Reimbursement

As director of the HIT Initiatives Group in the Office of E-health Standards and Services at CMS, Elizabeth Holland is intricately involved in shaping the meaningful use rules that some view as having the potential to transform healthcare. Holland is a veteran policymaker. She joined CMS in 1991. It was when the proposed rule for the Medicare fee schedule was in the works. CMS received 100,000 comments – all on paper.

Overall U.S. healthcare prices increased nearly a full percentage point from July to August 2012, rising 0.9 percent, according to the federal Bureau of Labor Statistics.

There are no set appropriations for how much the federal government can spend on rewarding providers who adopt and use electronic health records under the Medicare and Medicaid meaningful use EHR incentive program, according to National Coordinator for Health IT Farzad Mostashari, MD.

States that want to create their own health insurance exchanges, rather than accept a federal model, have until September 30 to inform the U.S. Department of Health and Human Services of the minimum requirements for all plans sold in the exchange.

Preparing for the growth of the retail market, while trying to maintain profit margins under the medical loss ratio requirements, some insurers are chucking their old administration, claims and sales systems in favor of more web-based and automated software.

Health Plan Alliance (HAP) along with Cardinal Health Specialty Solutions and oncology consulting firm Physician Resource Management have announced they will work together to launch in Michigan an evidence-based clinical pathways program that is intended to improve the quality and lower the costs of cancer treatment.

Twelve Iowa cities and towns are applying to be demonstration sites for the Blue Zones project, a micro-level experiment in trying to improve health and well-being by Healthways and with funding assistance from health insurer Wellmark.

For many years there were three typical owners of ambulatory surgery centers: surgeons, management and development companies, and recently hospitals/health systems. But there is a fourth group that has quietly remained involved in ASC ownership for several years and is now taking on a more active role: payers.

Most employers that measure the performance of their employee wellness and value-based healthcare offerings show a return on investment (ROI) for these programs, with a significant number showing savings of $3 or more for every dollar spent, according to new research published by the International Foundation of Employee Benefit Plans (IFEBP).

New York Downtown Hospital will pay a total of $13.4 million in a Medicare and Medicaid fraud settlement that alleged the hospital received claims on an unlicensed inpatient drug detox program and that it paid kickbacks to an out-of-state vendor for referrals to the program.