Reimbursement

The Aetna Medicare plan serving Maine and Security Health Plan's Medicaid product in Wisconsin, both highly ranked by the National Committee for Quality Assurance, offer examples of using quality measures to improve care coordination, case management, payment for value, and member satisfaction. 

The Democratic and Republican leaders of two key congressional committees have agreed on a framework to scrap the problematic Medicare payment formula for physicians and replace it with one that would link physician reimbursement to the quality of care provided, a step that could put an end to the annual "doc fix" debate.

The Affordable Care Act cuts Medicare price growth. But if hospitals respond by increasing the amount of care provided, the potential cost savings from price restraint may be lost.

Cigna raised its full-year outlook after a third strong quarter, although the company's executives and investors are worried about sustaining earnings from Medicare Advantage, which saw high quarterly claims costs.

With healthcare reform, physician practice acquisitions have been occurring at a rapid pace for nearly four years. In our experience working on hundreds of contemplated physician practice acquisitions, we have identified a series of ten recurring challenges and missteps associated with these acquisitions and alignments.

The Medicare Part A deductible will increase by $32 in calendar year 2014, while the monthly Part A premium will decline by $9 or $15. Part B monthly premiums and deductibles will remain unchanged.

Department of Health and Human Services Secretary Kathleen Sebelius tried to placate members of Congress, promising progress for Healthcare.gov.

The Affordable Care Act's lower-than-projected premiums may dampen healthcare spending significantly more than first estimated, perhaps as much as $190 billion over the next 10 years in savings, according to a recent study from the Center for American Progress.

Overall U.S. healthcare prices remained relatively unchanged from August to September 2013, according to the federal Bureau of Labor Statistics.

The three hours of questioning that CMS Administrator Marilyn Tavenner faced before the House Ways and Means Committee could be described by some as "a dog and pony show"--just more of the same intense finger-pointing and arguing Americans have grown to expect from federal lawmakers around the Affordable Care Act.