DOTmed Home MRI Oncology Ultrasound Molecular Imaging X-Ray Cardiology Health IT Business Affairs
News Home Parts & Service Operating Room CT Women's Health Proton Therapy Endoscopy HTMs Mobile Imaging
Current Location:
> This Story

Log in or Register to rate this News Story
Forward Printable StoryPrint Comment




Alzheimers/Neurology Homepage

Opening blood brain barrier, focused ultrasound is closing therapy gap Insights from the 6th International Symposium on Focused Ultrasound

Stryker inks two partnerships for enhanced surgical guidance Offering whole-brain tractography and detail-rich imaging

NuVasive to offer intraoperative neuromonitoring services to Premier clientele Reduces surgical risk for full range of procedures

FDA okays Insightec's MR-guided focused ultrasound with Siemens scanners Using Exablate Neuro for treating essential tremor

Cerveau Technologies partners with Ionis Pharmaceuticals Use of PET agent, [F-18]MK-6240

Professor Moshe Gomori Aspect Imaging announces new company board member

Study: AI detects neurological issues on CT scans in under two seconds 150 times shorter than average reading time of a physician

MaxQ-AI seeks $8 million public IPO listing on Nasdaq Will help FDA regulatory processes for Accipio software products

Study finds not all contact sport pro athletes at higher risk of CTE Comparing retired NFL and NHL players to non-contact sport athletes

Cerveau Technologies to expand production network for research on novel tau imaging agent Understanding Alzheimer's with [18F]MK-6240

CMS underpayments for sickest patients put at $2.6 billion annually: study

by John W. Mitchell , Senior Correspondent
Insurance plan managers who think they are not being paid enough to cover the costs of patients with multiple, chronic and high-cost conditions may be on to something. A recent analysis by Avalere Health concluded that CMS under-predicts the costs for such patients.

“I don’t think it is their (CMS) intent to underpay,” Tom Kornfield, vice president at Avalere told HCB News. “But Medicare Advantage plans have been expressing concern for some time that the payment model does not accurately reimburse for the care of patients with multiple and/or high cost diseases.”

Story Continues Below Advertisement


Special-Pricing Available on Medical Displays, Patient Monitors, Recorders, Printers, Media, Ultrasound Machines, and Cameras.This includes Top Brands such as SONY, BARCO, NDS, NEC, LG, EDAN, EIZO, ELO, FSN, PANASONIC, MITSUBISHI, OLYMPUS, & WIDE.

Overall, the underpayments for all multiple chronic conditions amounted to 3.3 percent, or about $2.6 billion a year, and the study found wide variances depending upon the conditions that were considered.

For example, the research found providers were paid about 15.3 percent less than expected for rheumatoid arthritis patients and 4 percent less than expected for chronic kidney disease patients.

The study also concluded that CMS under-predicted costs for patients within the 55 chronic conditions with the “largest disease burden” — or most expensive cases. For example, annual payments for Alzheimer’s disease and related senile dementia patients were underpaid 73.4 percent a year ($85,815), while care for Hepatitis C patients were underpaid by 71.6 percent ($103,897) annually.

According to Kornfield, who used to work at CMS, the CMS model relies on a risk-adjustment, regression analysis calculation that creates the underpayment. He said the model was last updated in 2014, with new revisions due for “dual eligible” (Medicare and Medicaid) in 2017.

“While CMS is considering changes to the risk model to address underpayments for low-income beneficiaries, the agency may also want to conduct research on methods to address underpayments for individuals with chronic conditions,” said Kornfield.

Alzheimers/Neurology Homepage

You Must Be Logged In To Post A Comment

Increase Your
Brand Awareness
Auctions + Private Sales
Get The
Best Price
Buy Equipment/Parts
Find The
Lowest Price
Daily News
Read The
Latest News
Browse All
DOTmed Users
Ethics on DOTmed
View Our
Ethics Program
Gold Parts Vendor Program
Receive PH
Gold Service Dealer Program
Receive RFP/PS
Healthcare Providers
See all
HCP Tools
A Job
Parts Hunter +EasyPay
Get Parts
Recently Certified
View Recently
Certified Users
Recently Rated
View Recently
Certified Users
Rental Central
Rent Equipment
For Less
Sell Equipment/Parts
Get The
Most Money
Service Technicians Forum
Find Help
And Advice
Simple RFP
Get Equipment
Virtual Trade Show
Find Service
For Equipment
Access and use of this site is subject to the terms and conditions of our LEGAL NOTICE & PRIVACY NOTICE
Property of and Proprietary to, Inc. Copyright ©2001-2018, Inc.