Medicare

Primary care delivery is similar across all Medicare patient mixes

March 27, 2024 - Care delivery, care coordination, and administrative challenges were similar across primary care physicians serving traditional Medicare patients and those serving Medicare Advantage patients, a Commonwealth Fund brief found. Unlike traditional Medicare, Medicare Advantage plans receive capitated payments from the government to cover...


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Does Medicare Value-Based Purchasing Exacerbate Racial Care Disparities?

by Victoria Bailey

Thirty-day mortality rates were higher for acute myocardial infarction and pneumonia at hospitals with higher shares of Black patients, suggesting that Medicare’s Hospital Value-Based...

Top 10 Accountable Care Organizations by Medicare Shared Savings

by Editorial Staff

The Medicare Shared Savings Program (MSSP) saved CMS $1.8 billion in 2022, marking the sixth consecutive year of overall savings for the program. This also represents the second-highest yearly savings since the program started in...

How Beneficiary Preferences Can Impact Hospital VBP Payment Incentives

by Victoria Bailey

If the Hospital Value-Based Purchasing (HVBP) program value weights were based on Medicare beneficiary preferences, nearly $86 million in payment incentives would be reallocated and smaller rural...

CJR Model Policy Changes Boosted Penalties for Safety-Net Hospitals

by Victoria Bailey

Safety-net hospitals and hospitals with high Black and Hispanic populations received disproportionate penalties under the Comprehensive Care for Joint Replacement (CJR) bundled payment model between...

Expanding Substance Use Disorder Coverage Would Cost Medicare $362M

by Victoria Bailey

Adding Medicare coverage for substance use disorder (SUD) services for residential programs, intensive outpatient programs, and licensed and certified counselors would cost Medicare $362 million...

CMS Suspends Certificates of Medical Necessity, DME Forms for 2023

by Victoria Bailey

CMS has announced that it will no longer require healthcare stakeholders to submit Certificates of Medical Necessity (CMNs) or Durable Medical Equipment (DME) Information Forms (DIFs) for service...

How Healthcare Spending, Utilization Varies by Payer, Region

by Victoria Bailey

There is substantial variation and low correlation in healthcare spending across Medicare, Medicaid, and private insurance plans within different US regions, a study published in JAMA Network Open...

Medicare, Beneficiaries Saw Higher Prices at Provider-Based Facilities

by Victoria Bailey

Medicare and its beneficiaries paid significantly higher prices at provider-based facilities than they would have paid to freestanding facilities for the same services, according to a report from the...

CMS Plans to Reweight 2021 MIPS Cost Performance Category

by Victoria Bailey

CMS will reweight the cost performance category under the Merit-Based Incentive Payment System (MIPS) for the 2021 performance period due to the COVID-19 pandemic’s impact on clinicians and cost...

CMS Reinstates COVID-19 Vaccination Mandate in 25 States

by Sarai Rodriguez

CMS announced it would be reinstating the COVID-19 healthcare worker vaccine mandate to facilities in 25 states and the District of Columbia that are not affected by the preliminary...

Private Equity Nursing Homes Linked to Lower Quality, Higher Costs

by Sarai Rodriguez

According to a JAMA Health Forum study, nursing homes acquired by private equity firms have been associated with lower quality long-term care and higher Medicare costs in comparison to for-profit...

Physician Practice Interruption Increased Due to COVID-19 Pandemic

by Victoria Bailey

Physician practice interruptions, like declining patient volumes and claims submitted, were abundant in 2020 compared to the previous year, likely due to the COVID-19 pandemic, according to research...

CMS to Repeal Medicare Coverage of Breakthrough Devices Rule

by Jacqueline LaPointe

CMS has proposed repealing a Trump-era rule that sought to deliver faster Medicare coverage for medical devices designated as "breakthrough" by the Food and Drug Administration (FDA). The rule also...

CMS to Tie Vaccine Mandate to Medicaid, Medicare Participation

by Jacqueline LaPointe

A COVID-19 vaccine mandate for healthcare workers will be tied to Medicaid and Medicare Conditions of Participation (CoP), the Biden-Harris Administration recently announced. The announcement made via...

How Has COVID-19 Impacted Medicare Spending, Solvency?

by Jacqueline LaPointe

The Medicare Trust Fund is still expected to run out by 2026 despite increased Medicare spending on COVID-19 treatment and prevention over the past year and a half, a new report reveals. The annual...

10 ACOs with the Highest Shared Savings Payments in 2020

by Hayden Schmidt

The Medicare Shared Savings Program (MSSP) saved over $4 billion in 2020. Between the $1.9 billion in Medicare savings and $2.3 billion in accountable care organization (ACO) savings, this represents...

When Medicare Fiscal Pressure Grows, Hospital Cost Shifting Follows

by Jill McKeon

Medicare funds are dwindling and revenues are declining. This financial strain could result in closures and acquisitions, paving the way for hospital cost shifting. A Harvard Medical School research...

AMA: Congress Must Reevaluate Medicare Physician Payment System

by Jill McKeon

AMA raised concerns over Congress’s “indifference” to the incoming pay cuts and financial instability of the Medicare physician payment system in a recent letter to congressional...

CJR Model Linked to Increased Health Disparities, Study Reveals

by Jill McKeon

In a study of over four million Medicare beneficiaries, researchers found that the Comprehensive Care for Joint Replacement (CJR) model may be widening racial and socioeconomic health disparities in...