The Future Of Delivery System Reform
Over the past several years, the federal government has put billions of dollars into a variety of programs aimed at improving the way health care is delivered. The Affordable Care Act (ACA) authorized a broad agenda of reform projects, including accountable care organizations (ACOs), bundled payments, value-based purchasing, primary care initiatives, and other payment and service delivery models. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 established new ways of paying physicians intended to promote high-quality patient care.
What will happen to these initiatives under a Congress where Republicans are...
Source: Health Affairs Blog - April 20, 2017 Category: Health Management Authors: Joseph Antos and James Capretta Tags: Costs and Spending Insurance and Coverage Medicare Payment Policy Accountable Care Organizations ACOs Affordable Care Act HMOs MACRA Medicare Advantage supplemental insurance reform Source Type: blogs
Measuring MACRA
By STEVEN FINDLAY
With all the machinations over ACA repeal and replace, the new law that makes big changes in the way the federal government pays doctors—the Medicare Access and CHIP Reauthorization Act, or MACRA—hasn’t garnered much attention lately.
But doctors nationwide are sure thinking about it. That includes many of the regular commentators on THCB. I think it’s accurate to say that most of them have been highly critical of MACRA since the law was enacted in April 2015, and even after it was significantly amended late last year to address physician complaints. (See, for example, Kip Sullivan’s most recent...
Source: The Health Care Blog - April 15, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized MACRA MIPS Steven Findlay Source Type: blogs
Deloitte Survey on Value-Based Care
We have written for years about the transition in health care from volume-based to value-based payment models. But the process has been a slow one. According to the Deloitte 2016 Survey of US Physicians, a nationally representative sample of 600 US primary care and specialty physicians, confirms the slow pace of adoption of value-based payment models among physicians. Generally, physicians are reluctant to bear financial risk for care delivery. Yet many physicians conceptually endorse some of the principles behind value-based care, such as quality and resource utilization measurement. The survey results suggest that financ...
Source: Policy and Medicine - March 24, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Interview: Medstro Pioneers Online Platform Accelerating Healthcare Innovation and Collaboration
Medstro, an online community site for physicians, medical students, and healthcare innovators recently announced passing the milestone of 100,000 registered users – less than three years since it was founded by CEO, Dr. Jennifer Joe, MD and co-founder and COO, James Ryan. This self-funded Boston-based startup has grown impressively given its organic, “grass-roots” expansion since its official launch in April 2014.
This online community is not only an innovative platform of its kind, but offers its users the possibility of interfacing and collaborating with other experts and community members interested in medical...
Source: Medgadget - March 17, 2017 Category: Medical Equipment Authors: Alice Ferng Tags: Exclusive Source Type: blogs
Value-Based Purchasing and “ Free Lunch Syndrome ”
By KIP SULLIVAN
Imagine that a drug company released a “study” that claimed to find that if all 75 million Americans with high blood pressure took the drug company’s hypertension drug the nation’s annual medical expenditures would drop by $20 billion. Imagine as well that the “study” failed to take into account the $40 billion cost to patients and insurers of buying all those hypertension drugs. Such a study would be roundly criticized for failing to take into account an essential component of cost – the cost of the intervention that led to lower medical expenditures.
But studies like the hypothetical drug c...
Source: The Health Care Blog - March 15, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Paying Doctors For Outcomes Makes Sense in Theory. So Why Doesn ’ t it Work in the Real World?
By STEPHEN SOUMERAI and ROSS KOPPEL
For decades, the costs of health care in America have escalated without comparable improvements in quality. This is the central paradox of the American system, in which costs outstrip those everywhere else in the developed world, even though health outcomes are rarely better, and often worse.
In an effort to introduce more powerful incentives for improving care, recent federal and private policies have turned to a “pay-for-performance” model: Physicians get bonuses for meeting certain “quality of care standards.” These can range from demonstrating that they have done procedures t...
Source: The Health Care Blog - March 1, 2017 Category: Consumer Health News Authors: John Irvine Tags: Repeal Replace Uncategorized Source Type: blogs
Walgreens to Pay $50M to Settle Anti-Kickback Suit
Walgreen Co. (“Walgreens”) has agreed to pay $50 million to settle allegations that it gave kickbacks to government health care beneficiaries who it enrolled in its Prescription Savings Club (PCS) discount and incentives program. The government specifically alleges that Walgreens violated the Anti-Kickback Statute (AKS) and False Claims Act (FCA) by providing government beneficiaries with discounts and other monetary incentives under the PSC program, to induce them to patronize Walgreens’ pharmacies for all of their prescription drug needs. The government also alleged that Walgreens understood that permitting governm...
Source: Policy and Medicine - February 2, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Medicare Physician Payment: Why It ’s Still A Problem, And What To Do Now
When the Medicare Access and CHIP Reauthorization Act (MACRA) passed Congress in 2015, most people felt it was better than the old “Sustainable Growth Rate” (SGR) approach to setting physician Medicare fees that had been in place for more than a decade. After all, MACRA avoided what was to be a double digit reduction in Medicare physician payment rates in 2015. Instead, the new legislation provides five years of a 0.5 percent payment rate update, followed by five years of no increase (but also no decrease) in the payment rate. In addition, beginning in 2019, physicians will be able to pick from two novel payment approa...
Source: Health Affairs Blog - January 27, 2017 Category: Health Management Authors: Robert Smoldt, Denis Cortese, Natalie Landman and David Gans Tags: Costs and Spending Featured Medicaid and CHIP Medicare Payment Policy Quality MACRA Physicians Source Type: blogs
HHS Releases Regulations on Alternative Pay Models in Last Weeks of Current Administration
Despite Republicans’ call for a suspension on new rules, the Department of Health and Human Services (HHS) pushed regulations regarding Medicare and Medicaid alternative pay models and insurance exchange stability out the door in the final weeks of the Obama administration. It is likely that the administration wanted to put final touches on changes to demonstrations, which test pay and delivery reforms in Medicare and Medicaid. However, the next administration might undo some of the biggest demonstrations for which the Centers for Medicare & Medicaid Services (CMS) published rules in December because they apply to po...
Source: Policy and Medicine - January 10, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
The Stop Procrastinating Now Course is Open to Join (but Closes on Monday)
We have now stepped into a brand new year.
And to help you to get 2017 off to a great start and make it your most successful, action-filled and fulfilling year yet I have now opened up the doors again to the 10-week Stop Procrastinating Now Course.
If you join during this period you also get free life-time access to all the material in my 31 Days to a Simpler Life Course as a special bonus.
Plus, you get free access to 6 extra bonuses on motivation, on getting your day off to a great start and more.
The registration to join this course will only be open for 5 days this time, until 1.00 p.m EST (that’s 18.00 GMT) on Mond...
Source: Practical Happiness and Awesomeness Advice That Works | The Positivity Blog - January 4, 2017 Category: Consumer Health News Authors: Henrik Edberg Tags: Personal Development Productivity Relaxation Success Source Type: blogs
The Rape of Emergency Medicine, 2017 version
Summa Health, an Ohio Hospital system, recently changed ED contracts from their 40 year group to a new one. On FOUR DAYS’ NOTICE! Four days, over the Christmas/New Year’s Holiday. That sounds distinctly unsafe, beyond the gross lack of sense, or commitment to a 40 year partner.
In case you think this is going smoothly, here’s a post to the ACEP ED Informatics Section from one of their former doctors (reproduced here with permission in its entirety):
I wanted to inform you, my colleagues, about what is going on at my home institution. You all know me as a colleague and a fierce advocate of patient safet...
Source: GruntDoc - January 2, 2017 Category: Emergency Medicine Authors: GruntDoc Tags: Emergency Policy Web/Tech Source Type: blogs
Pharmaguy's Top Five 2017 New Year's Resolutions for the Pharma Industry
As is my tradition – as well as the tradition for many other editors/pundits – it’s time for me to tell pharma what I’d like to see included in its list of 2017 New Year's Resolutions.Last year I noted that 2015 wasn ’t an especially good year considering that “the media and politicians have found a face for evil pharma and rising drug prices: Martin Shkreli!” (here).It ’s déjà vu all over again! Only this time many more evil pharma faces have come forward including the CEO of Mylan, aka “Pharma Sis” (read “Mylan ‘Gamed the System’ and Refuses to Testify at Senate Hearing About EpiPen Costs ...
Source: Pharma Marketing Blog - December 29, 2016 Category: Pharmaceuticals Tags: Celebrities Drug prices DTC Advertising FDA New Year ' s Resolution off-label PhRMA Guidelines women Source Type: blogs
The Demise of the Part B Demo: Doom For Value-Based Payment?
Last week, the administration announced that it would not finalize the demonstration project designed to test payment changes to drugs in Medicare Part B. Part B covers outpatient drugs, those that are administered in a doctor’s office or a hospital. Payments for drugs under Part B are made directly to providers based on the sales price — without any consideration of effectiveness or any formulary management. The pilot would have changed the payment rate from 6 percent of average sales price (ASP) to 2.5 percent plus a flat fee. A second phase would have tested the use of value-based purchasing tools. The demonstra...
Source: Health Affairs Blog - December 27, 2016 Category: Health Management Authors: Rachel Dolan Tags: Drugs and Medical Innovation Medicare Organization and Delivery Payment Policy CMMI Medicare Part B value-based payment Source Type: blogs
The Lavish Life of Overcompensated Bureaucrats
Yesterday Ishared some very good news about Brazil adopting a spending cap.Today, I also want to share some good news, though it ’s not nearly as momentous.Indeed, it ’s not even good news. Instead, it ’s just that some bad news isn’t as bad as it used to be.I ’m referring to the fact that the nation’s capital regionused to be home to 10 of the nation ’s 15-richest counties.
That was back in 2012, and I viewed it as a terrible sign that the DC area was packed withoverpaid bureaucrats, oleaginous rent seekers, and government cronies, all of whom wereenjoying undeserved wealth financed by hard-working taxpayers...
Source: Cato-at-liberty - December 16, 2016 Category: American Health Authors: Daniel J. Mitchell Source Type: blogs
Part Three: The Broader Impact of MACRA
Conclusion
This MACRA final rule is the start of a long journey in Medicare fee-for service payment reform, brought about by rare bipartisan Congressional compromise legislation based on the common understanding that for Medicare to achieve long-term sustainability, volume-based incentives need to be replaced with rewards for quality and patient-centered care. To come in future years are more rigorous targets, including scoring for cost performance with CMS providing clinical feedback to clinicians on their reported performance. We especially note the importance of MACRA for manufacturers, as APMs and MIPS will increasing...
Source: Policy and Medicine - December 11, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
