medicaid programs

CMS has begun recruiting rural hospitals for a demonstration project which will examine the impact of gainsharing projects on such hospitals. (Gainsharing refers to programs under which hospitals pay physicians a share of any savings generated by mutual quality and efficiency-improvement efforts.) Under the gainsharing program, the hospitals will be asked to provide their own measures of whether they've managed to improve quality and efficiency of care for Medicare beneficiaries. The …

It looks like psychiatrists are getting the most love from pharmaceutical companies, a relationship which critics say could be behind the increasing use of costly atypical antipsychotic drugs for children.

As states begin to track pharma gifts to doctors, psychiatrists are increasingly coming up as top beneficiaries for pharma payments. In Vermont, for example, pharma payments to psychiatrists more than doubled last year, hitting $45,692 per individual, up from $20,835 in 2005. …

Though it hasn't started yet, physicians are already questioning whether CMS's pay-for-performance program will work over the long term. Physician critics say that many practices won't have the time, resources or staff to begin quality reporting. To get the 1.5 percent bonus, physicians will be asked to report on 74 measures for claims between July 1st and December 31st. To make this happen, it's likely that the practices will have to upgrade their IT infrastructure, a step which can be …

A new survey by the Commonwealth Fund has concluded that more than half of U.S. states have begun rewarding doctors for delivering quality care to Medicaid patients. What's more, almost 85 percent of Medicaid programs plan to have pay-for-performance programs in place within five years, many of which rely on improved use of health information technology, researchers said. The study suggests that states are moving much more quickly than Medicare administrators, analysts say. CMS is …

According to a new report, Medicaid's future may be better than previously thought. The Kaiser Commission on Medicaid and the Uninsured has concluded that projected growth in government revenues should support Medicaid spending for at least 40 years. This is, in part, because the program's share of national health expenditures isn't expected to grow dramatically. As of 2005, Medicaid was 16.5 percent of national health expenditures, but should only climb 2.5 percent, to 19 percent, by …

Last year was a good year for federal healthcare fraud investigators, who expect to recover a total of $1.47 billion from fraud cases filed in fiscal 2005, according to a report in political newspaper The Hill. Working under the auspices of the federal Health Care Fraud and Abuse Control Program, which began in 1997, the Office of the Inspector General, Department of Justice and Department of Health and Human Services have recovered a total of $8.85 billion to date, according to …

After winning a degree of independence from strict federal rules, states are making "aggressive" changes to their Medicaid programs this year, The Washington Post reports, reshaping them so they "more closely resemble private insurance." A number are raising fees and making other changes designed to encourage beneficiaries to "take responsibility" for their care.

In West Virginia, recipients will be required to sign "member agreements" promising to keep doctors …

Federal inspectors are launching an investigation of Kaiser Permanente's kidney transplant center following last week's series in the Los Angeles Times detailing widespread problems during the program's start-up phase. The newspaper reports that CMS investigators are examining patient records, examining documents and interviewing staff in an effort to find out if federal laws were violated. In the worst case scenario, the transplant center could be dropped from Medicare and Medicaid programs. Article

Across the nation, liberal and conservative governors are pursuing very different approaches to controlling rising healthcare costs and providing coverage to the growing ranks of the uninsured. In Florida, Gov. Jeb Bush (R) is talking empowerment for low-income seniors and moving thousands from state-run Medicaid programs to managed care plans. A similar experiment is underway in South Carolina. In Illinois, Gov. Rod Blagojevich (D) is taking a diametrically different approach to the same …

This week sees three important new healthcare policy developments. For starters, the federal government is about to add a little more money to the pie used to promote EMRs. Also, the new Medicare Part D drug benefit is up and running--with some glitches--but that's to be expected. Finally, last year's budget vote cuts Medicaid and gives states the freedom to fairly radically change …