Bloomberg BNA: CMS Predicts Modest Health Spending Growth
July 28, 2015

Health spending is projected to grow to nearly $5.5 trillion in the next 10 years, spurred on by the Affordable Care Act’s coverage expansions, an aging population and a stronger economy, according to a July 28 report from the CMS. In the report, published in the journal Health Affairs, actuaries at the Centers for Medicare… more


CQ: CMS Mulls Next Steps on Leg-Artery Treatments
July 23, 2015

Officials at the Centers for Medicare and Medicaid Services are planning a deep look into treatments available to improve poor blood flow in the legs, a condition that can lead to gangrene and amputations in severe cases and raises risk for strokes and heart attacks. The agency may take as long as eight months to… more


Bloomberg BNA: Analysts Warn of Rising Medicare Outpatient Costs, Deficit Spending
July 23, 2015

Medicare Trustees’ Report Development: Analysts are concerned about deficit spending and rising cost of outpatient care threatening Medicare’s fiscal future. Context: Medicare’s Hospital Insurance Trust Fund (Part A) will remain solvent until 2030 according to most recent report. July 23 (BNA) — Deficit spending and the rising cost of outpatient care threaten Medicare’s fiscal future,… more


Bloomberg BNA: Medicare Trust Fund Depletion Date Stays at 2030
July 22, 2015

Development: Medicare’s hospital insurance (Part A) trust fund will run out of money in 2030, the same date as was projected last year. Additional Development: Part B premiums may rise for about 30 percent of beneficiaries in 2016. July 22 (BNA) — Medicare’s hospital insurance (Part A) trust fund will run out of money in… more


Healio: CMS panel moderately confident that some PAD treatments warrant national coverage
July 22, 2015

The Medicare Evidence Development and Coverage Advisory Committee of the CMS voted that it has moderate confidence that there is sufficient evidence for at least one intervention that improves most forms of lower-extremity peripheral artery disease. The panel’s vote could serve as a basis for a National Coverage Decision from the CMS. There is currently… more


Healthcare Finance News: ACOs mixed on Medicare Shared Savings Program final rule
July 14, 2015

Participating healthcare providers say a proposed final rule for accountable care organizations taking part in the Medicare Shared Savings Program shows officials are listening to concerns, but many say it doesn’t go far enough. On one hand, ACOs still getting their feet wet got some clarification. But for providers that are more seasoned, the June proposal… more


CQ: House Advances Medical Research Bill in Strong Bipartisan Vote
July 10, 2015

A highly touted package to spur new treatments for rare diseases passed the House in an overwhelmingly bipartisan vote Friday after a battle over whether funding for medical research should be mandatory. Members endorsed, 344-77, the “21st Century Cures” bill (HR 6), marking the second time this year that the chamber advanced a sweeping bipartisan health… more


Bloomberg BNA: Medicare Program Releases 2016 Doc Pay Proposal
July 8, 2015

Development: CMS seeks comments on new performance-based reimbursement system. Next Step: Comments due Sept. 8. July 8 (BNA) — The CMS July 8 began implementation of a new performance-based Medicare reimbursement system for doctors and other providers by seeking input through its proposed physician fee schedule rule for 2016 on building the new structure that… more


Vascular Health: Millions at Risk for Peripheral Arterial Disease
July 8, 2015

People who blame old age for their inability to walk short distances without pain may be suffering from peripheral arterial disease, a potentially limb-threatening condition that puts them at greater risk for cardiovascular disease, heart attack and stroke. “About 1 in every 20 Americans over the age of 50 has peripheral arterial disease,” says Dr…. more


Healthline: Saving limbs from Peripheral Artery Disease
June 11, 2015

Don’t ever take your legs for granted. That’s the message from a man who nearly lost one of his due to Peripheral Artery Disease (PAD). The Houma doctor who treated him recently presented new research about groundbreaking procedures that help doctors save more limbs. A simple walk down the hall is somewhat of a miracle… more


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




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