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Financial Impact of Medicare Payment Reform for E/M Visits on Compensation for Otolaryngologic Procedures in 2023.
Otolaryngol Head Neck Surg
January 2025
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA.
The Centers for Medicare & Medicaid Services (CMS) recently increased payment for evaluation and management (E/M) visits, but did not apply these updates to post-operative global period visits. We investigated the resulting Medicare fee-for-service revenue loss for otolaryngologists. Using publicly available Medicare spending/utilization data, we estimated how much additional payment otolaryngologists would have received in 2023 if CMS had reimbursed global period visits at the same rates as other E/M visits.
View Article and Find Full Text PDFTrends in anti-seizure medication spending by Medicare Part D and Medicaid from 2012 to 2022.
Epilepsy Behav
January 2025
Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA. Electronic address:
Objectives: The rising cost of anti-seizure medications (ASMs) in the United States (US) is a major concern for patients, healthcare providers, insurance payors, and policymakers. We aim to describe and analyze the spending trends on ASMs in the Medicare Part D (MPD) and Medicaid population in the US.
Methods: A retrospective study was conducted on the databases of MPD and Medicaid Spending by Drug from 2012 to 2022, which was published by the Centers for Medicare and Medicaid Services (CMS).
Payment models and the sustainability of community pharmacy practice: a qualitative interview study with community pharmacists.
J Pharm Policy Pract
January 2025
College of Pharmacy, University of Health Sciences and Pharmacy, St Louis, MO, USA.
Background: The sustainability of community pharmacies in the United States depends, in large part, on policies enacted by the Centers for Medicare and Medicaid Services (CMS). In 2003, CMS policy allowed retrospective direct and indirect remuneration (DIR) fees to manage costs. From 2024, only prospective DIR fees are permitted.
View Article and Find Full Text PDFStaffing Up: The Nursing Home Minimum Staffing Rule.
J Gen Intern Med
January 2025
Brown University, 222 Richmond St., Providence, RI, 02903, USA.
On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) announced new staffing mandates for long-term care (LTC) facilities in an effort to improve care quality in nursing homes (NHs). The guidelines require a minimum of 3.48 h of daily care per resident, including 0.
View Article and Find Full Text PDFMedicare Risk Adjustment: Goals, Reform Proposals, And New Frontiers.
Health Aff (Millwood)
January 2025
Aaron L. Schwartz University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
Risk adjustment modifies payments to health insurers based on enrollee characteristics that are predictive of higher or lower medical spending. Risk-adjustment policy is a key ingredient for the success of regulated individual insurance markets in Medicare and beyond. Researchers have identified shortcomings of Medicare's current risk-adjustment system, illustrated the limits of coarse fixes, and proposed new strategies that improve the data and calculations used to generate beneficiary risk scores.
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