Will Medicare Advantage be the future of Alternative Payment Models

CMS has focused in recent years on payment reform–especially alternative payment models–in Medicare’s fee-for-service (FFS) reimbursement system, but much less has been paid to beneficiaries enrolled in Medicare’s managed care program (i.e., Medicare Advantage).  Currently, however, more than 1 in 3 beneficiaries are enrolled in an Medicare Advantage plan, and by 2028 that number could…

Health insurance is not enough

Having health insurance is great.  It largely protects people against financial losses that accrue when you become ill.  It provides coverage for medical services.  And improves patients health. Well, that last one is only true if health insurance allows you to access care.  When health insurance provider reimbursement is low as is the case for…

EMR progress is too slow

Patients and providers should be able to securely access a patient’s medical record wherever they are.  Not having a patient’s full record could result in poor treatment choices and suboptimal patient outcomes.  The dream of a seamless, cloud-based electronic medical record (EMR), however, is years away.  Consider the example shared by CMS administrator Seema Verma…

Which Medicare initiatives use quality measures?

In December, CMS listed its quality measures that it is considering for incorporation into some of their value-based payment programs and quality reporting programs. However, which Medicare quality reporting and payment initiatives use quality measures?  A full list is below. Ambulatory Surgical Center Quality Reporting Program (ASCQR) End-Stage Renal Disease Quality Incentive Program (ESRD QIP)…

Medicaid and paperwork

When you buy a typical product, the vendor does its best to make the purchasing process as easy as possible.  There is a reason for this, clearly; they want your business.  State and federal governments, however, have no such incentive.  In fact, oftentimes reducing the number of people using government services saves money. Thus, it…

What happens to CHIP?

The Children’s Health Insurance Program (CHIP) is a federal program that provides matching funds to states in order for them to provide health insurance to children.  The program was designed to cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid. Currently, however, the program is in jeopardy.  In fact, federal funding for…