Many Medicaid programs, health plans, and ACOs are looking for new strategies to offset tight budgets. COVID-19 has dealt severe blows to the economy, state budgets and the provision of […]

The effort to develop vaccines against COVID-19 has been extraordinary and the process to distribute the vaccines needs to be just as successful—not only for the country overall, but also […]

I took advantage of the quieter work environment over the holidays to catch up on my policy reading. The Health Affairs top ten articles from 2019 included “The Forgotten Middle: […]

MedPAC, the advisory commission to Congress for Medicare, presented its evaluation of the Medicare Hospital Readmission Reduction Program (HRRP) at the September meeting. The HRRP was enacted in 2010. In […]

Recently, I came across an OIG announcement “Review of Medicare Part B Claims for Intravitreal Injections of Eylea and Lucentis” released in June 2019. Upon reading this announcement, I pulled […]

Patients are charged around $1,200 for an ambulance ride to the hospital, while the median price of an air ambulance for privately insured patients is $36,400. Why is the price […]

McAllen, Texas is a border town in the Rio Grande Valley with a metro population of 839,000. On May 25, 2009, Atul Gawande published The Cost Conundrum in which he […]

On October 3rd, 2018 Medicare announced significant changes to the Local Coverage Determination (LCD) process. As a result, a major change to the LCD format was also announced in Change […]

On February 9, a new telehealth bill was signed into law that expands coverage for accountable care organizations (ACOs), improves flexibility for telehealth use under Medicare Advantage plans, and allows […]

Recently, I reviewed the Medicare Hospital Value-Based Purchasing (VBP) scores for three hospitals recognized nationally for outstanding care and patient safety. They didn’t look good. The ratings for clinical outcomes […]

I attended the January 9, 2018 CMS Medicare Learning Network conference call covering the logistics of the settlement process offered by CMS for providers with pending appeals. This impacts: “The […]

Medicare beneficiaries are constantly bombarded with mail, emails and advertisements from insurers encouraging them to buy a Medicare supplemental insurance policy. It seems odd that there is such an aggressive […]