American Society of Anesthesiologists Extremely Frustrated with Another Year of Medicare Payment Cuts

Today the American Society of Anesthesiologists (ASA) expressed disappointment with the congressional “doc fix” provisions included in the recently passed government funding package. Instead of blocking the fourth straight year of Medicare payment cuts to physicians, the provisions only reduce the size of the 2024 payment cut by about half, leaving physician practices with unsustainable payment cuts.

New AI Technique Significantly Boosts Medicare Fraud Detection

In Medicare insurance fraud detection, handling imbalanced big data and high dimensionality remains a significant challenge. Systematically testing two imbalanced big Medicare datasets, researchers demonstrate that intelligent data reduction techniques improve the classification of high imbalanced big Medicare data.

Medicare Could Save an Additional $10 Billion Annually Across 10 Drugs by Using a Therapeutic Reference Pricing Approach in Upcoming Price Negotiations

Value in Health announced the publication of a study showing that United States Medicare could save up to an additional $5-$10 billion dollars annually across 10 drugs if it negotiated prices using a therapeutic reference pricing approach rather than using the statutory ceiling price alone.

Key Medicare payment model fails to improve mental health

A widespread Medicare program that aims to improve health care and lower costs by providing financial incentives to doctors and hospitals resulted in no improvements in mental health care, according to a study by researchers at Washington University School of Medicine in St. Louis and the Yale School of Public Health.

Infirmary Health partners with Ochsner Accountable Care Network to improve health outcomes for seniors across the Gulf Coast

Ochsner Health and Infirmary Health announce a landmark partnership with Ochsner Accountable Care Network, a top-performing accountable care organization (ACO) in both clinical performance and healthcare savings for the Medicare population.

Proposed Drug Pricing Policy Would Save Medicare Between $1 Billion and $2.1 Billion Annually

Value in Health, the official journal of ISPOR—The Professional Society for Health Economics and Outcomes Research, announced the publication of a report that identifies expensive Medicare Part B drugs with low added therapeutic benefit and models a reimbursement policy for them based on domestic reference pricing.

Anesthesiologists Denounce Another Year of Medicare Payment Cuts, Urge Immediate Reforms

The American Society of Anesthesiologists (ASA) condemned yet another year of cuts to Medicare payments for critically important anesthesia and pain medicine services. The proposed cuts, announced in the Centers for Medicare & Medicaid Services’ (CMS) 2024 Physician Fee Schedule (PFS), represent the fifth consecutive year of either a pay freeze or payment cut for the services anesthesiologists provide to their patients as shown in the table below. The CMS-proposed Medicare payment cuts will compound the financial strain anesthesia practices are already facing.

Sicker Americans are sticking with Medicare managed care plans

Following decades of criticism for “cherry-picking” the healthiest patients, Medicare managed care plans now appear to be holding onto sicker patients with more complex health needs, new research has found. The study, which appears today (June 26, 2023) in the Journal of the American Medical Association, found that older Americans with demanding health needs were not more likely to disenroll from Medicare Advantage, the increasingly popular managed care option for Americans age 65 and over.

Annual Medicare spending could increase by $2 to $5 billion if Medicare expands coverage for dementia drug lecanemab

The anti-dementia medication lecanemab and its ancillary costs could add $2 billion to $5 billion in annual Medicare spending if the Centers for Medicare and Medicaid Services (CMS) revise their coverage decision. Currently, the medication is covered only for patients who are enrolled in clinical trials.

Cataract surgery reimbursements may not be enough for some patients

Research suggests that Medicare reimbursements for complex cataract surgery cover less than two minutes of operating time, and an increase to reimbursements for the procedure may be justified. Complex cataract surgery requires more time and resources than simple cataract surgery, and this study indicates that the incremental reimbursement for the complex surgery is not enough to offset the increased costs.

Liver cancer treatment costly for Medicare patients, UT Southwestern study finds

Hepatocellular carcinoma (HCC), the most common type of liver cancer, can place a significant financial burden on patients, according to an analysis led by a researcher at UT Southwestern Medical Center.

Medicare Cuts to Physician Payments; Gravely Disappointing, says the American Society of Anesthesiologists (ASA)

Today, the American Society of Anesthesiologists (ASA) expressed its grave disappointment with Congressional leaders’ decision to cut Medicare payments for physicians as part of a large final end-of-year legislative package. The cuts will be effective January 1, 2023. Additional cuts will be implemented in January of 2024.

New therapies have raised Medicare treatment costs for metastatic prostate cancer

Medicare costs for treatment of metastatic prostate cancer have risen sharply within the last 15 years – reflecting increased use of new medications under Medicare Part D, reports a study in Urology Practice®, an Official Journal of the American Urological Association (AUA). The journal is published in the Lippincott portfolio by Wolters Kluwer.

American College of Rheumatology: Proposed Rule Will Bring Great Transparency to Medicare Advantage Prior Authorization

The American College of Rheumatology said the Centers for Medicare and Medicaid Services’ Advancing Interoperability and Improving Prior Authorization Proposed Rule will bring greater transparency, reduce administrative burden, & make turnaround on prior authorization more predictable for payers.

Critical Care Medicine Organizations Urge House Leadership to Stop Medicare Payment Cuts

Today, the American Society of Anesthesiologists (ASA), Society of Critical Care Anesthesiologists (SOCCA), and Society of Critical Care Medicine (SCCM) sent a formal communication to Speaker of the House of Representatives Nancy Pelosi, House Majority Leader Charles Schumer, and House Minority leaders Kevin McCarthy and Mitch McConnell, strongly urging them to take immediate action to stop pending Medicare physician payment cuts.

New Data Shows 85% Reduction in One-Year Mortality for Medicare Heart Failure Patients With BVA-Guided Care

New data validate the benefits of the BVA-100 blood volume measurement test for Medicare heart failure patients. Data were presented at the Heart Failure Society of America (HFSA) Annual Scientific Meeting (ASM) 2022 – which brought together the world’s leading experts in heart failure.

AAOS Comments on Proposed Medicare Payment Policy Changes for 2023

The American Association of Orthopaedic Surgeons (AAOS) issued formal comments to the Centers for Medicare & Medicaid Services (CMS) on the agency’s proposed payment policy changes for Calendar Year (CY) 2023. In both letters, AAOS urged the agency to address growing health care costs, expand access to care and ease physician burden as they continue to navigate patient care, amidst financial and practice management challenges exacerbated by the pandemic.

Ochsner Accountable Care Network announces sixth straight year of exceptional quality outcomes and multi-million-dollar healthcare savings

OACN’s 2021 clinical successes, highlighted by a 100% quality score, can be attributed to increasing primary care physician visits, focusing on high-risk patient care coordination and support, reducing unnecessary hospitalizations through ambulatory care coordination, and improving patient satisfaction.

New Study Shows Growth in Billing of Radiology Services by Non-Physician Providers in Radiology Practices

A study by the Harvey L. Neiman Health Policy Institute conducted a detailed review of clinical services billed to Medicare by non-physician providers (NPPs) employed by radiology practices. The study, published in the Journal of the American College of Radiology, was based on Centers for Medicare and Medicaid Services databases of doctors and clinicians who participated in Medicare.

Fixed vial sizes for controversial Alzheimer’s drug could waste $605 million in Medicare spending each year

Medicare could waste up to $605 million per year on the controversial Alzheimer’s drug aducanumab if it is eventually approved for widespread use because it is supplied in vials containing fixed doses that may not be appropriate for all patients–resulting in the trashing of large volumes of unused drug

What drives racial and ethnic gaps in Medicare’s quality program?

The improvements in care for older adults from the Accountable Care Organization movement haven’t reached all older Americans equally. ACOs that include a higher percentage of patients who are Black, Hispanic, Native American or Asian have lagged behind those with higher percentage of white patients in providing preventive care and keeping patients out of the hospital. Now, a new study shows that some of this inequity stems from how an ACO’s patients get their primary care.

CMS 2022 final rules: ASTRO deeply concerned and disappointed, emphasizes need for legislative solution

The American Society for Radiation Oncology (ASTRO) issued the following statement today in response to the 2022 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (HOPPS) final rules announced by the Centers for Medicare and Medicaid Services (CMS).

Turning 65 means a lot for Americans’ wallets, health spending study finds

Lowering the age when older adults can enroll in Medicare might save them a lot of money, even if the age drops only a year or two from the current age of 65, a new study suggests. Such a change could especially affect the small percentage of people in their early 60s who spend a major chunk of their disposable income on health costs.

Aging U.S. Immigrant Population Poses Challenges to State Health Care Systems

A team led by Dr. Arturo Vargas Bustamante, UCLA Fielding School of Public Health professor of health policy and management and director of faculty research at the UCLA Latino Policy and Politics Initiative (LPPI), has found the United States faces a potential crisis in terms of health care for documented, and undocumented immigrants.

Providing more low-value care doesn’t lead to higher patient experience ratings

Many healthcare providers and policy makers fear that increased pressure to please patients — and ensure high satisfaction ratings as a result — could lead to overuse of low-value care that doesn’t provide any clinical benefit while unnecessarily ratcheting up medical bills. But new research from the University of Chicago and Harvard Medical School may alleviate some of those concerns.