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House GOP's Effort to Repeal SGR Takes Aim at ACA's Individual Mandate
he lower chamber is expected to vote on legislation that would permanently repeal Medicare's sustainable growth-rate formula for physician payment, which might also include a provision to either repeal or delay the ACA's individual insurance mandate as a way to pay for the SGR fix.
House Republicans have found another back-door way to attempt a partial dismantling of the Affordable Care Act. The lower chamber is expected to vote on legislation that would permanently repeal Medicare's sustainable growth-rate formula for physician payment, which might also include a provision to either repeal or delay the ACA's individual insurance mandate as a way to pay for the SGR fix. But as before, their efforts are certain to die in the Senate, making another temporary, not a permanent, SGR fix more likely as a March 31 deadline looms.
The House is likely to vote this week on the SGR Repeal and Medicare Provider and Payment Modernization Act of 2014, but it remains unclear if the GOP lawmakers will attach a provision to repeal the individual mandate or delay it by several years, as one news report suggested. According to the Congressional Budget Office, a one-year delay of the individual mandate would save about $9 billion over 10 years. A permanent repeal of Medicare's SGR would cost about $138 billion over 10 years.
Julius Hobson, a senior policy adviser at the law firm Polsinelli and former lobbyist for the American Medical Association, said this approach is not likely the path to solving the SGR problem.
Read the full story here: http://bit.ly/NRztmT
Source: Modern Healthcare
ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
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New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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Contributor: For Complex Cases, Continuity in Acute Care Is Necessary
April 23rd 2025For patients with complex needs and social challenges like unstable housing, the hospital has become their de facto medical home—yet each visit is a fragmented restart, without continuity, context, or a clear path forward.
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Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
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Integrated CKD Care Model Cuts ED Visits by 30%, Boosts Specialized Treatment
April 21st 2025An analysis of an interdisciplinary care model for managing chronic kidney disease (CKD) shows hospital admissions dropped by 26% and emergency department (ED) visits decreased by 30% after clinic initiation.
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