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

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...
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...
Much of the nation's long-term care is paid for with Medicaid funding. Medicaid pays 43 percent of all long-term care, while Medicare pays 24 percent and a mix of private health plans and consumers funds the rest, according to the Kaiser Family Foundation. Only half of people who need...
Healthcare-associated infections (HAI) contribute significantly to U.S. health costs and spending. They can be a major problem in hospitals, with one in every 20 hospitalized patients contracting a healthcare-associated infection, according to the Centers for Disease Control and Prevention (CDC). Each year, HAIs kill more than 1.7 million people...
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...
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...
The Government Accountability Office (GAO) recommended in a recent report that the Internal Revenue Service (IRS) step up its enforcement of tax collections for Medicaid providers, finding that providers in three selected states owed nearly $800 million in unpaid taxes. In particular, the GAO suggested the IRS collect taxes...
State Medicaid directors need greater flexibility and faster federal approval to maintain or establish new managed long-term supports and services (MLTSS) programs in Medicaid. A growing number of states are implementing such programs, from 8 states in 2004 to 16 states in 2012. “A strong and effective federal-state partnership with clearly aligned...
Medicare reimbursement methods are highly complex and constantly changing.  Here are a series of concise briefings on Medicare payment policy for healthcare providers, Medicare Advantage plans, and Medicare Part D drug plans. These primers on Medicare payment basics are courtesy of the outstanding staff at the Medicare Payment Advisory Commission...
The nation’s 9 million Medicare-Medicaid dual eligibles - low-income frail seniors and persons of all ages with severe disabilities - now use about $350 billion in healthcare annually.  States and CMS are rolling out models to integrate Medicare and Medicaid financing and care delivery for dual eligibles.  These reforms are of...

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