Much attention has been paid to the federal deficit, and a great deal of this discussion has centered on Medicare and Medicaid spending. As a means for controlling what has been considered “out of control” health care costs, some have pushed for major program restructuring, most notable premium support...
Kip Piper -
Through the years, the Centers for Medicare and Medicaid Services (CMS) has changed its payment adjustment method for Medicare Advantage (MA) plans. These adjustments are made based on a calculated risk score per beneficiary, which should be consistent among individuals in similar demographics and with a comparable health status. Following policymaker concerns...
Medicare Fee-for-Service Benefits: Impact of Medicare Cost Sharing Changes on Beneficiaries and BudgetKip Piper -
Several Medicare reform proposals have concentrated on realigning financial incentives within Medicare’s provider payment and delivery system to improve program cost-effectiveness and quality, a key health policy challenge. There have been calls to modernize Medicare’s fee-for-service (FFS) benefit design and address other beneficiary incentive issues as a means of...
Medicare Secondary Payer: Options for Improving Medicare Payment Recoveries from Individual, Non-Group Health PlansKip Piper -
The Centers for Medicare and Medicaid Services (CMS), charged with protecting Medicare’s fiscal integrity, works to recover payments made by Medicare that are the responsibility of non-group health plans. While CMS has not always been aware of all such situations in the past, 2007 legislation introduced mandatory non-group health...
Lack of Price Transparency Could Limit Hospitals’ Ability to Secure Favorable Pricing for Implantable Medical DevicesKip Piper -
Policymakers expressed concern about the lack in price transparency for implantable medical devices (IMD), with confidentiality clauses in purchasing agreements frequently restricting the release of third-party prices. Because this lack of transparency could drive up hospital cost and Medicare spending, GAO examined trends in IMD Medicare spending and utilization,...
Medicare-Medicaid Dual Eligibles Market for Health Plans: Briefing by Kip Piper for Wall Street Analysts at Citi Global Healthcare ConferenceKip Piper -
The $350 billion Medicare-Medicaid dual eligible market is an extraordinary new business opportunity for health insurers, as well as a way for state Medicaid programs to generate significant budget savings and improve access and quality of care for frail seniors and persons with severe disabilities. A dozen states are now looking...
Medicare: American Enterprise Institute for Public Policy Research Finds Competitive Bidding Could Solve Fiscal CrisisKip Piper -
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,...
A third of U.S. health care expenditures are spent on care for the elderly. In terms of overall medical and drug spending, the top five conditions among the elderly are: Heart conditions Cancer Osteoarthritis and non-traumatic joint disorders Hypertension Trauma-related disorders Every year, of the 40 million seniors in the U.S. who live at home...
Medicare Data Book for 2010: MedPAC Data on Medicare Spending, Enrollment, Providers, Health Plans, Drug Plans, and MoreKip Piper -
MedPAC released its Medicare Data Book for 2010, with a wide range of useful information on Medicare spending, utilization, beneficiaries, providers, health plans, drug plans, access, and quality. The format is reader-friendly charts and tables with bulleted summaries. Specifically, the latest MedPAC Data Book includes information on: Medicare spending, including Medicare...
The Medicare Payment Advisory Commission (MedPAC) has released its Medicare payment recommendations to Congress for 2011. In addition to specific recommendations for payment updates for fee-for-service providers and Medicare Advantage plans, MedPAC's report includes interesting information and analysis on spending trends, consequences of rapid spending on Medicare and the...
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