Medicare Payment Advisory Commission

Medicare

Medicare Part C

Fitness Centers

United States

Centers for Medicare and Medicaid Services (U.S.)

Fee-for-Service Plans

Medicare Part D

Prospective Payment System

Economics, Hospital

Reimbursement Mechanisms

Cost Savings

Rate Setting and Review

Diagnosis-Related Groups

MedPAC24

• The Medicare Payment Advisory Commission (MedPAC) is an independent, non-partisan legislative branch agency headquartered in Washington, D.C. MedPAC was established by the Balanced Budget Act of 1997 (P.L. 105-33). (wikipedia.org)
• The BBA formed MedPAC by merging two predecessor commissions, the Prospective Payment Assessment Commission (ProPAC), established in 1983, and the Physician Payment Review Commission (PPRC), which was formed in 1985. (wikipedia.org)
• MedPAC is also relied on by Medicare administrators and policy makers to evaluate beneficiaries' access to care, quality of care, and other issues affecting the Medicare program and its beneficiaries. (wikipedia.org)
• MedPAC produces two major reports to the United States Congress each year that contain recommendations to improve Medicare. (wikipedia.org)
• M.P.H. Commission leadership Executive Director: Paul B. Masi, M.P.P. Deputy Director: Dana K. Kelley, M.P.A. Assistant Director: Stephanie Cameron, Sc.M. Chief Financial Officer: Mary Beth Parsons, M.S. List of United States federal agencies MedPAC. (wikipedia.org)
• The Medicare Payment Advisory Commission (MedPAC) is a nonpartisan legislative branch agency that provides the U.S. Congress with analysis and policy advice on the Medicare program. (psu.edu)
• According to the Medicare Payment Advisory Commission (MedPAC), rebates average over $2,300 per enrollee in 2023 . (kff.org)
• Members of the Medicare Payment Advisory Commission (MedPAC) considered several answers to that question at MedPAC's April meeting. (medpagetoday.com)
• The fines can be heavy, averaging $217,000 for a hospital in 2018, according to Congress' Medicare Payment Advisory Commission, or MedPAC. (healthleadersmedia.com)
• The Medicare Payment Advisory Commission, or MedPAC, recently reported that MA enrollment grew 10% from July 2020 to July 2021. (brookings.edu)
• The concern is that MedPAC reports that MA plans continue to be paid 104% of traditional Medicare Fee for Service (FFS) costs, and payment benchmarks remain at 108% of traditional Medicare FFS spending. (brookings.edu)
• 2) MedPAC changed their methodology for estimating FFS expenditures in 2010 in a way that reduced the estimated MA payment ratio. (hhs.gov)
• In 2006, the Comptroller General appointed Ms. Behroozi to the Medicare Payment Advisory Commission (MedPAC). (ahrq.gov)
• As I explained in Part 1 of this post, using figures from the non-partisan and highly respected Medicare Payment Advisory Commission (MedPAC) , these are groups that Medicare often overpays. (ncpssm.org)
• He recently completed a six-year term as a Commissioner on the Medicare Payment Advisory Commission (MedPAC). (academyhealth.org)
• The Medicare Payment Advisory Commission (MedPAC) has estimated that beneficiary copayments at hospitals are nearly triple that of freestanding physicians' offices. (pr.com)
• MedPAC estimated that equalizing payments across all providers could save Medicare beneficiaries as much as $380 million per year in out of pocket costs. (pr.com)
• WASHINGTON - The Medicare Payment Advisory Commission (MedPAC) has released its 2023 data book on health care spending and the Medicare program. (hmenews.com)
• In its annual June report to Congress, the Medicare Payment Advisory Commission (MedPAC) explores a number of reforms that could help improve outcomes and reduce spending in Medicare. (crfb.org)
• Last year, MedPAC recommended that Medicare payment rates for office visits should be the same regardless of if care is provided in an outpatient department (OPD) or in a freestanding physician's office. (crfb.org)
• Together, MedPAC estimates these reforms can provide $1.5 billion a year in savings to Medicare and beneficiaries. (crfb.org)
• To encourage accountability, care coordination, and efficiency in Medicare, MedPAC examined expanding current bundled payment reforms to post-acute care services. (crfb.org)
• MedPAC simply explores Medicare plan competitive bidding and does not recommend any specific policies. (crfb.org)
• The Medicare Payment Advisory Commission (MedPAC) recommendation on avoiding the discrepancies and site-of-service differentials in in-office settings, hospital outpatient settings, and ASCs has not been agreed to by CMS. (unboundmedicine.com)

Centers17

• 1 Centers for Medicare & Medicaid Services. (mckinsey.com)
• That number is expected to grow almost 10 percent to more than 24.4 million after this fall's open selection period, according to the Centers for Medicare & Medicaid Services (CMS). (mckinsey.com)
• The Centers for Medicare and Medicaid Services (CMS) is the de jure work RVU determining body. (wikipedia.org)
• Typically, the penalties are based on three years of patients, but the Centers for Medicare & Medicaid Services excluded the final six months in the period because of the chaos caused by the pandemic as hospitals scrambled to handle an influx of COVID-19 patients. (healthleadersmedia.com)
• Research in this area has increased since the Centers for Medicare & Medicaid Services (CMS) made readmissions within thirty (30) days a major quality indicator for health care organizations. (bartleby.com)
• Well, so Mike, after some delays, due to COVID-19 the centers for Medicare and Medicaid and the department of health and human services issued the final rule of the star claw and anti-kickback statute in December. (modernhealthcare.com)
• A substantial shift toward Medicare will continue, led by growth in the over-65 population of 3 percent per year projected over the next five years and continued popularity of Medicare Advantage among seniors, as reflected in the latest Centers for Medicare & Medicaid Services (CMS) enrollment data. (mckinsey.com)
• Medicare Advantage penetration was increasing by less than 2 percent annually from 2016 to 2019 but increased by about 3 percent annually in 2020 and 2021-for further information, see "Medicare advantage/part D contract and enrollment data," Centers for Medicare & Medicaid Services, US Government. (mckinsey.com)
• Despite these concerns, beginning next year, the Centers for Medicare and Medicaid Services plans to go even further and use the same flawed formulae to cut reimbursement rates by more than 30 percent over 6 years. (ama-assn.org)
• The Centers for Medicare & Medicaid Services is attempting to address the issue. (healthleadersmedia.com)
• [8] In New Jersey, hospital prices far outpace Medicare rates , which the Centers for Medicare and Medicaid Services sets at amounts that "reasonably efficient providers would incur in furnishing high-quality care. (njpp.org)
• Additionally, it studies care coordination for dual eligibles (beneficiaries eligible for both Medicare and Medicaid), noting that federally qualified health centers and community health centers may be uniquely positioned to coordinate care for these beneficiaries because they provide primary care, behavioral health services, and care management services, often at the same clinic site. (crfb.org)
• In recent years, the Centers for Medicare & Medicaid Services scheduled the pay cuts to offset the cost of increasing payments for underpaid services, like primary care. (finchannel.com)
• The Centers for Medicare and Medicaid Services (CMS) released the proposed 2017 Medicare physician fee schedule on July 7, 2016, addressing Medicare payments for physicians providing services either in an office or facility setting, which also includes payments for office expenses and quality provisions for physicians. (unboundmedicine.com)
• Patients pay according to Centers for Medicare and Medicaid the 3-stage definition of dependence of Services as hospitals where care is pro- Patients in LTCHs are generally de- national insurance ( 18 ). (who.int)
• The Centers for Medicare and Medicaid Services prospective payment system instituted documentation rules for inpatient rehabilitation facilities (IRFs) in 2010, with the goal of optimizing patient selection. (bvsalud.org)
• Despite the tragic emergency circumstances prompting waivers, the Centers for Medicare & Medicaid Services and Congress now have a unique opportunity to evaluate potential improvements revealed by COVID-19 regulatory relief and should consider permanent reform of the Three Midnight Rule. (bvsalud.org)

Medicaid13

• Similarly, Medicaid managed care plan payments are close to the relatively low Medicaid fee-for-service rates. (theincidentaleconomist.com)
• Since its creation over four decades ago, Medicare, and Medicaid, its companion program for the poor, have greatly increased demand for medical care by making it more broadly available. (concordcoalition.org)
• Today, there are some 45 million Medicare enrollees and 60 million Medicaid recipients. (concordcoalition.org)
• Third-party payments, whether through government entitlement programs such as Medicare and Medicaid or private insurance plans, tend obscure costs and make patients and providers less cost conscious than they might otherwise be if those seeking treatment had to pay for services directly "out-of-pocket. (concordcoalition.org)
• While that growth has been largely attributed to factors affecting health care costs in general, the aging of society and imminent impact of retiring baby boomers on government spending, notably under Medicare, Medicaid, and Social Security, will eventually create large and lasting fiscal strains on the U.S. Treasury. (concordcoalition.org)
• Under its most recent forecast, the Congressional Budget Office (CBO) projected that federal expenditures on Medicare and Medicaid, measured as a share of the gross domestic product (GDP), will rise from 4 percent in 2007 to 12 percent in 2050 and 19 percent in 2082-which is roughly equal to the total share of the economy that the federal government has traditionally spent on everything it does. (concordcoalition.org)
• Avoiding those outcomes will inevitably require containing the growth of Medicare and Medicaid. (concordcoalition.org)
• There may be ways, however, in which policymakers can reduce costs without harming the health of Medicare and Medicaid beneficiaries. (concordcoalition.org)
• The value-based system also affects Medicare and Medicaid. (bartleby.com)
• Due to the high costs of readmissions Medicare and Medicaid have implemented a Hospital Readmission Reduction program. (bartleby.com)
• Financial pressures also come from steadily falling reimbursement rates in government health programs like Medicare and Medicaid. (ama-assn.org)
• [10] This includes coverage for uncompensated care, bad debt, and expenses that Medicaid and Medicare do not cover. (njpp.org)
• He also advised the Center for Medicare and Medicaid Services on assumptions that actuaries were using to assess the financial status of the Medicare trust funds. (mitre.org)

Congressional Budget2

• As the Congressional Budget Office and other analysts indicate, traditional Medicare tends to be more efficient, on average, than private Medicare Advantage plans because of its lower administrative and marketing costs. (cbpp.org)
• At the time, the Congressional Budget Office (CBO) and the Medicare actuary predicted large scale exit from MA markets. (brookings.edu)

Congress17

• Its primary role is to advise the US Congress on issues affecting the administration of the Medicare program. (wikipedia.org)
• Specifically the commission's mandate is to advise the US Congress on payments to private health plans participating in Medicare and providers in Medicare's traditional fee-for-service program. (wikipedia.org)
• We are a nonpartisan independent legislative branch agency that provides the U.S. Congress with analysis and policy advice on the Medicare program. (medpac.gov)
• 3 Medicare Payment Advisory Commission Report to the Congress: Medicare Payment Policy. (mckinsey.com)
• Since its policymaking is concentrated within the federal government, Medicare provides an opportunity for Congress and the President to change its payment practices and apply them in a way that might be replicated by private insurers. (concordcoalition.org)
• Physician organizations call on Congress to stop Medicare physician payment cuts and more in the latest Medicare Payment Reform Advocacy Update. (ama-assn.org)
• The Alliance looks forward to supporting the Subcommittee's work and urges Congress to advance payment parity across sites of service and expand policies to equalize payments. (pr.com)
• When Congress established average sales prices (ASPs) as the basis for reimbursement for Medicare Part B drugs, it also provided a mechanism. (hmenews.com)
• He is the former vice chair of the Medicare Payment Advisory Commission, an independent agency that advises Congress on issues affecting the Medicare program. (mitre.org)
• The commission urged Congress to "equalize payment rates" or at least reduce the disparities, for doctor's office visits and hospital clinic visits in which similar patients receive the same or similar services. (crfb.org)
• Unfortunately, the final bill that Congress could vote on by the end of this week has lots of spending on drugs for today's seniors, but no meaningful Medicare reform for tomorrow's retirees. (nationalcenter.org)
• Doctors are urging Congress to call off cuts scheduled to take effect on Jan. 1 in the reimbursements they receive from Medicare.In what has become an almost yearly ritual, physician groups are arguing that patients will have greater difficulty finding doctors who accept Medicare if lawmakers allow the pay cuts to happen. (finchannel.com)
• Despite overwhelming bipartisan, bicameral support to stop the full Medicare physician payment cut, Congress failed once again to end the cycle of harmful Medicare cuts, showing a disregard for vulnerable seniors," the Surgical Care Coalition, an organization representing surgeons and anesthesiologists, said in a statement. (finchannel.com)
• Since the early 2000s, Congress has voted every year or two to delay or reverse plans to reduce Medicare payments to doctors. (finchannel.com)
• If Congress is unable to pass the spending bill, physicians face a 4.5% cut in Medicare fees. (finchannel.com)
• As in previous years, physicians have waged a frantic campaign to convince Congress that reducing the amount paid to care for Medicare patients would drive more doctors away from accepting them as patients at all. (finchannel.com)
• The National Clinical Care Commission (NCCC) was established by Congress to make recommendations to leverage federal policies and programs to more effectively prevent and treat diabetes and its complications. (cdc.gov)

Enrollees11

• T]he rates paid for Medicare Advantage enrollees are similar to or slightly above those that Medicare pays for FFS patients' care. (theincidentaleconomist.com)
• In Medicare Advantage, the federal government contracts with private insurers to provide Medicare benefits to enrollees. (kff.org)
• Medicare pays insurers a set amount per enrollee per month, which varies depending on the county in which the plan is located, the health status of the plan's enrollees, and the plan's estimated costs of covering Medicare Part A and Part B services. (kff.org)
• In 2023, more than 7 in 10 (73%) enrollees in individual Medicare Advantage plans with prescription drug coverage pay no premium other than the Medicare Part B premium, which is a big selling point for beneficiaries. (kff.org)
• Most Medicare Advantage enrollees have access to benefits that are not covered by traditional Medicare, such as vision, hearing and dental. (kff.org)
• Nearly all Medicare Advantage enrollees (99%) are in plans that require prior authorization for some services, which is generally not used in traditional Medicare. (kff.org)
• Most Medicare Advantage enrollees are in plans with a quality rating of at least 4 out of 5 stars, explained in part by the fact that more than half (51%) of plans receive ratings at or above this threshold. (kff.org)
• In 2023, 97% of Medicare Advantage enrollees in individual plans open for general enrollment are in plans that offer prescription drug coverage. (kff.org)
• Premiums paid by Medicare Advantage enrollees have declined since 2015. (kff.org)
• By operating its own I-SNP, a SNF directly receives the full Medicare payment for plan enrollees, controlling whether and how Medicare dollars are spent. (medicareadvocacy.org)
• WASHINGTON - Medicare and its enrollees have saved $73.4 million since 2013, because of CMS's price substitution policy for Part B covered drugs, according to an August issue brief from the Office of Inspector General. (hmenews.com)

Hospitals26

• Our analytic sample included 3078 acute care hospitals and 14,866 Medicare-certified SNFs in the United States, encompassing more than 47 million hospital discharges. (ajmc.com)
• More research is needed to understand how hospitals are responding to bundled payment incentives and specific practices that contribute to improvements in cost and quality. (ajmc.com)
• Hospitals participating in Medicare's Bundled Payments for Care Improvement model did not concentrate skilled nursing discharges among smaller groups of skilled nursing facilities (SNFs). (ajmc.com)
• Under bundled payment, hospitals bear financial responsibility for SNF care but may perceive themselves as constrained in their ability to direct patients to specific providers, which may limit shifts in referral patterns. (ajmc.com)
• Hospitals may respond to bundled payment in ways that do not affect discharge flows, such as sharing electronic health records, monitoring SNF performance, and hiring care coordinators to track patients after discharge. (ajmc.com)
• The Advisory Board, which in 1995 promoted a strategy of purchasing physician practices and being paid on capitation,7 four years later published Stopping the Bleed, Reversing Losses on Owned Practices ,8 reversing the advice by suggesting that hospitals divest their physicians and return to fee-for-service (FFS) payment. (mgma.com)
• The federal government's effort to penalize hospitals for excessive patient readmissions is ending its first decade with Medicare cutting payments to nearly half the nation's hospitals. (healthleadersmedia.com)
• In its 10th annual round of penalties, Medicare is reducing its payments to 2,499 hospitals, or 47% of all facilities. (healthleadersmedia.com)
• Of the 3,046 hospitals for which Medicare evaluated readmission rates, 82% received some penalty, nearly the same share as were punished last year. (healthleadersmedia.com)
• Readmissions occurred with regularity - for instance, nearly a quarter of Medicare heart failure patients ended up back in the hospital within 30 days in 2008 - and policymakers wanted to counteract the financial incentives hospitals had in getting more business from these boomerang visits. (healthleadersmedia.com)
• The commission added that untangling the exact causes of the readmission rates was complicated by changes in how hospitals recorded patient characteristics in billing Medicare and an increase in patients being treated in outpatient settings. (healthleadersmedia.com)
• How Cost-Sharing Leads to More Cost-Sharing: A Slippery Slope President Obama?s newest proposal for reducing the federal deficit would slice Medicare reimbursements to drug-makers, nursing homes, rehabilitation facilities, home health services and teaching hospitals. (ncpssm.org)
• This cost-saving strategy would disproportionately affect hospitals that treat high numbers of low-income Medicare beneficiaries: safety-net hospitals and rural hospitals. (ncpssm.org)
• Compares the relative percentage and composition of non-operating revenue (NOR) among Critical Access Hospitals (CAHs), rural Prospective Payment System (R-PPS) hospitals, and urban Prospective Payment System (U-PPS) hospitals from 2011-2019. (ruralhealthinfo.org)
• Presents an overview of Medicare payments for Critical Access Hospitals (CAHs). (ruralhealthinfo.org)
• Compares differences in Medicare payments for CAHs, Sole Community Hospitals, and Medicare-Dependent Hospitals. (ruralhealthinfo.org)
• In New Jersey, the breakeven rate for hospitals is estimated to be approximately 150 percent of Medicare rates. (njpp.org)
• The recommendation also includes a stop-loss policy to limit the loss of Medicare revenue for hospitals that provide services to a disproportionate share of low-income Medicare patients. (crfb.org)
• All Medicare does is entitle doctors and hospitals to get paid, at a rate that Medicare sets, if they provide services that Medicare deems "appropriate" to people covered by Medicare. (nationalcenter.org)
• The only way to keep the rest of us from enduring a retirement characterized by waiting in pain for government rationed medical care is to transform Medicare from a bureaucratically administered entitlement for doctors and hospitals into a system driven by the needs and preferences of patients. (nationalcenter.org)
• Review of payment rates show major discrepancies in payment schedules with high payments for hospitals, 2,156% higher than in-office procedures. (unboundmedicine.com)
• The significant advantage also continues for hospitals in their reimbursement for facility fee for evaluation and management services.This health policy review describes various issues related to health care expenses, health care reform, and finally its effects on physician payments for all services and also for the services provided in an office setting. (unboundmedicine.com)
• Recent history suggests hospitals will continue to struggle to record a positive Medicare margin, especially as healthcare reform and pay-for-performance programs start to take shape. (beckershospitalreview.com)
• According to a June report from the Medicare Payment Advisory Commission (pdf), overall Medicare margins at hospitals have dropped from a positive 6.3 percent in 1999 to a negative 4.5 percent in 2010. (beckershospitalreview.com)
• In 2010, roughly 25 percent of hospitals actually posted a positive Medicare margin of 4.6 percent or higher, but another quarter had margins of negative 15.8 percent or lower. (beckershospitalreview.com)
• Here are 12 statistics on the overall average Medicare margin at U.S. hospitals from 1999 through 2010. (beckershospitalreview.com)

Percent of all Medicare beneficiaries1

• If the restriction on first dollar Part B coverage were applied to all Medigap policyholders with plan C or plan F (not limited to "new" beneficiaries as it is in H.R. 2), 12 percent of all Medicare beneficiaries, or about 4.9 million people would have been affected by this provision, if implemented in 2010. (kff.org)

Beneficiary12

• Under the demonstration, which will start in 2010 and cover up to six metropolitan areas, each Medicare beneficiary will receive a choice of enrolling in traditional Medicare or Medicare Advantage, the part of Medicare that provides coverage through private insurance plans. (cbpp.org)
• The federal government will provide a fixed dollar amount per beneficiary, based on the average cost per beneficiary in the previous year in that metropolitan area over both traditional Medicare and Medicare Advantage. (cbpp.org)
• In the demonstration areas, then, the cost of enrolling in Medicare will likely exceed the fixed dollar amount provided per beneficiary, forcing beneficiaries who wish to remain in traditional Medicare to pay higher premiums. (cbpp.org)
• As healthy beneficiaries leave traditional Medicare, the population that remains will become sicker, on average, further increasing its per-beneficiary costs. (cbpp.org)
• The Alliance for Site Neutral Payment Reform is a coalition of patient advocates, providers, payers and employers who support payment parity across site of service in order to decrease Medicare and commercial spending, ensure patients receive the right care in the right setting, lower taxpayer and beneficiary costs and increase patient access. (pr.com)
• Presents data on the four Medicare Beneficiary Quality Improvement Project (MBQIP) domains: patient safety/inpatient, outpatient, patient engagement, and care transitions. (ruralhealthinfo.org)
• Under Medicare, if the DME MACs determine that a beneficiary-owned wheelchair (after the 13-month rental period) will not last the full 5-year reasonable useful life (RUL), the supplier is responsible for replacing the wheelchair without charging the beneficiary. (hmenews.com)
• The 200-page report provides Medicare data on spending, demographics, beneficiary access to care, and quality of care, among other information. (hmenews.com)
• When a Medicare beneficiary receives a certain type of echocardiogram in a doctor's office, the government and the patient together pay a total of $188. (crfb.org)
• Nothing in Medicare says that a beneficiary has a right to be seen by a doctor, or a right to receive an operation, drug or medical device. (nationalcenter.org)
• There is no guarantee any beneficiary will actually get a specific medical treatment under Medicare. (nationalcenter.org)
• And just because Medicare covers something, it doesn't follow that a Medicare beneficiary can get it. (nationalcenter.org)

20212

• This means MA accounted for 46% of all Medicare beneficiaries in 2021, with payments to MA plans totaling $350 billion. (brookings.edu)
• According to the American Medical Association, the costs of running a medical practice climbed 39% from 2001 to 2021, but Medicare payments to doctors, adjusted for inflation, dropped by 20% over that span. (finchannel.com)

20222

• The average penalty is a 0.64% reduction in payment for each Medicare patient stay from the start of this month through September 2022. (healthleadersmedia.com)
• WASHINGTON - The Senior Medicare Patrol (SMP) projects reported $153,812 million in expected Medicare recoveries for 2022 but cautions that COVID-19 continues to limit its activities, according to a new report from the Office of Inspector General. (hmenews.com)

20182

• Washington, DC, February 14, 2018 --( PR.com )-- The Alliance for Site Neutral Payment Reform today commended the House Subcommittee on Oversight and Investigations for highlighting the high costs of healthcare consolidation to patients, employers, and taxpayers. (pr.com)
• From 2016 to 2018, state health benefits programs paid, on average, prices equal to 230 percent of Medicare rates for inpatient and outpatient care, and 1.5 times the commercial breakeven rate. (njpp.org)

CHIP Reauthorization Act1

• This proposed rule occurs in the context of numerous policy changes, most notably related to the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) and its Merit-Based Incentive Payment System (MIPS). (unboundmedicine.com)

20199

• Washington: Medicare Payment Advisory Commission, March 2019. (mckinsey.com)
• Announcement of calendar year (CY) 2019 Medicare Advantage capitation rates and Medicare Advantage and Part D payment policies and final call letter. (mckinsey.com)
• In addition, Medicare Part B drug spending grew nearly 10% annually from 2009 to 2019, reaching $40.7 billion in 2020, with higher prices accounting for most of the spending increase, Ray said. (medpagetoday.com)
• The analysts simulated what effects each of the three options for changing the ASP-plus-6% formula would have on Medicare Part B drug spending, using 2019 data and assuming no changes in utilization. (medpagetoday.com)
• The current penalties are calculated by tracking Medicare patients who were discharged between July 1, 2017, and Dec. 1, 2019. (healthleadersmedia.com)
• The charges allege that between 2019 and 2023, the Yzaguires submitted more than $14 million in claims to Medicare for power wheelchairs, power scooters, parts and repairs for 37 individuals. (hmenews.com)
• Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF) Final Rule for FY 2019, SNF Value-Based Purchasing Program, and SNF Quality Reporting Program. (bvsalud.org)
• This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2019. (bvsalud.org)
• This final rule also replaces the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV) model, with a revised case-mix methodology called the Patient- Driven Payment Model (PDPM) beginning on October 1, 2019. (bvsalud.org)

20171

• The idea was to reviews, waste, fraud, and abuse in the fee for service system because it encourages providers to deliver more services, but providers and federal officials, and a number of experts thought those rules discovered providers from taking part in value-based arrangements pointing to the fact that only about 3% of net patient revenue came from capitation and risk based payments in 2017. (modernhealthcare.com)

Readmissions1

• It was reported that Medicare readmissions within 30 days of discharge cost 17 billion dollars annually (Edwoldt, 2012). (bartleby.com)

20204

• H.R. 2 includes a provision that would prohibit Medicare supplemental insurance (Medigap) policies from covering the Part B deductible for people who become eligible for Medicare on or after January 1, 2020. (kff.org)
• The Medigap provision in H.R. 2, as passed by the House of Representatives, would prohibit beneficiaries eligible for Medicare in 2020 or later years from purchasing a Medigap policy that covers the Part B deductible. (kff.org)
• Aged Care Quality and Safety Commission (2020). (who.int)
• Australian Government, Productivity Commission (2020). (who.int)

Outpatient2

• For example, Medicare reimburses hospital outpatient departments (HOPD) at vastly higher rates than community care clinics, for providing the exact same services, thereby financially incentivizing hospital systems for scooping up smaller physician practices and charging higher rates. (pr.com)
• The overall Medicare margins cover the costs and payments of acute-care inpatient, outpatient, inpatient psychiatric and rehabilitation, skill nursing, home health services, graduate medical education and bad debt. (beckershospitalreview.com)

Inpatient1

• The statutory requirement that Medicare beneficiaries stay three consecutive inpatient midnights to qualify for post-acute skilled nursing facility coverage is one such waiver. (bvsalud.org)

Reimbursements3

• wrote: Physician dissatisfaction with Medicare reimbursements and concerns about equity of reimbursements suggest that the role of the RUC in advising Medicare should be carefully evaluated. (wikipedia.org)
• Without an independent arbiter, physicians and physician groups are likely to continue having complaints about the equitability of reimbursements under Medicare. (wikipedia.org)
• Some skilled nursing facilities turn an 18 percent profit on Medicare patients while reimbursements to home health agencies have consistently and substantially exceeded costs.By and large, these recommendations make sense, and could help throw a spotlight on excesses in Medicare spending. (ncpssm.org)

Premiums10

• First, we see payers improving affordability for consumers, with average out-of-pocket maximums for $0 premium plans (seniors pay no monthly premium beyond their Part B premiums in these plans) lowered by 4 percent, and in some markets a new wave of products that give seniors a refund on their Medicare Part B premiums. (mckinsey.com)
• This brief provides information about Medicare Advantage plans in 2023, including premiums, cost sharing, out-of-pocket limits, supplemental benefits, prior authorization, and star ratings, as well as trends over time. (kff.org)
• Higher average PDP premiums compared to the MA-PD drug portion of premiums is due in part to the ability of MA-PD sponsors to use rebate dollars from Medicare payments to lower their Part D premiums. (kff.org)
• It also is likely to create hardship for large numbers of beneficiaries in the demonstration areas by causing premiums for traditional Medicare to rise significantly in those areas. (cbpp.org)
• [1] If the cost of enrolling in traditional Medicare or a particular private plan exceedsthe fixed dollar amount for the metro area, beneficiaries who enroll in the more costly coverage will have to pay higher premiums to fully cover the difference. (cbpp.org)
• That, in turn, will drive up premiums for traditional Medicare even more - and induce even more healthy beneficiaries to abandon Medicare for the private plans. (cbpp.org)
• Those wishing to remain in the fee-for-service program [i.e., traditional Medicare] will have to spend far more than they do now on premiums," according to two academic researchers who analyzed the demonstration project and similar approaches to altering Medicare. (cbpp.org)
• Many could be stranded in a traditional Medicare program with escalating premiums, as healthier beneficiaries abandon it. (cbpp.org)
• The Medicare actuaries reported in 2003, before the legislation mandating the demonstration was enacted, that the type of approach to be implemented under the demonstration would produce sharp increases in premiums for traditional Medicare. (cbpp.org)
• Since 2010 and the enactment of the Affordable Care Act (ACA), Medicare Part C or MA policy has aimed to improve alignment of plan costs and payments, in part by requiring that health plans in MA attain a Medical Loss Ratio (the share of premiums spent on medical care) of 0.85. (brookings.edu)

Reimbursement rates2

• Skilled nursing facilities (SNFs) do not like the prior authorization requirements, limited lengths of stay for residents, and lower Medicare reimbursement rates that are associated with Medicare Advantage (MA) plans. (medicareadvocacy.org)
• Many also believe that the formulae for updating the Medicare reimbursement rates are flawed. (ama-assn.org)

Medicare's6

• Hospital participation in Medicare's Bundled Payments for Care Improvement model was not associated with changes in number of skilled nursing facility (SNF) partners or in SNF discharge concentration. (ajmc.com)
• To evaluate whether participation in Medicare's voluntary Bundled Payments for Care Improvement (BPCI) model was associated with changes in discharge referral patterns to skilled nursing facilities (SNFs), specifically number of SNF partners and discharge concentration. (ajmc.com)
• What is not clear is whether a strategy to reform Medicare's payment practices or even a broader approach to revamp the payment practices of all who finance health care will suffice in taming the beast. (concordcoalition.org)
• With much of Medicare's growth in the next two decades coming from the aging of society, the program will drive the demand side of the health care equation whatever its system of payment. (concordcoalition.org)
• In addition, manufacturers are free to set whatever price they like for their drugs, "and Medicare's payment policies generally do not consider whether a new product results in better outcomes than its alternatives," she added. (medpagetoday.com)
• New Medicare beneficiaries would be hit with a penalty if they purchase MediGap insurance that covers all or most of Medicare's copayments and deductibles. (ncpssm.org)

Program12

• The Specialty Society Relative Value Scale Update Committee or Relative Value Update Committee (RUC, pronounced "ruck") is a volunteer group of 31 physicians who have made highly influential recommendations on how to value a physician's work when computing health care prices in the United States' public health insurance program Medicare. (wikipedia.org)
• With the federal government's Medicare program being the nation's largest financier of health care-paying for an estimated 20 percent of the medical services the public consumes-any comprehensive effort to slow the growing costs of health care would be incomplete without an examination of how Medicare can contribute. (concordcoalition.org)
• As such, key features of the program may need to be re-examined independently of efforts to slow growing health care costs through payment practices. (concordcoalition.org)
• People with Medicare have the option of receiving their Medicare benefits through the traditional Medicare program administered by the federal government or through a private Medicare Advantage plan, such as an HMO or PPO. (kff.org)
• WASHINGTON -- How should Medicare change the way it pays for drugs under the Part B program? (medpagetoday.com)
• There is a great deal of controversy and uncertainty regarding profits in the Medicare Advantage (MA) program. (brookings.edu)
• And so those rules made sense under the traditional fee for service Medicare program, because there's a real risk, but providers have been sort of spooked. (modernhealthcare.com)
• This year's report provides lawmakers with yet another set of options as they work to address the long-term sustainability of the Medicare program. (crfb.org)
• Second, Medicare already provides substandard care to the elderly, and the cost pressures that will result when the baby boomers retire and the size of the program almost doubles from 40 million to 70 million beneficiaries, virtually guarantee that the program's standard of care will get worse - much worse - if nothing is done now to change its basic character. (nationalcenter.org)
• While many assume that the elderly must be getting good care since Medicare is a fee-for-service system with generous funding, the evidence indicates Medicare is looking more and more like an urban public school system - ever more tax dollars go into the program, but the results keep declining. (nationalcenter.org)
• One priority of the incoming House Republican majority is curbing Social Security and Medicare, a federal health insurance program for people age 65 and older, among others. (finchannel.com)
• Other reductions - including a 4% cut under a congressional budget rule that balances spending and the expiration of a payment program that offered 5% bonuses - would be delayed further or reduced. (finchannel.com)

Payers2

• Bundled payment systems can yield savings for payers if a discounted rate is negotiated at the outset or if payment amounts are adjusted downward to reflect the efficiencies achieved after the system is in place. (rand.org)
• 3 Because third-party payers frequently use the Medicare rates as a reference point, they are likely to cut their own rates as well in the near future. (ama-assn.org)

Physicians3

• CHICAGO - At the Annual Meeting of the American Medical Association (AMA), the nation's physicians called for a multipronged campaign to overhaul the outdated Medicare payment system, saying that patient access and survival of practices are at risk. (ama-assn.org)
• The anti-kickback statutes were originally put in place to prevent the physicians and profiting off the referrals and Medicare providers that they are a family member had a financial stake in. (modernhealthcare.com)
• The new administrative tasks physicians have to perform include increased billing and coding, resubmitting denied claims, phone calls with pharmacies to resolve formulary drug issues, verifying insurance coverage, co-payments and deductibles for patients, and negotiating or renewing insurance contracts with multiple health plans. (ama-assn.org)

MedPAC's2

• MedPAC's recommendations and analysis have been used in the past to help provide policy ideas for much needed payment reforms and reductions, some of which have been used to pay for doc fixes. (crfb.org)
• While most of these recommendations and policy issues have been discussed and debated before, MedPAC's latest report helps to inject renewed support and analysis behind many of them at a time when momentum for Medicare reforms on Capitol Hill is critical. (crfb.org)

Chernew1

• Michael E. Chernew, the Leonard D. Schaeffer Professor of Health Care Policy and the director of the Healthcare Markets and Regulation (HMR) Laboratory at Harvard Medical School, is serving in an advisory role as a senior visiting fellow at The MITRE Corporation. (mitre.org)

Tricia Neuman1

• says Tricia Neuman, director of the Medicare Policy Project at the Kaiser Family Foundation. (ncpssm.org)

Patients10

• In 2013 an average of one out of eight Medicare patients are readmitted within a 30-day period which lead to the estimated costs of around $18 billion a year for Medicare patients alone. (bartleby.com)
• WASHINGTON - Over half of the falls among Medicare home health patients hospitalized for falls with major injury were not reported on patient assessments by home health agencies (HHAs) as required, according to a new Office of Inspector General report. (hmenews.com)
• According to physician surveys conducted for the Medicare Payment Advisory Commission, by 1999, 24 percent of doctors were refusing to take some, or even all, new Medicare patients, and in just the past three years that figure has increase to 30 percent. (nationalcenter.org)
• A bipartisan group of 115 House lawmakers rallied behind doctors in a letter to congressional leaders and President Joe Biden last week, urging them to prevent cuts that they argued would "only make a bad situation far worse" for Medicare patients. (finchannel.com)
• Payment cuts will only accelerate this unsustainable trend and undoubtedly lead to Medicare patients struggling to access health care services. (finchannel.com)
• Aux États-Unis, lorsque le séjour en unité des soins intensifs est prolongé, les patients peuvent être transférés vers un CHSLD. (who.int)
• Dans la pratique, les patients qui ont besoin de soins de longue durée en Turquie sont hospitalisés en unités de soins intensifs. (who.int)
• Une proportion importante des lits réservés aux unités de soins intensifs en Turquie sont utilisés pour les soins de longue durée aux patients atteints de problèmes complexes. (who.int)
• RÉSUMÉ La réadmission de patients diabétiques après leur sortie de l'hôpital peut être une information utile en tant qu'indicateur de la qualité des soins. (who.int)
• La présente étude cas-témoin, de cohorte et rétrospective visait à déterminer le taux de réadmission des patients diabétiques dans les 28 jours suivant leur sortie de l'hôpital et la relation entre la qualité des soins en séjour hospitalier et une réadmission non programmée. (who.int)

20231

• In 2023, most people (73%) enrolled in individual Medicare Advantage plans with prescription drug coverage (MA-PDs) pay no premium other than the Medicare Part B premium ($164.90 in 2023) (Figure 1). (kff.org)

Services16

• 2 This provision is designed to make future Medigap purchasers more price-sensitive when it comes to medical care, which could lead to a reduction in the use of health services and Medicare spending. (kff.org)
• Proposals that prohibit first-dollar Medigap coverage are projected to reduce Medicare spending, primarily because higher up-front costs are expected to result in beneficiaries using fewer services - both necessary and unnecessary services. (kff.org)
• Of course, innovation continues to occur in Medicare FFS as well-for example, CMS began reimbursing for an expanded set of telehealth services, which can enable more convenient access to care, for example, in rural areas and for individuals with behavioral health issues. (mckinsey.com)
• Bundled payment approaches create incentives for providers to eliminate unnecessary services and reduce costs. (rand.org)
• Savings will depend on the design of the payment system and the particular services that are bundled. (rand.org)
• system, reimbursement is directly related to the volume of services provided and there is little incentive to reduce unnecessary care, the use of bundled payment mechanisms promotes a more efficient use of services. (rand.org)
• The plans use these payments to pay for Medicare-covered services, and in most cases, also pay for additional benefits and reduced cost sharing. (kff.org)
• Medicare Advantage plans are also permitted to limit provider networks, and may require prior authorization for certain services, subject to federal requirements. (kff.org)
• It was originally targeted toward physician referrals for clinical lab services cause by Medicare to weed out any conflicts of interests. (modernhealthcare.com)
• As a result, some might not be able to offer all of the services that the nation?s most vulnerable Medicare beneficiaries need.In the aggregate, these changes are, as the President has said, ?modest. (ncpssm.org)
• In this role, he is responsible for research on innovation in organization of, and payment for, health care services, and for analysis of federal and state health policy initiatives. (academyhealth.org)
• Claims data shows just how significantly the Allowed Amount for hospital prices in the state health benefits plans outweigh the costs for those same services and procedures at Medicare and commercial breakeven rates. (njpp.org)
• The new report identified 66 groups of services where OPD payment rates can be aligned with physician office rates, and 12 groups of services where OPD payment rates can be aligned with ambulatory surgical center (ASC) rates. (crfb.org)
• While they do not provide an official recommendation, the Commission discusses an illustrative model where a bundled payment could be given for services within 90 days of a triggering event. (crfb.org)
• Third, access to health services for the elderly under Medicare is decreasing and actually getting care will become harder and harder for future retirees. (nationalcenter.org)
• Thus, even though the changes appear to be minor in physician services and in-office service payment, these changes cumulatively have been reducing payments for interventional procedures. (unboundmedicine.com)

Healthcare1

• There is great opportunity for reducing costs and improving efficiencies in the healthcare marketplace, including the expansion of site neutral payment policies. (pr.com)

Health9

• H.R. 2 would restrict first-dollar coverage for Medigap policies, but not other sources of supplemental coverage, such as retiree health plans or Medicare Advantage. (kff.org)
• This is Issue #3 in The Concord Coalition Series on Health Care and Medicare. (concordcoalition.org)
• In effect, Medicare can be an incubator for strategies to constrain the rise in overall national health care spending. (concordcoalition.org)
• The researchers also noted that in the demonstration areas, beneficiaries who are women aged 80 and over, members of a minority group, or people with less than a high-school education are likely to be the most adversely affected because they are in poorer health than Medicare beneficiaries on average. (cbpp.org)
• She is also on the Board of Directors of the Brooklyn Health Information Exchange and serves on the advisory board of the Industrial Relations Research Association. (ahrq.gov)
• Lawmakers would be wise to take on these suggestions and restart the debate on how to put Medicare and overall federal health spending on a more sustainable path. (crfb.org)
• While politicians from both parties are focused on winning senior votes in the next election with a Medicare drug benefit, the far more important issue is the kind of health care the rest of us will get when we retire. (nationalcenter.org)
• First, contrary to popular perception, Medicare isn't an entitlement to health care for the elderly. (nationalcenter.org)
• In other words, Medicare is really an entitlement for the health care industry, albeit one with low prices, lots of rules, caveats and strings attached and literally over 100,000 pages of regulations. (nationalcenter.org)

Enrollment5

• Medigap Enrollment Among New Medicare Beneficiaries: How Many 65-Year Olds Enroll In Plans With First-Dollar Coverage? (kff.org)
• This data note looks at the number and share of "new" Medicare beneficiaries who would be affected by the Medigap provision in H.R. 2, if it had been implemented in 2010, using the most current data sources available, and examines trends in Medigap enrollment among new beneficiaries since 2000. (kff.org)
• As Medigap enrollment declined between 2004 and 2010, Medicare Advantage enrollment increased among 65-year old beneficiaries, eclipsing Medigap enrollment by 2010. (kff.org)
• Based on declining Medigap enrollment trends among 65-year olds, a smaller share of new Medicare beneficiaries can be expected to be affected by this policy in the future. (kff.org)
• A companion analysis examines trends in Medicare Advantage enrollment. (kff.org)

Advantage8

• In addition, a growing share of Medicare beneficiaries are covered under Medicare Advantage plans (about 30%), which often provide first-dollar coverage. (kff.org)
• With so much attention focused on the debate over the merits of Medicare for All, it is easy to lose sight of changes in Medicare Advantage. (mckinsey.com)
• Consumers must make a choice as to whether to have their benefits administered by the federal government (Medicare fee-for-service or FFS) or through a private sector plan (Medicare Advantage or MA). (mckinsey.com)
• Do Medicare Advantage plans pay providers different rates than traditional Medicare? (theincidentaleconomist.com)
• With few exceptions, we learned that Medicare Advantage plans pay provider rates at or close to fee-for-service Medicare rates. (theincidentaleconomist.com)
• Medicare Advantage plans also have defined networks of providers, in contrast to traditional Medicare. (kff.org)
• That will give healthier beneficiaries a strong incentive to enroll in private Medicare Advantage plans, which tend to design their benefit packages and provider networks to appeal to healthier beneficiaries (and deter sicker ones). (cbpp.org)
• Commercial and Medicare Advantage segments, physician offices, HST and specialty pharmacy segments may grow most quickly. (mckinsey.com)

SNFs1

• The CEO of AllyAlign, a company that helps providers, including SNFs, implement provider-sponsored managed care plans, describes the model: "The construct is to grab the [Medicare] premium dollar directly if you're an LTC provider, and then manage in the best interests of the patient. (medicareadvocacy.org)

Chairman1

• In addition, he is Chairman of the ACC Payment Reform Workgroup and is Vice-Chair of the ACC Partners in Quality Subcommittee. (ahrq.gov)

Care7

• Whether through limiting size of provider networks, care management, prior authorization for high-cost treatments that could cause delays, payment reductions to providers, novel arrangements with providers (which may vary in quality), or other cost savings measures, MA plans are able to cover guaranteed Medicare benefits at a 9 to 10 percent discount to Medicare FFS. (mckinsey.com)
• if the costs of care exceed the bundled payment, the providers bear the financial liability. (rand.org)
• The evidence is limited regarding bundled payment for an episode of care surrounding a hospitalization. (rand.org)
• With reference to the research of William Hsiao and colleagues, the Omnibus Budget Reconciliation Act of 1989 was passed with the legislative intent of reducing the payment disparity between primary care and other specialties through use of the resource-based relative value scale (RBRVS). (wikipedia.org)
• So large bureaucracies have evolved not to deliver care, but to negotiate payments and, in many cases, to try to avoid paying for care. (ama-assn.org)
• Better coordination of care is also among the findings of a separate study of the Medicare population from the Medicare Payment Advisory Commission. (healthleadersmedia.com)
• Medicare offers an outdated structure of benefits, cost sharing, and limitations and it delivers care in an episodic, fragmented, acute-care fashion rather than in an integrated, chronic-care model. (nationalcenter.org)

Eligible1

• Every fall between October 15 and December 7, many of the 60 million Americans who are eligible for Medicare sit at their kitchen table, log onto a computer, and go through the annual ritual of selecting how they want to receive their benefits. (mckinsey.com)

Rates2

• Non-Medicare physician payment rates also appear to have at most a modest relationship to MA bids, suggesting that physician payment rates may be partly anchored to FFS prices. (theincidentaleconomist.com)
• And any payment choices that affect patient access to particular drugs, or drug payment rates, "may result in patient, clinician, or manufacturer dissatisfaction," she added. (medpagetoday.com)

Access1

• For people with diabetes and its complications, the NCCC recommended that barriers to proven effective treatments for diabetes and its complications be removed, the size and competence of the workforce to treat diabetes and its complications be increased, and new payment models be implemented to support access to lifesaving medications and proven effective treatments for diabetes and its complications. (cdc.gov)

Hospital2

• MA plan hospital prices are not tied to prices in the non-Medicare market, which is consistent with what we have heard from plans and other market participants. (theincidentaleconomist.com)
• Further research is needed to assess specific hospital responses to bundled payment and their impacts on cost and quality. (ajmc.com)

Costs3

• These plans can either lower costs for Medicare members or offer them extra benefits on top of the ones guaranteed by the federal government. (mckinsey.com)
• Proposals That Are Far More Likely to Find Support in Washington President Obama?s plan also targets future retirees, asking them to shoulder a larger share of Medicare?s costs. (ncpssm.org)
• WASHINGTON - Medicare paid $30.1 million in repair costs for wheelchairs that exceeded the federally recommended limit during their reasonable useful lifetime, according to a new report from the Office of Inspector General. (hmenews.com)

Practices1

• Currently, Medicare pays physician practices the average sales price (ASP) for most Part B drugs, plus a 6% administrative fee. (medpagetoday.com)

Legislation1

• Senate Democratic Leader Tom Daschle has identified with pinpoint accuracy the key stumbling block in the pending Medicare legislation. (nationalcenter.org)

Higher1

• When total payments to MA plans are taken into account, MA received 1 to 2 percent higher payments than FFS, in part due to a policy choice to fund "supplemental benefits" in MA. (mckinsey.com)

Physician payments1

• Before the 1992 implementation of the Medicare fee schedule, physician payments were made under the "usual, customary and reasonable" payment model (a "charge-based" payment system). (wikipedia.org)

System2

• standards would have to be met as part of the bundled payment system. (rand.org)
• There are three things you need to understand about the current Medicare system and why it desperately needs to be changed. (nationalcenter.org)

Plan2

• Among other proposals, they plan to consider repealing a provision of the 2003 Medicare drug law that requires a large-scale, six-year demonstration project under which private insurance companies will compete directly with traditional Medicare fee-for-service to see if they offer better coverage at lower cost. (cbpp.org)
• This analysis of the President's Deficit Reduction Plan and Medicare is a must-read. (ncpssm.org)

Lawmakers1

• A more than 4,000-page draft government spending bill released by lawmakers early Tuesday morning proposed much smaller-than-planned cuts to Medicare payments. (finchannel.com)

Coverage6

• If this policy had been implemented in 2010, it would have affected Medigap coverage for roughly 10 percent of all 65-year old Medicare beneficiaries. (kff.org)
• The MA-PD premium includes both the cost of Medicare-covered Part A and Part B benefits and Part D prescription drug coverage. (kff.org)
• Because regulations appear to require Medicare to pay on a fee-for-service basis for any Part B drug used for an FDA-labeled indication, "Medicare has few tools to address a product's coverage or payment," Ray explained. (medpagetoday.com)
• For new "first-in-class" drugs with high launch prices and limited evidence of effectiveness, Medicare could require coverage with evidence development (CED) -- that is, only cover the drug if the patient is enrolled in a clinical trial, as it recently did with the newly approved Alzheimer's disease treatment aducanumab (Aduhelm) -- and set a payment cap based on an analysis of the drug's cost-effectiveness. (medpagetoday.com)
• YARMOUTH, Maine - Diabetes providers are striving to fill an information gap for referral sources who may not be familiar yet with changes to Medicare policy that expanded coverage for continuous glucose monitors (CGMs). (hmenews.com)
• He repeated that Democrats want to add prescription drug coverage to Medicare, but added: "if we're going to change the character of Medicare itself, that's too high a price to pay. (nationalcenter.org)

Plans3

• Unfortunately, this project - which congressional conferees inserted in the drug law behind closed doors - "stacks the deck" in favor of private plans over traditional Medicare in order to produce an ideologically preordained result. (cbpp.org)
• In fact, the demonstration's supporters may well have intended this result, which would induce increasing numbers of beneficiaries to abandon traditional Medicare for private plans and could then be used to justify the nationwide application of the demonstration-project approach. (cbpp.org)
• [1] The ACA also reduced some payments to MA plans. (brookings.edu)

Data2

• We used Medicare claims data from 2010 to 2015 to identify admissions for lower joint replacement surgery and the following medical conditions: congestive heart failure, renal failure, sepsis, pneumonia, urinary tract and kidney infections, chronic obstructive pulmonary disease, and stroke. (ajmc.com)
• 2010). Analyses of malpractice claims data indicate that diagnostic errors are the leading type of paid claims, represent the highest proportion of total payments, and are almost twice as likely to have resulted in the patient's death compared to other claims (Tehrani et al. (nationalacademies.org)

Practice1

• Beginning in 2000, all three components of the Medicare RBRVS, physician work, practice expense and malpractice expense are resource-based as required by Section 1848(c) of the Social Security Act. (wikipedia.org)

Estimates1

• Medicare estimates the penalties over the next fiscal year will save the government $521 million. (healthleadersmedia.com)

Implement2

• Under the approach that the demonstration project will implement, they added, "Medicare fee-for-service would enter a gradual death spiral, as healthier individuals switch to HMOs and sicker ones remain in fee-for-service. (cbpp.org)
• For drugs that already have therapeutic alternatives , Medicare could implement "reference pricing," which is paying for a drug by taking its competitors' prices into account, she continued. (medpagetoday.com)

Average2

• On average, physician work RVUs make up slightly more than half of the value in a Medicare payment. (wikipedia.org)
• Under this approach, a value-based withhold could be designed where Medicare would continue FFS payments to participating providers, but would withhold a certain amount and return some portion of savings if average spending is below a spending target. (crfb.org)

Reduction1

• Over the past several years, policymakers have considered a variety of proposals to discourage or prohibit people on Medicare from purchasing first-dollar supplemental insurance, often in the context of deficit and debt reduction efforts. (kff.org)

Policy1

• Download PDFs of council reports that contribute to the policy options for reforming physician payment. (ama-assn.org)