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Medicare pay: Insurers preview a post-SGR world

A frustratingly familiar solution to the latest Medicare sustainable growth rate cut was signed into law after the new year with another pay patch enacted by Congress. The relief physicians felt at not sustaining a major cut — in this case 26.5% — was tempered by the knowledge that the next major reduction threatens to strike when the temporary measure expires. Medicare’s physician payment system continues to be panned universally by lawmakers, health economists, physicians, hospitals and insurers who would prefer a more stable, innovative system. But cost issues and a variety of other factors have stymied meaningful pay reform for the government-run entitlement program. For lawmakers, it was easier to pass the $25 billion stopgap measure at the last minute than to approve a package 10 times as costly — one that repeals the SGR and moves the Medicare pay system to one that rewards quality and efficiency. Still, physicians and insurers are not waiting for Medicare to chang ...

States using health IT to boost Medicaid sign-ups

Parents and adults without children continue to face difficulties in getting signed up for Medicaid despite otherwise successful state efforts to use health information technology tools and simplify enrollment procedures, according to a 50-state survey released Jan. 23 by the Kaiser Commission on Medicaid and the Uninsured. States are facing important changes to their programs before the Affordable Care Act’s Medicaid expansion starting in 2014, said Diane Rowland, the commission’s executive director. She’s also the executive vice president of the Kaiser Family Foundation. Many states are weighing their options on expanding their programs up to an effective rate of 138% of poverty, but at least 20 plan to do so, Rowland said during a Washington briefing to discuss the survey’s findings. The survey demonstrates that many states already have taken innovative steps to modernize their programs and improve access before 2014, Rowland said. A majority of states provide online a ...

Will deferred care follow rise in Medicaid co-pays?

A federal proposal that would allow states to increase certain co-pays for Medicaid patients seeks to encourage the more prudent use of costly services such as emergency department care, but some health care professionals believe the measure could lead to more access problems for beneficiaries. On Jan. 14, the Centers for Medicare & Medicaid Services issued a proposed rule that included a provision to simplify and update Medicaid premium and cost-sharing policies. Maximum co-payment amounts can vary based on what states pay for services and on income levels. In the interest of streamlining the system for the states, CMS is proposing an overall flat maximum rate of $4 for outpatient services for those under 100% of poverty, as well as higher cost sharing for certain services: an $8 maximum for using non-preferred drugs and for non-emergency use of the emergency department for individuals at or below 150% of poverty. Cost sharing isn’t a new idea for Medicaid — nominal fees for ...