The discussion about universal access to affordable healthcare usually stops at Medicare for All. Most Americans don’t realize that there are many different approaches to achieve that goal, and Medicare for All is only one. So this week, let’s look at the two countries with the best health outcomes...
Medicare open enrollment starts tomorrow. Between now and December 7, your mailbox, your TV, and probably your phone are going to fill up with cheerful people telling you about $0-premium plans with dental, vision, gym memberships, and grocery cards. Most of those ads are for Medicare Advantage. And for...
There is no question that the United States pays more for prescription drugs than any other country on Earth. The question is, why?The answer is a set of deliberate policy choices, made over decades, that together built a market where high prices are the predictable outcome rather than an...
This week’s edition isn’t a payment rate or a billing code — it’s a proposed change to how federal research dollars get awarded in the first place, and it has the research community paying close attention. Here’s what’s on the table, and what it could mean. On May 29,...
This week the Paragon Health Institute handed the administration a number it has been waiting for. Its report, “The Persistent Obamacare Enrollment Fraud,” estimates 6.2 million improper enrollees in 2026 at a cost of roughly $25 billion in improper subsidies. That 6.2 million figure represents nearly 27% of all...
THE HEARING On April 28, the chief executives of four of the nation’s largest hospital systems sat in front of the House Ways and Means Committee and tried to explain why care in America costs what it costs. Sam Hazen of HCA Healthcare. Brian Donley of New York Presbyterian....
What “site of service” means “Site of service” is simply where an outpatient procedure happens. The two settings that matter most in this discussion are: • Ambulatory surgery center (ASC): A facility built specifically for same-day procedures. • Hospital outpatient department (HOPD): An outpatient unit owned by and billed...
THE BILL On May 12, the Congressional Research Service released its first formal overview of a Medicare experiment that has been quietly underway since New Year’s Day. It is called the Wasteful and Inappropriate Service Reduction Model, or WISeR for short, and it represents the largest expansion of prior...
Value-based purchasing (VBP) is a payment approach that ties reimbursement to the quality of care delivered rather than simply the volume of services provided. Think about how the traditional fee-for-service model works. A provider gets paid for every test, procedure, and visit, regardless of whether the patient got better,...
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