By Jennifer Lubell July 26, 2010 Incentives for primary-care doctors under Medicare's proposed physician fee schedule for 2011 won't be enough to offset larger reimbursement woes, members of the industry say. ... FULL STORY
By Jennifer Lubell May 24, 2010 Bundling payments to hospitals and doctors for episodes of care is gaining momentum in the federal government and in the private sector as a way to increase provider accountability and improve care—but lingering challenges may deter its application on a broader scale. ... FULL STORY
By Jennifer Lubell March 08, 2010 A bold pledge from the government's top healthcare administrator to resolve Medicare's physician payment problem has yet to convince all doctors that a permanent fix will ever be realized. ... FULL STORY
By Jennifer Lubell February 08, 2010 Lawmakers are trying to free up more money to fix Medicare's long-standing physician reimbursement problem, but don't yet have a long-term plan for how to do so. ... FULL STORY
By Jennifer Lubell January 11, 2010 With health reform legislation edging closer to final passage, some physician groups are banking on Congress to address the flawed Medicare payment system within the context of larger reform—rather than in its aftermath. ... FULL STORY
By Andis Robeznieks December 28, 2009 The push for major healthcare reform has exposed a number of schisms between physician groups and among physician specialties. Now, a seemingly minor regulation threatens to do the same thing. ... FULL STORY
By Jennifer Lubell November 23, 2009 When it comes to fixing Medicare's physician payment formula in the House, the livin' is easy. The Senate, not so much. The physician lobby faces an uphill battle in the Senate after the House's uneventful passage of a bill that aims to prevent a scheduled 21.2% rate decrease to Medicare physicians... ... FULL STORY
By Andis Robeznieks November 09, 2009 Physician groups say they hope a new not-for-profit database on insurance payments to doctors will lead to fairer reimbursement for their services and lower out-of-pocket costs for patients. ... FULL STORY
By Matthew DoBias October 26, 2009 A measure to zero-out the physician payment formula was crushed in the Senate last week, failing to garner 13 members of the Democratic Caucus who could have advanced the bill and nary a single Republican. ... FULL STORY
September 28, 2009 One experiment to revamp how hospitals and doctors are paid has won converts at the Carilion Clinic, where executives are negotiating with insurers to boost quality and curb costs for a share of the savings. ... FULL STORY
September 14, 2009 Physicians and hospitals say they're in favor of the growing number of CMS demonstrations to improve quality—they just want to make sure they are reimbursed fairly if and when these demonstrations are put into practice. ... FULL STORY
August 24, 2009 HHS' inspector general's office is concerned that too often unqualified people are providing medical services that physicians bill Medicare for but don't personally perform. But officials don't have the data that would allow them to figure out exactly how often that happens. ... FULL STORY
July 13, 2009 While everyone hailed the CMS' decision to finally remove physician-administered drugs from the formula used to calculate Medicare's physician fee schedule, measures that are expected to boost payments to the ailing primary-care industry may come at the expense of some specialty physicians. ... FULL STORY
June 22, 2009 While some states have increased their Medicaid reimbursement rates for primary-care and obstetric services, in general, rate increases did not keep up with the rate of inflation between 2003 and 2008, according to a recent report from the Washington-based Urban Institute and published on the Web... ... FULL STORY
By Jennifer Lubell June 22, 2009 Robert Minkin, president and CEO of Exempla St. Joseph Hospital in Denver, says he expects to see long-term gains by participating in a new CMS demonstration project that will “bundle” payments to hospitals and physicians—even though at the outset his hospital will be getting paid less by Medicare. ... FULL STORY
April 27, 2009 Texas Attorney General Gregory Abbott secured a settlement agreement with Blue Cross and Blue Shield of Texas calling for the insurer to scrap its system of assigning affordability ratings. ... FULL STORY
March 23, 2009 Physicians say they are optimistic that President Obama’s upfront approach in his budget proposal to address the costs associated with fixing the Medicare physician payment formula will result in a permanent solution. ... FULL STORY
By Gregg Blesch January 26, 2009 New York Attorney General Andrew Cuomo has busted open the insurance industry’s principal system—benchmarking databases—for determining how much to pay when patients choose to go outside their provider networks for care, a system physicians have long criticized as secretive, flawed and unfair. ... FULL STORY
By Andis Robeznieks December 08, 2008 A recent study suggests that slow reimbursement discouraged physicians from seeing new Medicaid patients, but San Antonio pulmonologist John Holcomb, M.D., says it's the ordeal that physicians have to go through to get paid that makes them leery of taking on any new Medicaid patients. ... FULL STORY
November 17, 2008 Physician organizations appear confident that President-elect Barack Obama will make healthcare reform a major priority, although his interests in resolving Medicare payment issues are less clear. ... FULL STORY
By Jennifer Lubell November 03, 2008 Some physicians will benefit more than others under a final rule on the physician-fee schedule issued by the CMS last week that carries out the major provisions of the Medicare Improvement for Patients and Providers Act of 2008, or MIPPA. ... FULL STORY
By Andis Robeznieks September 22, 2008 It may not be worth it, but they're doing it anyway and would like some feedback on if they're doing it right. That's how more than 450 healthcare practice leaders felt about Medicare’s Physician Quality Reporting Initiative, according to an online survey by the Medical Group Management Association. ... FULL STORY
By Jennifer Lubell August 25, 2008 Second-year results of a Medicare physician group practice P4P demo project show it continues to save money and improve quality, but most participants have yet to reap any significant financial rewards for their efforts. Some of the participating groups are making it known that they don’t agree... ... FULL STORY
July 21, 2008 The CMS’ newly proposed rules for gain-sharing and other pay-for-performance initiatives released last month could be a significant step toward loosening financial-arrangement restrictions that many believe prevent doctors and hospitals from aligning on quality-improvement and cost-savings efforts,... ... FULL STORY
By Jennifer Lubell July 07, 2008 For the longest time, Michael Kitchell, M.D., a neurologist in Ames, Iowa, has been racking up the miles on his car, driving as far as 45, sometimes 70 miles from his home practice to see patients who require the specific care he can provide. However, a 10% cut looming over Medicare payments this... ... FULL STORY
June 09, 2008 A new report found that savings from physician-hospital gainsharing programs cut costs associated with coronary stents by 7.4%, or $315 per patient, which, if extrapolated nationwide, would equal $195 million in savings annually. ... FULL STORY
May 19, 2008 The CMS’ proposed regulations on the inpatient prospective payment system released last month include actions related to some hot-button issues directly involving physicians’ pocketbooks. ... FULL STORY
By Jennifer Lubell April 21, 2008 More money and better quality measures are the way to get more doctors to participate in the Physician Quality Reporting Initiative, or PQRI, industry representatives say. Preliminary data released by the CMS earlier this year on the PQRI show that only 99,000 physicians, nonphysician practitioners... ... FULL STORY
By Rebecca Vesely and Jennifer Lubell February 04, 2008 Pay-for-performance programs have hit the mainstream but assessing their effectiveness remains difficult, according to two recent reports on the topic. ... FULL STORY
By Andis Robeznieks November 19, 2007 The doctor doesn’t have to see you now. Thanks to new technology, patients may not always need a face-to-face visit with their doc to get the care they need. And because of a growing awareness of this fact on the part of health plans, structured, Internet-facilitated and reimbursable “virtual... ... FULL STORY
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