A new study looks at the effectiveness of capitated payments for Medicare Advantage plans on reducing incentives for clinicians to provide low-value services.
The study, published in JAMA Network Open, compared data for beneficiaries enrolled in fee-for-service (FFS) Medicare against those enrolled in Medicare Advantage in order to...Arizona News
Insurance company Centene defied the odds for the third quarter and overcame issues with Medicaid reimbursement for higher returns than investors had anticipated.
Centene reported $713 million in profit for Q3 on $42 billion in revenue, up from $469 million and $38 billion last year. Following the Medicaid redetermination period, more...Arizona News
Vice President Kamala Harris and former President Donald Trump delivered their final pitches to the American public this week ahead of election day on November 5. Both candidates refined their positions on healthcare policy and the people they'd entrust with health matters should they win the White House.
Throughout the campaign...National News
Election day is drawing near and the candidates for president are distinguishing themselves with healthcare policy proposals.
Vice President Kamala Harris's campaign released several health-related potential policies over the past several weeks, including a plan to boost long-term care at home. According to Axios, up to a third of...National News
Recent studies and legislative developments indicate significant healthcare changes with potential Medicare coverage for anti-obesity medications (AOMs). The latest analysis, published on August 15, 2024, sheds light on the financial implications and benefits of incorporating a AOMs into Medicare coverage.
Benedic Ippolito, a senior...National Reports & Surveys
A 2023 Affordability Survey reveals significant challenges Americans face with the appeals process for claim denials and billing errors.
Patients and their families are confused about their right to appeal and who to contact, and a high rate of successful appeals suggests potential flaws in the initial determination process. Sara...
At the end of June, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) that includes updates for renal dialysis payments and requirements for the ESRD Quality Incentive Program.
Renal dialysis services will get a 2.2% raise in both...
The U.S. Department of Justice announced that it has taken action to end a healthcare fraud scheme in Arizona that preyed on elderly patients and defrauded health payers $1.6 billion.
The DOJ announced it had charged 193 people with healthcare fraud in the sweep, all affiliated with companies Apex Mobile Medical LLC, Apex Medical LLC,...National Reports & Surveys
The uninsured rate is likely to climb over the next decade according to projections from the Congressional Budget Office (CBO).
The CBO said that it expects the rise in uninsured Americans was elevated to a higher rate when 23 million people lost benefits during the Medicaid redetermination period last year. More could lose insurance...National News
National health spending continues to skyrocket and is expected to eclipse one fifth of the total U.S. economy by 2032, according to projections released last week by the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary.
The Office of the Actuary estimates that national health spending rose to $4.8 trillion in...National News
The U.S. is in a maternity care crisis with some of the highest rates of maternal mortality in the world and ever-worsening access to reproductive healthcare services and providers due to punitive abortion restrictions and low reimbursement. The Medicare program wants to fix that.
Time reports that the health are system is failing the...National News
GLP-1 agonist medications are the hot topic of the health world, as the drugs that were initially designated to treat diabetes have demonstrated efficacy in producing significant weight loss. But as more Americans are accessing these drugs, the price tag for the manufacture and distribution of the highly-sought treatment remains a big...National News
This week, Senate Finance Committee Chair Ron Wyden (D-Ore.) and ranking Republican Mike Crapo (Idaho) released a white paper requesting public input on the Medicare physician payment system, signaling that reform could be included in the year-end healthcare package that is expected to include permanent telehealth expansion.
The paper...White Papers, E books, Reports and more
A new study from the Paragon Health Institute looked into the potential for expanding means testing within the Medicare program.
Paragon explains that the study was conducted because of the rising costs of Medicare and its relationship to federal debt, which require innovative solutions to stave off depletion of the Medicare Trust...
A new report by the RAND Institute shows that hospitals are charging private insurers 254% of what Medicare would have paid for both inpatient and outpatient services.
Spending on hospital services accounted for 42% of total U.S. personal healthcare spending for privately insured individuals in 2022. The RAND Report Press...
In a ruling that is expected to be appealed, a fourth federal judge sided with the government against pharmaceutical companies in upholding the Medicare Drug Price Negotiation Program.
This lawsuit was brought by Bristol Myers Squibb and Johnson & Johnson against the law that will require them to negotiate the prices of blood clot...National News
This week, the Social Security and Medicare Trustees Reports played a game of "good news, bad news" with the aging American public. The good news is that the date of Social Security and Medicare insolvency have been pushed back several years. The bad news is that they're both still anticipated to go broke in just over a...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) issued proposed rules for the FY 2025 inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) payment system. The agency proposes raising payments and the industry decried the boost as insufficient.
Hospitals will receive a 2.6% increase or $2.9 billion across...National News
President Joe Biden released his budget proposal this week which centers Medicare-boosting policies, lowering prescription drug prices and continuing subsidies to Affordable Care Act exchange insurers.
The president is pitching his $7.3 trillion budget for 2025 on the argument that it will curb national debt and reduce the deficit by...
A new survey from the Commonwealth Fund, a thinktank that promotes improvements in the healthcare system, found that most older Americans say they like their coverage regardless of whether they are enrolled in Medicare Advantage or Medicare fee-for-service (FFS). However, more people in Medicare Advantage plans reported delays in care...
