Inside Health Policy: AMA Suggests First Regulatory Steps For CMS To Implement SGR-Replacement
September 10, 2015

The American Medical Association is suggesting first regulatory steps that CMS could take to implement the alternative payment models that replace Medicare’s Sustainable Growth Rate formula for setting physician pay. AMA’s recommendations cover the definition of financial risk, eligible alternative pay entities, thresholds of participation, evaluation of alternative pay models and the application of SGR-replacement… more


Inside Health Policy: Stakeholders Spar Over Health Care Mergers At Judiciary Panel Hearing
September 10, 2015

Health industry mergers faced their first congressional spotlight at a hearing Thursday that pit Republicans versus Democrats and insurers versus providers, as a House Judiciary subcommittee launched its inaugural hearing in a series on health care marketplace competition this fall. Lawmakers’ concerns fell largely along party lines, with Democrats portraying the ACA as a tool… more


The Sage Group: September is Peripheral Artery Disease (PAD) Awareness Month; THE SAGE GROUP Highlights PAD Costs and Consequences
September 9, 2015

According to THE SAGE GROUP LLC, PAD is one of the most widespread chronic diseases. Currently afflicting almost 20 million U.S. citizens, PAD prevalence is exceeded only by diabetes and venous disease. Costing an estimated $212 to $389 billion, PAD direct disease costs exceed those of diabetes and coronary disease, as well as all cancers… more


Morning Consult: Medicare Advisory Committee Examines Benefits of Vascular Disease Intervention
September 8, 2015

Vascular disease is becoming increasingly common in America – particularly among Medicare aged individuals – however, it’s a health condition less commonly understood by patients and policymakers alike. An estimated 18 million Americans are living with Peripheral Arterial Disease, a condition where blood flow to the extremities is restricted, resulting in pain, infection and deterioration… more


HTR News: Ask A Doctor: Leg pain caused by many factors
August 25, 2015

Question: Why do my legs hurt? Answer: I am a board-certified vascular surgeon who treats circulation disorders of the arteries, veins and lymphatic systems. As a result, I see a lot of patients in my clinic with leg pain. Usually, I can diagnose the cause of leg pain, and if I cannot treat it myself,… more


Modern Healthcare: Federal healthcare spending projections inch upward
August 25, 2015

Federal spending on Medicare, Medicaid, the Children’s Health Insurance Program and exchange subsidies will rise from 5.2% of the country’s economic output in 2015 to 6.2% in 2025, the Congressional Budget Office said Tuesday in updated budget projections (PDF). The CBO said in its March report that those healthcare programs would constitute 6.1% of the country’s… more


Healthcare Finance News: Medicare ACOs vary in how they spend savings, though many aren’t reporting plans, study finds
August 24, 2015

While accountable care organizations in Medicare’s Shared Savings Program must publicly show not only the amount of savings they generate, but what they also plan to do with the cash, a new report published in the American Journal of Managed Care found that just over half of ACOs shared plans on how they’ll allocate savings…. more


Healio: Updated guidelines address new changes in PAD management
August 19, 2015

A group of experts recently published an update to the Inter-Society Consensus for the Management of Peripheral Arterial Disease, or TASC II, providing a complete classification on anatomic lower limb lesions and an update on new endovascular techniques and practice patterns. The TASC II guidelines, which represent the collaboration of international vascular specialties, were published… more


Bloomberg BNA: Medicare Agency Expands Bundled Payments Pilot
August 14, 2015

Development: CMS adds more providers to Medicare bundled payments pilot program that aims to improve care and cut costs. Significance: Attorney says organizations in test program will need to coordinate care well to receive payments for delivering savings and higher quality, or risk a penalty. Aug. 14 (BNA) — Additional providers have joined a Medicare… more


WTOP: The Silent Killer: Peripheral Vascular Disease
August 11, 2015

Between 8 and 12 million people in the United States have peripheral vascular disease (PVD), according to the National Institutes of Health, but many are unaware that they are at risk. Even when they experience the classic symptom – leg pain or cramping – people often attribute it to aging and do not seek treatment…. more


CQ Roll Call: Cancer Drug, Leg-Artery Devices Win Approval for Add-On Payments
August 5, 2015

Medicare officials have cleared special technology reward payments for a cancer drug and for devices developed by rival companies for treating poor blood flow in legs, while rejecting applications for four other unrelated products as not innovative enough to merit special reimbursement. The fiscal 2016 hospital inpatient payment rule details the deliberations surrounding the most… more


Modern Healthcare: Healthcare spending grows twice as fast as economy
July 30, 2015

Healthcare spending grew at twice the rate of the rest of the economy in the second quarter, renewing fears that the sector’s upward march has resumed after nearly a half decade of relative calm. The U.S. Commerce Department’s Bureau of Economic Analysis in its advance estimate (PDF) for second-quarter gross domestic product showed healthcare spending… more


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



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