All Articles In 'Medicare'
Medicare-Medicaid Dual Eligibles: Learn Basics of $350 Billion Market at Webinar on May 23, 2012
The nation’s 9 million Medicare-Medicaid dual eligibles - low-income frail seniors and persons of all ages with severe disabilities - now use about $350 billion in healthcare annually. States and CMS are rolling out models to integrate Medicare [...]
Medicare and Medicaid Spending: Enrollment Growth a Driver for Spending Increases
Much attention has been paid to the federal deficit, and a great deal of this discussion has centered on Medicare and Medicaid spending. As a means for controlling what has been considered “out of control” health [...]
Comparative Effectiveness Research: How Agency for Healthcare Research and Quality Spent $474 Million in ARRA Funds
As part of the $1.1 billion provided to the Department of Health and Human Services (HHS) earmarked for comparative effectiveness research (CER) under the American Recovery and Reinvestment Act (ARRA or Recovery Act) of 2009, $474 [...]
Medicare Advantage Risk Adjustment: GAO Recommends CMS Risk Score Adjustments for Diagnostic Coding
Through the years, the Centers for Medicare and Medicaid Services (CMS) has changed its payment adjustment method for Medicare Advantage (MA) plans. These adjustments are made based on a calculated risk score per beneficiary, which should be consistent [...]
Nursing Home Quality: Improving Efforts to Monitor Implementation of the Quality Indicator Survey
Nursing homes that receive federal Medicaid or Medicare funding must meet federal quality standards. The Centers for Medicare and Medicaid Services (CMS) and states, accountable for ensuring compliance, inspect nursing facilities periodically using a CMS-developed and state-administered survey or [...]
Medicare Fee-for-Service Benefits: Impact of Medicare Cost Sharing Changes on Beneficiaries and Budget
Several Medicare reform proposals have concentrated on realigning financial incentives within Medicare’s provider payment and delivery system to improve program cost-effectiveness and quality, a key health policy challenge. There have been calls to modernize Medicare’s fee-for-service [...]
CBO Reports Medicare’s Demonstration Project Results
The Congressional Budget Office’s issue brief, Lessons from Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment, provides details on the outcome of 10 major Medicare demonstrations following independent researcher evaluation. Demonstrations were conducted [...]
Physicians and Medicare: Report Cites Data Limitations When Reviewing Physicians Who Opt Out of Medicare
It is difficult to understand why physicians drop out from serving Medicare beneficiaries, says a new report from the HHS Office of the Inspector General (OIG). The OIG details data limitations encountered when reviewing physicians opting [...]
Prescription Drug Pricing: Estimating Generic Drug Cost Savings
Prescription drug spending rose by $135 billion between 2001 and 2010 to comprise approximately 12 percent of the nation’s overall healthcare outlay. While drug expenditure was one of the fastest growing components of U.S. healthcare spending [...]
Medicaid: Recommendations for Strengthening Medicaid Program Integrity
Federal and state Medicaid spending currently exceeds $460 billion and, with this, accountability is necessary on all levels. To ensure Medicaid program integrity: Consistent incentives must be offered for better health outcomes. Services must be used [...]
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