The Health Policy War Room

The Medicare Physician Fee Schedule (MPFS) Conversion Factor has played a significant role in shaping the reimbursement rates for healthcare services provided by physicians under the Medicare program in the United States. The conversion factor is a crucial component of the MPFS, determining the dollar value assigned to the relative value units (RVUs) assigned to each medical service. This factor has undergone several changes over the years in response to evolving healthcare policies and financial considerations. The history of the conversion factor dates back to the implementation of the Resource-Based Relative Value Scale (RBRVS) in 1992. The RBRVS system aimed to standardize physician payments based on the complexity and resource utilization of services provided. Over time, the conversion factor has seen several adjustments such as the creation (and elimination) of the sustainable growth rate formula and the more recent shift to quality payment programs and accountable care. Under cu...

In an ongoing effort to address the healthcare needs of Americans, Senator Bernie Sanders has introduced the Medicare for All 2023 Bill. This proposed legislation aims to transform the United States healthcare system by providing comprehensive healthcare coverage to all residents, regardless of their age, income, or employment status. Versions of Medicare for All have been introduced in some version since at least 2019 and the concept of single payer health reform has been around for decades. This version of the single payer proposal has 15 sponsors including Mr. Sanders, Ms. Warren (no relation), Mr. Booker and others and reportedly has upwards of 112 co-sponsors. While this level of support does not guarantee that the bill survives, it does demonstrate that Congress is taking health reform seriously and is willing to float various ideas designed to reform and improve the healthcare system. Image created by AI via http://www.gencraft.com Let's delve into the key provisions and obj...

Recently, much has been written about the escalating costs of drug prices in the US. Increasing drug prices are present challenges to those who struggle with affordability and access to their medications. The Inflation Reduction Act brought changes to the way the Medicare program reimburses for prescription drugs. Last year, President Biden challenged the Center for Medicare and Medicaid Innovation (CMMI) to develop and test new payment models that can support value-based payments and promote high-quality healthcare. CMMI has recently proposed three models intended to improve affordability and access to drugs as well as measuring the feasibility of implementation.       1. The Medicare High-Value Drug List Model Under this model, Part D plans would be encouraged to offer a low, fixed co-payment across all cost-sharing phases of the Part D drug benefit for a standardized Medicare list of generic drugs that treat chronic conditions. Patients picking plans that particip...

The Centers for Medicare & Medicaid Services (CMS) recently issued an update on its hospital price transparency enforcement efforts. This update is part of the agency's larger goal to increase transparency and empower consumers to make informed healthcare decisions. Under the new rule, hospitals that fail to comply with the transparency requirements will face penalties of up to $300 per day, and the CMS will also publicly disclose the names of non-compliant hospitals. This move is a significant step towards holding hospitals accountable for providing accurate and easily accessible pricing information to their patients. The CMS's update is a much-needed move towards transparency in the healthcare industry. It's no secret that medical bills are often complicated and difficult to understand, leaving many patients feeling helpless and vulnerable. By mandating that hospitals provide clear pricing information, patients will have the tools they need to make informed decisions ...