The Many Problems With Medicare ’s MIPS Exclusion Thresholds
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) allows the secretary of the Department of Health and Human Services, Tom Price, to define a low-volume threshold for the purpose of excluding some number of eligible clinicians from participating in MACRA’s Merit-Based Incentive Payment System (MIPS). Secretary Price may identify a minimum number of beneficiaries, a minimum number of items and services, and a minimum amount of Part B charges that if not exceeded would, again, exempt a provider from MIPS participation.
This year, MIPS performance year one, those eligible clinicians with less than or equal to $3...
Source: Health Affairs Blog - August 3, 2017 Category: Health Management Authors: David Introcaso Tags: Costs and Spending Featured Insurance and Coverage Medicare Payment Policy Quality MACRA Medicare Access and CHIP Reauthorization Act Merit-Based Incentive Payment System tom price Source Type: blogs
How The Private Sector Can Empower Entrepreneurs To Improve Global Health
For health entrepreneurs and funders, successful collaboration requires a variety of ingredients that go beyond an initial monetary investment. Strong communication, alignment of objectives, and a long-term outlook are critical for any partnership to thrive. But these collaborations require something else, too—flexibility.
When it comes to global health, we have long known that no single company, foundation, or organization has all the answers. In the past, the private sector, including corporate-giving programs and foundations, relied largely on cash and product donations tied to immediate health needs or interventions....
Source: Health Affairs Blog - August 2, 2017 Category: Health Management Authors: Caroline T. Roan and Zubaida Bai Tags: Featured GrantWatch Health Professionals Africa entrepreneurs Global Health Health Care Delivery Health Philanthropy Pfizer Foundation Pharma Source Type: blogs
What Could Happen If The Administration Stops Cost-Sharing Reduction Payments To Insurers?
Although the decision of the Court of Appeals for the District of Columbia Circuit to allow attorneys general from 17 states and the District of Columbia to join the House v. Price cost-sharing reduction (CSR) litigation as parties complicates President Trump’s ability to simply stop the CSR payments, rumors continue that he is preparing to do so. The CSR payments are made monthly; the next installment is due on August 21, 2017. If the administration intends not to make the August payment, it must announce its decision soon.
Changes to qualified health plan (QHP) applications in the federally facilitated exchange (FFE) a...
Source: Health Affairs Blog - August 2, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage California cost-sharing reduction payments Covered California house v. price risk adjustment Source Type: blogs
MinnesotaCare Buy-In: Maybe Not A Long Shot
States are developing creative policy options to address the high cost of premiums for those purchasing coverage in the individual market. Given the inaction and lack of leadership at the federal level, states need to continue to move forward. Minnesota, of course, is leading the way.
Under a proposal introduced in the Minnesota state legislature earlier this year, Minnesotans shopping for health insurance on the individual market would have been able to purchase public coverage through MinnesotaCare, Minnesota’s Basic Health Plan (BHP). The public buy-in was supported by the Democratic-Farmer-Labor (DFL) Party Governor ...
Source: Health Affairs Blog - August 2, 2017 Category: Health Management Authors: Lynn Blewett Tags: Featured Following the ACA Medicaid and CHIP Minnesota MinnesotaCare Section 1332 waivers State Innovation Waivers Source Type: blogs
The Latest Motion In House v. Price Has A Significant Impact On The Future Of CSR Payments
On August 1, 2017, the United States Court of Appeals for the District of Columbia granted the motion of the attorneys general of 17 states and the District of Columbia to intervene in House v. Price. House v. Price is before the D.C. Circuit on appeal from the ruling of a district court judge in favor of the House of Representatives in its lawsuit claiming that the reimbursement of insurers for reducing cost sharing for low-income qualified health plan enrollees is illegal because Congress had not appropriated funding for the payments. The judge enjoined the payments but stayed her order pending an appeal and the Obama ad...
Source: Health Affairs Blog - August 2, 2017 Category: Health Management Authors: Timothy Jost Tags: Costs and Spending Following the ACA house v. price Source Type: blogs
Professional Athletes And Back Surgery: A Teachable Moment On Overuse In Health Care?
After four back surgeries, Tiger Woods still is not back on the golf course. Steve Kerr, the coach of the Golden State Warriors, missed most of last season and even much of this year’s playoffs with headaches and recurrent pain after back surgery. These two high-profile patients, and their very public surgery results, should encourage us all to ask whether “more is always better” in health care.
The Institute of Medicine National Roundtable on Health Care Quality coined the term “overuse” to describe the provision of health care services for which potential harms outweigh potential benefits. Overuse in health car...
Source: Health Affairs Blog - August 1, 2017 Category: Health Management Authors: William Shrank, Donna Keyser and Anthony Delitto Tags: Costs and Spending Featured Payment Policy Quality chronic pain Source Type: blogs
ACA Round-Up: A Double-Threat Presidential Tweet, Cassidy-Graham-Heller, Bipartisan Market Stabilization Ideas, And Good News From Ohio
Although the high drama of the Senate debate on repeal of the Affordable Care Act seems to be over for the time being, health care reform remains in the headlines.
Trump’s Threats Regarding Congressional Coverage And Cost-Sharing Reduction Insurer Reimbursements
On July 29, 2017, President Trump tweeted, “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!” This tweet carries a double threat: to end the cost-sharing reduction (CSR) payments that insurance companies receive to reimburse them for reducing cost sharing for low-in...
Source: Health Affairs Blog - August 1, 2017 Category: Health Management Authors: Timothy Jost Tags: Costs and Spending Following the ACA Insurance and Coverage bare counties Cassidy-Graham-Heller Amendment cost-sharing reduction payments FEHB market stabilization Ohio Source Type: blogs
Outside Of Washington, There Is A New Vital Center In Health Care Reform
Republicans in Congress are mired in political quicksand. Following passage of the Affordable Care Act (ACA) in 2010, they locked themselves into a promise to repeal and replace it at the behest of ultra-conservative donors and party activists who control the GOP’s nomination process. Since 2010, however, Americans and rank-and-file Republicans increasingly came to expect help meeting the rising costs of medical care and insurance and to accept the ACA’s tangible programs to address these concrete challenges.
The Democrats created their own political trap. They passed the ACA on the promise of making health care afford...
Source: Health Affairs Blog - July 31, 2017 Category: Health Management Authors: Lawrence R. Jacobs and Suzanne Mettler Tags: Following the ACA Insurance and Coverage ACA repeal and replace Arthur M. Schlesinger Jr. Source Type: blogs
Physician Workforce Trends And Their Implications For Spending Growth
Controlling the growth rate of health care spending is central to the success of the Affordable Care Act or any subsequent reform. Because labor represents more than 50 percent of health care costs and the clinical workforce drives use and prices, the size and composition of the health care workforce has important ramifications for spending growth. We set out to understand the trends underlying the growth in the clinical workforce and their potential implications for health care spending, health policy, and health system design.
A large literature establishes a link between primary care–oriented health systems and lo...
Source: Health Affairs Blog - July 28, 2017 Category: Health Management Authors: Christopher Barbey, Nikhil Sahni, Robert Kocher and Michael Chernew Tags: Costs and Spending Featured Health Professionals Organization and Delivery nurse practitioners physician’s assistants Primary Care Source Type: blogs
The Senate ’ s Health Care Freedom Act
Editor’s Note: This post will be continually updated as debate in the Senate continues on July 27.
Update July 28, 1:41 am: After a vote to commit the bill to the HELP committee failed 48 to 52, the Senate voted on the HCFA. The vote failed 51 to 49 as Senators Collins, McCain, and Murkowski joined all 48 Democrats in voting against the bill. Senator McConnell then stated that it would be returned to the calendar, meaning it can be brought back, but consideration then ends for tonight.
Original Post
At 10:00 p.m. on July 27, 2017, Senator McConnell introduced amendment 502, his Health Care Freedom Act. The bill is ...
Source: Health Affairs Blog - July 28, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Source Type: blogs
With The ACA Under Fire, Can Health Conversion Foundations Patch The Safety Net For Low-Income Americans?
With the threatened repeal of the Affordable Care Act (ACA), a surprising source is emerging as the nation’s largest pool of philanthropic dollars for health: health conversion foundations. Together, 228 conversion foundations represent some $27.5 billion of assets, according to our estimates.
What’s more, conversion foundations are already often the largest health funders in their geographic area, dispensing more than $1.3 billion a year, based on our research, to enhance the health and well-being of mostly low-income Americans and patching a fraying safety net in the process.
Sometimes called health legacy foundation...
Source: Health Affairs Blog - July 27, 2017 Category: Health Management Authors: Taz Hussein and Mariah Collins Tags: GrantWatch Hospitals health conversion foundations health insurers health legacy foundations Health Philanthropy Health Reform mergers and acquisitions Safety Net Social Determinants of Health Source Type: blogs
US Drug Prices And R & D, Take 2: A Reply To Grabowski And Manning, And To Light
Recently we (along with Zachary Helms) published a Health Affairs Blog post refuting the pharmaceutical industry argument that the higher prices the industry charges in the US are justified because they are necessary to support research and development (R&D). Our analysis found that US taxpayers, patients, and private industry were paying 1.7 times the global R&D expenses of major pharmaceutical corporations as a result of paying more than these corporations charge European countries for the same products — an excess amounting to $40 billion in 2015, about 10 percent of total spending in the US on pharmaceuti...
Source: Health Affairs Blog - July 27, 2017 Category: Health Management Authors: Nancy Yu and Peter Bach Tags: Costs and Spending Drugs and Medical Innovation Pharmaceutical R&D prescription drug prices Source Type: blogs
The Skinny On The Senate ACA Debate, Day Three
Editor’s note: This post is part of ongoing Health Affairs Blog coverage by Tim Jost of the Senate debate over repealing and replacing—or maybe just repealing, or maybe just minimally repealing, or maybe retaining—the Affordable Care Act. See Tim’s earlier post and updates for more coverage.
Update: Medicare-for-All And Abortion
At about 2:30, the Senate voted on an amendment put forward by Senator Daines (R MT) incorporating the House Medicare-for-All bill. His intent was to embarrass and perhaps divide the Democrats by forcing them to vote on a proposal that some of them embrace, but some do not. In fact,...
Source: Health Affairs Blog - July 27, 2017 Category: Health Management Authors: Timothy Jost Tags: Costs and Spending Following the ACA Insurance and Coverage 1332 waivers Congressional Budget Office employer mandate individual mandate medical device tax skinny ACA repeal Source Type: blogs
Request For Abstracts: Precision Medicine
Health Affairs is planning a theme issue on Precision Medicine, to be published in May 2018. The rapid development of technologies in this sphere has generated important questions for public policy makers, private sector leaders, and the public that we intend to explore in the issue. For our purposes, we define precision medicine as an approach to treating illness that takes into account the variability of human genetics along with environment and lifestyle for better diagnoses, treatments, and outcomes.
We plan to publish about 20 peer-reviewed articles in the issue. This will include several invited overview papers that ...
Source: Health Affairs Blog - July 26, 2017 Category: Health Management Authors: Health Affairs Tags: Elsewhere@ Health Affairs Source Type: blogs
Health Affairs Web First: ACA Reduced Disparities In Health Care Access
This study will also appear in the August issue of Health Affairs. (Source: Health Affairs Blog)
Source: Health Affairs Blog - July 26, 2017 Category: Health Management Authors: Health Affairs Tags: Elsewhere@ Health Affairs Featured Web First Source Type: blogs
