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Medicare, Medicaid, Health Reform

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Monthly Archives: January 2013

Legality of Pay for Delay Settlements: SCOTUS Pharma and Biotech Case Preview

The 2012 Supreme Court got a lot of attention for its decision to uphold most of the Affordable Care Act (ACA) health reform law in NFIB v. Sebelius. But this year’s court docket will be no dud. There will be a number of interesting and important cases for pharma and biotech manufacturers, health plans, hospitals, and other providers. This post...

Preventive Care Use in Urban and Rural Areas

Prevention and wellness care are widely recognized as means to reduce health costs and spending, while also improving outcomes for patients. Preventive services typically include screenings for diseases, such as cancer, or harmful conditions, such as obesity. They also include immunizations. For example: someone gets a flu shot costing $20 and avoids becoming victims of the early 2013 flu...

Military Health System and TRICARE: Medical Care for Military Personnel, National Guard and Reserve Members, Retirees, and Dependents

The U.S. Military Health System, with a budget of $48.7 billion in FY 2013, provides medical benefits to 9.7 million active duty servicemembers, National Guard and Reserve members, retirees, and dependents. Specifically, the Military Health System provides services through Department of Defense (DOD) medical treatment facilities (MTFs) – 56 hospitals and 365 clinics – as space is available, private health plans, and...

Analyzing Costs and Benefits of CMS Rules for Affordable Care Act

Presidential Executive Orders have long required cost estimates and impact analyses for every major proposed or final rule.  However, the Centers for Medicare and Medicaid Services (CMS), perhaps under direction from the White House Office of Management and Budget (OMB), has apparently stopped providing cost estimates for rules implementing the Affordable Care Act (ACA) health reform law. Analysis of Costs and...

Medicaid Disproportionate Share Hospital Payments: Understanding DSH and Funding Cuts Under Affordable Care Act

A common story during the health reform debate was that of an uninsured person who went to the hospital for treatment and left behind a mountain of unpaid medical bills.  Uninsured and under-insured patients account for billions of dollars in uncompensated health care each year, which reached a total $57.4 billion in 2008 according to a study from the Urban...

10 Considerations for Health Insurers Deciding on Health Insurance Exchange Participation

A year from now, in January 2014, new health insurance exchanges (HIX) will offer coverage to individuals and small-business employees. Part of the Affordable Care Act (ACA), the exchanges present vast and complex challenges for states, the federal government, and health insurers weighing whether to participate by becoming qualified health plan (QHP). The Center for Consumer Information and Insurance Oversight...

Health Insurance Exchanges: CMS Guidance for State Partnership Exchanges

State Partnership Exchanges are a hybrid model for operation of a Health Insurance Exchange (HIX) under the Affordable Care Act.  In this model, responsibility for Exchange functions is shared between the state and Centers for Medicare and Medicaid Services (CMS).  The other two models are a Federally Facilitated Exchange (FFE, i.e., federally run Exchange) and a state-run Exchange. Each state...

Electronic Patient Communication: Recommendations to Promote Patient-Centered Tools that Improve Care

Communication with patients is at the heart of new primary care tools and models that improve outcomes and lower costs, such as patient-centered medical homes (PCMH) and interactive preventive health records (IPHR). Often, communication means electronic communication, and is part of efforts by Medicare, Medicaid, and private health plans to create incentives for use of health information technology (HIT) by physicians,...

Hospital Quality Reporting and EHRs: Inpatient Quality Data Reporting Using Electronic Health Records

By making hospital quality of care information public, the Hospital Inpatient Quality Reporting (IQR) program is designed to help patients make informed decisions and encourage hospitals and physicians to improve the quality of inpatient care.  Under the Hospital IQR program, hospitals submit clinical quality data to the Centers for Medicare and Medicaid Services (CMS) and CMS makes the information available...

State Medicaid Changes: Cuts and Increases During Recession to Medicaid Benefits and Provider Payments

Medicaid accounts for the largest share of state budgets and is growing still. Since fiscal year 2010, state Medicaid spending nationwide grew from 22.2 percent to about 24 percent of the average state budget, according to the National Association of State Budget Officers (NASBO). Since the recession began in 2007, Medicaid enrollment has grown by more than 10 million...

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