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

Special Needs Plans (SNP) are part of the Medicare Advantage program and were created by the Medicare Modernization Act of 2003 (MMA). There are three types of SNPs, each intended to provide coordinated care for Medicare beneficiaries that meet specific criteria. Institutional SNPs (I-SNP) serve beneficiaries who, for 90 days...
Compounded drugs are a new hot issue in the pharmaceuticals industry and in Congress. There are little data about compounding pharmacies, but a new Congressional Research Service brief gives a comprehensive overview. Compounded Drugs Personalize Drug Treatments: Compounded drugs are created when a physician or pharmacist mixes or changes pharmaceuticals to...
Hypertension, or high blood pressure, is related to several major chronic diseases. Obesity and diabetes raise your chance of developing high blood pressure, which in turn makes you more likely to suffer from heart disease and stroke. High blood pressure also becomes more prevalent with age. Those factors make high...
Hospitals face another year of tight Medicare reimbursement, with rates for FY 2014 falling farther behind cost increases and margins declining as a result.  Most hospitals already lose money on caring for Medicare and Medicaid patients.  Hospitals are entering a far more challenging new business environment under the Affordable...
For over a decade, the sustainable growth rate (SGR) has been a source of financial worry for physicians who serve Medicare patients. Medicare’s physician payment rate is based on a composite measure of the cost of care, multiplied by a factor derived from the SGR formula. Every year since...
State Medicaid programs will spend about $175 billion this year on health care for dual eligibles - low-income seniors and persons with disabilities who receive benefits from both Medicare and Medicaid.  State spending on dual eligibles falls primarily in three areas:  long term services and supports (nursing home, home...
Many new care models in both the public and private sector focus on people with chronic diseases, particularly conditions like diabetes, congestive heart failure, and hypertension. The Veterans Health Administration (VHA) Care Coordination/Home Telehealth (CCHT) pilot program serves veterans at risk of needing long term care for chronic conditions. Physician...
One of the most talked-about aspects of the Affordable Care Act (ACA) is how it will affect women’s health care. The biggest After 2014, health plans will no longer be allowed to charge different premiums based on gender, regardless of whether or not they are Qualified Health Plans (QHP)...
It’s not uncommon for a patient to be confused or overwhelmed by a diagnosis or treatment plan.  Complicated medical procedures or decisions can overwhelm patients to the point that they feel that they cannot, or should not, ask questions of their providers.   However, this lack of patient involvement in...
The nation's largest health care buyers - Medicare, state Medicaid programs, large employers, and health plans - are eager for ways to improve the quality and efficiency of chronic health conditions, which drive the bulk of health spending.  Payment reform and care delivery reforms are critically important.  Providers -...

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