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CMS Updates Fee Schedule, Hospital Outpatient Rates and Obamacare Lowers Uninsured Rates


IP Blog | Dave Melin | July 13, 2014

BioBlogWeeklyThis week in healthcare, CMS announces an update to the 2015 Medicare Physician Fee Schedule and Kaiser Health reports that Obamacare may lower uninsured rates.

Obamacare Lowers Uninsured Rate, Three Studies Find

“According to three new studies, the health law has in its first year reduced the number of uninsured adults by between 8 million and 11 million, and the majority of enrollees report satisfaction with their plans.”

Mixed reactions to CMS 2015 Medicare Physician Fee Schedule proposed rule

In a recent announcement, CMS proposed an update to their 2015 Medicare Physician Fee Schedule that “doesn’t include changes to the sustainable growth rate (SGR) formula, but revises the Medicare Shared Savings Program (MSSP).” While some are glad to see a stronger emphasis on outcomes, others are disappointed that the proposal fails to address SGR reform.

Fact sheets: Proposed policy and payment changes to the Medicare Physician Fee Schedule for Calendar Year 2015

This fact sheet, provided by CMS, details the important points of its recent proposed update to the 2015 Medicare Physician Fee Schedule. Among the proposed changes are “a new process for establishing PFS payment rates” as well as “changes to several of the quality reporting initiatives that are associated with PFS payments – the Physician Quality Reporting System (PQRS), Medicare Shared Savings Program, and Medicare Electronic Health Record (EHR) Incentive Program, as well as changes to the Physician Compare tool on the Medicare.gov website.”

CMS Releases Proposed 2015 Hospital Outpatient Payment Rates: 7 Things to Know

In addition to changes to the Physician Fee Schedule, CMS has also released a proposal regarding Hospital Outpatient Payment Rates for 2015. Among the changes is “updating the OPPS market basket by 2.1 percent in 2015.”

Aetna’s Ed Pezalla on how ACOs can leverage pharma

In an interview with FierceHealthPayer, Aetna’s National Medical Director for Pharmacy Policy and Strategy Edmund Pezalla said that pharma needs to be a consideration for ACOs. “As ACOs become more established, Pezalla said he expects they will become more savvy and innovative in their approach to pharmaceuticals.”

Does It Pay to Use Pathways? Evidence-Based Decision Making and Clinical Pathway Adherence

In this audio recording, AJMC TV moderates a panel discussion on the question of provider incentives to promote pathway adherence. From panelist Peter Paul Yu, ASCO President: “Institutions will need to get to the point where they begin to say, ‘we need to get a handle on other rising costs of care. And we need to look at what decisions are being made and the downstream consequence of that.”

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