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Southwestern Health Resources ACN Ranked No. 7 with Millions Saved, Quality Measures Above 95%

The Southwestern Health Resources Accountable Care Network (ACN) has saved the Centers for Medicare & Medicaid Services (CMS) more than $73 million over the past three years, including nearly $37.3 million in 2016, while maintaining a Quality Score over 95 percent, according to the latest figures. The savings rank the Southwestern Health Resources ACN No. 7 in the nation.

Will CMS Pop the Gross-to-Net Bubble in Medicare Part D With Point-of-Sale Rebates?

Last week, the Centers for Medicare & Medicaid Services (CMS) released its 713-page proposed policy changes and updates for the Medicare program. See the links below. Buried in this document is a radical concept: Part D plans would be required to recognize the value of manufacturer rebates and pharmacy payments in retail prescription prices. Show More Summary

American College of Rheumatology responds to CMS Innovation Center request for information

(American College of Rheumatology) The American College of Rheumatology (ACR) urged the Centers for Medicare and Medicaid Services (CMS) to remove barriers that make it difficult for subspecialists and providers in small practices to...Show More Summary

CMS Administrator Seema Verma To Outline Her Plan At 2017 Forbes Healthcare Summit

Seema Verma, the Administrator of the Centers for Medicare and Medicaid Services and a key figure in the future of the Affordable Care Act, will be interviewed live on-stage at the Forbes Healthcare Summit by Forbes Opinion Editor Avik Roy on November 30.

If Medicare wants value, it should cancel MACRA

From the CMS website, October 30, 2017, “Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma discussed the agency’s efforts to streamline quality measures, reduce regulatory burden, and promote innovation … We need to move from fee-for-service to a system that pays for value and quality — but how we define value and […]

CMS Report on Radiation Therapy Payment Model Charts Path to Value-Based Cancer Care

The American Society for Radiation Oncology (ASTRO) today called on the Centers for Medicare and Medicaid Services (CMS) to move forward urgently with the development of a radiation oncology alternative payment model (RO-APM) following a new report to Congress from the Center for Medicare and Medicaid Innovation (CMS Innovation Center).

An Oops in your favor (New Mexico Edition)

Christus Health Plan made a mistake in New Mexico.  They filed the wrong rates for their plans this year.  The Center for Medicare and Medicaid Services (CMS) is allowing them to correct their rates at the next data refresh.  This data refresh will be in the middle of the month.  Until then, CMS and Healthcare.gov […]

Internists support CMS on its patients over paperwork and meaningful measures initiative

(American College of Physicians) In a letter sent today to the Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma, the American College of Physicians (ACP), expressed support and appreciation for the new initiatives...Show More Summary

Medicare graduate nurse education demonstration increases primary care workforce

(University of Pennsylvania School of Nursing) The Report to Congress on the Centers for Medicare and Medicaid Services (CMS) Graduate Nurse Education Demonstration has just been released documenting health care workforce gains addressing the nation's shortage of primary care. Show More Summary

Medicare Graduate Nurse Education Demonstration Increases Primary Care Workforce

The Report to Congress on the Centers for Medicare and Medicaid Services (CMS) Graduate Nurse Education Demonstration has just been released documenting health care workforce gains addressing the nation's shortage of primary care. The...Show More Summary

AACC Calls on CMS to Protect Patient Access to Essential Medical Tests

Today, AACC sent a letter to the Centers for Medicare & Medicaid Services (CMS) in response to the agency's proposed 2018 rates for clinical test reimbursement under the Protecting Access to Medicare Act (PAMA). In its statement, AACC...Show More Summary

EXCLUSIVE: Preferred Pharmacy Networks Will Dominate 2018 Medicare Part D Plans (Plus: We Review the Top Plan Sponsors)

The Centers for Medicare & Medicaid Services (CMS) has just released the initial raw data on the 2018 Medicare Part D plans. Our exclusive analysis of these data reveals that preferred cost sharing pharmacy networks have officially won. Show More Summary

Rheumatology leaders applaud CMS for withdrawing Medicare Part B payment demonstration

(American College of Rheumatology) The American College of Rheumatology commends the Centers for Medicare and Medicaid Services (CMS) for finalizing its decision to withdraw the Part B Drug Payment Demonstration.

CMS Unveils “New Direction” for Innovation Center to Promote Patient-Centered Care

The Centers for Medicare & Medicaid Services (CMS) has unveiled a “new direction for the Innovation Center” to promote patient-centered care and test market-driven reforms. The goal of this new direction for the CMS Innovation Center...Show More Summary

Remicade: A Case Study in How U.S. Pricing and Reimbursement Curb Adoption of Biosimilars

The Centers for Medicare & Medicaid Services (CMS) has just released the Average Sales Prices (ASP) reimbursement data for the fourth quarter of 2017. You can download the drug pricing files here. Below, I use these data to explore the reimbursement and payer dynamics behind the relatively slow adoption of Inflectra, the first biosimilar of Remicade. Show More Summary

Telehealth and Online Platforms Should not be Overlooked as Key Tools in 2018 Expansion of Medicare Diabetes Prevention Program (MDPP)

The American Association of Diabetes Educators (AADE) filed public comments recently on a proposal by the Centers for Medicare & Medicaid Services (CMS) to provide education on how to prevent or delay the onset of type 2 diabetes via the Medicare Diabetes Prevention Program (MDPP). Show More Summary

ACP submits recommendations on 2018 Physician Fee Schedule proposal

(American College of Physicians) ACP today provided more than a dozen recommendations on the proposed rule for the calendar year 2018 Medicare Physician Fee Schedule to the Centers for Medicare and Medicaid Services (CMS). ACP's recommendations...Show More Summary

Am I the first user of the CMS’ Hospice Compare website?

In a terrible twist of fate, the very day that the Centers for Medicare & Medicaid Services (CMS) Hospice Compare website went live, I found myself in a pulmonologist’s office with my parents, taking in the news of my mother’s advanced cancer and malignant pleural effusion. The shock of it, and the uncanny timing are […]

AANEM Comments on 2018 MACRA Proposed Rule

The American Association of Neuromuscular & Electrodiagnostic Medicine submitted a comment letter to the Centers for Medicare & Medicaid Services (CMS) on August 21 regarding its proposed rule changes on Medicare payment and delivery reform enacted by MACRA (Medicare Access and CHIP Reauthorization Act).

Iowa’s 1332 waiver and CSR populations

Iowa submitted a Section 1332 State Innovation Waiver to the Center for Medicare and Medicaid Services (CMS) yesterday.  It is the biggest and most complex waiver yet to be submitted.  It is an invitation to long and costly lawsuits because of how it uses CSR funding. Other states have submitted reinsurance waivers where they are […]

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