News

AMA to Assist Physicians During Transition to Value-Based Payment Models
June 10, 2015

The American Medical Association’s policy-making body is directing the organization to assist physicians as the nation moves toward “value-based payment models” and work with regulatory agencies to control the skyrocketing cost of generic prescription drugs. The AMA’s House of Delegates (HOD) June 9 supported a series of resolutions from the association’s Medical Service and Health System… more

 

AMA Calls for Physician Engagement In Health-Care Pricing Transparency
June 9, 2015

Pointing to transparency as a critical driver of value-based decision making and improved health outcomes for millions of Americans, the American Medical Association approved two policy directives June 8 designed to boost physician engagement in health-care price and quality transparency. The AMA House of Delegates (HOD), meeting during the organization’s annual meeting in Chicago, adopted two… more

 

Health care costs projected to rise 6.5 percent in 2016
June 9, 2015

Health care costs are expected to rise 6.5 percent next year, the lowest anticipated rate of growth in a decade but still well above that of inflation, according to a new report. The report by PwC’s Health Research Institute sees the higher spending pushed by the spiraling cost of specialty drugs, including breakthrough treatments for hepatitis C and efforts… more

 

Nation’s sickest seniors reshape health care
June 5, 2015

When Debby White was rushed to the hospital last fall with a rare type of blood cancer, what worried her wasn’t her own medical problems: It was the health of her husband Jack. Jack, 74, suffers Lewy body disease, with symptoms similar to Parkinson’s and Alzheimer’s. He takes nine medications a day, and no one but Debby… more

 

CMS Grants ACOs Some Of Their Requests; Extends Pioneer ACO Demo Via Shared-Savings Program
June 4, 2015

CMS on Thursday unveiled a highly anticipated final rule for the second round of applications for accountable care organizations that will serve as the vehicle for expanding the Pioneer ACO demonstration. The agency is giving ACOs another three years without the risk of penalties at the same shared-savings pay rates as the first three-year period,… more

 

Medicare vies to keep ACOs on board with more flexible rules
June 4, 2015

More flexibility is coming for Medicare accountable care organizations under a final rule the CMS published Thursday (PDF). The revisions are intended to strike a balance between maintaining the program’s rigor and making sure providers continue to participate. The Medicare Shared Savings Program will offer a new track to take on more financial risk of patient… more

 

CMS Tests Largest Value-Based Pay Model To Date
May 29, 2015

CMS on Tuesday (May 28) announced a heart attack prevention initiative that the agency says is the largest test to date of a Medicare value-based pay model, and the Bipartisan Policy Center separately recommended ways to pay doctors for counseling patients on how to prevent health problems. The Million Hearts Cardiovascular Disease Risk Reduction Model… more

 

Obama Signs Medicare SGR Repeal, CHIP Extension Into Law
April 16, 2015

President Barack Obama April 16 signed into law legislation (H.R. 2) that permanently replaces a controversial formula for calculating Medicare physician payments and prevents future annual congressional debate on cuts. The law took effect upon signing. Obama called the bill a “significant bipartisan achievement” and congratulated House Speaker John A. Boehner (R-Ohio) and House Minority… more

 

Low spending growth saves Medicare $316 billion, HHS says
April 15, 2015

HHS patted itself on the back Wednesday, saying Medicare spending was $316 billion lower than expected between 2009 and 2013 thanks to its policies. But various economic trends indicate the slowdown may not last. Annual spending on Medicare beneficiaries—those in traditional Medicare and Medicare Advantage—grew by 5.9% on average from 2000 to 2008. That annual… more

 

CMS Says A Few Physician Claims Will Be Subject To Cuts, Then Re-Processed
April 15, 2015

CMS Wednesday (April 15) said that while it instructed contractors not to implement the 21 percent Sustainable Growth Rate cuts after Congress passed an SGR replacement bill late Tuesday, a small number of claims will be paid at the reduced rate, then re-processed at the normal pay level. House Speaker John Boehner’s (R-OH) office said… more

 

Senate Clears ‘Doc Fix’ Package Before 21 Percent Cuts Take Effect
April 14, 2015

The Senate late Tuesday ended a long-running pattern of temporarily blocking scheduled fee cuts to doctors who treat Medicare patients, replacing an oft-criticized payment formula in a strong bipartisan vote just hours before 21 percent reimbursement reductions were scheduled to take effect. The 92-8 vote to pass the legislation (HR 2), which would repeal the sustainable growth rate formula,… more

 

Senate overwhelmingly approves ‘doc fix’
April 14, 2015

The Senate on Tuesday overwhelmingly approved a $200 billion Medicare reform package that will end a two-decade-old headache for Congress known as the “doc fix.” The rare bipartisan bill, which passed 92-8, marks one of the biggest achievements yet from the newly GOP-controlled Congress. It will now head to President Obama, who has promised to… more

 

Permanent ‘Doc Fix’ Will Require Future Fixes, CMS Memo Warns
April 13, 2015

Congress appears to be on the brink of passing a long-anticipated permanent “doc fix” to change the way Medicare pays physicians. But the House-negotiated deal may not be as permanent as the moniker implies. Paul Spitalnic, chief actuary for the Centers for Medicare and Medicaid Services, warned in a memo that the measure (HR 2) “raises important long-range… more

 

Bipartisan Medicare bill would end yearly fixes
March 20, 2015

At least once a year, doctors and their elderly patients endure a hated ritual where lawmakers use the threat of deep cuts to physician payments as a political bargaining chip. Now, in a rare instance of bipartisan cooperation, House leaders aim to stop the practice, once and for all. Speaker John Boehner and Representative Nancy… more

 

Bipartisan Coalition Releases Policy for SGR Repeal, but Offset Details Still to Come
March 19, 2015

A bipartisan group of House and Senate lawmakers March 19 introduced a bill (H.R. 1470) that would permanently repeal Medicare’s sustainable growth rate formula for physician reimbursement and provide incentives for doctors to focus on value-driven care. The SGR Repeal and Medicare Provider Payment Modernization Act of 2015 outlines ways to improve fee-for-service Medicare and… more

 

Heart, imaging groups join 700 societies in SGR plea
March 18, 2015

The letter is short and the list is long. Almost all of the major cardiovascular and imaging societies banded together with approximately 700 medical associations to implore Congress to repeal the sustainable growth rate (SGR) formula. The American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, the Society of Thoracic Surgeons, the Heart… more

 

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

 

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