Insurance news
Federal Agency Clarifies PPACA Language on Access to Non-MD/DO Providers
Written by Editor   
Wednesday, June 17, 2015 04:58 PM
Quick Brief:  New CMS FAQ guidelines correct previous language that led some states to limit patient access based solely on the type of a provider’s licenseThis language has been rectified.

 

At the urging of the American Chiropractic Association (ACA), the Centers for Medicare & Medicaid Services (CMS) has clarified a section of the Patient Protection and Affordable Care Act (PPACA) that led some states to improperly limit patient access to chiropractic physicians and other qualified non-MD/DO health care providers.

On May 26, CMS withdrew and replaced a Frequently Asked Questions (FAQs) document on Section 2706(a) of the 2010 Patient Protection and Affordable Care Act (PPACA) with one containing a more realistic approach to the issue of provider non-discrimination. The new FAQs establish a more reasonable standard for Section 2706(a) enforcement and are more in line with ACA's understanding of the issue.

"This clarification signifies a remarkable achievement for ACA and its health care association partners in ensuring that all patients have free and fair access to the providers of their choice," said ACA President Anthony Hamm, DC, noting that the previous FAQs had served as a "severe impediment to quality patient care and genuine reform in the nation's health care system."Proper implementation of the law had been hampered in part by flawed information distributed in 2013 by the HHS Center for Consumer Information and Insurance Oversight (CCIIO), which led some states to limit patient access to qualified health care providers, including chiropractic physicians, based solely on the providers' licenses -- in direct contradiction to the intent of Congress.

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Medicare Advantage Pay Rates to Rise 1.25% in 2016
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Friday, April 24, 2015 12:00 AM

Payments to Medicare Advantage plans will increase by an average of 1.25% in 2016, the Centers for Medicare and Medicaid Services (CMS) has announced.  The increase, announced as part of CMS' final notice and call letter for Medicare Advantage in 2016, is a change from the projected decrease of 0.95% announced in the advanced notice and draft call letter issued in February.

The change occurred "largely because the Medicare actuaries recently updated Medicare per capita spending estimates for 2014 and 2015," CMS said, adding that "Medicare per capita spending in 2014, 2015, and 2016 is still expected to be below historical standards."

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Quality-based Payment Systems Vastly Expands
Written by Editor   
Friday, April 17, 2015 12:00 AM

The Massachusetts health care industry’s traditional system of paying doctors for every office visit, test, and procedure may be nearing its end.  The state’s largest health insurer, Blue Cross Blue Shield of Massachusetts, will vastly expand its system that pays doctors based on how well they care for patients — not just for the number they see and volume of services they provide. The move will extend the quality-based system to more than 1 million health plan members, making it the biggest initiative of its kind in the state and probably the country.  Performance-based systems are expected to be widely adopted as state and federal health care laws pressure providers to lower expenses.

Payment reform has gained steam nationally.  Two dozen health care providers and insurers launched a task force in January and vowed to commit 75 percent of their businesses to value-based contracts by the end of the decade.  And Medicare, the insurance program for seniors, said it will shift half of its payments to new models by 2018.  Thousands of Medicare patients are already part of alternative contracts in what are known as accountable care organizations, which receive incentives for keeping patients healthy.  Traditional fee-for-service medicine remains the norm, accounting for 66 percent of the Massachusetts market, according to state data. But health care providers say they expect those numbers to go down as more insurers adopt performance-based contracts.

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Insurers Move Gradually Toward Wellness Care
Written by Editor   
Friday, April 17, 2015 12:00 AM

Cigna insurance CEO David Cordani says the Centers for Medicaid and Medicare Services' recent payment changes that emphasize quality over quantity in healthcare will shift the focus on "sick care to more well care." But a widespread embrace of diet, fitness and other wellness programs is still a way off.  "As a country, we're in a transitional state in many ways," he says.

Aetna's Joseph Zubretsky agrees. Hospitals and insurers have been focusing on changing how they pay for health care and using technology and clinical services to help track and manage that care, he says Accountable Care Organizations, which are groups of doctors and often hospitals that unite to keep a population of patients well, are a big part of the push.

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VBR vs FFS the New Future is Here
Written by Editor   
Wednesday, April 15, 2015 12:00 AM

A shift toward value-based reimbursement, which only a couple of years ago seemed very slow in the making, may unseat the entrenched fee-for-service (FFS) payment model in five years, according to experts.  Health care usually moves glacially, but that’s not what’s happening here.  A move away from FFS payment will mean that contracts with thousands of provider groups will have to be rewritten.

In its first scorecard on payment reform, released in March 2013, the Catalyst for Payment Reform (CPR), a not-for-profit organization that advises large employers and insurers about quality improvement, reported that just 11% of payment to providers is not under a FFS model.

Well, guess what? CPR’s second report card last year found that 40% of commercial health plan payments were made through payment methods designed to improve quality and reduce waste

That’s quite a jump—but not a complete surprise, considering the clues. Top executives at UnitedHealthcare, Anthem Blue Cross, and Aetna have all been quoted in recent months about the concerted value-based efforts their companies are making. CMS is throwing its weight behind the trend by mandating that 30% of Medicare outlays by 2016, and half by 2018, be routed through alternative payment models such as ACOs and bundled payments.

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