Carle’s Health Alliance to exit Medicare Advantage market
Carle Health said Thursday they will discontinue Health Alliance’s Medicare Advantage plan at the end of the year.
Medicare Debuts Another Primary Care-Focused Accountable Care Model
Medicare is trying again with another accountable care organization (ACO) payment model aimed at primary care doctors, but reactions to the new model are mixed so far. The voluntary model, known as ACO Primary Care Flex, would pay organizations that participate in Medicare’s Shared Savings Program a monthly fee that would be distributed to the […]
MedPAC Wrestles With How to Fix Deep Flaws in Medicare Advantage Quality Metrics
The methods used to compare quality between one Medicare Advantage (MA) plan and another are so seriously flawed that the system needs an overhaul, members of the Medicare Payment Advisory Commission (MedPAC) suggested last week. A commission review has determined the program “is costly and not a good basis for judging quality,” MedPAC principal policy […]
MedPAC Members Pan Rural Hospitals’ ‘Cost-Plus’ Billing System for Medicare Patients
Rural hospitals’ ability to bill fee-for-service Medicare patients and the uninsured on a “cost-plus” basis — essentially setting their charges at whatever level they think is appropriate — is untenable and must be changed, several members of the Medicare Payment Advisory Commission (MedPAC) said Thursday. “Charges are made up, inflated in ways that are unbelievable,” […]
CMS Focusing on Better Aligning Quality Measures, Adding New ACO Models
Are you exasperated by all the different quality measures you’re required to report? One official at the Centers for Medicare & Medicaid Services (CMS) knows exactly how you feel. “I led care transformation at a health system before coming into this role, and we had this huge spreadsheet of the 500 different metrics from all […]
Q&A: Talking Prior Authorization With Rep. Suzan DelBene
Although the Centers for Medicare & Medicaid Services (CMS) issued a final rule on prior authorization, there is more that can be done to ease clinician burdens in this area, according to Rep. Suzan DelBene (D-Wash.). DelBene sponsored the Improving Seniors’ Timely Access to Care Act, which would, among other provisions, require affected plans to […]
Contraceptive Use in Medicare Varies by Enrollment Type
Contraceptive use among Medicare enrollees — including among beneficiaries of childbearing age who are on Medicare due to a permanent disability — varies greatly depending on whether they’re enrolled in Medicare Advantage (MA) or traditional Medicare, researchers reported. Use of contraceptives was higher among MA enrollees compared with those in traditional Medicare, with significant variation […]
MedPAC Draft Recommendation Calls for 1.3% Pay Bump for Medicare Clinicians
Physicians who treat Medicare patients would get about a 1.3% pay increase in 2025 under a draft chairman’s recommendation released Thursday by the Medicare Payment Advisory Commission (MedPAC). That figure represents half of the projected 2.6% increase in the Medicare Economic Index (MEI), a measure of the costs of running a medical practice, Brian O’Donnell, […]
Medicare Finalizes 3.4% Payment Cut for Physician Fees in 2024
Physicians would receive a 3.4% cut in their Medicare reimbursement under a final rule released Thursday by the Centers for Medicare & Medicaid Services (CMS). Overall, the finalized calendar year 2024 physician fee schedule conversion factor is $32.74, a decrease of $1.15, or 3.4%, from 2023, CMS said in a press release. CMS’s Positive Spin […]
House Members Mull Bills to Cut Red Tape and Improve Docs’ Medicare Pay
A House hearing on ways to increase payments and cut red tape for physicians who treat Medicare patients also included a discussion over whether Republicans wanted to cut Medicare benefits for seniors. “Just yesterday, in a speech on the House floor nominating [Rep.] Jim Jordan (R-Ohio) as their candidate for Speaker, Republicans expressed concern with […]