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UrduA new Penn Nursing Center for Health Outcomes and Policy Research (CHOPR) study – published in INQUIRY – has found a strong association between the quality of the nurse work environment and COVID-19 mortality rates among socially vulnerable Medicare beneficiaries. The study examined data from 238 acute care hospitals across New York and Illinois.
Tag: Medicare
Cracking the Code on Medicare’s Drug Price Negotiations
ISPOR announced the publication of a study that provides estimates of how the Centers for Medicare & Medicaid Services (CMS) may have determined initial price offers for the first 10 drugs selected for Medicare price negotiation.
More than one fifth of Medicare Advantage users classified as homebound or semi-homebound
Homebound status a powerful predictor of hospitalization and health care utilization
Follow up after cardiovascular hospitalizations lacking, especially among marginalized populations
A retrospective cohort study found that between 2010 and 2019, timely post-discharge follow-up after acute myocardial infarction (AMI) and heart failure (HF) hospitalizations increased substantially for Medicare fee-for-service beneficiaries, but many patients still not getting the follow-up they need, and racial and socioeconomic disparities have worsened.
Video and Transcript Available – FDA Changes to Laboratory Developed Test Regulation: Livestreamed Expert Panel
Live from the annual conference of the Association for Diagnostics & Laboratory Medicine (ADLM, formerly AACC), experts will discuss how the new FDA rule on laboratory developed tests will hinder patient care. This rule will place these tests under duplicative FDA oversight, even though laboratory developed tests are already regulated by the Centers for Medicare & Medicaid Services. This will force many labs to stop performing these essential tests, which play a critical role in diagnosing rare disorders, such as inherited genetic conditions in newborns.
Co-use of CYP2D6-metabolized opioids and antidepressants associated with adverse events in older nursing home patients
A target trial emulation study found that concomitant use of CYP2D6-metabolized opioids (hydrocodone, codeine, tramadol, and oxycodone) with antidepressants was associated with adverse outcomes among older nursing home residents.
UCLA selected by Centers for Medicare & Medicaid Services to test Medicare dementia care model
UCLA has been selected by the Centers for Medicare & Medicaid Services (CMS) to participate in a new Medicare alternative payment model designed to support people living with dementia and their caregivers.
Massachusetts Patients now Have Increased Access to Anesthesia Care
Massachusetts patients now have increased access to safe, affordable anesthesia care. The state is the latest to opt out from federal regulations that require physician supervision of Certified Registered Nurse Anesthetists (CRNAs), also known as nurse anesthesiologists or nurse anesthetists.
The State of Social Security and Medicare Benefits In Jeopardy
Public Health Sara Rosenbaum, is professor emerita of health law and policy and founding chair of the Department of Health Policy at the GW Milken Institute School of Public Health. She also holds an emerita title School of Law. She…
Competition from “skinny label” generics saved Medicare billions
An analysis of 15 name-brand drugs and their “skinny label” generic counterparts found that competition from these counterparts saved Medicare Part D nearly $15 billion from 2015 to 2021.
Continued Medicare Reimbursement Declines Could Threaten Access to Physicians
A new Harvey L. Neiman Health Policy Institute study found that physician reimbursement per Medicare patient decreased 2.3% between 2005 and 2021 when accounting for inflation, despite a concurrent increase of 45.5% in physician services to each patient. These reimbursement trends varied widely by physician specialty (-57.6% for cardiac surgery to +189.1% for pain management).
Rutgers Health Experts Are Available to Discuss Harmful Impacts of New Medicare, Medicaid Data Policies
The Centers for Medicare and Medicaid Services (CMS) recently announced changes to data access policies for researchers, substantially increasing costs and significantly limiting access for institutions.
Medicare pays for message-based e-visits. Are older adults using them?
E-visits have become a regular part of everyday health care for some of the 30 million older Americans who have traditional Medicare. About 1% of them have used asynchronous patient portal messaging in a way that prompted their doctor or other health care provider to bill Medicare for their time.
In sickness and in health, older couples mostly make Medicare moves together
Older Americans who enroll in Medicare, or change their coverage, do so as individuals, even if they’re married or live with a partner. But a new study suggests the need for more efforts to help both members of a couple weigh and choose their options together.
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.
25% Decline in Radiology Fee-for-Service Medicare Reimbursements Over 16 Year Period
This study found that radiologist reimbursement for imaging provided to Medicare patients has decreased substantially over 16 years when accounting for inflation.
Medicare drug price news: Johns Hopkins Bloomberg School of Public Health experts available
Two experts from the Johns Hopkins Bloomberg School of Public Health are available for media interviews to discuss today’s announcement identifying the 10 drugs that will be subject to price negotiations under the Medicare program, as directed by the Centers…
Hackensack Meridian Hackensack University Medical Center Earns Five-Star Rating by Centers for Medicare & Medicaid Services in 2023 Overall Hospital Quality Star Rating Program
Hackensack University Medical Center has received a five-star rating from the Centers for Medicare & Medicaid Services (CMS), the highest rating offered by the federal agency’s Overall Hospital Quality Star Rating program.
Nineteen Surgical Organizations Strongly Oppose CMS’ Plan to Implement the G2211 Code
The American College of Surgeons (ACS), with 18 other surgical organizations, has expressed strong opposition to the implementation of Centers for Medicare & Medicaid Services (CMS) code G2211.
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.
ASA Urges Congress To Fix Broken Medicare Payment System: Physicians Deserve Better
The American Society of Anesthesiologists (ASA) urged Congress to take steps to address the broken Medicare physician payment system. The formal request came as part of a House Energy and Commerce Oversight & Investigations Subcommittee hearing held yesterday on the Medicare Access and CHIP Reauthorization Act (MACRA).
Hackensack Meridian Health Announces New Emergency Triage, Treat and Transport Program for Patients Covered by Medicare
Innovative new model allows Medicare beneficiaries to choose options for emergency care other than a hospital Emergency Department
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.
Neurosurgeons Endorse Legislation to Improve Medicare Physician Payment System
Groups state that an updated payment system will preserve patient access to value-based care.
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.
Eli Lilly ‘just the first shoe to drop’ in drug cost changes
Drugmaker Eli Lilly and Company announced it would significantly reduce the prices of several of its insulin products and cap patient insulin out-of-pocket costs at $35 per month. Nick Fabrizio, professor of health policy at Cornell University, says this is…
Mount Sinai Researchers Study Pathways to Hospice Care Among Medicare Enrollees
In an original investigation published today in JAMA Health Forum, Mount Sinai researchers describe how older adults with Medicare Advantage (MA) plans are more likely to enter hospice care from the community settings, versus inpatient stays in hospitals and…
Biden’s healthcare priorities will aid in ‘providing much needed care for more Americans.’
In his second State of the Union address, President Biden touted his administration’s policies on healthcare and medical research. The President cited recent efforts to expand health care coverage through the Affordable Care Act, ban surprise billing practices, and allow Medicare to…
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.
Rutgers Public Health Expert Available to Discuss the Impact of Allowing Medicare to Negotiate Drug Prices
Stephen Crystal, a distinguished research professor at Rutgers’ Institute for Health and School of Social Work who has spent decades studying the effect of public policy on health, is available to talk about the impact of allowing Medicare to negotiate…
Big Win for Patients: Aetna Drops Prior Authorization for Most Cataract Surgeries
After a year of sustained advocacy from the ophthalmology community, Aetna announced this week that it will no longer require pre-approval for cataract surgeries starting July 1, 2022.
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
Medicare could save up to $3.6 billion by purchasing generic drugs at Mark Cuban prices
A brief research report found that Medicare could have saved up to $3.6 billion by purchasing generic drugs at the same prices as the Mark Cuban Cost Plus Drug Company (MCCPDC) in 2020. These findings suggest that Medicare is overpaying for some generic drugs. The report is published in Annals of Internal Medicine.
Dementia diagnosis often comes as part of costly crisis
Medicare costs around the time of a dementia diagnosis are much lower for older adults screened proactively rather than those diagnosed while experiencing a health issue.
Private insurers paid hospitals 224% of what Medicare would in 2020
Prices paid to hospitals during 2020 by employers and private insurers for both inpatient and outpatient services averaged 224% of what Medicare would have paid, with wide variation in prices among states, according to a new RAND Corporation report.
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.