Wyden’s on to something

Sen. Ron Wyden (D OR) has come up with a plan for health care that just might work. Wyden’s plan requires all Americans to purchase health insurance, prohibits medical underwriting, replaces Medicaid with private insurance, and funds the program by a combination of employer contributions, individual payments, and recaptured funds from the mishmash of programs that attempt to address cost-shifting and indigent care.
Those folks making less than the poverty level will not pay anything for their coverage, with graduated subsidies for those making from 1x the poverty level to 4x. There’s a lot more detail to the plan, which you can peruse at your leisure at Wyden’s site.

Continue reading Wyden’s on to something


HWR 22 is up!

A well-done and tip of the cup, er, cap to Rita Schwab of MSSP Nexus. Rita has done and exemplary job hosting the latest edition of Health Wonk Review, wherein the best of the biweekly blogosphere are brung to you.


AWP suits – what, if any impact?

The pharma industry is still in a bit of a tizzy about the lawsuits alleging improprieties in pricing, with some saying there will be wholesale changes (pun intended) while others ho-hum the notion. But, as more information comes out regarding the McKesson – First DataBank suits, there appears to be more to the notion that changes are in the wind.
This is not just an item of passing interest; the plaintiffs in the suit alleged that these pricing practices have cost payers upwards of $6 billion over a three-year period.

Continue reading AWP suits – what, if any impact?


Third party billers on the block

Third party billers WorkingRx and Third Party Solutions may be for sale. The two pharmacy factoring companies together own the work comp script factoring business, a sector that has been under some pressure lately. According to several industry sources, the owners of both entities (Fiserv for TPS and investment firm Arcapita for WorkingRx) have engaged investment bankers to shop their respective companies.

Continue reading Third party billers on the block


Medicare reimbursement’s downstream impact

In what will come as no surprise to anyone, Congress will eliminate the pending cut in Medicare physician reimbursement. Not only that, but docs who agree to report certain data to CMS will actually get a 1.5% increase in reimbursement from the Feds.
If you listen very closely, you can almost hear the medical community’s resounding “yippee”.
The reasons docs are not exactly ecstatic about the news are two-fold.

Continue reading Medicare reimbursement’s downstream impact


Patients should know which providers are cheaper

Next year, CIGNA will be (financially) encouraging members to go to more cost efficient providers. The mid-tier health plan has announced that it will be charging members less if they go to lower cost physicians.
CIGNA’s not alone. Aetna’s been a leader in disclosing cost data. Other health plans, partially motivated by a mandate from the Federal Employee Health Benefit Program to publish cost data, more and more health plans are dipping their corporate toes in the water.

Continue reading Patients should know which providers are cheaper