CMS will no longer pay for medical treatment(reg req) for injuries or illnesses resulting from hospitalization. Expect private insurers to follow suit.
Its about time.
Aug
20
Insight, analysis & opinion from Joe Paduda
Category: Medicare and Medicaid
Aug
8
CMS’ hospital reimbursement change is going to create winners and losers; among the biggest winners will be UnitedHealthcare.
Among the losers, their competitors.
Aug
7
The adage goes something like – when the US sneezes, the world catches a cold, signifying just how much influence this country has on the rest of the world.
That’s analogous to Medicare’s impact on the health care sector. And Medicare is about to change the way it pays hospitals, a change that will have a dramatic effect on every private payer from HMO to individual carrier to workers comp insurer to self-insured employer.
Aug
6
The latest shot in the battle against drug costs comes from the Centers for Medicaid and Medicare Services, which is reported to be denying coverage for off-label use of drugs such as Actiq and Fentora.
Whenever CMS moves, the healthcare world shakes, and this is no exception. There are a host of possible ‘downstream implications’ in areas as diverse as workers comp, formulary management, and hospice.
May
11
I’m on a brief vacation mountain biking in Moab, Utah. A gorgeous place, great people, great riding. And upon return from a long and tiring but very fun ride this am, I open up the latest from Fierce Healthcare to read reports about not one, but two reimbursement scams and one piece on docs who don’t disclose when they make mistakes.
That just crushed the hard-earned buzz.
May
1
I’ve been following Bob Laszewski’s views on Medicare Advantage with some interest. My take is the program is about to embark on a financial bread-and-water diet, a regimen prescribed by the Democratic Congress seeking funds to offset physician reimbursement increases (or more accurately to prevent decreases) and fund the S-CHIP program.
Bob’s view is that the rural programs will not suffer too much, while MA plans located in urban areas may well have their subsidies reduced. The MA program sponsors are now pulling out the lobbying stops, employing a variety of questionable and downright distasteful marketing.
The latest descent-to-previously-unplumbed-depths is their manipulation of minority groups as “victims” of the heartless Dems.
Mar
22
Two timely topics are in the news; the likelihood of cuts in the additional payments for Medicare Advantage programs and reductions in Medicare reimbursement rates for physicians.
The juxtaposition is just too…obvious to pass without comment.
Jan
16
Pundits and experts on the right side of the political spectrum are claiming that giving CMS the authority to negotiate drug prices will cost Americans $500 billion in lost productivity due to an annual loss of five million life years.
There are so many flaws in their arguments it’s hard to know where to start, but let’s plunge in.
Jan
10
Coventry CEO Dale Wolf presented at the JPMorgan Healthcare Investment Conference earlier this week; I was particularly interested in his comments re the business opportunity in Medicare and Medicaid.
Medicare Advantage (MA) programs are likely to suffer a significant cut in funding this year as the Democrats, led by Rep. Pete Stark (D CA) take a chain saw to the subsidies paid to MA plans.
Coventry will be close to a $9 billion business in 2007.
The loss of a good chunk of the subsidy will make the MA business less attractive for many health plans; Wolf believes there is a significant opportunity for Coventry as it has successfully become the low cost producer in their markets, an achievement of which Wolf is quite proud.
Continue reading Medicare as a business – Coventry’s perspective
Jan
5
Bob says it better than I could.