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Healthcare Economics & Policy


In its fourth annual update on medical overuse, JAMA Internal Medicine names 10 procedures and practices that are ripe for the curtailing. In the category of “overtesting,” the klieg lights fall on four exams—and all are based in imaging.

Anthem’s recent decision to no longer pay for outpatient CT and MR exams performed in hospitals didn’t come from nowhere—and, going forward, the move is not likely to be an outlier among private payers’ business stratagems.

In Harris County, Texas, three outpatient family-medicine affiliates of Baylor College of Medicine have slashed their unnecessary orders of lumbar-spine MRIs—and improved the appropriateness ratings of those they did order—by attending educational sessions and using the American College of Radiology’s R-SCAN program.

Offering first-year medical students an elective introduction to interventional radiology (IR), researchers at the University of Pennsylvania and its Perelman School of Medicine have found considerable receptivity to the learning opportunity and heightened interest in the specialty.

It’s no secret that radiology ranks among the medical specialties with the highest mean markups on list prices. However, a new review of Medicare data on prices listed and payments made shows that, far from being arbitrarily set—as is often assumed if not alleged—many of radiology’s highest prices reflect real-world, case-by-case factors involving heightened risk, greater clinical complexity and increased need for subspecialized expertise.


Recent Headlines

Supreme Court upholds ACA subsidies nationwide

The U.S. Supreme Court ruled on Thursday that the subsidies offered as part of the Affordable Care Act (ACA) will be available nationwide, regardless of whether they are used to buy health insurance on an exchange established by the federal government or an individual state.

Medical device tax's days may be numbered

Despite a veto threat from the White House, the U.S. Senate is preparing to fast track a bill to kill the 2.3 percent medical device tax that was instituted as part of the Affordable Care Act (ACA).

Funding bill would provide boost to NIH, terminate AHRQ

A House subcommittee has approved a draft fiscal year 2016 Labor, Health and Human Services funding bill that would increase funding for the National Institutes of Health (NIH) by $1.1 billion, but also puts the Agency for Healthcare Research and Quality (AHRQ) on the chopping block.

Waiting is the hardest part

We find ourselves in the familiar position of waiting on a major decision from Washington, D.C., that could have major implications on U.S. healthcare. Unlike the debates in the legislature earlier this year to settle the “doc fix” saga, this time we are waiting on the judicial branch to decide the future of the Affordable Care Act.

2014 AHRQ Report: Making strides in access, coverage

The latest installment of the National Healthcare Quality and Disparities Report, a report sent to Congress on an annual basis as mandated by the American Healthcare Research and Quality Act (AHRQ), paints an optimistic picture of progress while acknowledging that efforts to reduce disparities must continue.

Newly introduced bill looks to establish ICD-10 grace period

After a series of delays, it looks like the U.S. healthcare system will finally upgrade to the ICD-10 coding standard on Oct. 1. While there’s no political will to push back the rollout any further, a new bill introduced in the U.S. House looks to implement a transition period that would protect reimbursements when inaccurate codes are submitted.

MEDNAX to acquire vRad in $500M deal

National radiology services and telemedicine provider vRad has announced it has entered into a definitive agreement to be acquired by MEDNAX, a provider of maternal-fetal, newborn, pediatric subspecialty and anesthesia physician services.

The SGR is history. Now what?

Right up until the Senate officially sealed the fate of Medicare’s flawed sustainable growth rate (SGR) with a 92-8 vote late Tuesday night, it was easy to see how it all might unravel. The Senate had already pushed the vote back as far as possible due to a two-week recess, concerns about the repeal bill’s cost were becoming more vocal, and six amendments were to be voted on before the final SGR repeal vote

Senate passes SGR repeal

It came down to the wire, but late Tuesday night the Senate passed a bill that would repeal the Medicare sustainable growth rate (SGR) formula by a vote of 92-8. The historic vote sent the bill to President Obama and will finally end a series of temporary fixes that annually threatened physician payments.

CMS actuary questions long-term impact of SGR repeal bill

When a bill to permanently repeal and replace the Medicare sustainable growth rate (SGR) easily passed the U.S. House late last month, it seemed like legislators were closer than ever to fixing the yearly threat to physician pay. As another deadline looms for the Senate, however, a report from the Centers for Medicare & Medicaid Services’ (CMS’) Office of the Actuary is pointing out the limits of the bill.