Reimbursement

President Barack Obama gave doctors a holiday gift of sorts at the end of the year when he signed the Pathway for SGR Reform Act, sparing physicians and other practitioners who treat Medicare patients from the 24 percent payment reduction previously slated to take effect the first of the year.

Humana and Minnesota-based Healthsense, a provider of aging services technologies, have enrolled Medicare members with chronic health conditions in a pilot to measure the impact that in-home sensors and remote monitoring technology have on improving health outcomes and reducing frailty and fall-related hospital admissions.

Medicaid directors in the 25 states, plus D.C., expanding eligibility are cautiously optimistic of the benefits, but they're also expecting new costs from some potentially overlooked areas and they're not entirely trustful of Congress.

While the past year was relatively tame regarding ICD-10, at least in regard to the mad scramble some expect leading up to October 1, 2014, there were some significant developments.

The December issue of Healthcare Finance News highlights the biggest stories our staff covered across the previous 12 months. And as has been the case for much of the past decade, many of the top issues deal with the tremendous changes impacting the healthcare industry.

With one open enrollment period closed and another beginning, HealthCare.gov and state exchanges have sold about 20 percent of the number of health plans that federal budget officials think is enough for a sustainable risk pool.

The California Department of Managed Health Care is trying to end the practice of emergency care "balance billing," just as thousands of new HMO members are being created.

After the disastrous launch of Obamacare the enrollment of 1.1 million people in the 36 state exchanges run by the feds is a major accomplishment. It is likely that the enrollment in the 14 state-run exchanges will take total Obamacare's private insurance enrollment to near 2 million for the year.

After several years on the decline, improper payment rates for Medicare and Medicaid increased in 2013, according to the government's estimates. How much of that represents fraud, though, still remains a mystery.

All the talk about moving healthcare reimbursement from volume to value sounds great, in theory. But how this shift takes place in practice is more complex than simply ending one form of payment and starting a new one.