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Congress is as close as it has ever been to scrapping the Medicare sustainable growth rate (SGR) for an alternative system of paying doctors based on the quality – rather than the quantity – of services. The SGR system has been in place since 1997, and every year since 2002 Congress has passed legislation to […]

Although Medicare reform is not currently a front-burner issue, proposals to reduce Medicare spending appear regularly on the policy agenda. Various Medicare savings proposals have recently emerged in the context of efforts to control the national deficit and debt, and could arise in the next few months when Congress considers how to modify Medicare’s physician […]

The Patient Protection and Affordable Care Act (ACA) contains several provisions that address access to community based services for the 4.5 million people in the U.S. with intellectual and developmental disabilities (I/DD). Many of these provisions are aimed at balancing the array of services between those offered in institutions and those in the community. However, […]

Despite slower health care spending growth over the last few years, long-term forecasts for overall health spending – and for public programs like Medicare – signal continuing concern. The idea behind numerous recent proposals is to find lasting solutions, and some areas of consensus are beginning to emerge. Many proposals recommend paying for value instead […]

Increasingly, hospitals are “observing,” instead of admitting, Medicare beneficiaries, even when they are there for more than 48 hours. Health care experts say the situation is far from ideal for both hospitals and patients. Hospitals are feeling increased pressure from Medicare to classify patients the “right” way or risk losing reimbursements. In turn, patients face […]

Health insurance marketplaces, or exchanges, opened October 1, and while states have released some enrollment data, and much of the attention has been on the initial technical challenges, there has been less information about overall consumer experience. Who is trying to access the marketplace websites, and how many have successfully enrolled? Of those who shopped […]

Many employers have begun to adopt a strategy known as “reference pricing” to help reduce health care costs. Under this benefit design, employees get insurance plans that set price caps on certain services and procedures. Enrollees are allowed to use any provider. But if they use providers with fees higher than the “reference price,” they […]

Health care policy leaders are counting on public and private initiatives, such as paying for performance, to improve value in the health care equation in which cost and quality at times seem to be at odds. Health care costs are high and quality outcomes are low in several metrics, compared to other developed nations. And, […]

More than a third of Pioneer ACOs succeeded in reducing costs in Medicare in their first year, according to a recent Centers for Medicare and Medicaid Services (CMS) report. The program initially saved Medicare about $87 million and cut Medicare spending by 0.5 percent. The Pioneer ACO model is a CMS Innovation Center initiative that […]

*FOR MEMBERS OF THE PRESS ONLY*The Association of Health Care Journalists’ DC Chapter and the Alliance for Health Reform will hold a reporters’ roundtable, for reporters only, on Covering the ACA Marketplaces. With the marketplaces scheduled to launch Oct. 1, no topic is as newsy, complicated and filled with political spin. Come learn about some best […]

With millions of people projected to obtain health insurance coverage under the Patient Protection and Affordable Care Act (ACA), access to care is expected to be an issue. Efforts to promote telehealth and telemedicine could help. In addition to electronic health records there is telestroke, teleICU and telepsychiatry. “Robodocs” have attracted recent media attention. Studies […]