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Demands of an aging population will have Medicare, Medicaid fighting for dollars

By Merrill Goozner  |  May 23, 2015

Medicare and Medicaid evolved in dramatically different ways. Medicare, which provided health coverage for seniors, became the third rail of American politics. Medicaid, a state-based program that provided health coverage for the poor, existed in a political netherworld. All that is about to change.

Will Medicare and Medicaid predict ACA's future?

By Harris Meyer  |  May 23, 2015

While politicians debate the future of Medicare and Medicaid, few question that those programs are here to stay. It's easy to forget how controversial the idea of government healthcare programs was for most of the 20th century, and how many decades it took to enact the programs.

Drugmakers funnel payments to high-prescribing doctors

By Bob Herman  |  May 23, 2015

Nearly one-quarter of Medicare's top-prescribing physicians received consulting fees or other financial perks from manufacturers of the drugs they prescribed in 2013, renewing nagging questions about conflicts of interest in medical decisionmaking.

Late News

CMS to release Medicaid managed-care rule

By Virgil Dickson  |  May 23, 2015

The CMS is about to release a sweeping proposed rule that could fuel a major expansion of Medicaid managed long-term care for elderly and disabled beneficiaries.

AHIP's Ignagni moving to head up troubled N.Y. insurer

By Bob Herman  |  May 23, 2015

Karen Ignagni, 61, the longtime head of America's Health Insurance Plans, is leaving the industry's powerful lobbying group to become president and CEO of EmblemHealth, a financially troubled insurer based in New York.

The Week Ahead

Summit to examine physician concerns about bundled payments

By Virgil Dickson  |  May 23, 2015

Providers and policymakers will explore implementation strategies for bundled-payment models and address physician concerns about the CMS' bundled-payment experiments at the Fifth National Bundled Payment Summit in Washington.

Regional News

Report alleges poor care by Illinois prison system

By Michael Sandler  |  May 23, 2015

A report issued last week by court-approved researchers provides a detailed look at medical care in Illinois prisons, outlining delays in treatment, desultory follow-up care and poor record-keeping. The filing claims a host of issues could have cut short the lives of some inmates.

Stanford Health Care adds ValleyCare

By Adam Rubenfire  |  May 23, 2015

Stanford Health Care, Palo Alto, Calif., has completed its merger with ValleyCare Health System, a single-hospital system in Pleasanton, Calif.

CMS signals change in stance over Florida Medicaid waiver

By Virgil Dickson  |  May 23, 2015

The CMS is appearing to blink in its stare-down with Florida over Medicaid expansion. The agency informed state officials last week that it tentatively plans to renew a waiver that has provided Florida billions in supplemental Medicaid funding to help hospitals with uncompensated-care costs.

News

FDA overhaul bill moves ahead after funding deal

By Steven Ross Johnson  |  May 23, 2015

Sweeping legislation to overhaul the nation's drug and device approval process and boost medical research funding raced ahead this past week in the House of Representatives.

ASCO proposes reformed pay model for cancer care

By Sabriya Rice  |  May 23, 2015

Oncologists have proposed a new payment model for cancer care using consolidated billing codes, bundled payments and care-management fees, which they hope will improve quality of care and reduce costs.

CareFirst data hoarding widened breach's impact

By Adam Rubenfire  |  May 23, 2015

The newly announced cyberattack against CareFirst Blue Cross and Blue Shield and the massive earlier hacks at Premera Blue Cross and Anthem would have had a narrower impact if the health insurers hadn't retained customer data for so long, experts say.

Cover Story

Drugmakers funnel payments to high-prescribing doctors

By Bob Herman  |  May 23, 2015

Nearly one-quarter of Medicare's top-prescribing physicians received consulting fees or other financial perks from manufacturers of the drugs they prescribed in 2013, renewing nagging questions about conflicts of interest in medical decisionmaking.

Features

Demands of an aging population will have Medicare, Medicaid fighting for dollars

By Merrill Goozner  |  May 23, 2015

Medicare and Medicaid evolved in dramatically different ways. Medicare, which provided health coverage for seniors, became the third rail of American politics. Medicaid, a state-based program that provided health coverage for the poor, existed in a political netherworld. All that is about to change.

Will Medicare and Medicaid predict ACA's future?

By Harris Meyer  |  May 23, 2015

While politicians debate the future of Medicare and Medicaid, few question that those programs are here to stay. It's easy to forget how controversial the idea of government healthcare programs was for most of the 20th century, and how many decades it took to enact the programs.

Uncapped programs fuel vast expansion of healthcare sector

By Steven Ross Johnson  |  May 23, 2015

Medicare and Medicaid have precipitated the vast expansion—and even the creation—of many profitable industry sectors including hospitals, physician groups, managed-care insurers, home health, drug manufacturers, devicemakers and others.

Medicaid a lifeline for the poor and disabled

By Virgil Dickson  |  May 23, 2015

Before Medicaid was established, low-income Americans had limited access to healthcare, relying heavily on charity care and public hospitals. "To be old and poor and sick was to suffer and to die prematurely,” said Trish Riley of the National Academy for State Health Policy.

Commentary: Defined-contribution model would improve care

By Douglas Holtz-Eakin  |  May 23, 2015

Douglas Holtz-Eakin, president of the American Action Forum and a former Congressional Budget Office director, writes that Medicare and Medicaid have an obligation to provide high-quality care to America's seniors and low-income beneficiaries, and they must be made financially sustainable.

Commentary: Medicare, Medicaid protect us from healthcare risks

By Judy Feder  |  May 23, 2015

Georgetown University professor and former HHS official Judy Feder writes that the 50th anniversary of Medicare and Medicaid enactment calls for a celebration. Medicare provides health insurance protection to virtually all older Americans and many workers who become disabled.

From the publisher: Happy anniversary, Medicare and Medicaid

By Fawn Lopez  |  May 23, 2015

Modern Healthcare has documented every Medicare and Medicaid milestone and challenge since Crain Communications purchased the magazine in 1976. This section commemorates the programs' 50th anniversary by providing some history and an overview of their challenges.

Editorial

The 21st Century Cures Act ignores value

By Merrill Goozner  |  May 23, 2015

As Congress barrels toward passage of the 21st Century Cures Act, it has failed to ask a crucial question: Will it help or harm the nation's drive to derive greater value from its healthcare dollars?

Guest Commentary
Letters

Taking a closer look at hospice, palliative care, and other letters

By Modern Healthcare  |  May 23, 2015

I want to applaud Modern Healthcare for the May 18 cover story on assisted suicide/hospice. It's a great topic, and as a family member of multiple hospice patients and executive director of Pathways Hospice in Ohio, I know that education on this subject is vital.

Best Practices

Curbing healthcare drug theft in Minnesota

By Maureen McKinney  |  May 23, 2015

While there are no exact statistics about the prevalence of drug theft in healthcare facilities, experts agree it is widespread, and a Minnesota coalition can point to progress against the problem.

Q&A

MGMA CEO Fischer-Wright on SGR repeal, ICD-10 and the impact of mergers

By Modern Healthcare  |  May 23, 2015

Dr. Halee Fischer-Wright, president and CEO of the Medical Group Management Association, discusses legislation repealing the sustainable growth-rate formula for physician payment, physician group readiness for ICD-10, and the effect of mergers and acquisitions among medical practices.

By the Numbers

Novartis still biggest drugmaker; Gilead sees huge growth

By Michael Sandler  |  May 23, 2015

A strong sales year for its prescription products and participation in emerging markets enabled Novartis Corp. to maintain its position as the largest pharmaceutical company in 2014. Meanwhile, Actavis saw a 50.5% revenue increase, and Biogen's revenue grew by 40%.

Pharmaceutical companies, 2015

May 23, 2015

A list of the largest publicly traded pharmaceutical companies, ranked by 2014 revenue reported to the U.S. Securities and Exchange Commission and other sources. Source: Modern Healthcare reporting. Published May 25, 2015. p. 50

News Makers

Pat Fry to retire as Sutter CEO

By Modern Healthcare  |  May 23, 2015

Pat Fry, 57, will retire as president and CEO of Sutter Health, Sacramento, Calif., effective Jan. 4.

Data Points

Data Points for May 25, 2015

By Modern Healthcare  |  May 23, 2015

Data Points for the week of May 25, 2015, covered the following topics: Paying physicians based on quality, infections from contaminated duodenoscopes, nursing home quality ratings, TV ads for children for poor quality food

Outliers

Preparing for the end—it's in the cards

By Modern Healthcare  |  May 23, 2015

It's not every day that a doctor at a leading academic medical center recruits strangers to sit in circles and play games about “the end.” So researcher Dr. Lauren Van Scoy had to get used to skepticism.

Miss 'Mad Men'? Why not try Med Men?

By Modern Healthcare  |  May 23, 2015

The Madison Avenue adventures of Don Draper, Peggy Olson and the other denizens of Sterling Cooper & Partners faded to black this month as “Mad Men” ended its heralded seven-season run on AMC.

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