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
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
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
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
If you cover health care payment reform, then you know that health insurers, states, and the Medicare program are all developing methods to replace fee-for-service payment. Some of the new payment methods are just being discussed, some are in the pilot-project stage, and some have a multi-year record. All aim to promote what’s called value-based payment, which is designed to get physicians and hospitals focused on improving quality while controlling costs.
For those of us who cover this angle of the health care beat, this week will be a good one to learn what’s happening with a variety of payment reform models. Four webinars on payment reform are scheduled this week: one today and three on Thursday, March 19. Here’s a brief rundown. Continue reading
Image of glass by Tim Caynes via flickr.
Health care consumers in North Carolina got some welcome news last month when the state Department of Health and Human Services published what it said was “the most current price information” from hospitals and ambulatory surgery centers. North Carolina became the latest state to make health care prices available to consumers, joining Maine and Massachusetts as the only other states that publish price data on the web, according to the Report Card on State Transparency Laws (PDF), published March 25, 2014, by the Catalyst for Payment Reform and the Health Care Incentives Improvement Institute.
Actually, the state data were not all that useful, but Blue Cross Blue Shield of North Carolina also published price data within days of the opening of the state’s price transparency site and the Blue Cross data was eye opening and may be of some use to consumers. Continue reading