Tag Archives: medicare

Employers and insurers paid hospitals 247% more than Medicare rates, new study shows

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.

Photo: stevenharman via Flickr

Research released today shows that from 2016 through 2018, self-insured employers and commercial health insurers in 49 states and the District of Columbia paid 247% more, on average, than what the Medicare program would have paid for the same inpatient and outpatient hospital services.

Researchers from RAND analyzed hospital claims data from 3,112 hospitals in every state except Maryland, which was excluded because the state has an all-payer rate setting model in which hospitals charge prices that are equal to what Medicare and private insurers pay, the report explained. The claims totaled $33.8 billion and came from self-insured employers, six state all-payer claims databases and health plans from 2016 to 2018. Continue reading

Report shows wide variation in what insurers pay providers versus what Medicare would have paid

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.

Researchers from the Health Care Cost Institute reviewed 210 million claims from individuals with health insurance through their employers in 2017 and compared what insurers paid physicians and other providers for those services against what Medicare would have paid for the same services in 271 metropolitan areas.

Graphic: Health Care Cost InstituteResearchers from the Health Care Cost Institute reviewed 210 million claims from individuals with health insurance through their employers in 2017 and compared what insurers paid physicians and other providers for those services against what Medicare would have paid for the same services in 271 metropolitan areas. (Click to enlarge graphic.)

During the coronavirus pandemic, any number of good news stories seem to get little or no coverage because most health care journalists are busy covering COVID-19.

One such case in point was a report earlier this month from the Health Care Cost Institute. In Comparing Commercial and Medicare Professional Service Prices, HCCI researchers compared what health insurers paid to physicians and other providers with what Medicare pays for those services.

This report should not be overlooked for at least three reasons. Continue reading

Tip sheet offers story ideas when reporting on Medicare Advantage

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

Photo: John Jacobi via Flickr

Medicare Advantage plans may not be all they’re cracked up to be and often mislead consumers, according to a new MedPage Today story by reporter Cheryl Clark, who also is AHCJ’s new patient safety core topic leader. As Clark puts it, “getting out is a lot harder than getting in.”

Anyone turning 65 has several months on either side of their birthday to choose to enroll in traditional Medicare, the government-run health insurance for older adults and certain people under 65 with disabilities. Medicare includes Parts A (hospitalization), B (physician services) and an optional Part D (prescription drug plan). As of November, Medicare covered nearly 39 million people. Continue reading

As employers attempt to contain health insurance costs, workers and families struggle too

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.

Photo: Pictures of Money via Flickr

One of the largest and most important parts of our health care system is the role employers play in providing health insurance coverage for workers, retirees, and family members. U.S. employers cover 55.1% of Americans who have health insurance, according to a report released by the U.S. Census Bureau.

By providing health insurance for more than half of all Americans, employers pay for the biggest share of health coverage in the United States. Continue reading

New rule allows Medicare reimbursement to ambulatory surgery centers for knee replacements, stents

Cheryl Clark

About Cheryl Clark

Cheryl Clark (@CherClarHealth) is AHCJ's core topic leader for patient safety, a MedPage Today contributor and inewsource.org investigative journalist. For most of 27 years, she covered medicine and science for the San Diego Union-Tribune. After taking a buyout in 2008, she became senior quality editor for HealthLeaders Media.

Knee replacement surgeries and stenting procedures will now be reimbursed in free-standing ambulatory surgery centers for Medicare fee-for-service beneficiaries as of Jan. 1 under a new rule finalized by the Centers for Medicare & Medicaid Services on Friday.

The controversial policy shift will mean hundreds, if not tens of thousands, of older patients will now have these complex procedures in a facility not attached to a hospital, and will go home the same day. Continue reading

CMS proposal would make knee replacements, stents reimbursable at ambulatory surgery centers

Cheryl Clark

About Cheryl Clark

Cheryl Clark (@CherClarHealth) is AHCJ's core topic leader for patient safety, a MedPage Today contributor and inewsource.org investigative journalist. For most of 27 years, she covered medicine and science for the San Diego Union-Tribune. After taking a buyout in 2008, she became senior quality editor for HealthLeaders Media.

Who reads Medicare rules?

Nobody, right?

They’re long, boring, hard to read because of the small type in narrow columns and they’re full of repetition and jargon.

But just in case you have a sleepless night, I recommend pulling up proposed or final rules for an IPPS, (inpatient prospective payment system) or an OPPS (outpatient prospective payment system) or a PFS (physician fee schedule), for starters. Continue reading