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

Medicare Advantage plans provide many benefits to Medicare beneficiaries, including lower costs, added services, higher quality than traditional fee-for-service (FFS), and less paperwork.  However, the way Medicare paid Medicare Advantage health plans led to a situation where Medicare was paying health plans more than the average cost of Medicare FFS...
Medicare’s new value-based payment method for reimbursing physicians will begin in 2015 to affect physician groups with at least 25 eligible professionals. Groups will have the option to participate in a tiered payment system, which would adjust Medicare Part B fee schedule payment rates by an as-yet undetermined amount or...
Medicare is slowly but steadily moving toward value-based methods of reimbursing physicians, hospitals, and other health care providers differentially based on quality and cost of care.  The evolving payment methods add performance or value-based modifiers to traditional Medicare fee-for-service reimbursement.  For physicians, new value-based payment modifiers will adjust each provider's payment rates under the Medicare Part B fee...
Hospitals ought to invest in processes that keep discharged patients from returning, and should do so for two main reasons, a new report argues: (1) readmissions are costly and are increasingly a concern for Medicare, Medicaid, and private payers, and (2) steps to reduce readmissions will prepare hospitals for...
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...
Are you ready to be an Accountable Care Organization (ACO)? Significant new opportunities and challenges face health systems, hospitals, and physician practices as they decide whether to participate in the new Medicare Shared Savings Program and join together to form an Accountable Care Organization. Accountable Care Organizations: Your Guide to Strategy, Design, and Implementation is...
Hospital readmission rates are receiving increasing attention by Medicare, Medicaid, and private health plans.  Research shows that a high proportion of hospital readmissions are preventable.  Most hospital payment methods, most notably the Medicare Part A inpatient prospective payment system (IPPS), create strong financial incentives for hospitals to discharge patients...
The latest issue of the journal American Health & Drug Benefits includes a valuable mix of studies and articles on economic, regulatory, and clinical issues of particular interest to payors, purchasers, and policymakers. Obesity: Effective Treatment Requires Change in Payers' Perspective by Rhonda Greenapple, MSPH and Jackie Ngai, MS, with...
Payment reform is an integral part of national and state-based health reform efforts. Indeed, payment reform is essential to moving from quantity-based reimbursement to a performance-based health care system. That is, moving from fee-for-service to fee-for-value. Payment innovations, such as global payment, are designed to reward efficiency and higher...
The incoming leadership at the U.S. Department of Health and Human Services (HHS) face a number of serious management challenges. These challenges, recently identified by the Office of the Inspector General (OIG), will require close, sustained attention by the Secretary's Office and the agency heads, particularly at CMS and...

Latest Articles