Tag Archives: payment

Senate Finance Committee hearing focuses on nursing home abuse

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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.

Compelling, heartbreaking stories of abuse and neglect from the daughters of two elderly women drove home a call for tighter regulations, better oversight and more careful screening of nursing home staff during a Senate Committee on Finance hearing on March 6. The hearing comes in the wake of another horrific story, when a woman in a 14-year coma at a long-term care facility in Arizona gave birth after being raped.

Legislators from both sides of the aisle expressed outrage over mistreatment, neglect and other serious violations at nursing homes, despite years of efforts to enact additional reforms and more government supervision. Continue reading →

Six things to know about MACRA’s final rule

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Rebecca Vesely

About Rebecca Vesely

Rebecca Vesely is AHCJ's topic leader on health information technology and a freelance writer. She has written about health, science and medicine for AFP, the Bay Area News Group, Modern Healthcare, Wired, Scientific American online and many other news outlets.

Photo: 24oranges.nl via Flickr

Photo: 24oranges.nl via Flickr

The final rule on the massive physician payment overhaul law came out on Oct. 14. Since then, interest and advocacy groups have been combing through the 2,400-page regulation and further clarifications are trickling out.

As a refresher, the Medicare and CHIP Reauthorization Act of 2015 (MACRA) aims to replace years of uncertainty around Medicare payments to physicians. It also revises requirements for health IT adoption and provides incentives for physicians to move towards value-based payments. Continue reading →

Pros and cons of health payment reform: Capitation

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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. Follow her on Facebook.

Photo: Yann via Flickr

Photo: Yann via Flickr

The Urban Institute and the Catalyst for Payment Reform have collaborated on a series of briefs about various forms of health payment reform. Over the summer we’ll look at some that are receiving a lot of attention from policymakers and payers.

Let’s start with capitation. The recent Centers for Medicare & Medicaid Services (CMS) announcement about Comprehensive Primary Care Plus (CPC+) isn’t a switch to a fully capitated system. But this five-year model, scheduled to launch in January, does offer a degree of capitation, and moves further toward shifting more payments to a per-patient fee. Let’s look at what Urban/Catalyst says about the benefits and drawbacks of a capitated primary care payment system. Continue reading →

For finance editor, covering value-based care takes well-versed sources, hours of interviews

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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.

money-and-medicineWe’ve all heard the talk about how the health care system is moving quickly from fee-for-service payment to value-based care. Certainly a new payment model is needed, but what is the difference between fee-for-service and value-based payment?

As health care journalists we have a good idea about how FFS works, but what are the characteristics of new models in which physicians and hospitals are paid for delivering value? And how do payers define value exactly? Continue reading →

DC journalists dig into secrets behind AMA’s physician payment committee

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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.

A secretive committee of the American Medical Association exaggerates how much physician time and effort is involved in performing many medical procedures, according to an analysis of the committee’s work by journalists at The Washington Post.

That exaggeration skews payment in favor or physician specialists and at the expense of primary care physicians, according to the article by the Post’s Dan Keating (@dtkeating) and Peter Whoriskey (@PeterWhoriskey).

The claim that the committee overstates the time involved to do many procedures has been reported previously. What is unusual about Keating and Whoriskey’s analysis of the AMA’s 31-member Relative Value Update Committee is that they calculated the committee’s estimates of the time involved for physicians to do many procedures and found the numbers to be off by as much as 100 percent in favor of specialist physicians. Continue reading →