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Weekly News, Analysis, and Commentary

Reimbursement Features & News

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Goodbye SGR, Hello MIPS and APS

U.S. Capitol / Source: www.aoc.gov
U.S. Capitol / Source: www.aoc.gov

Congress finally dumped the hated sustainable growth rate formula that constantly threatened draconian cuts to physician payments from Medicare. The replacement offers physicians new rewards and risks and introduces MIPS and APS. Now the fight over defining “quality” starts. Read what the new law brings.

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Uncle Sam and FeeFee File for Divorce

Photo creation by RRY Publications, LLC / Sources: Niek Verlaan and pixabay
Photo creation by RRY Publications, LLC / Sources: Niek Verlaan and pixabay

It was one of the most enduring relationships in healthcare. Uncle Sam and FeeFee (“fee-for-service.”) But the couple grew apart and a new flame, PayFee (“pay-for-performance,”) with her siren song of “quality over quantity” stole Uncle Sam’s heart. What’s it mean for the $2.9 trillion U.S. health system and specialty docs? We found out.

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CMS Takes a Second Look at HA Knee Injections

Knee Injection / Source: Wikimedia Commons and Harry Gouvas
Knee Injection / Source: Wikimedia Commons and Harry Gouvas

CMS has decided to take a second look at HA knee injections. Furthermore, CMS’ sister agency, AHRQ, released a study that says evidence is lacking that intra-articular HA knee injections delay knee replacement surgery; improve function or quality of life. CMS wants public comment. These are ominous signs. Could CMS change HA national coverage policy? Read on.

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