Tavenner slams CMS over Medicare Advantage underpayments

  CMS’ previous administrator Marilyn Tavenner is criticizing her former agency after a new analysis shows the CMS is underpaying Medicare Advantage plans for the costs of treating individuals with multiple chronic conditions. Key findings from an study (PDF) of federal data by Avalere Health, funded by America’s Health Insurance Plans (AHIP), found that the… Continue Reading

Obama Administration Works to Fix Health Insurance Co-Ops By Stephanie Armour | January 21, 2016 WASHINGTON—An Obama administration official said Thursday the government is taking steps to help health cooperatives set up under the Affordable Care Act remain solvent, while seeking to recoup federal funds from those that failed. The nonprofit co-ops were established to offer health insurance to consumers on the health… Continue Reading

UnitedHealth Raises Forecast for Losses on Affordable Care Act Plans By Anna Wilde Mathews | January 19, 2016 UnitedHealth Group Inc. said its projected losses on the Affordable Care Act exchanges for 2016 deepened as enrollment grew despite the company’s efforts to reduce sign-ups. The biggest U.S. health insurer said it is expecting losses of more than $500 million on its 2016 ACA plans,… Continue Reading

ACA, healthcare programs partly responsible for higher federal deficit By Bob Herman | January 19, 2016 Spending on Medicare, Medicaid and the Affordable Care Act’s insurance exchanges will rise by 11% in 2016, making healthcare a major reason why the federal deficit will increase this year, according to a new economic summary from the Congressional Budget Office. CBO officials estimated Tuesday that this… Continue Reading

Is an Annual Physical Necessary? By Sumathi Reddy | January 18, 2016 Every year on his wedding anniversary Louis Sinclair pays a visit to his family physician for what has become a ritual: the annual physical. “That way I don’t forget my anniversary and I don’t forget my physical,” says the 66-year-old in Raleigh, N.C., who has been getting… Continue Reading

Adjusting for social determinants in value-based payments still fuzzy By Sabriya Rice | January 12, 2016 There’s no question that race, gender, socio-economic status and health literacy influence a patient’s healthcare access, cost and outcomes. But what’s still fuzzy is an understanding of which factors are within a provider’s control, and how to adjust for these factors in value-based payments, a new report… Continue Reading

Large, Independent PCP Groups an Attractive Alternative By Marcia Frellick | January 12, 2016 Medscape is reporting that large, independent, physician-owned primary care groups are a viable alternative to employment with a hospital or multispecialty practice under value-based contracting, according to a new analysis. These large groups with physician autonomy have several advantages: They can offer imaging, laboratory services, health information technology,… Continue Reading

Doctors Unionize to Resist the Medical Machine By Noam Scheiber | January 9, 2016 Early in the morning on Aug. 12, 2015, a 68-year-old man named Barry turned up at PeaceHealth Sacred Heart Medical Center in Springfield, Ore., confused and feverish. The case was not a candidate for even a minor subplot on “House.” The admitting doctor stopped one of the patient’s… Continue Reading

Feeley & Driscoll’s OIG Update: December 2015

Feeley & Driscoll’s OIG Update: December 2015 The Department of Health and Human Services Office of the Inspector General (HHS-OIG) was established by Congress in 1976 to identify and eliminate fraud, abuse, and waste in HHS programs and to promote efficiency and economy in departmental operations. The OIG is responsible for conducting audits, evaluations, and… Continue Reading

The Health of Obamacare By Daniel P. Kessler | December 11, 2015 More than five years ago, the Affordable Care Act—what most of us call Obamacare—was passed into law with two big declared goals: to reduce the number of Americans who lack health insurance and to cut health spending that doesn’t give good value for money. Has the… Continue Reading