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
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
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
In 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
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