prescribed… more

 

Burwell Stresses Need for a Permanent ‘Doc Fix’
February 25, 2015

Health and Human Services Secretary Sylvia Mathews Burwell told an influential doctors lobby on Tuesday that permanently replacing Medicare’s controversial physician payment formula is an imperative but didn’t offer ideas about how to pay the estimated $174.5 billion cost over a decade. A leading congressional Republican later predicted Congress would be unable to find a quick solution… more

 

House Budget Chairman Tells AMA Short-Term SGR Patch Likely by March 31
February 24, 2015

House Budget Committee Chairman Tom Price (R-Ga.) told the American Medical Association Feb. 24 that a four- to six-month patch of Medicare’s sustainable growth rate formula is likely by the March 31 expiration of the current patch. Price said he doesn’t think there’s enough time for lawmakers to get a full repeal passed by the… more

 

Stakeholders Say They’re Preparing For Another Short-Term SGR Patch
February 23, 2015

With the deadline for fixing Medicare’s physician payment formula just over four weeks away and no solution on how to pay for it on the horizon, stakeholders say they are preparing for yet another short-term patch. Lobbyists interviewed by Bloomberg BNA were quick to note that although no official policy has been put forward, their… more

 

House Members Mull October ICD-10 Launch at Hearing
February 12, 2015

The U.S. implementation of the ICD-10 diagnosis coding system has been delayed several times, but members of a House subcommittee seemed to be leaning Wednesday toward making sure the current Oct. 1 deadline sticks. “Many providers and payers, including the Centers for Medicare and Medicaid Services (CMS), have already made considerable investments in the ICD-10… more

 

CMS to Penalize Doctors $200M For Failing to Participate in Meaningful Use
February 10, 2015

The federal government in 2015 will pay an estimated $200 million less in reimbursements to the 256,000 doctors who failed to participate in the Medicare Electronic Health Record Incentive program, according to Centers for Medicare & Medicaid Services data and officials’ comments Feb. 10. Provider participation in the meaningful use program was relatively low in… more

 

Medicare Has Made Progress on ICD-10 Transition, Readiness, GAO Report Says
February 6, 2015

The Centers for Medicare & Medicaid Services has rolled out several policies and procedures to smooth the health-care industry’s transition to ICD-10, and a majority of stakeholders say the CMS efforts have been helpful, according to a report from the Government Accountability Office released Feb. 6. “CMS has taken multiple steps to help prepare covered… more

 

As ‘Doc Fix’ Cost Rises, Hospitals Tell Congress to Find SGR Funding Elsewhere
February 4, 2015

Just days after the Congressional Budget Office increased the cost for permanently replacing the Medicare sustainable growth rate, leading hospital groups and health systems sent a letter Feb. 3 to the Senate Finance, House Ways and Means and House Energy and Commerce committees, calling for the rejection of any additional cuts to providers as a way to… more

 

Letter to the Editor Re: “Medicare Bills Rise For Stents Put Into Limbs”
February 4, 2015

  The following letter was submitted to the New York Times in response to an article titled Medicare Bills Rise For Stents Put Into Limbs: As President and a Founding Member of the Outpatient Endovascular and Interventional Society (OEIS), I am writing in response to an article published in the January 30, 2015 issue of… more

 

Site-Neutral Coalition Formed As Obama, Congress Consider Equalizing Pay Among Settings
February 3, 2015

Health plans, cancer patients, nursing homes, and primary care doctors and internists have formed the Alliance for Site-Neutral Payment Reform to lobby Congress for pay policies that would reduce Medicare spending while increasing pay for providers in the coalition — a move that comes as President Obama pushes site-neutral pay policies for outpatient services in… more

 

Medicare to Publish Physician-Payment Data Yearly
February 2, 2015

The U.S. government will begin releasing Medicare physician-payment records every year, cementing public access to how tens of billions of dollars are spent annually on everything from office visits to radiation therapy. Last April, a year’s worth of the data was released for the first time in more than three decades after Wall Street Journal parent Dow… more

 

Obama’s 2016 budget cuts Medicare but eliminates sequestration
February 2, 2015

President Barack Obama’s budget proposal would slash more than $415 billion in Medicare funding over the next 10 years—largely echoing previous editions—and he inserted several provisions that would advance the administration’s effort to move Medicare to value-based payments. With the lame-duck president facing Republican majorities in the House and Senate, his spending blueprint is generally… more

 

CBO’s Estimated Cost Of Freezing Medicare Physician Pay Edges Up Again
January 26, 2015

The goals CMS set Monday (Jan. 26) for moving providers to alternative pay models and value-based payments make it all the more important for physicians that Congress pass Medicare physician pay reform, provider lobbyists said, because Congress can pay doctors extra for simply participating in alternative pay models and CMS cannot. Last year’s bipartisan Sustainable… more

 

U.S. to Overhaul Medicare Payments to Doctors, Hospitals
January 26, 2015

The Obama administration will make historic changes to how the U.S. pays its annual $3 trillion health-care bill, aiming to curtail a costly habit of paying doctors and hospitals without regard to quality or effectiveness. Starting next year Medicare, which covers about 50 million elderly and disabled Americans, will base 30 percent of payments on… more

 

Agreement Between Lawmakers, Stakeholders On ‘Doc Fix’ Offsets Remains Elusive
January 22, 2015

Providers and lawmakers agreed that the sustainable growth rate (SGR) formula for determining Medicare physicians’ reimbursement needs to be permanently fixed, but during a Jan. 22hearing, they offered no new ideas on how to pay for it. Representatives from hospitals, physicians and nursing groups told members of the House Energy and Commerce health subcommittee they… more

 

CMS Expected To Announce Plans To Speed Performance-Based Pay
January 22, 2015

CMS officials are expected to announce Monday (Jan. 26) that they are moving a certain percentage of Medicare provider contracts to performance-based pay in the near future, provider lobbyists say. The expected announcement coincides with work Congress is doing to reform the Sustainable Growth Rate (SGR) formula, which calls for moving physicians to alternative pay… more

 

‘Doc Fix’ Hearing Yields Familiar Talking Points
January 21, 2015

Lawmakers kicked off a two-day hearing on the perennial question of how to forestall Medicare’s physician payment cuts Wednesday by discussing how to pay for a compromise struck in the 113th Congress. But prospects for a package of offsets that could satisfy both parties remained murky. Neither Democrats nor Republicans moved much beyond their talking points… more

 

MedPAC seeks reimbursement rate freeze
January 16, 2015

The Medicare Payment Advisory Commission has voted unanimously to make a series of recommendations to Congress that would either freeze reimbursements or make them site neutral. The goal is to potentially save Medicare several billion dollars. Also, in an effort to better incentivize primary-care doctors, MedPAC is asking Congress to restructure an initiative created by… more

 

Upton, DeGette Lay Out Basic Framework For 21st Century Cures Bill
January 13, 2015

House Energy & Commerce chair Fred Upton (R-MI) and Rep. Diana DeGette (D-CO) on Tuesday laid out five broad goals of the 21st Century Cures draft bill they plan to introduce later this month: targeting clinical trials to the “right group” of patients; better integrating the patient perspective into the regulatory process through public-private partnerships;… more

 

Medicare, Medicaid To Loom Large In 2015 On Capitol Hill & In Many States
January 6, 2015

Medicare and Medicaid reform issues are expected to loom large this year on Capitol Hill and in many states. Congress’ short-term Medicare physician payment patch ends after March and funding for the Children’s Health Insurance Program runs out Oct. 1. Legislation to avoid those pitfalls, especially physician payment cuts driven by the Sustainable Growth Rate… more

 

CardioBreak: PAD Approval, HF Drug for Duchenne
January 5, 2015

The FDA approved the IN.PACT Admiral drug-coated balloon for peripheral arterial diseasein the superficial femoral artery and popliteal artery, Medtronic announced. A technology using polymer beads to soak up inflammatory cytokines during heart-lung machine use for cardiac surgery has entered trials. The heart failure drug eplerenone (Inspra) slowed the progressive cardiac damage of Duchenne muscular… more

 

Interventional cardiology recognized as separate specialty by CMS
January 5, 2015

Effective on January 5, CMS now recognizes interventional cardiology as its own specialty. CMS in May had granted a request from the Society for Cardiovascular Angiography and Interventions for a new specialty designation for interventional cardiology; the new designation can now be used. The new specialty designation, C3, will enable interventional cardiologists to be compared against… more

 

AHA, ASA release annual statistical update for heart disease, stroke
January 4, 2015

The incidence of death due to heart disease and stroke has decreased in recent years, but the prevalence of both conditions remains high worldwide and risk factors such as tobacco use, an unhealthy diet and low levels of physical activity are common in adults and children. The annual Heart Disease and Stroke Statistics – 2015… more

 

CMS Adds 68,000 Records To Open Payments Database
December 22, 2014

CMS added about 68,000 payment records to the Sunshine Act and Affordable Care Act’s Open Payments database on Friday (Dec. 19). The Open Payments database details financial relationships among certain providers and drug and device manufacturers and group purchasing organizations.The additional records include updates to payments that were disputed by doctors and teaching hospitals at… more

 

Medicare Advisers Address Pay Disparities for Common Services
December 19, 2014

Congress’ advisers on Medicare will renew their call to change a system that now often pays hospitals more than private doctors’ office for delivering the same services. The Medicare Payment Advisory Commission on Thursday began discussing draft recommendations for many services covered by the federal health plan for the elderly and disabled. The panel will vote… more

 

Senate Sends to President Obama One-Year Tax Package With Medicare Cuts
December 17, 2014

Senators voted 76-16 late Dec. 16 to approve legislation that reduces some Medicare benefits to pay for a new type of tax-favored savings account. Included in a $41.6 billion tax extenders bill (H.R. 5771), which the White House says President Barack Obama will sign, is language from H.R. 647 to create tax-favored accounts for the… more

 

New Test Detects Heart Disease Risk, Especially for Black Women
December 15, 2014

A new test makes it easier for doctors to measure a fairly new indicator of heart disease risk — one that is especially helpful for African-American women. The U.S. Food and Drug Administration approved the test Monday. It measures the inflammation caused by the buildup of dangerous gunk in the arteries and can show a… more

 

ObamaCare’s Threat to Private Practice
December 10, 2014

Here’s a dirty little secret about recent attempts to fix ObamaCare. The “reforms,” approved by Senate and House leaders this summer and set to advance in the next Congress, adopt many of the Medicare payment reforms already in the Affordable Care Act. Both favor the consolidation of previously independent doctors into salaried roles inside larger institutions,… more

 

‘Doc Fix’ Uncertainty Freezes Other Health Efforts, Panel Is Told
December 10, 2014

Failure to replace Medicare’s oft-criticized physician payment formula has shifted federal attention away from other necessary health reforms, witnesses told a House hearing on Tuesday, further stoking the debate over advancing permanent “doc fix” legislation in Congress. “The sustainable growth rate was designed to control Medicare physician reimbursements, but has instead continued to stifle other federal… more

 

A Focus on the Heart for Older Patients
December 4, 2014

The first geriatric cardiology clinic in New York opened at N.Y.U. Langone Medical Center in August. It’s different. For starters, an older patient’s first visit with cardiologist Dr. John A. Dodson, the program’s director, takes a full hour. Beyond taking a complete history, Dr. Dodson looks for frailty by measuring things like gait and grip… more

 

Leader of Republican Doctors Caucus Sees No Action on SGR During Lame Duck
December 4, 2014

Efforts to find a long-term fix for Medicare’s sustainable growth rate (SGR) formula for physician payment will have to wait until 2015, the co-chairman of the Republican Doctors Caucus said Dec. 4. Speaking to reporters, Rep. Phil Roe (R-Tenn.) said he plans to take up the issue in the early days of the 114th Congress…. more

 

Medicare Contributes To Slow National Health Care Spending Growth In 2013
December 3, 2014

Health care spending increased 3.6 percent in 2013, which one CMS official says is the lowest percentage on record going back to 1960, driven by slow growth rates in private insurance and Medicare. Some Affordable Care Act provisions — including the medical loss ratio provisions, Medicare productivity adjustments, and cuts to Medicare Advantage — put… more

 

House Passes Bill on Savings Accounts For Disabled, Funded by Medicare Changes
December 3, 2014

A bill that would make tax-free savings accounts available to people with disabilities passed the House by a 404-17 vote Dec. 3. Twelve Democrats and five Republicans voted against the bill. Although the Achieving a Better Life Experience (ABLE) Act (H.R. 647) enjoyed bipartisan support, lawmakers said they were concerned about the bill’s use of… more

 

CMS Proposes Revising How Accountable Care Organizations Are Paid
December 1, 2014

Health provider alliances known as accountable care organizations could be paid differently under a proposed rule released by the Centers for Medicare and Medicaid Services late Monday. If hospitals and doctors that coordinate the care of Medicare patients save money, they can share some of the savings with the government. The proposed rule affects the… more

 

Rest of lame duck won’t be a snooze
November 30, 2014

December was supposed to be a sleepy month for Congress — a chance to finish up a productive lame-duck session and leave the decks clear for the new Republican majority that takes control in January. Instead, the next two weeks have morphed into a minefield. Government funding is suddenly in peril, as conservatives fume over… more

 

CMS Guide Foresees Increased Use Of CED, Even In Local Coverage Calls
November 25, 2014

CMS signals plans to increasingly rely on coverage with evidence development (CED) in a final guidance that backs away from an earlier expectation that the agency would only use the policy infrequently as new technologies were presented for coverage early in the development process. The agency also reiterates that it will neither duplicate efforts by… more

 

As Doctors Push For Unpaid SGR Bill, Budget Think Tank Suggests Offsets
November 19, 2014

As physicians lobby Congress to replace the Sustainable Growth Rate without paying for the fix, the think tank Center for a Responsible Federal Budget published Wednesday (Nov. 19) a plan to pay for Medicare physician-pay reform using policies that generate half of the savings from providers and half from beneficiaries — beneficiary policy changes would… more

 

Providers, Consumers Urge NAIC To Address Concerns On Network Adequacy
November 19, 2014

The American Medical Association has joined forces with more than 115 health care groups to urge the National Association of Insurance Commissioners (NAIC) to address several key issues as it puts together a final model regulation on network adequacy that will affect exchange and other insurance plans. The AMA, Children’s Hospitals Association and other national and state-level… more

 

Wyden Urges Quick Action on ‘Doc Fix,’ Citing Rising Costs
November 19, 2014

Senate Finance Chairman Ron Wyden said the rising cost of replacing Medicare’s physician payment formula adds urgency to the effort to pass compromise legislation during the lame duck instead of waiting until the March 31 deadline to prevent scheduled cuts to doctors. The Congressional Budget Office estimated late Friday that a bipartisan, bicameral “doc fix” plan introduced in… more

 

CBO’s Estimated Cost Of Freezing Medicare Physician Pay Falls Slightly
November 17, 2014

The Congressional Budget Office lowered by $5 billion its 10-year estimate of the cost of freezing Medicare payments to physicians, which is good news for those pushing to replace the Sustainable Growth Rate formula. However, physicians are lobbying to replace SGR without paying for it, and some Republicans reportedly are warming to the idea. When… more

 

SCOTUS subsidies case weighs on states
November 17, 2014

Insurance regulators in states where HHS runs the Obamacare exchanges are discussing contingency plans or workarounds should the Supreme Court strip the law’s insurance subsidies across a wide swath of the country. The discussion of the King v. Burwell case came up on Monday at a meeting of the National Association of Insurance Commissioners in… more

 

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