The federal budget has been in the news more than usual lately. Congress early in 2013 postponed a 2 percent across-the-board cut in Medicare payments, 8 percent cuts for certain domestic spending, and 10 percent cuts in non-military personnel defense spending, using a measure called sequestration. But the deadline...
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...
Kip Piper -
Here is a summary of the Medicare, Medicaid, and other health care related provisions of H.R. 8, the American Taxpayer Relief Act of 2012, as passed by House and Senate as part of the fiscal cliff negotiations. President Obama is expected to sign the law shortly. The Congressional Budget Office (CBO)...
Medicare and Medicaid spending will exceed $1 trillion in FY 2013. Together, the two programs now serve about 113 million Americans - over a third of the population. Policymakers in Washington and the states face a daunting challenge to containing costs in Medicare and Medicaid – both health programs are...
Hospitalization of Seniors from Nursing Homes: High Cost of Avoidable Hospital Admissions of ElderlyKip Piper -
The cost of hospitalizations, particularly hospital readmissions, is increasingly a concern for Medicare, Medicaid, and private health plans. The Centers for Medicare and Medicaid Services (CMS) in particular has emphasized reducing hospitalizations and readmissions. Results from the CMS Medicare Coordinated Care Demonstration pilot project show coordinated care for Medicare...
When Congress enacted the Medicare Modernization Act of 2003 (MMA), it set a spending target of about $400 billion over 10 years for the Medicare Part D drug benefit, after accounting for revenues from premiums and other sources. Seven years into the program’s life, Medicare Part D spending is...
Prescription drugs often play an important role in keeping people healthy, especially for people with chronic conditions. Medicare beneficiaries with diabetes or asthma, for example, might take regular medicines to prevent emergencies that would put them in the hospital. Hospital stays, doctor’s appointments, and other medical services covered under...
Medicare Reimbursement Explained: MedPAC Briefings on Medicare Payment Methods for Providers, Medicare Advantage, and Drug PlansKip Piper -
Medicare program payment methods are highly complex and change constantly. The Affordable Care Act (ACA) makes further, very significant changes to how Medicare pays hospitals, physicians, post-acute providers, and Medicare Advantage health plans. In a series of excellent briefs, the Medicare Payment Advisory Commission (MedPAC) explains the basics of Medicare reimbusement, including...
Kip Piper -
Fraud and abuse are common and persistent problems for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Combined federal and state spending now exceeds $1 trillion, with fraud and abuse likely costing taxpayers well over $100 billion annually. Together with state Medicaid agencies and state attorneys general, several federal offices, such...
Kip Piper -
Medicare Advantage plans provide many benefits to Medicare beneficiaries, including lower costs, added services, higher quality than traditional fee-for-service (FFS), and less paperwork. However, the way Medicare paid Medicare Advantage health plans led to a situation where Medicare was paying health plans more than the average cost of Medicare FFS...
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