Kip Piper's Health Care Blog
Medicare, Medicaid, Health Reform

Though most commonly associated with Medicare, Accountable Care Organizations are now making their way into state Medicaid programs. Providers, of course, are an essential part of the ACO model. But many providers don’t yet have the resources to coordinate care, analyze cost and usage data, and adapt to value-based...
Even as Accountable Care Organizations and other payment reform models become more common, there is still not much comprehensive information about which models providers participate in most often, and what exactly to do to make those arrangements work well. It is also important for providers to understand the best practices...
Billy Millwee, former Texas Medicaid director, recently published an excellent piece with insight into that state’s experience with quality-based payment reform. Health care payors, both private and public, are looking more and more to tie payment with outcomes. Millwee’s article is a thoughtful and thorough assessment of Texas Medicaid's...
Special Needs Plans (SNP) are part of the Medicare Advantage program and were created by the Medicare Modernization Act of 2003 (MMA). There are three types of SNPs, each intended to provide coordinated care for Medicare beneficiaries that meet specific criteria. Institutional SNPs (I-SNP) serve beneficiaries who, for 90 days...
Hypertension, or high blood pressure, is related to several major chronic diseases. Obesity and diabetes raise your chance of developing high blood pressure, which in turn makes you more likely to suffer from heart disease and stroke. High blood pressure also becomes more prevalent with age. Those factors make high...
Hospitals face another year of tight Medicare reimbursement, with rates for FY 2014 falling farther behind cost increases and margins declining as a result.  Most hospitals already lose money on caring for Medicare and Medicaid patients.  Hospitals are entering a far more challenging new business environment under the Affordable...
Growth in health care spending has slowed recently.  Why?  Supporters of the Affordable Care Act (ACA) - aka Obamacare - says its due to the controversial law, although most of the ACA's provisions are yet to take effect.  However, new evidence shows that the economy is the cause of...
Much of the story about rising health costs and spending has to do with relatively small groups of people with expensive health needs. For example, the Centers for Medicare and Medicaid Services (CMS) estimates Medicare beneficiaries with two or more chronic conditions accounted for 93 percent of Medicare spending...
For over a decade, the sustainable growth rate (SGR) has been a source of financial worry for physicians who serve Medicare patients. Medicare’s physician payment rate is based on a composite measure of the cost of care, multiplied by a factor derived from the SGR formula. Every year since...
The term “post-acute care” (PAC) covers a range of services patients receive after a hospital stay. Skilled nursing facilities, home health care agencies, long-term care hospitals, and inpatient rehabilitation hospitals all provide post-acute care. PAC providers are an important part of efforts to reduce hospital readmissions, which are a...

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