Medicaid Pay Hike Opened Doors For Patients, Study Finds

Money talks.

A temporary Medicaid pay raise that was part of President Barack Obama’s health law made it easier for poor adults to get appointments with primary care doctors, according to a study published Wednesday.

Paying more to doctors who participate in the federal-state insurance program for the poor usually improves access for patients, but the law’s two-year limit on the raise, its slow rollout and other regulatory problems made many skeptical about how physicians would react to the extra money — which in many states equated to a 50 percent pay hike or more.

News Author: 
Phil Galewitz

Medicare to Finally Pay Doctors for Care They Were Giving Away

Medicare will start compensating physicians for all the work they do to manage the chronic care of beneficiaries. Live, face-to-face encounters with patients will no longer be a requirement for payment.

It's just an extra $42.60 a month in pay for care provided to certain Medicare patients, but for primary care doctors it's a huge cause for celebration.

Finally, Medicare has adopted a new code that pays physicians for the ton of work they and their staffs provide for millions of their sicker patients when the patients aren't seated in front of them.

News Author: 
Cheryl Clark

Legislation Aims for More ACO Flexibility

Proposed legislation introduced in the U.S. House calls for Medicare to pilot a reimbursement mechanism for accountable care organizations based on outcomes and encourages ACO use of telehealth and remote patient monitoring services.

Rep. Diane Black (R-TN), a registered nurse for 40 years, sponsors The ACO Improvement Act (H.R. 5558) along with Rep. Peter Welch (D-VT). Both serve on powerful committees--Black on Ways & Means and Welch on Energy & Commerce.

News Author: 
Joseph Goedert

For their first year, ACOs see varied scores in quality measures

Quality varied widely among Medicare accountable care organizations during their first year, with a few earning millions of dollars in bonuses but scoring below average on all but a handful of quality measures. 

On Sept. 23, federal officials posted the first published quality results for more than 200 ACOs with one year of results in Medicare's Shared Savings Program. The organizations are among the first to accept new Medicare incentives under the health reform law that reward hospitals and medical groups if they treat patients at less expense while meeting quality targets. 

News Author: 
Melanie Evans

Medicare's Pioneer program down to 19 ACOs after three more exit

Three more accountable care organizations dropped out of Medicare's Pioneer program, which was designed to test the payment and delivery model with a small group of elite providers deemed best prepared to handle the operational demands and financial risks. 

The Franciscan Alliance, Genesys PHO and Renaissance Health Network have exited the program, which is now in its third year. In August, Sharp HealthCare, San Diego, announced its decision to pull out after determining “the model was financially detrimental” despite the ACO's performance managing quality and healthcare use.

News Author: 
Melanie Evans

Primary Care Physician-Led ACOs, in Partnership with Universal American Subsidiary, Generated $57 Million in Savings for Medicare Shared Savings Program

Universal American Corp. (NYSE:UAM) announced today that the Accountable Care Organizations (ACOs) it formed in partnership with primary care physicians generated $57 million in total program savings for the Centers for Medicare & Medicaid Services (CMS) as part of the Medicare Shared Savings Program for program years 2012 and 2013.

Demography drives Medicare disparities

New research by the Brookings Institution suggests that socioeconomic factors can account for most of the geographical variation in Medicare spending.

These findings contradict previous research that claimed geographic differences in “practice styles” are the main reason for differences in Medicare spending.

News Author: 
Chris Nerney

How an Influential Group of Doctors Exerts Influence Over Medicare Payments to Physicians

Imagine a scenario in which Exxon Mobil recommends to the U.S. Environmental Protection Agency (EPA) how much carbon dioxide that oil and gas companies should be allowed to emit -- and the EPA approves those recommendations 90 percent of the time. We all know that industry often has outsized influence over the regulatory process, but having 90 percent of its recommendations rubber-stamped would be outrageous.

News Author: 
Adam Crowther

A Health Care Success Story

IT may have been the most influential magazine article of the past decade. In June of 2009, the doctor and writer Atul Gawande published a piece in The New Yorker called “The Cost Conundrum,” which examined why the small border city of McAllen, Tex., was the most expensive place for health care in the United States.

News Author: 
Bob Kocher
Farzad Mostashar

Medicare gives first glimpse of ACO quality performance

The CMS for the first time publicly released individual performance data for Medicare accountable care organizations on 33 measures of healthcare quality. 

The results for 220 of the participants (PDF) in the Medicare Shared Savings Program reveal how ACOs performed on measures (PDF) of patient experience and preventive care and disease management for some of the leading causes of death among U.S. elderly, including heart disease, cancer and diabetes. 

News Author: 
Melanie Evans


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