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

The massive reforms to Medicare physician reimbursement mandated under Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) present many issues and opportunities for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP).  While moving Medicare Part B to a new merit-based system of physician and clinic payment, MACRA also...
Childhood Diseases in Adulthood
Increased immunizations have reduced the rates of specific diseases associated with childhood. However, adults who are infected with the same viruses can experience dire consequences—and a vaccination in childhood may not guarantee immunity in middle age.  While the evidence supporting childhood vaccination and booster immunizations for adults is overwhelming, ignorance...
How have alternative health care payment models, aimed at lowering costs while improving patient outcomes, affected physicians and physician practices in the United States? A recent RAND Corporation study, sponsored by the American Medical Association, looks at the effects payment reform models have on physicians' finances, practice management, and...
As policymakers in Washington argue over the best way to reform America's health care system, a compelling new book by Eric Topol, MD, suggests that the advance of technology is going to change how health care services are delivered in more profound and unpredictable ways than most people can...
The practice of behavioral healthcare is being transformed by technological innovations in mobile health and a growing understanding of the role patient behavior, behavioral health conditions, and dual physical/behavioral health diagnoses play in health outcomes and costs.  This transformation has in turn given rise to a profusion of fascinating and...
Delivery of physical medical care and behavioral health services is too often uncoordinated, operating in silos with little or no communication between physicians and other providers providing a patient with primary, specialty, acute, and pharmacy services and behavioral health professionals proving that same patient with mental health care or...
Hospital readmissions are costly but largely preventable. Reducing inpatient readmissions are a top priority for Medicare, state Medicaid programs, and private health plans.  The opportunities to lower costs and improve patient outcomes are considerable.  Therefore, healthcare purchasers are realigning hospital payment methods to reward hospitals for fewer readmissions and...
The basis for medical treatment of heart disease is the belief that interventions like coronary angioplasty and bypass surgery are effective, and that their benefits outweigh the risks. Does this conviction stem from a solid scientific foundation, or might it be an illusion? Is it conceivable that both physicians and...
To control rising health care costs and improve outcomes, health care purchasers - Medicare, state Medicaid programs, and large employers - and health plans are eager to entirely replace traditional, inefficient, volume-based fee-for-service (FFS) physician and hospital reimbursement with value-based payment models.  Value-based payment comes in various flavors but...
High hospital emergency room use by Medicaid enrollees is a perennial concern. What do we know about Medicaid emergency department visits? Are they medically necessary? What drives Medicaid emergency department visits? Is Medicaid ER utilization increasing under the Affordable Care Act? The Medicaid and CHIP Payment and Access Commission (MACPAC)...

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