Reimbursement

Grand Junction, Colo., gets a lot of credit and attention as being home to pioneers in providing high-quality, low-cost healthcare. Healthcare leaders in the city of more than 58,000 are once again demonstrating their initiative.

A new report from the Centers for Medicare & Medicaid Services shows that health insurers that offer commercial and Medicare plans operate at a loss for their Medicaid plans, while those that specialize in Medicaid only operate at a profit.

A Government Accountability Office report issued late last week examining Medicare EHR incentive payments found only 16 percent of eligible hospitals and 9 percent of professionals received payments under the program in 2011.

If mobile medical apps are going to stand any chance of survival -- with physicians as well as consumers -- they'll have to be able to integrate with other devices and healthcare platforms, with electronic medical records and personal health records.

Upcoding. Overpayment. Out-and-out fraud. By some estimates, such vulnerability adds up to hundreds of billions of dollars of unnecessary healthcare spending each year. Yet healthcare still struggles to get at the root of fraud, waste and abuse (FWA). Why has this consistently been the case, when we all understand the imperative to find a solution?

A new accountable care health plan from Aetna offered in conjunction with Aurora Health Care will offer a price guarantee to employers, many of whom may see an average reduction of 10 percent based on their past claims expenses.

When it comes to patient experience, U.S. safety-net hospitals -- those serving a disproportionately larger number of low-income and Medicaid patients -- are getting poor performance reviews, which may indicate they will struggle under value-based purchasing models.

The Obama Administration has launched what it calls a "ground-breaking partnership" among the federal government, state officials, leading private health insurance organizations, and other healthcare anti-fraud groups to prevent healthcare fraud.

Officials at Milwaukee, Wis.-based Aurora Health Care announced on Thursday they are forming an accountable care collaboration with Aetna, Inc., an effort aimed to provide employers with a new health plan created to improve employee health outcomes while controlling costs.

A new study sponsored by the Commonwealth Fund found that less than 3 percent of hospitals use all 10 recommended practices for reducing readmissions for patients admitted with heart failure or acute myocardial infarction (AMI).