Reimbursement

With the implementation of the Affordable Care Act (ACA) over the next few years there are going to be several new fees for both health insurers and employers sponsoring self-insured health plans that go into effect.

Gene Lindsey, MD, president and CEO of Newton, Mass.-based Atrius Health shares his thoughts on accountable care organizations (ACOs) and talks about Atrius' experience as a Pioneer ACO.

Despite objections of a large block of fiscally conservative Republicans, the House yesterday approved a fiscal cliff compromise crafted in the Senate in the first hours of the new year by a vote of 257 to 167, which also averted steep Medicare payment cuts to doctors for yet another year.

Insurers looking to compete in the ever-changing healthcare marketplace will continue to focus on technology in 2013 both as a means of improving payment models and partnerships with provider groups and as the industry looks to make the transition to consumer-focused products it will offer on health insurance exchanges.

The Department of Health and Human Services estimates that some 25 million Americans will be buying health insurance through Affordable Care Act-certified exchanges within the next few years. But that and a lot of other HIX outcomes remain to be seen.

New research from the Employee Benefit Research Institute (EBRI) shows that employees enrolled in a Consumer Directed Health Plan (CDHP) are more likely than members of traditional health plans to exhibit cost-conscious behaviors including doing additional research on healthcare costs.

In the 166 pages of health insurance exchange rules published by the Department of Health and Human Services last March, one provision came as a pleasant surprise to some private HIX firms -- section 155.220, letting public exchanges contract with "web-based entities" to market and sell qualified health plans.

Medicare on Dec. 20 disclosed bonuses and penalties for nearly 3,000 hospitals as it ties almost $1 billion in payments to the quality of care provided to patients.

Kroll Advisory Solutions has released its 2013 Cyber Security Forecast, spotlighting some of the pressing and perhaps unexpected privacy and security issues healthcare and other organizations may be grappling with in the coming year.

Hospital readmissions are costly and often preventable events. Yet intense efforts to decrease readmissions rates and avoid penalties under the 2010 federal healthcare reform law have yet to have a significant impact, as one in five hospitalized Medicare beneficiaries are still being readmitted within 30 days of discharge.