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Medicare, Medicaid, Health Reform

Home Health Care Policy Health Costs and Spending

Health Costs and Spending

As part of the Affordable Care Act (ACA), Medicaid coverage could be expanded to cover nearly 400,000 currently uninsured American Indians and Alaska Natives (AI/AN). This population, particularly sensitive to health disparities, suffers from elevated disease burdens and poorer overall health than that of the general population. The AI/AN...
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,...
The Patient-Centered Outcomes Research Institute (PCORI) has published its first set of proposed national priorities for research, Draft National Priorities for Research and Research Agenda Version 1. This 22-page publication highlights five focus areas for use in guiding comparative clinical effectiveness research and funding announcements. The Institute invites comments from...
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,...
A new federally mandated tax on health insurers will increase costs for state Medicaid programs and Medicaid health plans. In an excellent new report, PPACA Health Insurer Fee Estimated Impact on State Medicaid Programs and Medicaid Health Plans, Milliman, retained by the Medicaid Health Plans of America (MHPA), conducted an independent...
A study funded by AHRQ and published in the Journal of the American Medical Informatics Association, Transmitting and processing electronic prescriptions: Experiences of physician practices and pharmacies, identifies both the benefits and challenges with electronic prescribing (eRx) practices. Authors believe that, as more physicians convert to electronic health record...
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...
As part of the $1.1 billion provided to the Department of Health and Human Services (HHS) earmarked for comparative effectiveness research (CER) under the American Recovery and Reinvestment Act (ARRA or Recovery Act) of 2009, $474 million went to HHS’s Agency for Healthcare Research and Quality (AHRQ) to support...
The Food and Drug Administration (FDA) reviews the safety and effectiveness of new medical devices sold in the United States, and The Medical Device User Fee and Modernization Act of 2002 (MDUFMA) authorizes FDA to collect user fees to support the device submission review process. MDUFMA also establishes performance...
As the second-largest health care service purchaser, employers have an opportunity to use their substantial market leverage as a means to augment quality. If mobilized and motivated, employers could act as a key change agent by influencing other stakeholder groups, exercising a leadership role, and pushing community health plans...

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