CMS: anti-amyloid drug Leqembi (lecanemab) doesn ’t meet the “reasonable and necessary” standard required for wider Medicare coverage
CMS Sticks to Sharply Limited Coverage of New Alzheimer’s Drug, Leqembi (Managed Healthcare Executive):
For now, CMS (Note: Centers for Medicare & Medicaid Services) is sticking to the coverage decision it made for Aduhelm (aducanumab) and applying it Leqembi (lecanemab). The decision limits Medicare coverage of the two Alzheimer disease’s drugs to Medicare beneficiaries who have enrolled in clinical trials of the drugs
The decision, which was announced in a press release yesterday, was denounced in strong language by the Alzheimer’s Association.
“CMS’ role is to provide health care coverage” said Joanne Pi...
Source: SharpBrains - February 28, 2023 Category: Neuroscience Authors: SharpBrains Tags: Brain/ Mental Health aducanumab Aduhelm Alzheimer's drug Alzheimers-Association amyloid CMS dementia FDA lecanemab Leqembi Medicare monoclonal antibodies Source Type: blogs
State and Local Spending Since 1962: DC, Alaska, Delaware, New Mexico and New York Growing Fastest Relative to Income
Marc JoffeCensus data shows, on average, state and local government spending as a percentage of personal income rose sharply between 1962 and 1977, but then flattened out in the years leading up to 2020. However, there is substantial variation across jurisdictions: while some states have seen little overall change in the percentage of income devoted to government spending since 1962, others experienced dramatic growth.The animation below shows how state and local government spending have evolved in all fifty states and DC since 1962. Spending data comes from the Census Bureau ’s Annual Survey of State and Local Governm...
Source: Cato-at-liberty - February 28, 2023 Category: American Health Authors: Marc Joffe Source Type: blogs
Let ’ s Do Public Health Better
BY KIM BELLARD
Eric Reinhart, who describes himself as “a political anthropologist, psychoanalyst, and physician,” has had a busy month. He started with an essay in NEJM about “reconstructive justice,” then an op-ed in The New York Times on how our health care system is demoralizing the physicians who work in it, and then the two that caught my attention: companion pieces in The Nation and Stat News about reforming our public health “system” from a physician-driven one to a true community health one.
He’s preaching to my choir. I wrote almost five years ago: “We need to stop viewing public healt...
Source: The Health Care Blog - February 28, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Health Policy Dr. Reinhart gun violence Kim Bellard Opioid Addiction public health Source Type: blogs
Medicaid Recovery for All?: Iowa ’s Controversial Managed Care Organization and the State’s Abrogation of the Collateral Source Rule
Jenna Nelson (University of Iowa), Medicaid Recovery for All?: Iowa ’s Controversial Managed Care Organization and the State’s Abrogation of the Collateral Source Rule, 108 Iowa L. Rev. 2 (2023): While the collateral source rule has deep roots in state, common... (Source: HealthLawProf Blog)
Source: HealthLawProf Blog - February 28, 2023 Category: Medical Law Authors: Katharine Van Tassel Source Type: blogs
---
As all states reassess Medicaid eligibility after the public health emergency, higher coverage losses are expected in the 11 that have not expanded the program.
(Source: The Commonwealth Fund: Blog)
Source: The Commonwealth Fund: Blog - February 27, 2023 Category: International Medicine & Public Health Authors: Akeiisa Coleman, Sara Federman, Jesse C. Baumgartner Source Type: blogs
Retaining Patients and Employees in Healthcare
Health care institutions, like many colleges and businesses, have trouble retaining people. Tiffany A.S. Wright, vice president of operations at CareMax, says that it’s one thing to engage with patients but a much bigger challenge to retain them.
Retention is particularly key to maintain the funding for fee-for-value programs, which are growing in popularity. What if you spend a year investing heavily to improve the health of a patient, only to see her leave and give another institution the benefits of your investment?
This video is therefore important viewing for anyone concerned with making a fee-for-value program ...
Source: EMR and HIPAA - February 27, 2023 Category: Information Technology Authors: John Lynn Tags: Ambulatory Analytics/Big Data Communication and Patient Experience Health IT Company Healthcare IT Hospital - Health System CareCognitics CareMax Healthcare IT Video Interviews Healthcare Scene Featured Medicaid patient engagement Source Type: blogs
Bonus Features – February 26, 2023 – Accenture says more adequate Medicaid networks could save $912 million annually, InterSystems named data partner of NCQA, and more
This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job.
News
A new report from Accenture, US health inequity: beyond the statistics, indicated that inequity in care contributes to an additional 3,400 Black infant deaths and an additional 9,200 Black cancer deaths annually. Proposed f...
Source: EMR and HIPAA - February 26, 2023 Category: Information Technology Authors: Brian Eastwood Tags: Healthcare IT Accenture Accenture Healthcare AHIOS Augusta University Health System Bart Howe Bicycle Health Biofourmis Boomi BrightInsight D14.AI Dhealth directtrust Ellipsis Health FEI Systems FutureRx Google Cloud Grac Source Type: blogs
As I was saying
I seldom link to the NYT (or, as Atrios calls it, " that f.ing newspaper) because it ' s paywalled. But I believe you get three free reads a month, and in any case I ' m going to pull the good stuff fromKrugthulu ' s latest.It ' s about this:Many House Republicans arereportedly listening to Russell Vought, Donald Trump ’s former budget director, who has a new think tank and has been circulating abudget proposal titled “A Commitment to End Woke and Weaponized Government,” which purports to show a way to balance the budget without touching Medicare and Social Security. The document uses the word “woke” 77 tim...
Source: Stayin' Alive - February 25, 2023 Category: American Health Source Type: blogs
Makers and Takers
Speaker of the House Marjorie Taylor Greene recently twitted this: The entire population of the earth is about 8 billion. The population of China is about 1.4 billion. With that as background, let ' s consider her other recent proposal, a " divorce " between the red and blue states. Okay, let ' s try that. This is from the Brookings Institution. In case that ' s difficult to read, 71% of U.S. GDP is generated in counties won by Joe Biden. Here ' s another fun fact. These are the states that are most dependent on the federal government, i.e. they get back more in federal spending than they pay in...
Source: Stayin' Alive - February 24, 2023 Category: American Health Source Type: blogs
Retrieving Billions in Overpayments by CMS
This article focuses on the relatively young technologies that enable CMS to uncover overbillings, whether they be errors or fraud. The article is based on an interview with Kel Pults, chief clinical officer and vice president of MediQuant. A future article will explain how Medicare Advantage plans are trying to improving data collection and reporting, and how AI helps.
Challenges of Investigating Overpayments
Undeserved payments are needles lurking in the haystack of 135 million Americans enrolled in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). But the needles pile up fast. Improper payments f...
Source: EMR and HIPAA - February 17, 2023 Category: Information Technology Authors: Andy Oram Tags: AI/Machine Learning Analytics/Big Data Health IT Company Healthcare IT Regulations Revenue Cycle Management #COVID19 CMS COVID Reimbursement Healthcare AI Healthcare Analytics Kel Pults MAOs Medicare Advantage MediQuant Overp Source Type: blogs
All Three Legs of the Obamacare Stool Are Working Well – Part 2
BY GEORGE HALVORSON
2022 Medicare Advantage data gathering process change made last year just made upcoding for plans irrelevant and impossible, but the critics do not accept that it happened.
CMS just ended that upcoding debate for 2022 by completely killing the coding system for the plans, effective immediately. The plans can’t code risk levels up because the coding system was eliminated entirely for 2022.
RAPS is dead.
The payment approach for Medicare Advantage now has no upcoding components and the government just used their new and more accurate numbers to create the 2023 payment level for the pla...
Source: The Health Care Blog - February 17, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Health Policy Affordable Care Act Medicaid Medicare Medicare Advantage Obamacare Source Type: blogs
Don ’ t fall for the Medicare Advantage hype: the realities of coverage for low-income enrollees [PODCAST]
Subscribe to The Podcast by KevinMD. Catch up on old episodes! We’re joined by Aniyizhai Annamalai, an internal medicine-psychiatry physician. Dr. Annamalai’s patients are mostly indigent, not employed due to disability, and have serious mental illnesses. Most of them qualify for Medicaid. In this episode, Dr. Annamalai shares her insights on Medicare Advantage plans and
Read more…
Don’t fall for the Medicare Advantage hype: the realities of coverage for low-income enrollees [PODCAST] originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - February 17, 2023 Category: General Medicine Authors: The Podcast by KevinMD Tags: Podcast Medicare Source Type: blogs
---
Medicaid enrollment may end for 15 million beneficiaries when states start eligibility redeterminations following the end of the COVID-19 public health emergency.
(Source: The Commonwealth Fund: Blog)
Source: The Commonwealth Fund: Blog - February 16, 2023 Category: International Medicine & Public Health Authors: Sara Rosenbaum, Alexander Somodevilla Source Type: blogs
The CBO Budget and Economic Outlook in the Post ‐COVID Fiscal Era
Romina Boccia and Dominik LettThe Congressional Budget Office (CBO) just released its latestBudget and Economic Outlook for 2023 to 2033, providing 10 ‐year fiscal projections for the post‐COVID fiscal era. The United States is on the tail‐end of an unprecedented surge in emergency spending during which inflation hit a 40‐year record high. To control this surge in inflation, the Federal Reserve adopted a tighter monetary stan ce by increasing interest rates. In this context, CBO’s report forecasts a worsening fiscal trajectory characterized by high and rising federal debt. Pandemic spending followe...
Source: Cato-at-liberty - February 15, 2023 Category: American Health Authors: Romina Boccia, Dominik Lett Source Type: blogs
Wisconsin Medicaid Expansion — Is the Risk Worth the Reward?
Marc JoffeIn his new budget, Governor Evers is once again proposing that Wisconsin expand its Medicaid program to take advantage of additional subsidies available under the 2010 Affordable Care Act. Senators and Assembly Members should carefully consider the long ‐term risks of expansion before accepting this proposal.From a short ‐term budgetary perspective, Medicaid expansion seems like a great deal for Wisconsin. The federal government covers 90% of the costs for providing medical care for individuals in the expansion population compared to60.66% (in 2024) for those currently eligible for Medicaid an...
Source: Cato-at-liberty - February 15, 2023 Category: American Health Authors: Marc Joffe Source Type: blogs
