Insurance

Ophthalmologists are among Medicare's highest paid specialists-a finding already drawing scrutiny from policymakers and watchdogs worried about waste and overuse.

HHS Secretary Kathleen Sebelius has resigned her post barely a week after the close of the tumultuous initial open-enrollment period for the healthcare reform law's insurance exchanges.

Sylvia Mathews Burwell is about to become the biggest name in health care after news broke Thursday night that she will be the nominee to replace the resigning Health and Human Services Secretary Kathleen Sebelius.

Routine office visits accounted for the single largest share of Medicare physician billings in 2012 even though they amounted to just one one-seventh of the $77 billion paid by the government for physician services through the nation's senior citizens healthcare program.

The American Medical Association (AMA) said it would not block the release of 880,000 physician billing records from the Medicare claims database. The government's decision to release the information is a response to the pressure they received from employers, insurers, and consumer groups for increased transparency and access to physician payment information.

The nation's largest doctors' group said Monday it won't try to block Medicare's release of billing records for 880,000 physicians, although it continues to oppose the government's recent decision to open up the massive data trove.

The duals demonstration project launched last week in five counties, according to officials from the Department of Health Care Services, which is overseeing the project.

Just over half of the 114 organizations to join one of two Medicare accountable care organization efforts in 2012 report no decrease in health spending below targets during their first 12 months.

Health insurers often try to influence Washington through quiet persuasion in plush offices. To fight potential government cuts for private Medicare plans, however, they've hit the streets.

With 2015 Medicare Advantage payment rates and policy changes pending, some lawmakers and associations are urging the Centers for Medicare & Medicaid Services to stick to the cut it proposed while others are calling for rates not to drop.

Heartland Regional Medical Center had more to lose than most when it gambled and joined Medicare's experiment with accountable care in 2012. For the first year at least, that risky bet paid off.

In a 64-35 vote, the Senate approved the seventeenth fix to the sustainable growth rate (SGR) payment formula.

The Safety Assurance Factors for Electronic Health Record (EHR) Resilience, or SAFER guidelines, could assist healthcare providers as they integrate technology into their everyday practices.

Big data, electronic health records, online health insurance portals-countless technology innovations are emerging, but how important are they for health leaders to adopt? According to analysts at Forrester Research, a global research and advisory firm, it's not only extremely imperative, but a matter of organizational survival.

The Senate approved a bill Monday evening that prevents steep cuts to Medicare physician payments from going into effect for one year and delays the conversion to ICD-10 diagnostic and procedure codes for at least one year.

The Medicare Payment Advisory Commission (MedPAC) recently aired concerns as to whether the patient-centered medical home (PCMH) can serve as a model for providing value-based care. In particular, several members asserted that the medical home model may have a real cost disadvantage for health systems. They explained that without evidence-based research, it is difficult to determine if the model encourages practices to use their cost savings to improve care.

Doctors are trying to stoke a rebellion against the doc fix.

The House of Representatives passed a controversial bill that will extend the sustainable growth rate (SGR) formula for physician payments for 1 year.

The Centers for Medicare & Medicaid Services' proposal to mandate broader provider networks in public insurance exchanges could have the unintended consequence of discouraging insurer participation, according to analysts at Moody's.

Despite opposition from doctors' groups, on a voice vote Thursday, the House of Representatives passed a one-year patch for Medicare's unpopular sustainable growth-rate formula for physician payments and, in the same bill, extended the implementation deadline for ICD-10 diagnostic and procedural codes for at least a year.

Facing heavy bipartisan opposition on Capitol Hill as well as from patient groups, businesses, insurers and others, the Centers for Medicare & Medicaid Services said Monday it did not plan to move ahead at this time with several proposed changes to the Medicare prescription drug program.

The House Ways and Means bill to temporarily prevent Medicare physician payment cuts also would deliver an Easter gift to hospitals-a six-month extension to comply with a controversial new inpatient payment rule for hospitals.

Another temporary 12-month patch will be enacted for the doc fix prior to the scheduled March 31 expiration of the current patch, House Speaker John Boehner (R-Ohio) indicated Wednesday.

New rules for Medicare Advantage (MA) plans would protect elderly citizens who might otherwise lose access to their preferred network of doctors.

The prospects for a permanent doc fix prior to the March 31 deadline are looking increasingly remote.

Gary Liska, with Alere Home Monitoring Inc, says Alere's commitment to patients' safety is why they supported the STABLE study.

The American Journal of Accountable Care will be the media sponsor for a seminar set for March 27-28, 2014, at Innisbrook Golf and Spa Resort in Palm Harbor, Fla., sponsored by TripleAim ACO Consulting Group. TripleAim's mission for the event is to share how the 29 ACOs that experienced shared savings of $126 million in 2012 accomplished the task, and to guide newer ACOs to success.

As Congress tries to reform Medicare, the program's independent advisor has its own suggestions, including a call to end to what has become a revenue buffer for many hospitals and an integral part of their physician acquisition strategies.

This study examines disparities in important patient-reported functional outcomes not routinely assessed among diverse racial/ethnic groups in Medicare managed care.