"Three separate pay-for-performance programs affect the amount of Medicare payment for inpatient services to about 3,400 US hospitals. These payments are based on hospital performance on specified measures of quality of care. A growing share of Medicare hospital payments (6 percent by 2017) are dependent upon how hospitals perform under the Hospital Readmissions Reduction Program, the Value-Based Purchasing Program, and the Hospital-Acquired Condition Reduction Program. In 2015 four of five hospitals subject to these programs will be penalized under one or more of them, and more than one in three major teaching hospitals will be penalized under all three. Interactions among these programs should be considered going forward, including overlap among measures and differences in scoring performance."
Read full PDF at healthaffairs.org
"Health insurance giant Blue Shield of California owes $82.8 million in rebates to consumers and small employers under requirements of the federal health law.
The majority of that money, $61.7 million, will be divvied up among 454,000 individual policyholders who had Blue Shield coverage in 2014. The average rebate is $136.
The remaining rebates of $21.1 million are owed to about 19,000 small employers. Customers will receive their money by the end of next month, according to the San Francisco insurer."
Read more on LA Times
"Jaws dropped at news this summer that the federal government was seeking as much as $3.3 billion from drugmaker Novartis for allegedly paying kickbacks to pharmacies.
But the feds aren't the only ones trying to make Novartis pay up on false claims allegations, and it's not just Medicare dollars at stake. Eleven states are also parties to the lawsuit under the authority of their own false claims laws. They're seeking to recover money paid out by their state Medicaid programs.
The Novartis case is the latest example of states using their own false claims laws to pursue questionable Medicaid billings by drugmakers, healthcare providers and suppliers. Lured by the potential for big paydays, several states, including Maryland and Vermont, passed or expanded their false claims laws this year, bringing the number of states with their own false claims statutes to nearly 30, according to the Taxpayers Against Fraud Education Fund.
Many state false claims laws are similar to the federal law, financially penalizing those who knowingly submit false claims to state programs such as Medicaid. Many of the state laws also allow whistle-blowers to initiate lawsuits on behalf of the state."
Read more at Modern Healthcare
"Most physicians in the United States continue to work in small practices despite the challenging healthcare working environment, according to an updated Policy Research Perspectives from the American Medical Association (AMA).
"These data show that the majority (60.7%) of physicians were in small practices of 10 or fewer physicians, and that practice size changed very little between 2012 and 2014 in the face of profound structural reforms to healthcare delivery," AMA president-elect Andrew W. Gurman, MD, says in a news release.
But the percentage is down markedly from 30 years ago, when more than three quarters of doctors worked in the small practice setting, the report notes. "It is clear that physician practice has undergone marked changes over the past 30 years," the report says."
Read more on Medscape
"WASHINGTON — The Supreme Court ruled on Thursday that President Obama’s health care law allows the government to provide nationwide tax subsidies to help poor and middle-class people buy health insurance, a sweeping vindication that endorsed the larger purpose of Mr. Obama’s signature legislative achievement.
The 6-to-3 ruling means that it is all but certain that the Affordable Care Act will survive after Mr. Obama leaves office in 2017, and will give it a greater chance of becoming an enduring part of America’s social safety net."
Continue reading on The New York Times.