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Medicare, Medicaid, Health Reform

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Monthly Archives: February 2012

Hospital Community Benefits under the Affordable Care Act: Opportunities for Community Health Improvement

In February 2012, The Hospital Community Benefit Program, established by the Hilltop Institute at the University of Maryland, Baltimore County (UMBC), published the third issue brief in a series, Hospital Community Benefits after the ACA: Partnerships for Community Health Improvement. The series, published across a three-year span, is funded by the Robert Wood Johnson Foundation and the Kresge Foundation. The...

Medicare: American Enterprise Institute for Public Policy Research Finds Competitive Bidding Could Solve Fiscal Crisis

As a natural outcome of program incentives, physicians and other health care providers are motivated to deliver more services as a means to increase Medicare fee-for-service (FFS) payments. Chronic overtreatment, and the resulting overpayment, has led Medicare into its current financial crisis. Medicare’s private insurance plans, Medicare Advantage (MA) plans, offer a fixed-cost payment to cover the monthly care of...

Medicare Advantage and Risk Adjustment: GAO Advises CMS to Improve Risk Score Adjustments for Diagnostic Coding

Over time, the Centers for Medicare and Medicaid Services (CMS) has revised the risk adjustment methodology for Medicare Advantage plan payments.  The risk adjustment process calculates a risk score for each Medicare Advantage (MA) plan enrollee, consistent with specific demographic factors and health status.  An MA plan's overall risk score is applied to the plan's base rate, increasing or decreasing...

PCORI Identifies Five National Priorities for Comparative Clinical Effectiveness Research

The Patient-Centered Outcomes Research Institute (PCORI) has published its first set of proposed national priorities for research, Draft National Priorities for Research and Research Agenda Version 1. This 22-page publication highlights five focus areas for use in guiding comparative clinical effectiveness research and funding announcements. The Institute invites comments from members of the general public including professionals, patients, and caregivers...

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