Tag Archives: medicare

GAO confirms Center for Public Integrity’s findings on Medicare Advantage overspending

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Fred Schulte

In a report last week, the U.S. Government Accountability Office confirmed what Fred Schulte and other journalists at the Center for Public Integrity (CPI) have been reporting on the Medicare Advantage program for two years.

In the report, “Medicare Advantage Fundamental Improvements Needed in CMS’ Effort to Recover Substantial Amounts of Improper Payments,” the GAO showed that CMS estimated that it improperly paid $14.1 billion in 2013 to insurers running Medicare Advantage plans. Continue reading

Indiana project to reduce hospitalization of nursing home residents gets boost

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in Kaiser Health News, The Atlantic.com, New America Media, AARP.com, Practical Diabetology and Home Care Technology report. She is a senior fellow at the Center for Health, Media & Policy at Hunter College in New York City, and co-produces HealthStyles for WBAI-FM/Pacifica Radio.

Photo: Alyssa L. Miller via Flickr

Photo: Alyssa L. Miller via Flickr

The Centers for Medicare and Medicaid Services (CMS) thinks Indiana University may be on to something when it comes to more effective nursing home care. It recently announced a second round of funding for Project OPTIMISTIC, which stands for Optimizing Patient Transfers, Impacting Medical Quality and Improving Symptoms: Transforming Institutional Care. Continue reading

Knees and hips and what they could reveal about ACA’s quality drive

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Photo: Oka Tai-Lee via Flickr

Photo: Oka Tai-Lee via Flickr

The Affordable Care Act created many opportunities for Medicare to test new ways of paying for health care. One of the biggest and most dramatic tests is now getting underway: bundled payments for hip or knee replacement.

Unlike most Center for Medicaid and Medicare Innovation (CMMI) projects on payment and delivery reform, this one is mandatory for hospitals in 67 geographic areas designated as participants. The test began April 1 and is supposed to run for five years. Continue reading

AHCJ update: Three years of Medicare provider payment data for your state

Jeff Porter

About Jeff Porter

Jeff Porter is the special projects director for AHCJ and plays a lead role in planning conferences, workshops and other training events. He also leads the organization's data collection and data instruction efforts.

map-with-excelIn 2014, Medicare paid more than $78 billion to surgeons, ambulance services, podiatrists, hospice services, eye doctors, family physicians, speech, physical and occupational therapists, and dozens more.

AHCJ has updated Medicare payment data for its members in an easy-to-use format – spreadsheet files listing specific providers and broken down by state. Journalists can download and analyze these files – covering 2012, 2013 and now 2014 – to find stories for their audiences. Continue reading

Chicago panel explores the world of drug pricing

Carla K. Johnson

About Carla K. Johnson

Carla K. Johnson (@CarlaKJohnson) is a medical writer at The Associated Press and has covered health and medicine since 2001. A former member of AHCJ's board of directors, she leads the Chicago AHCJ chapter.

Photo: Carla K. JohnsonCraig Garthwaite, assistant professor, Northwestern University's Kellogg School of Management (left); Roy Guharoy, Pharm.D. vice president and chief pharmacy officer for the Resource Group at Ascension (middle); and independent journalist and AHCJ member Duncan Moore (right) spoke at the Chicago chapter event “Drug Pricing: Covering the Controversy” at Columbia College in Chicago on Feb. 23.

Photo: Carla K. JohnsonCraig Garthwaite, assistant professor, Northwestern University’s Kellogg School of Management (left); Roy Guharoy, Pharm.D. vice president and chief pharmacy officer for the Resource Group at Ascension (middle); and independent journalist and AHCJ member Duncan Moore (right) spoke at the Chicago chapter event “Drug Pricing: Covering the Controversy” at Columbia College in Chicago on Feb. 23.

A blockbuster hepatitis C drug costs $84,000, straining state budgets. Martin Shkreli acquires the rights to a generic and raises its price 5,000 percent. Presidential candidates react to the public outcry, claiming they know what to do about the drug prices.

What does it all mean? Until recently, “there’s been an equilibrium in the public mind between a free market regimen of the market setting prices and what the public and payers are willing to pay,” said independent journalist Duncan Moore,  “but there are indications this informal tradeoff has begun to swing out of control.” Continue reading