CullmanTimes.com - Cullman, Alabama

Health

November 23, 2012

With health-care law set, now come the new rules

(Continued)

Dan Mendelson, chief executive of the consulting firm Avalere Health, said: "It's a breakneck time frame, because there's really only eight months left before open season, and they have to get these products up."

Mendelson said a lot is at stake for the government to make sure its rules lead to a marketplace that doesn't founder. He pointed to Medicare officials' efforts to get the prescription drug plan, Part D, ready to roll out in 2006. The Centers for Medicare and Medicaid Services needs "to work collaboratively with the health insurance industry to bring to market a new set of products," Mendelson said. "It's always a challenge for CMS. They did it beautifully under Medicare Part D and that resulted in a market that is quite robust and functioning."

Bundled payments

The administration has already gotten off the ground two major changes to the way the government pays hospitals and doctors. One designates accountable-care organizations that reward hospitals and doctors for working together to provide more efficient care. The other begins to pay hospitals on the quality of the care they provide through the value-based purchasing program. By January, the law calls for the government to launch another major initiative: bundled payments.

The Center for Medicare and Medicaid Innovation is in the final stages of selecting which providers will be included in the program. Under the plans, the government would pay a lump sum to cover all the medical needs of patients going into the hospital, a nursing home or getting home health services for a specific ailment.

Applicants have tailored their proposals to specify whether it covers just one part of the patients' medical treatment, such as post-hospital care, or all the services in the episode. The applicants have also selected specific diagnoses that they will use to test this new payment method. The goal is the same as the other ongoing experiments: to move providers away from being paid piecemeal for each service — a method that encourages excess treatments and drives up Medicare's expenses.

"People in our community are looking at it as a way to dip their toes in the water," said Atul Grover, chief public policy officer at the Association of American Medical Colleges.

Kaiser Health News (www.kaiserhealthnews.org) is an editorially independent news service, a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente.

Text Only
Health
  • COMMENTARY: An alternative diagnosis to ADHD: Schoolchildren need more time to move

    The Centers for Disease Control and Prevention tells us that in recent years, there has been a jump in the percentage of young people diagnosed with attention deficit and hyperactivity disorder, commonly known as ADHD: 7.8 percent in 2003 to 9.5 percent in 2007 to 11 percent in 2011.

    July 18, 2014

  • Guideline: Most healthy women can skip pelvic exam

    No more dreaded pelvic exam? New guidelines say most healthy women can skip the yearly ritual.

    July 1, 2014

  • Sanofi targets fake Viagra market with non-prescription Cialis

    Sanofi sees an attractive opportunity in the rampant market for counterfeit Viagra: luring men away from dodgy online pharmacies with an over-the-counter version of a competing erection drug.

    June 5, 2014

  • Hospital charges to treat chest pain jump 10 percent in a year

    The charge to treat Medicare patients with chest pain at U.S. hospitals rose 10 percent to $18,568 in just a year, the biggest rise seen among the most common inpatient procedures, according to federal data.

    June 2, 2014

  • Study: Both men and women feel less stress at work than at home

    In a newly released study in the Journal of Science and Medicine, researchers carefully examined the levels of the stress hormone, cortisol, of a variety of workers throughout the day. The data clearly showed that both men and women are significantly less stressed out at work than they are at home.
     And the women they studied said they were happier at work. While the men said they felt happier at home.

    May 26, 2014

  • Jobless contend with weight gain as they search for work

    A subject long ignored by policymakers, and one that unemployment counselors are too sheepish to raise with job seekers, the link between bulging waistlines and joblessness is now of intense interest to researchers studying the long-term effects of the country's economic malaise.

    May 12, 2014

  • COMMENTARY: Helmets won't protect your kids from concussions

    When I was a kid, helmets were for motorcyclists. Now I see children wearing helmets when they're scooting down sidewalks, skating, skiing, sledding and playing soccer. Last week one of my friends saw a helmeted kid power-walking in Prospect Park. You can even buy $40 baby helmets on Amazon, because, according to the product description, "babies will always fall taking their first steps."

    May 2, 2014

  • 400px-Cannabis_Plant.jpg How bad is marijuana for your health?

    The Journal of Neuroscience recently published a study linking recreational marijuana use to subtle changes in brain structure. The researchers, led by Jodi Gilman of Massachusetts General Hospital, identified increased gray matter density in the left nucleus accumbens and some bordering areas.

    May 1, 2014 1 Photo

  • American sunscreens need an upgrade

    The last time a new sunscreen ingredient came on the U.S. market, the Y2K bug was threatening to destroy our way of life. Intel had just introduced the Pentium III processor, featuring an amazing 500 MHz of computing power.

    April 24, 2014

  • Cuba is running out of condoms

    The newest item on Cuba's list of dwindling commodities is condoms, which are now reportedly in short supply. In response, the Cuban government has approved the sale of expired condoms.

    April 23, 2014