Tag Archives: payments

Untying the knots of MACRA

Photo: Emily via Flickr

Photo: Emily via Flickr

When I think about the forthcoming physician payment and EHR incentive program, known as MACRA, it brings to mind macramé, the 1970s crafting fad of tying cords to make decorative household items.

When I think about macramé, I naturally think about knots. And when I think about knots, I start thinking about MACRA again, because MACRA is an extremely knotty topic – even for health care.

In a new tip sheet, I attempt to untangle MACRA by laying out the basics. MACRA is important for journalists to understand because it is about to become a big deal for physician practices across the country.  It’s arguably the biggest change to physician payments in 20 years. And it will require physicians to continue down the path to EHR adoption and interoperability. Continue reading

Getting behind the confusion that leads some to lose their subsidized health insurance

Photo: frances1972 via Flickr

Photo: frances1972 via Flickr

We posted recently about California’s assessment of who was dropping out of the exchange, including the finding that most people leaving Covered California were getting health insurance elsewhere.

But as Abby Goodnough later reported from Yazoo City, Miss., that’s not always the reason for higher turnover in other areas. Retaining enrollees is a challenge – and affordability is one big reason. That’s true even for people whose premiums are heavily subsidized. Continue reading

Some hospitals slow to adopt new systems of care

PhotoJoel Dinda via Flickr

Photo: Joel Dinda via Flickr

We’ve told you over and over again on this blog that the Affordable Care Act isn’t just about coverage. It’s also about changing how health care is delivered, moving away from fee-for-service to a more value- and quality-based system. Medicare is aiming to have half of its payments under alternative payment models by 2018.

That means hospitals have to change. But not all of them want to.

Fee-for-service is the preferred business model for many. Why should those hospitals want to go through considerable expense and upheaval to switch to a new system that demands more – and may well pay less? Continue reading

Three CMS proposals would shift basis of payments from volume to value



Announcements from the U.S. Department of Health & Human Services last week on rules about bundled payments for hip and knee replacement surgeries, home care, and physician payment reform, move the agency forward in its goal to move 50 percent of fee-for-service Medicare payments into alternative payment models by the end of 2018.

To recap: In January, the U.S. Department of HHS announced that it aimed to shift 30 percent of fee-for-service Medicare payments into alternative payment models by the end of the year. By the end of 2018, it plans to have shifted 50 percent to alternative payment models. We explained that under alternative payment models, the federal Centers for Medicare & Medicaid Services rewards physicians, hospitals and other providers who focus on quality and value, such as in accountable care organizations or bundled payment arrangements. Continue reading

Medicare ‘doc fix,’ passed by House, shifts some costs to seniors

Image by 401(K) 2012 via Flickr

Image by 401(K) 2012 via Flickr

The U.S. House of Representatives passed H.R. 2 on Thursday, a bill that would prevent an automatic cut of 21 percent in Medicare payments to physicians and would require seniors to pay more in the form of higher copayments and premiums. The Medicare Access and CHIP Reauthorization Act of 2015 also would extend the Children’s Health Insurance Program (CHIP) for two years through 2017.

The vote was hailed as a step forward for physicians because it eliminates the formula Congress has used for many years to increase payments to physicians. That formula, called the sustainable growth rate (SGR), was renegotiated annually and usually at the last minute. It’s been replaced with an annual payment increase of 0.5 percent. The vote was 392 to 37, including 212 Republicans and 180 Democrats voting in favor, according to Govtrack.us.

The strong support from both Republicans and Democrats puts pressure on the U.S. Senate to approve the bill, before Congress adjourns on Friday, Paul Demko wrote in Modern Healthcare. Continue reading