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

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...
Several Medicare reform proposals have concentrated on realigning financial incentives within Medicare’s provider payment and delivery system to improve program cost-effectiveness and quality, a key health policy challenge. There have been calls to modernize Medicare’s fee-for-service (FFS) benefit design and address other beneficiary incentive issues as a means of...
Care management for Medicare beneficiaries at high risk of hospitalization can significantly reduce hospital admissions without increasing costs, according to two studies in Health Affairs and sponsored by the Robert Wood Johnson Foundation. The studies found decreases in Medicare inpatient admissions of 17 percent and 8 to 33 percent, respectively. Care management...
States might find it useful to have a database replete with health care service claims data to identify Medicaid fraud, evaluate disease trends, establish cost and utilization rates, and share price information with consumers. Typically such comprehensive data is difficult to gather because it comes from various public and...
Fraud and abuse are common and persistent problems for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).  Combined federal and state spending now exceeds $1 trillion, with fraud and abuse likely costing taxpayers well over $100 billion annually. Together with state Medicaid agencies and state attorneys general, several federal offices, such...
When Congress enacted the Medicare Modernization Act of 2003 (MMA), it set a spending target of about $400 billion over 10 years for the Medicare Part D drug benefit, after accounting for revenues from premiums and other sources. Seven years into the program’s life, Medicare Part D spending is...
Prescription drugs often play an important role in keeping people healthy, especially for people with chronic conditions. Medicare beneficiaries with diabetes or asthma, for example, might take regular medicines to prevent emergencies that would put them in the hospital. Hospital stays, doctor’s appointments, and other medical services covered under...
Medicare program payment methods are highly complex and change constantly.  The Affordable Care Act (ACA) makes further, very significant changes to how Medicare pays hospitals, physicians, post-acute providers, and Medicare Advantage health plans.  In a series of excellent briefs, the Medicare Payment Advisory Commission (MedPAC) explains the basics of Medicare reimbusement, including...
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...
The cost of hospitalizations, particularly hospital readmissions, is increasingly a concern for Medicare, Medicaid, and private health plans. The Centers for Medicare and Medicaid Services (CMS) in particular has emphasized reducing hospitalizations and readmissions. Results from the CMS Medicare Coordinated Care Demonstration pilot project show coordinated care for Medicare...

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