Analysis: COVID-19 could raise Medicare spending by as much as $115B over next year

FierceHealthIT

A new analysis gave the first details on how the COVID-19 outbreak could impact Medicare spending, potentially increasing costs past $100 billion through 2021

ACOs saved Medicare $755M from 2013 to 2017, new analysis finds

FierceHealthIT

Accountable care organizations lowered Medicare spending by $755 million from 2013 to 2017, a new analysis found

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UnitedHealth: MA plan holders save nearly 40% more compared to fee-for-service Medicare beneficiaries

FierceHealthIT

Medicare Advantage plan holders spent nearly 40% less than their counterparts in Medicare’s fee-for-service program, according to a new analysis from UnitedHealth Group

ACOs saved Medicare $2.7B to date, outpacing CMS estimates

FierceHealthIT

Accountable care organizations in the Medicare Shared Savings Programs have saved Medicare $2.7 billion to date, including $859 million in 2016, according to a new analysis commissioned by NAACOS.

A look at 4 ways to grow dental coverage in Medicare

FierceHealthIT

Expanding options for dental care in Medicare is a popular idea, but policymakers could take several avenues toward this goal, according to a new analysis

#IBMWoW cognitive solutions for cyber threat analysis and collaboration

The Healthcare Guys

Given how hard cybersecurity threat comprehension happens to be from a single company viewpoint, I’m eager to learn how we’ll be able to use next generation cognitive type tools for cyber threat analysis across firms or within logical groupings of firms.

Avalere: CMMI will not generate as much savings for Medicare as CBO projected

FierceHealthIT

The Center for Medicare and Medicaid Innovation will only save Medicare nearly half of what the Congressional Budget Office projected, according to a new analysis

MedPAC: Hospitals got $201B in Medicare payments last year, a 3.6% bump from 2017

FierceHealthIT

Hospitals got $201 billion in Medicare fee-for-service payments in 2018, a 3.6% increase from 2017 as Medicare is footing the bill for higher drug prices, a new analysis found

Medicare Drug Prices Up Despite Decrease in Prescriptions

BHM Healthcare Solutions

Editor’s Note: Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries. ” Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries.

Medicare Opens the Door to Reimbursement for Remote Patient Monitoring

Digital Health Today

When CMS unveiled the first standalone reimbursement for Remote Patient Monitoring (“RPM”) by “unbundling” CPT Code 99091 in the 2018 Medicare Physician Fee Schedule , it opened the door to the widespread use of RPM services for patients and promised there was more to come.

Medicare charges spike for specialties most associated with surprise bills

FierceHealthIT

Average list prices for emergency medicine and anesthesiology, the most common sources of surprise billing, outpaced annual growth compared to all other specialties, a new analysis finds

Analysis shows frequent prescribers of opioids receive larger payments from pharma

FierceHealthIT

Doctors who write the most opioid prescriptions get paid the most money from the pharmaceutical companies that manufacture the drugs, an analysis by CNN and researchers at Harvard University found. Using government databases, the report found that 54% of doctors who wrote prescriptions to Medicare patients in 2014 and 2015 for opioids received a payment from pharmaceutical companies that make the drugs

KFF: Small share of Medicare Advantage and Part D enrollees switched up plans

FierceHealthIT

Only a small share of Medicare Advantage and Part D beneficiaries switched their health plans during the 2016 and 2017 open enrollment, even though plan options have expanded, a new analysis finds

National Health Spending Will Reach Nearly 20% of U.S. GDP By 2027

Health Populi

every year from 2020 to 2027, the actuaries at the Centers for Medicare and Medicaid Services forecast in their report, National Health Expenditure Projections, 2018-2927: Economic And Demographic Trends Drive Spending And Enrollment Growth , published yesterday by Health Affairs.

Medicare Told to Cover CGMs in Ruling

Insulin Nation

Medicare doesn’t typically provide coverage for continuous glucose monitors (CGMs), as insurors who oversee Medicare coverage have long argued that CGMs are a “precautionary” device rather than a “medically necessary” one. The Medicare-insuring contractor denied the claim.

Medicare Advantage beats fee-for-service in utilization, outcomes

FierceHealthIT

A new analysis from Avalere shows Medicare Advantage patients have fewer inpatient stays, ER visits and avoidable hospitalizations than fee-for-service beneficiaries, despite higher rates of social and economic risk factors

Some payers and providers could thrive under ‘Medicare for All.’ But only if they’re willing to adapt 

FierceHealthIT

Most of the legacy health organizations—both payer and provider—would stand to lose substantially under a ‘Medicare for All’ system, but a select few could thrive, according to a new analysis.

2019 Medicare Physician Fee Schedule Could Expand RPM Reimbursement

care innovations

Just as it did for the 2018 calendar year , the Centers for Medicare & Medicaid Services (CMS) is seeking to further expand reimbursement for remote patient monitoring, virtual visits and other telehealth services as part of its proposed 2019 Medicare physician fee schedule.

Health Care and the Democratic Debates – Round 2 – Battle Royale for M4All vs Medicare for All Who Want It – What It Means for Industry

Health Populi

Sanders, noting his call for big new government benefits like universal health care through Medicare for All and free college tuition. Senator Harris, too, mentioned government benefits like free college and Medicare for All as her health plan preference.

Changes to Medicare Advantage Plans Could Allow for Expansion of RPM Services in Senior Care

care innovations

And that means that “senior living companies that double as Medicare Advantage insurers” will be given the opportunity for reimbursement for new modes of care targeting patient with chronic conditions. Changes to Medicare Advantage Plans Designed to Reduce Rehospitalizations.

Analysis finds shoppable hospital services at center of transparency rule a small part of Medicare spending

FierceHealthIT

The required shoppable healthcare services that are the subject of the Trump administration’s controversial hospital transparency rule made up a small amount of Medicare spending in 2017, a new analysis finds

Technology, Aging and Obesity Drive Healthcare Spending, BEA Finds

Health Populi

Financial health Health Consumers Health costs Health Economics Health policy Heart health Medicare Medicines Mental health Money and health Obesity Personal health finance Pharmaceutical Prescription drugs Prevention Public health Specialty drugs TransparencyThe U.S.

AHIP: CMS must fix flaw in Medicare Advantage rate formula

FierceHealthIT

As Medicare Advantage grows in popularity, America’s Health Insurance Plans says it is vital that the Centers for Medicare & Medicaid Services fix the flaws in its funding formula to maintain the program’s stability. AHIP’s assessment rests on a new legal analysis that shows CMS calculates current benchmarks for Medicare Advantage using data from patients who are not eligible to participate in the program

Report: Axing protected drug classes in Medicare Part D may not substantially lower spending

FierceHealthIT

Eliminating the protected classes of medications for Medicare Part D plans could give insurers more leverage to negotiate rebates but may have a limited financial payoff, according to a new analysis

Medicare readmission rates offer incomplete picture of hospital quality

FierceHealthIT

Condition-specific readmission rates do not offer a fair proxy for overall hospital quality, according to a new analysis of federal data. The authors of the study pointed to an imbalance between 30-day readmissions among Medicare patients and overall quality, concluding that broadening the scope of the program would eliminate penalties for 40% of hospitals

Heart-Love – Omron’s Holy Grail of Blood Pressure Tracking on the Wrist

Health Populi

It’s February 1st, which marks the first of 28 days of American Heart Month – a time to get real, embrace, learn about, and engage with heart health. Heart disease kills 610,000 people in the U.S. every year, equal to 1 in 4 deaths in America.

New Study on Lowering Opioid Prescription Challenges

BHM Healthcare Solutions

Editor’s Note: Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries. Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries.

3 Big Healthcare Trends To Watch in 2015

BHM Healthcare Solutions

In 2013 The Centers for Medicare & Medicaid Services launched Bundled Payments for Care Improvement (BPCI) Initiative, which breaks down bundled payment in to four models of care to help target and hone in on the different types of bundled payments used by healthcare entities.

Part D catastrophic threshold to spike in 2020, hiking out-of-pocket costs: KFF report

FierceHealthIT

Medicare Part D beneficiaries could see their out-of-pocket costs go up next year before they reach the catastrophic phase of the benefit, a new analysis shows.

Combating Opioid Overprescription

BHM Healthcare Solutions

Editor’s Note: Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries. The majority of the indictments reportedly stemmed from data analysis, which produces much more straightforward results in opioid investigations than in other potential cases of healthcare-related fraud. Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries.

Altarum: Growth in spending on privately insured patients outpacing Medicaid, Medicare

FierceHealthIT

A new analysis from the Altarum Institute found that spending and price growth among the privately insured sped up in 2017 and the first half of 2018 compared to public payers. It's a reversal from prior trends when private spending growth was near or below Medicare and Medicaid rates

Best Practices for Payer-Provider Partnerships

BHM Healthcare Solutions

CMS also analyzed data from the National Committee for Quality Assurance, Healthcare Effectiveness Data and Information Set, and CMS Medicare Advantage Star Ratings.

KFF: MA plans per beneficiary to reach highest level in 2020 in a decade

FierceHealthIT

The average number of Medicare Advantage plans per beneficiary will increase in 2020 to the highest level since 2010, according to a new analysis

Study: Hospital Prices Show ‘mind-boggling’ Variation

BHM Healthcare Solutions

The study provides the most comprehensive and detailed analysis of private health care spending in the United States and examines the real prices hospitals negotiate with private insurers for medical services.

More Medicare Part D beneficiaries reaching catastrophic phase, likely setting up calls for reform

FierceHealthIT

A new analysis from Avalere shows that more Part D enrollees are reaching their catastrophic phase, and the consulting group told FierceHealthcare such growth in spending is likely to lead to future reforms

New Opioids Bill Addresses Patient Brokering

BHM Healthcare Solutions

The kickback payments are already illegal under Medicare and Medicaid. Behavioral Health Integration Care Coordination Clinical Analysis Clinical Operations Improvement Strategic Planning Healthcare Payers Opioid Opioid Epidemic Payer Challenges

Physician-led ACOs generated almost seven times more savings than hospital-led ACOs: Avalere

FierceHealthIT

Physician-led accountable care organizations generated nearly seven times more savings for Medicare last year compared to more high-revenue ACOs typically led by hospitals, a new analysis finds

Why People Are Still Avoiding the Doctor (It’s Not the Virus)

Henry Kotula

In a recent analysis of the sharp decline in emergency room visits during the pandemic, officials from the Centers for Disease Control and Prevention said there were worrisome signs that people who had heart attacks waited until their conditions worsened before going to the hospital.

Doctors Without Patients: ‘Our Waiting Rooms Are Like Ghost Towns’

Henry Kotula

Federal officials have taken some steps to help small practices, including advancing Medicare payments and reimbursing doctors for virtual visits. Federal officials used last year’s payments under the Medicare program to determine which groups should get the initial $30 billion in funds.

Study Finds Flaws in Physician Performance Metrics

BHM Healthcare Solutions

The measures were part of the Medicare’s Merit-based Incentive Payment System/Quality Payment Program, a sweeping initiative to link physician performance – and patient outcomes – to reimbursement under the program.