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Centers for Medicare and Medicaid Services (CMS)

Latest Headlines

Latest Headlines

Feds consider $3B treatment comparison initiative

Legislators in the U.S. House of Representatives have begun considering a bill that would fund research comparing the effectiveness of standard treatments for common medical conditions. The bill would be financed not only from CMS revenues, but also insurers and employers. The research would then be performed by HHS's Agency for Healthcare Research and Quality. Drug makers and medical device companies will not be asked to fund the research; the assumption is that if they pay in, they …

Home care model growing popular

A California company is quickly becoming one of the leaders in a new--and some say, critically important--care delivery niche. Care Level Management, of Woodland Hills, CA, cares for chronically ill patients in their homes rather than making them come to a physician's office. The idea is to head off potentially serious and expensive complications which would otherwise put them in the hospital. Care Level's primary client is CMS, which is paying Care Level a monthly case stipend and fee …

CMS considers anemia drug payment limits

The fallout continues for anemia drugs, which are taking a severe beating of late--and this time it's the mighty hand of CMS doing the slapping. CMS is now proposing some limits to covering anemia drugs like Procrit, Aranesp and Epogen, reserving payments for treating anemia associated with certain cancers. If the proposal goes through, CMS won't pay to use the drugs to prevent anemia, and it won't pay unless patients have a specified hemoglobin level. The announcement comes as an …

CMS may target 'inefficient' doctors

Adding yet another wrinkle to the agency's complex relationship with doctors, CMS may begin profiling physicians and targeting those it deems inefficient sometime next year. Herbert Kuhn, acting deputy administrator of CMS, told a House subcommittee that the agency will have the data and computer capacity available to do the tracking as soon as mid-2008. To monitor efficiency, CMS would compare levels of tests physicians order for certain types of patients to tests ordered by other …

FL DME companies named in $142M fraud

Federal officials have arrested 38 individuals in South Florida--a world capital of DME fraud--accusing them of defrauding the Medicare program of more than $142 million. Working with state and local authorities, the feds investigated the individuals for two months, relying in part on real-time computer data to track the progress of their activities. The officials concluded that the defendants paid Medicare enrollees to use the enrollees' card numbers. Prosecutors say that the accused …

CMS P4P research finds consistency to be key

How can hospitals benefit from the research being done by CMS on pay for performance? In part, just by accepting that improving quality results requires a high level of commitment, according to Richard Norling, CEO of Premier, which runs the P4P pilot on CMS's behalf. Norling, who's in Washington, DC this week for the American Hospital Association's annual meeting, conducted a briefing yesterday on lessons learned from the P4P demonstration program, the Hospital Quality Incentive …

Researchers fight for ethnic diversity in trials

Concerned that they aren't addressing the different ways various ethnic groups respond to medication, researchers are mounting major efforts to recruit varied racial and ethnic groups for clinical trials. Right now, the average clinical trial volunteer is a white male between 18 to 40 years old--and this is a problem. Researchers have increasingly found that race and ethnicity can be important factors in how a patient responds to medications, with some drugs functioning better in certain …

Quality studies proposed for children's healthcare

To date, virtually all of the major studies of healthcare quality have focused on care for adults, partly because children aren't prone to chronic diseases like diabetes whose outcomes can be measured easily. The gap in quality measures is particularly large when it comes to inpatient care, according to a study by the National Association of Children's Hospitals. However, a new bill being considered in the Senate would change the equation, budgeting $100 million over the next five years …

Medicare may boost nursing-home rates

CMS may be instituting a $690 million boost in Medicare nursing home payments for 2008. Nursing facilities would get a 3.3 percent increase in payments under the new adjustments to the skilled nursing facility prospective payment system. Right now, payments are based on a "market basket" of services calculated in 1997, but the new initiative would adjust the rates to reflect 2004 costs. The change would result in an increase for room, board, medical care and other nursing home expenses. …

Many players support P4P

Not sure where you stand on pay-for-performance schemes? It seems that many of your peers have made up their mind. A new survey, conducted at the Fourth Annual World Health Care Congress in Washington, DC, found that about half of health purchasers and providers would like to see P4P use move ahead more quickly. Sixty-nine percent of the event's attendees said that the federal government should be moving more quickly into P4P-based reimbursement. That doesn't mean the entire …