One objective of the 2009 Health Information for Economic and Clinical Health (HITECH) Act is to encourage more physicians and hospitals to adopt electronic health record (EHR) systems. Physicians and hospitals that effectively use electronic health records will play an important role in preventing medical errors, reducing costs, and...
Medicare’s new value-based payment method for reimbursing physicians will begin in 2015 to affect physician groups with at least 25 eligible professionals. Groups will have the option to participate in a tiered payment system, which would adjust Medicare Part B fee schedule payment rates by an as-yet undetermined amount or...
Medicare Value-Based Physician Payment Modifier: Recommendations from Physicians, Health Plans, and Policy ExpertsKip Piper -
Medicare is slowly but steadily moving toward value-based methods of reimbursing physicians, hospitals, and other health care providers differentially based on quality and cost of care. The evolving payment methods add performance or value-based modifiers to traditional Medicare fee-for-service reimbursement. For physicians, new value-based payment modifiers will adjust each provider's payment rates under the Medicare Part B fee...
Pharmaceutical Payment: Pharma and Biotech Market Shifting to Value or Outcomes-Based Drug Revenue ModelKip Piper -
Pharmaceutical manufacturers face an economic transformation as payors look more toward value-based – as opposed to transactional, unit-based – models for drug reimbursement. This value-based revenue model presents enormous implications for the future of pharma and biotech, impacting everything from innovation, clinical trials, pricing, and marketing. The Health Research Institute at PwC surveyed...
Health Plans and Quality Improvement Reporting Under the Affordable Care Act: Recommendations for Implementing Reporting of Quality Improvement StrategiesKip Piper -
The Affordable Care Act (ACA) requires the Centers for Medicare and Medicaid Services (CMS) issue employer group health plan quality improvement reporting requirements. Reports shall cover specified quality improvement activities regarding plan or coverage benefit and provider reimbursement structures. Those requirements shall include efforts to improve health outcomes, ensure...
Kip Piper -
Nursing homes that receive federal Medicaid or Medicare funding must meet federal quality standards. The Centers for Medicare and Medicaid Services (CMS) and states, accountable for ensuring compliance, inspect nursing facilities periodically using a CMS-developed and state-administered survey or inspection process. The Quality Indicator Study (QIS) is a new electronic study slated...
Healthcare Quality and Cost: Engaging Employers as Change Agents in Lowering Costs and Improving QualityKip Piper -
As the second-largest health care service purchaser, employers have an opportunity to use their substantial market leverage as a means to augment quality. If mobilized and motivated, employers could act as a key change agent by influencing other stakeholder groups, exercising a leadership role, and pushing community health plans...
National Advisory Council Subcommittee Identifies Core Set of Health Quality Measures for Medicaid-eligible AdultsKip Piper -
The AHRQ released its background report, National Advisory Council Subcommittee: Identifying Health Care Quality Measures for Medicaid-Eligible Adults. Required by the Affordable Care Act, this report identified a recommended core set of quality measures for Medicaid-eligible adults. Also aimed at providing states with insight into health care quality for...
As the new Obama Administration and the 111th Congress focus on health care issues, here is a quick list of some of the Medicare policy changes Democrats will likely seek in 2009-2010: Likely Changes in Medicare Advantage: 1. Phase-out of difference between Medicare Advantage plan rates and Medicare fee-for-service: Some Medicare Advantage...
Management Challenges at Department of Health and Human Services: Implications for CMS and FDA AppointmentsKip Piper -
The incoming leadership at the U.S. Department of Health and Human Services (HHS) face a number of serious management challenges. These challenges, recently identified by the Office of the Inspector General (OIG), will require close, sustained attention by the Secretary's Office and the agency heads, particularly at CMS and...
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