Payment Reform

The Department of Justice filed an antitrust lawsuit to block 2 proposed health insurance plans mergers: Anthem’s acquisition of Cigna Corporation and Aetna’s acquisition of Humana. The suit alleges that the consolidations would reduce the United States’ largest national health insurers from 5 to 3, decrease competition, and raise healthcare costs. Read More ›

Enhanced Reimbursement for Oncology Services Pays for Patient-Centered Care

By Wayne Kuznar

Payment Reform

Payment models that align reimbursement to support treatment planning and care coordination encourage oncology care providers to adhere to cancer treatment pathways, said Jennifer Malin, MD, PhD, Staff Vice President for Clinical Strategy, Anthem, Thousand Oaks, CA, at the 2015 American Society of Clinical Oncology annual meeting. Read More ›

CMS Steps Forward with Proposed Changes to PFS in Wake of SGR Repeal

By Rosemary Frei, MSc

Payment Reform

The Centers for Medicare & Medicaid Services (CMS) took the first step toward the Merit-based Incentive Payment System (MIPS) on July 8 with the release of a proposed rule on payment policies and rates, as well as quality provisions, under the Medicare Physician Fee Schedule (PFS). Read More ›

Federal Government Outlines Stage 3 of Meaningful Use

By Rosemary Frei, MSc

Payment Reform

Criteria for stage 3 of Meaningful Use was announced and published recently, detailing benchmarks that eligible providers and hospitals will have to meet to qualify for certain incentive payments and avoid reimbursement penalties. Read More ›

Repeal of Sustainable Growth Rate Met with Relief

By Laura Morgan

Payment Reform

The April 14, 2015, repeal of the sustainable growth rate (SGR) formula for physician payments under Medicare is being welcomed by the healthcare community, including the American Society of Clinical Oncology (ASCO). Read More ›

SGR Repealed, But the Work Is Just Beginning

By Gail Thompson

Payment Reform

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law on April 16, making history not just by repealing the sustainable growth rate (SGR) formula for Medicare physician payment, but for the resounding bipartisan support of the legislation after decades of partisan posturing in the US House of Representatives and Senate. Read More ›

Federal Government Outlines Stage 3 of Meaningful Use

By Rosemary Frei, MSc

Payment Reform

Criteria for Stage 3 of Meaningful Use was announced and published at the end of March, detailing benchmarks that eligible providers and hospitals will have to meet to qualify for certain incentive payments and avoid reimbursement penalties. Read More ›

SGR Repealed, But the Work Is Just Beginning

By Gail Thompson

Payment Reform

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law on April 16, making history not just by repealing the sustainable growth rate (SGR) formula for Medicare physician payment, but for the resounding bipartisan support of the legislation after decades of partisan posturing in the US House of Representatives and Senate. Read More ›

Federal Government Outlines Stage 3 of Meaningful Use

By Rosemary Frei, MSc

Payment Reform

Criteria for Stage 3 of Meaningful Use was announced and published at the end of March, detailing benchmarks that eligible providers and hospitals will have to meet to qualify for certain incentive payments and avoid reimbursement penalties. The proposed ruling by the US Department of Health & Human Services and the Centers for Medicare & Medicaid Services (CMS) outlines a framework that is in some ways more flexible and in others more rigid than Stage 1 and Stage 2. Read More ›

Congress Acts to Repeal SGR Formula

By Gail Thompson

Payment Reform

The verdict is in: Congress has passed legislation to permanently repeal Medicare’s sustainable growth rate (SGR) formula. The bill was approved by the US House of Representatives on March 26, and the 92-8 vote in the US Senate on April 14 now puts the legislation in the hands of President Barack Obama, who is expected to sign it. The $200-billion deal staves off a 21.2% cut to Medicare payment rates and extends the Children’s Health Insurance Program (CHIP) while repealing the nearly 20-year-old formula. Read More ›

Payment Reform

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December 2021, Vol 9, No 1