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

Under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Congress increased payments to Medicare Advantage plans. The objective is to increase participation by health plans and thereby create more choices for Medicare beneficiaries. While many pundits have criticized the payment increases as a
The pay-for-performance (P4P) movement continues to grow: 1. The Medicare Payment Assessment Commission (MedPAC) is calling on Congress to incorporate quality incentives in Medicare payments to hospitals, physicians, and home health agencies. In 2003, MedPAC released similar P4P recommendations for Medicare managed care plans and dialysis facilities. MedPAC says the...
Congress could improve the newly created Medicare prescription drug benefit by applying the lessons of welfare reform, according to an excellent new article by Paul Barringer. In American Outlook, the Hudson Institute's quarterly journal, Mr. Barringer lays out what made welfare reform successful: ● Pay for performance: bonuses for performing well...
The Centers for Medicare & Medicaid Services (CMS) today released the final rule governing the new Medicare prescription drug benefit. To help folks understand the 1,162-page final rule, CMS created a variety of fact sheets, timelines, and other background materials to help stakeholders understand the extraordinarily complex drug benefit: ● Overview...
Adjusted for cost-of-living differences, rural physicians have 13 percent more purchasing power than urban physicians. And while there are fewer physicians per capita in rural areas, the overall urban-rural disparity is likely due to an over supply of physicians (particularly specialists) in urban areas. So says a new study by...
Some legal gurus are questioning the constitutionality of a key provision of the Medicare prescription drug benefit: the so-called "clawback" provision that requires states to send the federal government cash to help cover the cost of drugs for dual eligibles. The mandatory payments are enormous - $6 billion in...
When the Medicare prescription drug benefit begins on January 1, 2006, about seven million beneficiaries face more restricted drug formularies. Currently, these "dual eligible" individuals receive their drug benefit through state Medicaid programs, which offer more liberal formularies than what will be expected of the new Medicare drug plans. In...
New evidence on the high incidence of preventable, often deadly drug errors in nursing homes raises serious implications for the new Medicare prescription drug benefit. Each month, one in ten nursing home residents suffer a medication-related injury, according to a new study in the American Journal of Medicine. The lead...
The supply chain for prescription drugs is as complex as it is important. It represents a fascinating, continuously evolving maze of players, relationships, and processes from manufacturers all the way to individual patients. With Medicare's new approach to Part B drug reimbursement, the upcoming Medicare Part D drug benefit, increasing...
Medicare observers expect heavy competition for drug plan contracts with the Centers for Medicare & Medicaid Services (CMS). It now appears CMS will receive several hundred applications, including applications from major insurers offering drug benefit packages in every state. Since adoption of the Medicare Modernization Act (MMA), most observers -...

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