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

Controlling statewide costs in prisons was the rationale for privatizing the correctional healthcare delivery system across the nation, but there have been consequences.  The increased incarceration levels and shift from governmental to private criminal justice system medical care has resulted in an additional burden of care placed on hospitals...
The medical goal for children diagnosed with pediatric cancers is remission or cure, but consistency and speediness of health insurance coverage is critical to access to preferred treatment. The therapeutic intervention differs based on the cancer type, stage, tolerance of the child to radiation and pharmaceutical agents, and numerous...
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...
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...
Health care payment reform efforts focus on substituting cost-effective value for volume and ultimately aligning the financial incentives of provider reimbursement with expectations for patient outcomes, care management, and efficiency.  The complex dynamics and trade-offs of different payment reform models are discussed in a helpful new report from the Urban Institute...
Health care expenditures are three times greater for patients who have both functional limitations and multiple chronic conditions than for patients without functional limitations. This was the impetus for a recent report, entitled High-Need, High-Cost Patients: Who are They and How Do They Use Health Care?1 The following is...
Today, prices driving prescription drug spending are largely rooted in a long history of pricing by dosing unit.  In most cases, the pricing of a given prescription drug or biologic does not vary by clinical indication it is being used for, whether the use is on-label or off-label, or...
For the 2.4 million Americans with an opioid use disorder, the over 10 million who abuse prescription opioids, and the nearly one million heroin users, access to medication-assisted treatment (MAT) is critically important, according to the National Institute on Drug Abuse (NIDA) and Substance Abuse and Mental Health Services Administration (SAMHSA) guidelines....
Teen Hospital Stays for Childbirth Latest Trends
Teen pregnancy rates in the U.S. remain high with significant variation among states in both pregnancy rates and teen hospital stays for childbirth, according to a recent brief from the Agency for Healthcare Research and Quality (AHRQ).  Entitled Teen Hospital Stays for Childbirth, 2004-2013,1 the report compares hospital-acquired data...
Medicare Episode-Based Payment Reform Demonstrations GAO Review of Voluntary and Mandatory Models
The Centers for Medicare and Medicaid Services (CMS) is investigating the effects of different episode-based payment methodologies on health care cost efficiency and quality in the Medicare program. A new report released by the U.S. Government Accountability Office (GAO) details the results of some of CMS' most...

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