Insurance

A one-minute look at managed care news during the week of April 13, 2015, including a the official repeal of the sustainable growth rate formula and a look at the rising cost of generic drugs.

Missouri already spends $1.2 billion on Medicaid managed care in less than half its counties. The new plan would extend managed care to all Medicaid clients except the blind, disabled, and elderly. Meanwhile, in North Carolina, the CEO of the Medical Society argued against moving Medicaid to managed care, citing problems in other states.

Following last night's vote by the Senate to repeal the SGR bill, the largest society of oncologists praised the action by Congress to end this Medicare reimbursement controversy.

With just hours to go before an automatic 21% cut in Medicare fees was scheduled to take effect, the Senate passed legislation to repeal the much-reviled sustainable growth rate formula.

While Medicare is ready to pay for an annual spiral CT scan for long-term smokers, some doctors think it's an unnecessary procedure that might do more harm than good.

Cancer patients without insurance can be paying up to 43 times what Medicare pays for the same chemotherapy drugs, according to a new study published in Health Affairs from the University of North Carolina at Chapel Hill.

A new coalition of consumers, healthcare providers, and industry launched the Clear Choices Campaign on April 9 to advocate for more transparent, accountable, and consumer-friendly health markets.

UPMC is threatening to lock Highmark's Medicare Advantage customers out of its hospitals, a move Governor Tom Wolf calls "unacceptable."

In Montana, 13 Republicans helped give a Medicaid expansion bill a solid majority to send it back to the Senate for reconciliation. A bill signing could come by next week. In Florida, Governor Rick Scott appeared to reverse his 2013 position that he could not deny the uninsured access to care.

The study's lead author said delays in melanoma surgery were more common than expected, and the team at Yale School of Medicine is looking into explanations. Right now, there is no "gold standard" for how long it should take between a diagnosis and excision.

Instead of the original 0.95% rate cut for the Medicare Advantage (MA) program proposed in February, CMS announced on Monday that the MA pay rate for 2016 would be a 1.25% increase.

Medicare Advantage has the potential to be the most powerful part of the solution for American healthcare, but the government needs to create reimbursement stability in order for that to happen, said Kent Thiry, chief executive officer of DaVita Healthcare Partners Inc.

Physicians were accepting nearly equal amounts of new Medicare and privately insured patients in 2013, but much fewer were accepting new Medicaid patients, according to a new report from the CDC's National Center for Health Statistics.

Long before patient-centered care and value-based models were the order of the day, Geisinger was focused on delivery care that was not focused on figuring out who would pay the bill.

The failure of federal agencies to implement 25 sets of "significant" recommendations from the HHS Office of Inspector General has cost US taxpayers and beneficiaries some $24 billion.

The overhaul would fix the Medicare reimbursement system and align payment with CMS' current efforts to reward value-based care. For the first time, the wealthiest seniors would be asked to pay higher premiums.

Links between cardiorespiratory fitness and cardiovascular events are well-established. More recently, researchers are turning their attention to the connections between fitness and certain cancers.

The Health Care Payment Learning and Action Network kicked off with its inaugural meeting bringing together public and private sector actors to discuss efforts to move healthcare toward a system that pays based on quality rather than quantity.

In a show of solidarity, state oncology societies from across the United States today joined the American Society of Clinical Oncology in its call on Congress to repeal Medicare's Sustainable Growth Rate formula before the current payment patch expires at the end of the month.

More than $3 billion was returned to the Medicare Trust Fund in 2014 from individuals and companies attempting to defraud federal health programs, according to an announcement by HHS.

A one-minute look at managed care news during the week of March 16, 2015, including bills from Congress to fix the sustainable growth rate formula and anticipation over the PCSK9 inhibitors.

A bipartisan coalition in the House and Senate introduced identical bills that repeal Medicare's notorious formula for setting physician pay and, have implications for health information technology.