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Senator Grassley Sets Sights On Medicare Advantage; Sends Letters To CMS and DOJ Asking For Their Strategies To Mitigate "Risk Score" Fraud
Senator Charles Grassley (R-IA), the co-author of the Physician Payments Sunshine Act, sent letters last week to the Centers for Medicare and Medicaid Services (CMS) and the Department of Justice (DOJ) concerning alleged Medicare Advantage fraud. Update: Senator Claire McCaskill, the top ranking Democrat on the Senate Special Commission on Aging, also sent a letter to CMS asking what steps the government is taking to combat alleged Medicare Advantage fraud and abuse.    Medicare Advantage plans are run through approved private insurance companies, and offer an alternative to traditional Medicare for seniors. CM...
Source: Policy and Medicine - June 1, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

The Core Quality Measures Collaborative: A Rationale And Framework For Public-Private Quality Measure Alignment
Editor’s note: The full list of authors for the Core Quality Measures Collaborative Workgroup is included at the end of the blog post. In today’s health care system, physicians are faced with an unprecedented number of quality measures required by different entities. Payment is pivoting away from traditional reimbursement models toward value-based health care, where value is a function of both quality and cost. Patients are making an about-face from traditionally passive receivers of health care to informed consumers with expectations of transparency. Payers and employer groups are demanding accountability for how thei...
Source: Health Affairs Blog - June 23, 2015 Category: Health Management Authors: Patrick H. Conway and the Core Quality Measures Collaborative Workgroup Tags: Featured Hospitals Organization and Delivery Payment Policy Population Health Quality 3Rs AHIP AHRQ CMS health outcomes National Quality Forum Source Type: blogs

Until Next Year
It’s been our great pleasure to collaborate with the Health Affairs Blog on this series stemming from the Third Annual Health Law Year in P/Review symposium at Harvard Law School. This annual event takes a look back over the prior year and previews the year to come with regard to hot topics in health law. After the symposium, we asked our speakers to keep the conversation going online by expanding on their topics from different angles or by honing in on particularly intriguing features. These pieces were published on the Health Affairs Blog through the spring and into summer. We heard more from Kevin Outterson on how to...
Source: Health Affairs Blog - June 24, 2015 Category: Health Management Authors: Holly Fernandez Lynch, I. Glenn Cohen and Gregory Curfman Tags: Costs and Spending Featured Insurance and Coverage Medicaid and CHIP Organization and Delivery Population Health Public Health ACA Antibiotics Brittany Maynard Common Rule Ebola FDA Harvard Law Hobby Lobby MassHealth Petrie Source Type: blogs

"Quality" Measures Update
According to CMS, more than 460,000 of the 1.25 million eligible Medicare providers did not meet deadlines to submit data for the Physician Quality Reporting System in 2013. The agency noted that about 70% of those who did not meet the deadlines see fewer than 100 Medicare patients annually. Nearly 40 percent of healthcare providers treating Medicare patients will have their payments docked 1.5% this year because they did not submit data on patients’ health to the government. However, nearly 642,000 providers did comply in 2013 and will earn a 0.5% boost in payments this year. For many small practices, the administrative...
Source: Policy and Medicine - July 9, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

What the Atlanta HIV Data Tells Us About Public Health in America
This article was initially published in Georgia Health News.  
Source: The Health Care Blog - July 10, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB AIDSVu Atlanta CDC HIV Maithri Vangala Source Type: blogs

Health Affairs’ August Issue: Hospital Quality And Care
The August issue of Health Affairs contains a cluster of articles focusing on hospital quality and care. Other subjects covered in this variety issue: ways state vaccine exemption laws affect disease outbreaks; how states with strong health insurance rate review managed lower premiums; and characteristics of health care “super-utilizers.” State Vaccination Exemption Laws, Exemption Rates, And Disease Outbreaks In the United States, it is left to individual states to require that their kindergarteners show proof of vaccinations or have a vaccination exemption before being admitted to school. W. David Bradford and Anne M...
Source: Health Affairs Blog - August 3, 2015 Category: Health Management Authors: Chris Fleming Tags: Costs and Spending Elsewhere@ Health Affairs Equity and Disparities Organization and Delivery Population Health Public Health Quality Health Affairs August Issue Mental Health pay-per-performance super-utilizers vaccination laws Source Type: blogs

The Real Dark Side of Health Care: Health Care Corruption
The editors of the prestigious Annals of Internal Medicine just stated they they were shocked, shocked to find out that physicians occasionally express disrespect for patients when the patients cannot hear or see them.  The occasion was an editorial signed by three editors whose title included the phrase, "shining a light on the dark side of health care."(1)  The editorial referred to an anonymous narrative that recounted two incidents from the past.(2)Two Alleged Incidents of Physicians' Expression of Disrespect for Patients The first incident, discussed second hand, was of a obstetrician who made a sexist comme...
Source: Health Care Renewal - August 25, 2015 Category: Health Management Tags: anechoic effect Annals of Internal Medicine health care corruption medical journals professionalism Source Type: blogs

Social Security Technical Panel: 75-Year Shortfall Might be 28 Percent Larger
A recent report from the Social Security Advisory Board’s Technical Panel found that the 75-year shortfall could be 28 percent (roughly $2.6 trillion) larger than the estimate in this year’s Trustees Report due to changes in some of the underlying technical assumptions. This disparity is more the product of the difficulties related to projecting the trajectory of a program as large and complicated as Social Security so far into the future, with the chair of the Technical Panel taking pains to reiterate that “the methods and assumptions used by the Social Security actuaries and Trustees are reasonable.” Even so, the...
Source: Cato-at-liberty - October 9, 2015 Category: American Health Authors: Charles Hughes Source Type: blogs

HHS Expects ACA Exchange Enrollment to Stagnate in 2016
For the second year in a row, the Department of Health and Human Services (HHS) estimates that enrollment in the health insurance exchanges will come in far below earlier projections from the Congressional Budget Office (CBO). According to the research brief released yesterday, HHS estimates that effectuated enrollment, or enrolled and paying premiums, will be in the range of 9.4 to 11.4 million at the end of 2016. In a conference call with reporters HHS Secretary Burwell said she believes “10 million is a strong and realistic goal… our target assumes something that is probably pretty challenging, which is that more th...
Source: Cato-at-liberty - October 16, 2015 Category: American Health Authors: Charles Hughes Source Type: blogs

Wave of Health Insurance CO-OPs to Shut Down in Latest ACA Failure
Hundreds of thousands people will lose their insurance plans as a raft of health insurance cooperatives (CO-OPs) created by the Affordable Care Act will cease operations. Just last week, CO-OPs in Oregon, Colorado, Tennessee and Kentucky announced that they would be winding down operations due to lower than expected enrollment and solvency concerns (although the one in Colorado is suing the state over the shutdown order).  They join four other CO-OPs that have announced that they would be closing their doors. In total, only 15 out of the 23 CO-OPs created by the law remain. These closures reveal how ill-advised this aspec...
Source: Cato-at-liberty - October 22, 2015 Category: American Health Authors: Charles Hughes Source Type: blogs

About Those Social Security ‘Promises’
In the Republican debate last night, former Gov. Mike Huckabee of Arkansas criticized calls for Social Security reform, saying “people paid their money. They expect to have it,” and that the country needs to honor its promises to seniors. There are problems with this line of argument: the Social Security payroll taxes a person pays are not tied to the benefits they receive in a legal sense, and the ‘promises’ made by Social Security are, and always have been, subject to change. Congress has had the authority to alter Social Security since its inception. Section 1104 of The Social Security Act of 1935 explicitly say...
Source: Cato-at-liberty - October 29, 2015 Category: American Health Authors: Charles Hughes Source Type: blogs

Zombie Corporate Welfare
Perhaps in anticipation of Halloween, two components of corporate welfare have been doing their best impression of a Hollywood monster that refuses to die. The Export-Import Bank (Ex-Im) seems poised to come back from the grave, and promises have already been made to reverse the minor cuts to the crop insurance subsidy program agreed to in this week’s budget deal. These cases give some insight into just how difficult it is to actually get rid of corporate welfare. Cato has long criticized both corporate welfare and crony capitalism, which benefit the few, the powerful, and the politically connected at the expense of ever...
Source: Cato-at-liberty - October 30, 2015 Category: American Health Authors: Charles Hughes Source Type: blogs

Expanded Coverage Appears To Explain Much Of The Recent Increase In Health Job Growth
The rate of health sector hiring started to increase in the middle of 2014, and has continued to accelerate through the first three quarters of 2015. The timing of this acceleration corresponds to the recent expansion of health insurance coverage, but thus far there is little direct evidence of a relationship between expanded coverage and health jobs. We use state-level data on health jobs and insurance coverage to show that much of the acceleration in health jobs can be explained by expanded coverage. This suggests that as insurance coverage stabilizes, health job growth should revert back to more typical historical level...
Source: Health Affairs Blog - November 20, 2015 Category: Health Management Authors: Charles Roehrig, Ani Turner and Katherine Hempstead Tags: Costs and Spending Featured Health Professionals Insurance and Coverage American Community Survey Bureau of Labor Statistics Current Employment Statistics health sector jobs Source Type: blogs

Senate Finance Committee Releases Results of Investigation Into Gilead’s Pricing Strategy for Hepatitis-C Drugs
Discussion The Gilead example does not represent the life science community well, and highlights the need to put extra thought into the way drugs are priced. Gilead clearly was allowing marketing to drive the pricing ship and displayed what could be considered an almost reckless disregard for availability and affordability. Pharmaceutical companies can, and should, attempt to maximize their profit, but should consider doing so in a way that ensures availability and affordability for patients and payers alike. While there is no clear answer to the drug pricing dilemma we currently face, perhaps more thought and research s...
Source: Policy and Medicine - December 2, 2015 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

The Impact Of New Hepatitis C Drugs On National Health Spending
Those who follow Altarum Institute’s monthly health sector briefs and trend reports are well aware that the five-year run of record low growth rates in national health spending (from 2009 through 2013) has come to an end, or at least been interrupted. According to data just released by the Centers for Medicare & Medicaid Services (CMS), health spending grew by 5.3 percent in 2014, compared to 2.9 percent in 2013 and roughly 4 percent from 2009 through 2012. Our estimates for the first eight months of 2015 show growth of 6.2 percent, though on a downward path, indicating that the year could finish at around 6 percent ...
Source: Health Affairs Blog - December 7, 2015 Category: Health Management Authors: Charles Roehrig Tags: Costs and Spending Drugs and Medical Technology Featured Medicare Quality Harvoni hepatitis C Prescription Drugs Sovaldi spending growth Source Type: blogs