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Editorials

Still using horses and buggies

Paul Levy

I recently had to reschedule a routine exam with my hospital-based primary care doctor and so decided to use the supposed rescheduling functionality on the patient portal to carry out this task. 

Raw pricing data doesn't mean much

Emily Newhook

The price transparency movement may be picking up speed, but consumers lack the ability and resources to translate and comprehend the information.

Measuring Medicare Advantage risk coding, devising optimal policy

Richard Kronick, AHRQ

Medicare Advantage remains an attractive option for Medicare beneficiaries, and enrollment has increased substantially, by 66 percent in the past six years. Also increasing, it seems, is coding intensity for risk adjustments.

Will there be some Obamacare rate shock in 2015?

Robert Laszewski

Hanging around actuaries as long as I have, one of the old sayings I picked up was: "Figures don't lie, but liars figure."

Payer-provider transactions are evolving

Tom Dean, Emdeon

Like many other industries, from manufacturing to retail, healthcare is looking to use information technology to transform and automate financial payments. Providers, though, have a lot of old and new choices.

A more complete picture of Pioneer ACOs

Larry Kocot and Mark McClellan, MD

The Centers for Medicare and Medicaid Services recently released more detailed ACO-level data for participants for the first two years of the Pioneer ACO Model. Despite the decline in participation and mixed results so far, upcoming regulatory may help.

CMS rulemaking lags cost millions

Debra McCurdy

The Office of Inspector General at the U.S. Department of Health and Human Services continues to fault the Centers for Medicare & Medicaid Services for failing to issue final regulations to enforce the location requirements for rural health clinics.

Medicare Advantage plans can prepare for compliance reviews

Tonya Teschendorf, Cody Consulting

Conformity with CMS compliance guidance requires highly efficient communication and effective collaboration between a number of operative departments throughout a health plan.

As healthcare becomes more integrated, information exchange is more critical

Charlotte Hovet, MD, Dell Healthcare Services

The new payment models in the healthcare marketplace all provide incentives for coordinated care as a means of improving outcomes and lowering costs, especially for chronic diseases. As a consequence, 2014 looks to be the year of the health information exchange (HIE).

Door-to-balloon-time and the perils of quality metrics

Aaron Segal, MD, and Richard Young, MD

"The ER doctor ordered the heart cath, so I just went ahead and did it. Besides, if I didn’t do the cath it would make our door-to-balloon-time quality score go down."

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