Medicare and billing

Physicians writing on KevinMD about Medicare payment, the relative value unit system that sets it, coverage and authorization rules, and what the program pays for time and thinking against procedures. Three maintained records draw on this archive: Primary care: what physicians say, in their own words, Prior authorization: what physicians say, in their own words, and Direct primary care: what physicians say, in their own words.

March 4, 2010Mar 4, 2010

Originally published in MedPage Today by John Gever, MedPage Today Senior Editor Many hospitals that spend relatively little per patient deliver good-quality care, researchers said. Medicare data indicated that hospitals in the highest quartile of per-patient cost for initial treatment…

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Many hospitals that spend relatively little per patient deliver good-quality care, researchers said.

Medicare data indicated that hospitals in the highest quartile of per-patient cost for initial treatment of pneumonia or congestive heart failure (CHF) did not have markedly lower readmission or risk-adjusted mortality rates than hospitals in the lowest …

Policy

Medicare slashes pay to doctors, and what that really means

Wes Fisher, MD

March 1, 2010Mar 1, 2010

What we're learning from the 21% Medicare pay cut to physicians that occurred today: * There really must be a cost-control crisis with Medicare and the only politically-acceptable way to implement those cost controls are by cutting working physicians' payments.…

What we’re learning from the 21% Medicare pay cut to physicians that occurred today:

* There really must be a cost-control crisis with Medicare and the only politically-acceptable way to implement those cost controls are by cutting working physicians’ payments.

* There’s was widespread political support for blocking the scheduled pay cuts to doctors, but central government control moves very slowly. That’s because doing so is expensive. For now, doctors have been …

Policy

Medicare cuts will strengthen doctors’ negotiating position

Richard Reece, MD

March 1, 2010Mar 1, 2010

Doctors will soon be wagging the reform dog. Look at it this way. Expansion of insurance coverage to the 31 million more Americans, as envisioned in the current reform bill, will require more doctors to care for them. The starting…

Doctors will soon be wagging the reform dog.

Look at it this way. Expansion of insurance coverage to the 31 million more Americans, as envisioned in the current reform bill, will require more doctors to care for them. The starting entry of 78 million baby boomers in the Medicare pool, starting in 2011, will also take more doctors.

As everybody knows, coverage does not equal access. This is most vividly illustrated in …

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Policy

Never events in hospitals depend on patient risk

MedPage Today

February 25, 2010Feb 25, 2010

Originally published in MedPage Today by John Gever, MedPage Today Senior Editor Occurrence of some so-called "never events" in hospitals may depend partly on unmodifiable risk factors such as patient characteristics, undermining the rationale for denying Medicare payment for their…

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Occurrence of some so-called “never events” in hospitals may depend partly on unmodifiable risk factors such as patient characteristics, undermining the rationale for denying Medicare payment for their treatment, researchers said.

Analysis of some 890,000 surgeries performed in 1,368 hospitals showed that patient age and pre-existing conditions such as weight …

Policy

AMA: Why patients should care about fixing the Medicare physician payment cut

American Medical Association & J. James Rohack, MD

February 11, 2010Feb 11, 2010

The following is part of a series of original guest columns by the American Medical Association. by J. James Rohack, MD Prominently displayed at the top of the AMA’s Web site this week is a “countdown clock” to this year’s…

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, MD

Prominently displayed at the top of the AMA’s Web site this week is a “countdown clock” to this year’s 21 percent Medicare physician payment cut, which will hurt physicians ability to care for all Medicare and …

Policy

Increasing copays will increase costs for health insurance companies in the long run

MedPage Today

February 9, 2010Feb 9, 2010

Originally published in MedPage Today by Todd Neale, MedPage Today Staff Writer Raising seniors' copayments for ambulatory care to offset increasing healthcare costs may backfire on insurers, researchers asserted. Seniors enrolled in Medicare plans that increased copayments had significantly fewer…

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Raising seniors’ copayments for ambulatory care to offset increasing healthcare costs may backfire on insurers, researchers asserted.

Seniors enrolled in Medicare plans that increased copayments had significantly fewer outpatient visits but spent more time in the hospital than patients in plans that left copayments untouched, according to Amal Trivedi, MD, …

Policy

Why the Mayo Clinic is refusing to see Medicare patients

Toni Brayer, MD

January 25, 2010Jan 25, 2010

Medicare, the government insurance company for everyone over age 65 (and for the disabled), pays fees to primary care physicians that guarantee bankruptcy. Additionally, 70 percent of hospitals in the United States lose money on Medicare patients. That's right, for…

Medicare, the government insurance company for everyone over age 65 (and for the disabled), pays fees to primary care physicians that guarantee bankruptcy.

Additionally, 70 percent of hospitals in the United States lose money on Medicare patients. That’s right, for every patient over age 65, it costs the hospital more to deliver care than the government reimburses. That is why Mayo Clinic has said it will not accept Medicare payments for …

Policy

The history of Medicare and its influence on American health care

MedPage Today

January 13, 2010Jan 13, 2010

Originally published on MedPage Today by Emily P. Walker, MedPage Today Washington Correspondent As Congress stands poised to make the most sweeping change to the U.S. healthcare system since the creation of Medicare, a look back at the incremental growth…

Originally published on MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

As Congress stands poised to make the most sweeping change to the U.S. healthcare system since the creation of Medicare, a look back at the incremental growth in that program may serve as a harbinger for the progress of healthcare reform.

The program — which provides insurance for some 43 million …

Policy

The American College of Cardiology (ACC) sues Medicare over physician rate cuts

MedPage Today

January 11, 2010Jan 11, 2010

Originally published in MedPage Today by Kristina Fiore, MedPage Today Staff Writer The American College of Cardiology (ACC) has filed suit against U.S. Department of Health and Human Services Secretary Kathleen Sebelius charging that the 2010 Medicare Physician Fee Schedule…

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

The American College of Cardiology (ACC) has filed suit against U.S. Department of Health and Human Services Secretary Kathleen Sebelius charging that the 2010 Medicare Physician Fee Schedule was adopted unlawfully.

The complaint seeks an injunction that will prevent the cuts — which the association claims used a flawed survey for …

Physicians

How a psychiatrist can write 100,000 prescriptions a year, and what that means for primary care

Matthew Mintz, MD

January 8, 2010Jan 8, 2010

The Miami Herald is reporting an investigation of a psychiatrist who wrote almost 100,000 prescriptions a year. Sen. Grassley and the feds have halted payment to this Miami psychiatrist who stated that "he prescribes only what is medically necessary" and…

The Miami Herald is reporting an investigation of a psychiatrist who wrote almost 100,000 prescriptions a year. Sen. Grassley and the feds have halted payment to this Miami psychiatrist who stated that “he prescribes only what is medically necessary” and “works long hours, seeing patients for 10 minutes at a time and many of his patients need four or five medications.”

I have no personal knowledge, interaction, acquaintance with psychiatrist Dr. …

Policy

Will physician and hospital penalties improve patient care?

Alan Berkenwald, MD

January 5, 2010Jan 5, 2010

Originally published in HCPLive.com by Alan Berkenwald, MD In 1904, the Scottish author Sir James Matthew Barrie sent Peter Pan off to Never-Never Land to escape growing up and to enjoy many-many adventures. As children, we all hoped it really…

Originally published in HCPLive.com

by Alan Berkenwald, MD

In 1904, the Scottish author Sir James Matthew Barrie sent Peter Pan off to Never-Never Land to escape growing up and to enjoy many-many adventures. As children, we all hoped it really existed. In truth, many of us fantasized, one day, to make the trip ourselves.

Well, good news for physicians – that day has arrived!

…

Policy

The limits of using Medicare patient data for quality outcomes

MedPage Today

December 16, 2009Dec 16, 2009

Originally published in MedPage Today by Todd Neale, MedPage Today Staff Writer Most primary care physicians don't see enough Medicare patients to determine statistically significant differences in cost and performance between practices, researchers found. In fact, nearly two-thirds (65.7%) of…

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Most primary care physicians don’t see enough Medicare patients to determine statistically significant differences in cost and performance between practices, researchers found.

In fact, nearly two-thirds (65.7%) of primary care doctors worked in practices that saw too few Medicare patients to provide reliable comparisons with national benchmarks for cost and …

Policy

AMA weighs in on the Senate health reform bill

American Medical Association & J. James Rohack, MD

December 15, 2009Dec 15, 2009

The following is part of a series of original guest columns by the American Medical Association. by J. James Rohack, M.D. As the year winds down, health system reform continues to move forward. The Senate bill currently under debate includes…

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

As the year winds down, health system reform continues to move forward. The Senate bill currently under debate includes a number of provisions that are consistent with the AMA’s reform priorities, some provisions we oppose and others that need to be improved to better benefit patients and physicians. As part …

Conditions

Why health reformers should be worried about the breast cancer screening backlash

Kevin

November 19, 2009Nov 19, 2009

What if a non-partisan, authoritative entity wrote a robust, evidence-based guideline, but nobody followed it? That is precisely what's happening with the USPSTF's recent revision of their breast cancer screening recommendations. The change most find problematic is their recommendation that…

What if a non-partisan, authoritative entity wrote a robust, evidence-based guideline, but nobody followed it?

That is precisely what’s happening with the USPSTF’s recent revision of their breast cancer screening recommendations. The change most find problematic is their recommendation that women younger than 50 not undergo any breast cancer screening, such as with a mammogram.

Here are their reasons explaining why:

The harms resulting from screening for breast cancer include psychological harms,

…

Policy

AMA: Permanent repeal of the Medicare physician payment formula must be part of health reform

American Medical Association & J. James Rohack, MD

October 8, 2009Oct 8, 2009

The following is part of a series of original guest columns by the American Medical Association. by J. James Rohack, M.D. All eyes are on the Senate Finance Committee this week as they prepare to vote to move health reform…

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

All eyes are on the Senate Finance Committee this week as they prepare to vote to move health reform legislation forward. The AMA is committed to health reform, and as the process moves to the Senate floor, it’s crucial that the Senate include permanent repeal of the current Medicare …

Policy

Health Care Reform: Putting Patients First, medical bloggers at Washington, DC

Kevin Pho, MD

July 20, 2009Jul 20, 2009

Well, that was fun. This past Friday, I participated in Health Care Reform: Putting Patients First, an event put together by Better Health's Dr. Val Jones. It was an impeccably organized gathering, and provided medical bloggers a valuable opportunity to…

Well, that was fun.

This past Friday, I participated in Health Care Reform: Putting Patients First, an event put together by Better Health’s Dr. Val Jones. It was an impeccably organized gathering, and provided medical bloggers a valuable opportunity to discuss health care reform. Great timing too, given the fact that two major reform bills were introduced earlier …

Policy

Can the American Medical Association still be an influential voice in health reform?

Kevin

June 29, 2009Jun 29, 2009

The repercussions after Obama's speech to the AMA's delegates continue to be felt. Not least of which are the murmurings of the other professional physician groups, who say that the AMA does not represent a majority of physicians. In this…

The repercussions after Obama’s speech to the AMA’s delegates continue to be felt.

Not least of which are the murmurings of the other professional physician groups, who say that the AMA does not represent a majority of physicians. In this piece from pediatrician Rahul Parikh, he notes that about 30 percent of physicians are AMA members. Remaining doctors belong to groups with more liberal political leanings, including the American …

Policy

Reflections from the AMA: President Obama’s Speech

American Medical Association & J. James Rohack, MD

June 21, 2009Jun 21, 2009

The following is part of a series of original guest columns by the American Medical Association. by J. James Rohack, M.D. We have a historic opportunity for health reform this year and the AMA was delighted to welcome President Obama…

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

We have a historic opportunity for health reform this year and the AMA was delighted to welcome President Obama to our Annual Meeting in Chicago earlier this week. Like the President, we are committed to health-care reform that will provide all Americans with affordable, high-quality health coverage.

I was personally honored …

Policy

My reaction to President Obama’s speech to the AMA

Kevin Pho, MD

June 15, 2009Jun 15, 2009

I was seeing patients during the actual speech, so I had to rely on the transcript. The points that interested me the most were any language pertaining to malpractice, addressing the AMA's recent concerns about the public plan option, and…

I was seeing patients during the actual speech, so I had to rely on the transcript.

The points that interested me the most were any language pertaining to malpractice, addressing the AMA’s recent concerns about the public plan option, and reforming the physician payment system.

I think he did pretty well.

Regarding the physician payment system, he again addressed McAllen, Texas, which is fast becoming the symbol of what’s wrong with American …

Tech

AMA: Health information technology help for physicians

American Medical Association & Joseph M. Heyman, MD

June 11, 2009Jun 11, 2009

The following is part of a series of original guest columns by the American Medical Association. by Joseph M. Heyman, M.D. Health information technology (HIT) remains a hot button issue for many physicians, and opinions run the gamut. There are…

The following is part of a series of original guest columns by the American Medical Association.

by Joseph M. Heyman, M.D.

Health information technology (HIT) remains a hot button issue for many physicians, and opinions run the gamut. There are physicians and practice managers who are satisfied long-time users and those who question how HIT will benefit their practice and their patients.

My own experience is that of a solo-practitioner using HIT …

Medicare and billing

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