MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Piper Report on Health Care' source. Thu, 17 Feb 2011 20:45:51 +0100 http://www.piperreport.com/archives/2010/12/medicare_payment_policy_primers_on_medicare_provider_and_health_plan_reimbu.html The federal Medicare program has an array of complex payment policies for health care providers, health plans, and prescription drug plans. Fortunately, the outstanding staff at the Medicare Payment Advisory Commission (MedPAC) offer a series of crisp primers on Medicare reimbursement policy. MedPAC updates these annually to reflect changes in CMS payment rules and Congressional legislation. Medicare Hospital Payment Policies:... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=4269398 Sun, 19 Dec 2010 12:16:24 +0100 4269398 http://www.piperreport.com/archives/2010/11/health_reform_and_2010_mid-term_elections_quick_observation.html It's always fascinating and often amusing to watch the partisan spin masters and media talking heads following an election. Some practice spin like it was high art, suitable for framing in the Louvre. But with a 24-hour news cycle to fill, many are about as sophisticated as a reality TV show, only less enlightening. This year, of course, much of... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=4146693 Mon, 08 Nov 2010 15:52:32 +0100 4146693 http://www.piperreport.com/archives/2010/09/accountable_care_organizations_primer_on_acos_and_medicare_shared_savings_p.html The Accountable Care Organization (ACO) model is a new Medicare option for physicians, hospitals, and other providers to share in cost-savings. ACOs represent a dramatic change in Medicare policy and an opportunity to transform care delivery and provider alignment. The Medicare Gain Sharing Program, part of the newly enacted healthcare reform law, creates the option for healthcare providers to form... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3985337 Mon, 20 Sep 2010 22:39:38 +0100 3985337 http://www.piperreport.com/archives/2010/09/accountable_care_organizations_kip_pipers_interview_with_mark_b_mcclellan_m.html Under the Patient Protection and Affordable Care Act (PPACA) of 2010, Medicare providers, including physician groups and hospitals, will soon have the option to form Accountable Care Organizations (ACOs) to improve quality and efficiency. ACO providers may share financial gains generated from improved clinical and economic performance, provided that quality goals and patient safeguards are met. Through future regulations, the... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3985338 Wed, 01 Sep 2010 18:39:25 +0100 3985338 http://www.piperreport.com/archives/2010/07/comparative_effectiveness_research_primer_on_federal_comparative_effectiven.html Comparative Effectiveness Research holds extraordinary implications for healthcare stakeholders, notably the pharmaceutical, biotechnology, and medical technology industries; patients; physicians; hospitals; the federal Medicare program; state Medicaid programs; and health plans. In addition to guiding and hopefully improving day-to-day decisions by clinicians and patients, Comparative Effectiveness Research will be extraordinarily influential in coverage and reimbursement decisions. Here is a quick primer... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3792651 Tue, 27 Jul 2010 21:42:27 +0100 3792651 http://www.piperreport.com/archives/2010/07/state_health_exchanges_and_qualified_health_plans_briefing_for_health_plans.html As part of health reform implementation, states will create a large and complex new marketplace for the buying and selling of health insurance coverage. Through State Exchanges, individuals and small businesses may buy federally defined benefit packages from state licensed and certified Qualified Health Plans. For health plans, this is a huge new market with potential enrollment of 25 million... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3785474 Sat, 24 Jul 2010 17:52:57 +0100 3785474 http://www.piperreport.com/archives/2010/06/medicaid_drug_rebate_expansion_of_federally_mandated_prescription_drug_reba.html Federally mandated rebates for prescription drugs in Medicaid were expanded significantly - by $38 billion - under the new health reform law, with extraordinary financial, administrative, and compliance implications for pharmaceutical manufacturers, Medicaid health plans, and state Medicaid programs. In a new journal article, I explain changes to the Medicaid drug rebate program and implications for drug makers, health plans,... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3724201 Sun, 04 Jul 2010 21:22:14 +0100 3724201 http://www.piperreport.com/archives/2010/07/american_health_drug_benefits_june_2010_issue.html The latest issue of the journal American Health & Drug Benefits includes a valuable mix of studies and articles of interest to decision makers. Topics include health reform, bundled payment, drug pricing, benefit design, Medicaid, medication therapy, and specific clinical conditions. The Health Reform Law: Key Changes to Be Implemented in 2010 By Kip Piper, MA, FACHE Federal Drug Price... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3785475 Thu, 01 Jul 2010 15:34:24 +0100 3785475 http://www.piperreport.com/archives/2010/06/medicare_data_book_for_2010_medpac_data_on_medicare_spending_enrollment_pro.html MedPAC released its Medicare Data Book for 2010, with a wide range of useful information on Medicare spending, utilization, beneficiaries, providers, health plans, drug plans, access, and quality. The format is reader-friendly charts and tables with bulleted summaries. Specifically, the latest MedPAC Data Book includes information on: Medicare spending, including Medicare spending compared to national health care spending. Medicare beneficiary... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3785476 Wed, 30 Jun 2010 14:41:00 +0100 3785476 http://www.piperreport.com/archives/2010/05/the_patient_priority_achieving_pharmaceutical_success.html Please join American Health & Drug Benefits in Philadelphia on May 21, 2010 for The Patient Priority: Achieving Pharmaceutical Success in a Fractionated, Multi-Stakeholder Healthcare Environment. The program will help identify clinical, business, and policy governing dynamics and tactics for patient-centered drug development and commercial success. A dinner reception will follow with Xcenda's Managed Care Network, giving you unprecedented networking... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3579727 Thu, 20 May 2010 14:03:06 +0100 3579727 http://www.piperreport.com/archives/2010/05/impact_of_health_reform_on_medicare_advantage_and_medcare_prescription_drug.html Medicare Advantage plans and Medicare Part D prescription drug plans face an extraordinary array of changes as a result of the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA). These include: New payment benchmarks for Medicare Advantage (MA) plans, phased in and based on relative fee-for-service (FFS) costs. Other payment related changes... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3532346 Wed, 05 May 2010 00:21:58 +0100 3532346 http://www.piperreport.com/archives/2010/04/american_health_and_drug_benefits_march_-_april_2010_issue.html The latest issue of the journal American Health & Drug Benefits includes a valuable mix of studies and articles on economic, regulatory, and clinical issues of particular interest to payors, purchasers, and policymakers. Obesity: Effective Treatment Requires Change in Payers' Perspective by Rhonda Greenapple, MSPH and Jackie Ngai, MS, with Stakeholder Perspective by Jeff Januska, PharmD. Health Insurance Premium Increases... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3513584 Thu, 29 Apr 2010 03:40:33 +0100 3513584 http://www.piperreport.com/archives/2010/04/wellness-based_healthcare_system_of_chronic_diseases_prevention_interventio.html Creating a wellness-based healthcare system is the focus on a new series of articles published by American Health and Drug Benefits, a peer reviewed journal. They cover a wide spectrum of topics on how to build and support prevention and wellness, particularly for chronic conditions. The ideas and information are particularly timely given the array of prevention and wellness initiatives... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3503831 Sun, 25 Apr 2010 22:09:34 +0100 3503831 http://www.piperreport.com/archives/2010/04/medical_malpractice_evaluation_of_options_for_medical_malpractice_reform.html An interesting new report assesses a variety of medical malpractice reforms. The study synthesizes the evidence or theoretical predictions regarding several leading medical malpractice reform ideas. The report synthesizes published evidence on 8 reforms widely used by states: Caps on non-economic damages Pretrial screening panels Certificate of merit requirements Attorney fee limits Joint and several liability rule reform Collateral source... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3436018 Sat, 03 Apr 2010 22:07:28 +0100 3436018 http://www.piperreport.com/archives/2010/03/long_term_care_new_ltc_reforms_in_patient_protection_and_affordable_care_ac.html The federal health reform legislation - Patient Protection and Affordable Care Act (PPACA) - includes an ambitious list of changes to long-term care (LTC) services for seniors and the disabled. Most include a massive infusion of federal funding to help state Medicaid programs provide more LTC through home and community-based settings. Here's a quick run-down of the new LTC reforms:... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3397320 Wed, 24 Mar 2010 14:54:23 +0100 3397320 http://www.piperreport.com/archives/2010/03/medicare_payment_policy_medpac_recommendations_to_congress_for_2011.html The Medicare Payment Advisory Commission (MedPAC) has released its Medicare payment recommendations to Congress for 2011. In addition to specific recommendations for payment updates for fee-for-service providers and Medicare Advantage plans, MedPAC's report includes interesting information and analysis on spending trends, consequences of rapid spending on Medicare and the overall health care system, and the process of assessing payment adequacy.... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3436019 Thu, 18 Mar 2010 21:24:52 +0100 3436019 http://www.piperreport.com/archives/2010/03/american_health_and_drug_benefits_january_-_february_2010_issue.html Here are articles from the latest issue of American Health & Drug Benefits. AHDB is a peer-reviewed journal for 30,000 decision makers in health plans, PBMs, Medicare, Medicaid, and the pharma and biotech industries: Orphan Drug Pricing and Payer Management in the United States: Are We Approaching the Tipping Point? by Rebecca Hyde and Diana Dobrovolny, with Stakeholder Perspective by... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3401553 Thu, 04 Mar 2010 12:02:57 +0100 3401553 http://www.piperreport.com/archives/2010/02/national_health_expenditures_for_2009-2019_cms_actuary_projections.html The Centers for Medicare and Medicaid Services' Office of the Actuary (CMS/OACT) has released its projections of U.S. health care spending for the ten years 2010 through 2019, with premliminary estimates of 2009 health spending. The projections, released each year around this time, offer a fascinating, detailed look at patterns and trends in public and private health spending across programs... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3237957 Thu, 04 Feb 2010 02:14:01 +0100 3237957 http://www.piperreport.com/archives/2010/01/health_insurance_exchanges_how_two_proposals_differ_an_unexpected_complicat.html Health Insurance Exchanges - either state-based exchanges favored by moderate Democrats and Republicans (reflected in Senate bill) or a national, federally-run exchange favored by liberal Democrats (version in the House bill) - are an essential component of national health reform. Bottom line, health insurance exchanges would provide a far more efficient, competitive, and seamless marketplace for consumers and small business... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3241983 Fri, 22 Jan 2010 16:12:15 +0100 3241983 http://www.piperreport.com/archives/2009/11/health_care_payment_reform_considerations_for_global_payments_in_medicaid.html Payment reform is an integral part of national and state-based health reform efforts. Indeed, payment reform is essential to moving from quantity-based reimbursement to a performance-based health care system. That is, moving from fee-for-service to fee-for-value. Payment innovations, such as global payment, are designed to reward efficiency and higher quality, while supporting providers as they invest in patient-centered models... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=3010770 Thu, 19 Nov 2009 20:19:10 +0100 3010770 http://www.piperreport.com/archives/2009/11/american_health_and_drug_benefits_september_-_october_issue.html Here are articles from the latest issue of American Health & Drug Benefits. AHDB is a peer-reviewed journal for 30,000 decision makers in health plans, PBMs, Medicare, Medicaid, and the pharma and biotech industries: Predictive and Prognostic Models: Implications for Healthcare Decision-Making in a Modern Recession: F. Randy Vogenberg, RPh, PhD examines the role of predictive modeling in the healthcare... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2972835 Sun, 08 Nov 2009 23:19:08 +0100 2972835 http://www.piperreport.com/archives/2009/11/stroke_prevention_and_management.html A series of new articles from the journal American Health and Drug Benefits address key issues in stroke prevention and management, with a special focus on transient ischemic attacks. A transient ischemic attack (TIA), a transient stroke that lasts only a few minutes, can be a warning sign that a person is at risk for a more serious, debilitating, and... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2971621 Sat, 07 Nov 2009 17:41:45 +0100 2971621 http://www.piperreport.com/archives/2009/11/legislative_process_for_health_care_reform.html The legislative process for health care reform bills is complex, involving a series of unique steps needed in the House and Senate. My friends at Sellers Dorsey have prepared a concise, helpful outline of the next steps required for passage of a health reform bill. This includes the specific steps required by the House, Senate, House-Senate conference committee, and the... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2957295 Tue, 03 Nov 2009 20:13:27 +0100 2957295 http://www.piperreport.com/archives/2009/11/medicare_reimbursement_primers_on_medicare_payment_methods_for_providers_he.html The Medicare Payment Advisory Commission (MedPAC) has updated its excellent series of reader-friendly primers on Medicare payment methodologies for hospitals, physicians, Medicare Advantage plans, prescription drug plans, and other health care providers. MedPAC is an advisory agency to Congress and is highly influential, particlarly on payment methods, delivery systems, and Medicare reforms. Medicare Part A Reimbursement of Hospitals: Medicare Inpatient... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2953040 Mon, 02 Nov 2009 18:09:02 +0100 2953040 http://www.piperreport.com/archives/2009/08/pharmaceutical_research_development_in_a_value-based_healthcare_system.html At the last annual meeting of the Academy of Managed Care Pharmacy, several of us spoke on pharmaceutical research and development in the quickly emerging value-driven healthcare system. Topics focused on the impact of value-based benefit designs, comparative effectiveness research, and government policies on the development of new drugs and biologics: Research and Development in the Current Healthcare System: An... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2684730 Sun, 09 Aug 2009 23:32:13 +0100 2684730 http://www.piperreport.com/archives/2009/08/comparative_effectiveness_research_ahrq_plan_for_300_million_in_new_researc.html The HHS Agency for Healthcare Research and Quality (AHRQ) has announced plans for spending its $300 million share of the $1.1 billion Congress appropriated for comparative effectiveness research (CER) under the American Recovery and Reinvestment Act of 2009 (ARRA or Recovery Act for short). AHRQ plans to solicit grant applications this fall and award grants and contracts by spring 2010.... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2683293 Sun, 09 Aug 2009 04:50:41 +0100 2683293 http://www.piperreport.com/archives/2009/07/american_health_drug_benefits_june-july_2009_issue.html Here are articles from the latest issue of American Health & Drug Benefits. AHDB is a peer-reviewed journal for 30,000 decision makers in health plans, PBMs, Medicare, Medicaid, and the pharma and biotech industries: June - July 2009 Issue: Applying Evidence for Medical Technologies: Closing the Gap between R&D and Decision Maker Need Interview with Sean R. Tunis, MD, MSc... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2683294 Thu, 30 Jul 2009 17:30:13 +0100 2683294 http://www.piperreport.com/archives/2009/07/medicaid_and_chip_payment_and_access_commission_macpac_primer_on_new_congre.html The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) created the Medicaid and CHIP Payment and Access Commission (MACPAC) to advise Congress on a wide range of Medicaid and CHIP issues. MACPAC will start operating in early 2010. MACPAC Membership and Staff: Modeled closely after the long standing and highly influential Medicare Payment Advisory Commission (MedPAC), MACPAC will be... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2647592 Tue, 28 Jul 2009 23:21:32 +0100 2647592 http://www.piperreport.com/archives/2009/05/comparative_effectiveness_research_definition_prioritization_criteria_and_i.html Federal agencies are busy implementing the new program for comparative effectiveness research. The Federal Coordinating Council for Comparative Effectiveness Research (CER) has released, for public comment, a draft definition of CER and draft prioritization criteria for making research selections. The definition and criteria are intended to help guide, albeit at a high level, federal use of the $1.1 billion appropriated... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2438279 Thu, 28 May 2009 01:36:50 +0100 2438279 http://www.piperreport.com/archives/2009/05/american_health_drug_benefits_may_2009_issue.html Here are articles from the latest issue of American Health & Drug Benefits. AHDB is the peer-reviewed journal for 30,000 decision makers in health plans, PBMs, Medicare, Medicaid, and the pharma and biotech industries: May 2009 Issue: The Paradox of Public Policy Reform: Change or Continuum? By Robert E. Henry Are You Kidding Me? Clinical Comparative Effectiveness or Evidence-Based Medicine... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2432954 Sun, 24 May 2009 23:42:59 +0100 2432954 http://www.piperreport.com/archives/2009/04/state_health_access_grant_program_new_federal_grants_for_state_health_refor.html As part of the FY 2009 Omnibus Appropriations Act, Congress created the State Health Access Grant Program. On a competitive basis, states may receive grants of $2 million to $10 million each year for five years to improve access to health insurance coverage. Grant funds will help cover the cost of staff, actuarial work, etc. to design and implement major... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2336442 Tue, 14 Apr 2009 02:09:04 +0100 2336442 http://www.piperreport.com/archives/2009/02/medicare_and_health_reform_likely_agenda_for_obama_administration_and_democ.html As the new Obama Administration and the 112th Congress focus on health care issues, here is a quick list of some of the Medicare policy changes Democrats will likely seek in 2009-2010: Likely Changes in Medicare Advantage: 1. Phase-out of difference between Medicare Advantage plan rates and Medicare fee-for-service: Some Medicare Advantage (MA) plans will see lower annual increase. Others... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2194942 Tue, 17 Feb 2009 20:13:22 +0100 2194942 http://www.piperreport.com/archives/2009/01/management_challenges_at_department_of_health_and_human_services.html The incoming leadership at the U.S. Department of Health and Human Services (HHS) face a number of serious management challenges. These challenges, recently identified by the Office of the Inspector General (OIG), will require close, sustained attention by the Secretary's Office and the agency heads, particularly at CMS and FDA. The nominees for Secretary and Deputy Secretary - Tom Daschle... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2100997 Wed, 14 Jan 2009 00:01:44 +0100 2100997 http://www.piperreport.com/archives/2008/12/medicare_part_d_comparing_prescription_drug_use_in_special_needs_plans_and.html Medicare beneficiaries in Special Needs Plans (SNPs) have higher Part D prescription drug utilization and costs than enrollees in other Medicare Advantage Prescription Drug Plans (MA-PDs) do. This is no surprise since, by design, Special Needs Plans serve higher-risk Medicare patients, including many dual eligibles. However, despite higher drug utilization rates in SNPs, SNP enrollees and other MA-PD enrollees... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2061034 Tue, 23 Dec 2008 04:07:48 +0100 2061034 http://www.piperreport.com/archives/2008/12/health_indicators_20_key_indicators_of_us_health_care.html The Institute of Medicine (IOM) has identified 20 key indicators that together "reflect the overall health of the nation and the efficiency and efficacy of U.S. health systems." Each of the 20 indicators can be readily measured over time using existing, publicly collected, reasonably high quality data. In addition to supporting nationwide snapshots, they permit drill-down views based on geography,... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2056080 Mon, 22 Dec 2008 01:27:13 +0100 2056080 http://www.piperreport.com/archives/2008/12/hospital_quality_and_medicare_adverse_event_reporting.html Historically, traditional payment policies - coupled with lax oversight by regulators, weak leadership from many corners of the hospital and physician communities, and an uninformed, reverential public - have served to perpetuate (sometimes even reward) the use of unsafe practices and antiquated technologies in the hospital industry. This, in turn, resulted in a frightening number of adverse events - instances... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2056081 Sun, 21 Dec 2008 18:21:14 +0100 2056081 http://www.piperreport.com/archives/2008/12/national_health_reform_federal_budget_options_for_115_health_reforms_propos.html To aid the incoming 111th Congress and Obama Administration, the Congressional Budget Office (CBO) released a 235-page report outlining 115 budget options for health care reform. The report catalogs most of the hottest legislative ideas on Capitol Hill, with useful background information and scores of costs and savings. Here's the list of reform ideas in the report: The Private Health... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2052809 Thu, 18 Dec 2008 21:25:59 +0100 2052809 http://www.piperreport.com/archives/2008/12/medicare_reimbursement_primers_on_medicare_payment_policies_for_providers_a.html Medicare reimbursement policies are highly complex. Yes, that could be the litotes of the decade. Thankfully, the outstanding staff at the Medicare Payment Advisory Commission (MedPAC) produce and routinely update a series of basic primers on Medicare payment methodologies for hospitals, physicians, other providers, Medicare Advantage plans, and Part D prescription drug plans. MedPAC's primers are reader friendly and crafted... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2040080 Tue, 16 Dec 2008 18:43:16 +0100 2040080 http://www.piperreport.com/archives/2008/12/state_medicaid_budgets_fiscal_survey_of_the_states.html Comprising 21% of state budgets and growing faster than revenues, Medicaid continues to be a serious challenge for governors, state legislatures, and state Medicaid directors. The National Association of State Budget Officers (NASBO) has released its latest Fiscal Survey of the States. Every six months, NASBO provides a crisp, informative snapshot on the revenue and spending situation in every state.... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2040081 Mon, 15 Dec 2008 19:03:26 +0100 2040081 http://www.piperreport.com/archives/2008/12/presidential_appointees_hhs_cms_fda_omb.html A new Administration in the White House also means an array of new political appointees. The aptly named Plum Book, a quadrennial publication, identifies 7,000 senior-level policy making positions in the Executive and Legislative Branches. It includes all the well-know top positions - such as HHS Secretary, CMS Administrator, FDA Commissioner, and OMB Director - as well as their deputies,... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2033212 Fri, 12 Dec 2008 20:29:03 +0100 2033212 http://www.piperreport.com/archives/2008/12/federal_budget_and_health_reform_primer_on_budgeting_for_health_reform.html The budgetary impact of proposed health reform initiatives - whether through legislation, rules, or waivers - significantly affects the likelihood of success. The following provides a concise briefing on some key players and processes affecting cost estimates of federal health care initiatives. Congressional Budget Office (CBO): The Congressional Budget Office (CBO), a nonpartisan agency of Congress, provides Congressional committees with... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=2027126 Wed, 10 Dec 2008 17:19:49 +0100 2027126 http://www.piperreport.com/archives/2008/10/medicaid_managed_care_requirements_for_medicaid_health_plans_1.html Medicaid managed care is a complex business, far more complex than commercial, employer-sponsored health plans or Medicare Advantage plans. Medicaid health plans must meet a range of competitive, financial, clinical, operational, compliance, and political challenges. However, in smart hands, Medicaid managed care organizations (MMCO's) can and often do delivery positive results for beneficiaries (better access and higher quality), taxpayers (lower... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=1934034 Wed, 05 Nov 2008 02:44:10 +0100 1934034 http://www.piperreport.com/archives/2008/08/medicare_policy_making_quick_primer.html The next President and Congress will face many fiscal and policy challenges from the $436 billion Medicare program. Following my earlier quick primers on Medicaid policy making and Medicare and Medicaid waivers, here is a similar briefing on the primary vehicles of Medicare policy making. As a federal health program operating nationwide, Medicare policies are made through: Federal Medicare Statutes:... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=1734025 Wed, 27 Aug 2008 04:51:51 +0100 1734025 http://www.piperreport.com/archives/2008/08/medicaid_policy_making_a_primer_on_the_mechanisms_for_federal_and_state_med.html Many of my clients ask me how Medicaid policy is made, particularly for coverage, reimbursement, and managed care and other delivery systems. The $360 billion Medicaid program is highly complex and there are many nuances and exceptions, but here is a high-level primer on the basics. Given the Medicaid program's shared federal-state funding and governance, underlying complexity, and variability across... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=1713965 Mon, 18 Aug 2008 22:27:06 +0100 1713965 http://www.piperreport.com/archives/2008/08/medicare_and_medicaid_demonstration_waivers_primer.html Federal waivers are powerful tools to demonstrate Medicare or Medicaid reforms, including new payment methods, benefit packages, and delivery systems. The business and policy opportunities are considerable. Here's a quick primer. Demonstration Waivers: Historically, federal policymakers have understood the need to test new ideas in the complex Medicare and Medicaid programs. Research and demonstrations projects - whether initiated by states,... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=1700767 Wed, 13 Aug 2008 00:14:37 +0100 1700767 http://www.piperreport.com/archives/2008/06/medicaid_financing_and_waivers_podcasts_on_medicaid_financing_101_and_feder.html Are you curious or mystified by the intricucies and vagaries of Medicaid financing or federal Medicaid waivers? If so, please check out my new podcasts courtesy of Sellers Dorsey, the influential Medicaid and health reform consultancy. Medicaid Financing 101: Concise review of Medicaid financing and the many opportunities available to find solutions to Medicaid budget needs. To listen, click here... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=1501448 Sun, 08 Jun 2008 18:56:22 +0100 1501448 http://www.piperreport.com/archives/2008/05/resultsdriven_health_care_the_five_steps.html Serious and costly performance problems riddle U.S. health care. Because of overuse, under use, and misuse of health care, researchers at the Juran Institute and elsewhere estimate that about 30 percent of health care costs are generated by poor quality. Therefore, poor quality medical care will cost about $720 billion in 2008 (30% of $2.4 trillion). Poor quality also reduces... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=1432525 Fri, 09 May 2008 20:55:54 +0100 1432525 http://www.piperreport.com/archives/2008/02/medicare_payment_policy_medpac_recommendations_to_congress.html The Medicare Payment Advisory Commission (MedPAC) - the influential independent Congressional agency charged with advising Congress on a wide range of Medicare policy issues - has released its Medicare payment policy recommendations for 2009. The 355-page report includes a weath of information for those tracking Medicare provider or health plan issues, particularly annual provider payment updates, reforms to Medicare Advantage,... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=1274879 Mon, 03 Mar 2008 18:17:17 +0100 1274879 http://www.piperreport.com/archives/2008/02/medicare_advantage_value_of_extra_benefits_offered_by_medicare_advantage_he.html Enrollment in Medicare Advantage plans has jumped 63 percent since 2005. Over 22 percent of all Medicare beneficiaries - 8.8 million total - now receive their Medicare Part A and Part B benefits through a private health plan instead of the traditional fee-for-service system. About 88 percent of all Medicare Advantage plan enrollees also receive their Part D drug benefits... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=1194800 Fri, 01 Feb 2008 16:13:08 +0100 1194800 http://www.piperreport.com/archives/2008/01/valuebased_drug_benefit_designs_impact_on_drug_manufacturers.html More purchasers and payors are moving away from simplistic cost-driven drug benefit designs to formularies and cost sharing based on value. The impact of value-based drug benefit designs on manufacturers will depend on how quickly individual firms adapt their business thinking and communications strategies. Until recently, the path to success for a drug manufacturer was based largely on product novelty,... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=1187171 Tue, 29 Jan 2008 21:45:04 +0100 1187171 http://www.piperreport.com/archives/2008/01/diabetes_opportunities_to_improve_outcomes_and_reduce_costs.html The latest issue of the American Journal of Managed Care has several interesting articles on diabetes, demonstrating several opportunities to improve outcomes and reduce costs: How Managed Care Organizations Contribute to Improved Diabetes Outcomes: Patricia Salber, MD, chief medical officer and SVP at Universal American, a large Medicare health and drug plan, outlines how MCOs are improving outcomes for patients... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=1163234 Sun, 20 Jan 2008 20:46:16 +0100 1163234 http://www.piperreport.com/archives/2007/10/comparative_effectiveness_and_safety_emerging_methods_and_tools_to_compare.html The journal Medical Care has published series of outstanding articles on emerging methods and tools to compare the effectiveness of medical therapies, prescription drugs, and devices. The peer-reviewed articles are an outgrowth from a symposium on comparative effectiveness research sponsored by the Agency for Healthcare Research and Quality (AHRQ). Here are links to the individual articles in PDF format: Emerging... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=939806 Wed, 10 Oct 2007 05:14:04 +0100 939806 http://www.piperreport.com/archives/2007/10/medicare_payment_policy_medpac_primers.html The Medicare Payment Advisory Commission (MedPAC), the savvy nonpartisan shop that advises Congress on Medicare program issues, has updated its excellent series of primers. Extremely complex and changing constantly, Medicare payment policy will drive $479 billion in health spending in 2008. MedPAC's primers, typically four crisply-written pages, explain the basic steps and methodologies Medicare uses to reimburse fee-for-service providers, Medicare... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=933188 Sun, 07 Oct 2007 13:53:18 +0100 933188 http://www.piperreport.com/archives/2007/08/state_childrens_health_insurance_program_update_on_schip_reauthorization.html The 10-year old, extremely popular, and reasonably successful State Children's Health Insurance Program (SCHIP) expires in six weeks. Congress and the White House must agree on a reauthorization bill, and so far the parties are far apart. Here are some key resources to understand the radically different House and Senate bills. Most notably, the House bill is far more expansive... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=809615 Mon, 20 Aug 2007 04:05:49 +0100 809615 http://www.piperreport.com/archives/2007/07/prising_of_biologics_and_other_physicianadminirered_drugs_the_rise_of_avera.html The well-regarded industry trade journal Biotechnology Healthcare has an excellent article by Patrick Mullen on The Arrival of Average Sales Price. In it, Mr. Mullen interviews several top industry experts (yes, including me) on the rationale for and impact of Average Sales Price (ASP) and how health plans are following Medicare's lead: Health plans are beginning to adopt the average... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=747180 Fri, 20 Jul 2007 21:57:24 +0100 747180 http://www.piperreport.com/archives/2007/07/pharmaceutical_pricing_new_federal_rules_on_average_manufacturer_price_and.html In the Deficit Reduction Act (DRA), Congress made major, controversial, and technically complex changes to Medicaid prescription drug pricing and pharmacy reimbursement. The policy changes, which are expected to save the feds and states $8.4 billion over the next five years, present significant challenges to both drug manufacturers and retail pharmacies. To implement the DRA changes, the Center for Medicare... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=744843 Thu, 19 Jul 2007 22:47:01 +0100 744843 http://www.piperreport.com/archives/2007/06/cms_administrator_nomination_hearings_challenges_facing_kerry_weems.html Kerry Weems, Secretary Mike Leavitt's deputy chief of staff and President Bush's nominee to head the Centers for Medicare and Medicaid Services (CMS), faces tough Senate confirmation hearings in July. A savvy, career HHS insider with a wealth of experience in the fiscal and organizational mechanics of federal health programs, Mr. Weems is a good choice for an administrator to... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=695306 Mon, 25 Jun 2007 21:05:15 +0100 695306 http://www.piperreport.com/archives/2007/06/medicare_advantage_understanding_medicare_private_feeforservice_plans.html Of the 45 million Medicare beneficiaries, 19 percent are enrolled in a Medicare Advantage health plan. The other 81 percent choose to remain in traditional fee-for-service Medicare for Part A and Part B services. Governed under Part C of Medicare, Medicare Advantage health plans come in several flavors, most notably HMOs, PPOs, special needs plans (SNPs), and private fee-for-service plans.... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=683165 Wed, 20 Jun 2007 20:42:12 +0100 683165 http://www.piperreport.com/archives/2007/06/health_care_innovation_in_real_world_medicaid_and_state_health_reform.html When it comes to innovation in health coverage, finance, and purchasing, states are the most likely innovators. The role states can play as laboratories of reform is a key advantage of our Federalist system of government. Right now, as many states find themselves in a strong fiscal condition, states are taking the lead in expanding health coverage, reforming market dynamics,... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=675904 Fri, 15 Jun 2007 20:11:32 +0100 675904 http://www.piperreport.com/archives/2007/03/comparative_effectiveness_of_different_treatments_and_clinical_practices_ah.html Normally, $15 million a year doesn't buy you much in the federal government. A notable exception is the Effective Health Care Program at the Agency for Healthcare Research and Quality (AHRQ). Drug manufacturers, device makers, health plans, state Medicaid agencies, Wall Street analysts, physicians, and patient groups should all follow it closely. The Medicare Modernization Act of 2003 (MMA) authorized... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=515274 Sun, 01 Apr 2007 18:41:32 +0100 515274 http://www.piperreport.com/archives/2007/03/enhancing_drug_safety_and_innovation_act_of_2007.html The Enhancing Drug Safety and Innovation Act of 2007 (reintroduced as Senate Bill 484), sponsored by Senator Mike Enzi (R-WY) and co-sponsored by Senator Ted Kennedy (D-MA), is worth watching as the new Congress contemplates pharmaceutical industry legislation. As proposed, The Enhancing Drug Safety and Innovation Act of 2007 has five components: 1. Amends the Federal Food, Drug, and Cosmetic... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=515275 Thu, 22 Mar 2007 06:11:02 +0100 515275 http://www.piperreport.com/archives/2007/03/hhs_and_cms_leadership_changes_likely_leadership_changes_and_implications.html My sources in the Bush Administration tell me that the President will nominate Kerry Weems as the next administrator of the Centers for Medicare and Medicaid Services (CMS). Mr. Weems, a savvy finance expert with a long career at HHS, is well-liked by HHS Secretary Mike Leavitt, former Secretary Tommy Thompson, and the White House Office of Management and Budget... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=482994 Mon, 19 Mar 2007 17:56:07 +0100 482994 http://www.piperreport.com/archives/2007/03/new_federal_ove.html Under a new Executive Order, President Bush has significantly expanded the authority of the White House Office of Management and Budget (OMB) over policymaking by the Centers for Medicare and Medicaid Services (CMS) and the Food and Drug Administration (FDA). Specifically, OMB now has the authority to review and approve a vast array of written guidance issued day-to-day by CMS... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=482995 Sat, 03 Mar 2007 15:36:32 +0100 482995 http://www.piperreport.com/archives/2007/02/health_insurance_regulation_and_debate_over_medical_loss_ratios.html In health policy, bad ideas never go away. Case in point is the proposal in California to require that health plans spend at least 85% of premium revenue on provider payments. Specifically, as part of his $12 billion Stay Healthy California package of reforms, Governor Arnold Schwarzenegger proposes to set a new minimum medical loss ratio for health plans. In... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=482996 Tue, 20 Feb 2007 10:22:58 +0100 482996 http://www.piperreport.com/archives/2007/02/understanding_pharma_and_biotech_best_books_on_pharmaceutical_industry_issu.html Science Business: The Promise, the Reality, and the Future of Biotech Summary: Why has the biotechnology industry failed to perform up to expectations - despite all its promise? In Science Business, Gary P. Pisano, Ph.D. answers this question by providing an incisive critique of the industry. Dr. Pisano not only reveals the underlying causes of biotech's problems; he offers the... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=482997 Sun, 18 Feb 2007 00:06:13 +0100 482997 http://www.piperreport.com/archives/2007/02/state_childrens_health_insurance_program_issues_and_information_in_schip_re.html The $7 billion State Children's Health Insurance Program (SCHIP) is up for reauthorization in Congress this year. SCHIP, which began in October 1997, now covers over four million Americans, primarily children in families with incomes too high to qualify for Medicaid but too low to afford commercial health insurance coverage. Popular with both Democrats and Republicans, SCHIP is certain to... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=482998 Tue, 13 Feb 2007 17:34:43 +0100 482998 http://www.piperreport.com/archives/2007/02/state_health_ca_1.html In health care, states serve as the nation's laboratories of reform - able to test innovations in financing, coverage, regulation, and care delivery. In 2007, states are leading the way on health insurance coverage expansion, leveraging a mix of policies including universal coverage, individual mandates, tax credits and Section 125 plans, and insurance "exchanges" or "connectors" to facilitate buying of... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=482999 Sat, 10 Feb 2007 15:10:13 +0100 482999 http://www.piperreport.com/archives/2007/01/bush_health_ref.html President Bush has joined the health reform debate with a proposal of his own. The Bush approach is as intriguing as it is controversial. First, the Administration seeks to reform the federal tax code to change the tax treatment of health insurance premiums and offer new tax deductions to help make coverage more affordable. Second, the White House wants to... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=483000 Thu, 25 Jan 2007 02:34:27 +0100 483000 http://www.piperreport.com/archives/2007/01/medicare_prospe.html When asked about health care innovations, especially practices directed at controlling costs, most policymakers and wonks point to private sector solutions, such as the cost-constraining effects of HMOs in the 1990's or today's ideation of consumer-directed health plans. But is this conventional wisdom wrong? What about public sector health policies, most notably in Medicare or Medicaid? In a fascinating... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=483001 Sun, 14 Jan 2007 21:32:01 +0100 483001 http://www.piperreport.com/archives/2007/01/medicare_drug_p.html With sound, furry, and a fair quota of sound bites and photo opps, House Democrats are pushing for quick adoption of H.R. 4, the Medicare Prescription Drug Price Negotiation Act of 2007. The bill would require the Secretary of HHS to negotiate with pharmaceutical manufacturers on drug prices in Medicare Part D. As I explained in an earlier post, federal... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=483002 Wed, 10 Jan 2007 14:24:53 +0100 483002 http://www.piperreport.com/archives/2006/12/health_care_fra.html The federal False Claims Act has been an effective tool in combating fraud and abuse in government programs, particularly Medicare. Several states have their own state versions of false claims legislation. The federal Deficit Reduction Act (DRA), enacted last February, gives states a powerful new financial incentive to enact state false claims acts modeled after the federal version and directed... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=483003 Sat, 30 Dec 2006 06:40:37 +0100 483003 http://www.piperreport.com/archives/2006/12/medicare_a_policy_primer_by_marilyn_moon.html Medicare is a study in contrasts. In its financing, the program is modeled as what health wonks call "social insurance," which in reality is a euphemism for a politically effective but fiscally troubling mix of social welfare, health insurance, and cross-generational income transfers. Limited in coverage, slow to add coverage of new technologies, and often high in cost sharing, Medicare... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=483004 Wed, 27 Dec 2006 22:10:14 +0100 483004 http://www.piperreport.com/archives/2006/12/impact_of_defic.html In the Deficit Reduction Act (DRA), Congress made a series of significant changes to pharmaceutical pricing, Medicaid best price rebates, and Medicaid payments to pharmacies for prescription drugs. The new policies, which are expected to save the feds and states $8.4 billion over the next five years, create major challenges to both pharmaceutical manufacturers and pharmacies. DRA Drug Pricing Changes... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=483005 Tue, 19 Dec 2006 00:27:59 +0100 483005 http://www.piperreport.com/archives/2006/12/medicaid_change.html The 109th Congress ended in the early morning hours on Saturday, with both houses passing by comfortable margins the Tax Relief and Health Care Act of 2006. With Democrats taking control of both the House and Senate when the 110th Congress begins the first week of January, GOP leaders were anxious to resolve some key policy items before Democrats take... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=483006 Tue, 12 Dec 2006 00:34:36 +0100 483006 http://www.piperreport.com/archives/2006/12/should_federal.html There's a lot of truth in the old joke about the problem with Republicans and Democrats: Republicans need a heart and Democrats need a brain. As Democrats prepare to take control of Congress, they appear eager to prove the joke by pursuing legislation to require government "negotiations" on prescription drug prices in Medicare Part D. The idea has emotional appeal,... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=483007 Sat, 09 Dec 2006 18:42:45 +0100 483007 http://www.piperreport.com/archives/2006/10/post.html The Bush Administration remains intent on issuing new regulations to implement several Medicaid budget cuts proposed in the President's FY 2007 budget last February. Most notably, the Administration wants to reduce state use of provider taxes by capping assessments at three percent, instead of the current six percent. This could be done by mandating that states phase down state provider... (Source: Piper Report on Health Care) Piper Report on Health Care news http://www.medworm.com/rss/comments.php?id=483008 Tue, 17 Oct 2006 14:41:20 +0100 483008