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Medicare pay: Insurers preview a post-SGR world
A frustratingly familiar solution to the latest Medicare sustainable growth rate cut was signed into law after the new year with another pay patch enacted by Congress. The relief physicians felt at not sustaining a major cut — in this case 26.5% — was tempered by the knowledge that the next major reduction threatens to strike when the temporary measure expires. Medicare’s physician payment system continues to be panned universally by lawmakers, health economists, physicians, hospitals and insurers who would prefer a more stable, innovative system. But cost issues and a variety of other factors have stymied meaningful pay reform for the government-run entitlement program. For lawmakers, it was easier to pass the $25 billion stopgap measure at the last minute than to approve a package 10 times as costly — one that repeals the SGR and moves the Medicare pay system to one that rewards quality and efficiency. Still, physicians and insurers are not waiting for Medicare to chang [Read more]
States using health IT to boost Medicaid sign-ups
Parents and adults without children continue to face difficulties in getting signed up for Medicaid despite otherwise successful state efforts to use health information technology tools and simplify enrollment procedures, according to a 50-state survey released Jan. 23 by the Kaiser Commission on Medicaid and the Uninsured. States are facing important changes to their programs before the Affordable Care Act’s Medicaid expansion starting in 2014, said Diane Rowland, the commission’s executive director. She’s also the executive vice president of the Kaiser Family Foundation. Many states are weighing their options on expanding their programs up to an effective rate of 138% of poverty, but at least 20 plan to do so, Rowland said during a Washington briefing to discuss the survey’s findings. The survey demonstrates that many states already have taken innovative steps to modernize their programs and improve access before 2014, Rowland said. A majority of states provide online a [Read more]
Will deferred care follow rise in Medicaid co-pays?
A federal proposal that would allow states to increase certain co-pays for Medicaid patients seeks to encourage the more prudent use of costly services such as emergency department care, but some health care professionals believe the measure could lead to more access problems for beneficiaries. On Jan. 14, the Centers for Medicare & Medicaid Services issued a proposed rule that included a provision to simplify and update Medicaid premium and cost-sharing policies. Maximum co-payment amounts can vary based on what states pay for services and on income levels. In the interest of streamlining the system for the states, CMS is proposing an overall flat maximum rate of $4 for outpatient services for those under 100% of poverty, as well as higher cost sharing for certain services: an $8 maximum for using non-preferred drugs and for non-emergency use of the emergency department for individuals at or below 150% of poverty. Cost sharing isn’t a new idea for Medicaid — nominal fees for [Read more]
WellPoint expands telemedicine opportunities for doctors
WellPoint is offering some physicians the chance to be paid, without having to submit claims, for evaluations when on call. Software provided by the health plan would allow them to see patients on online video. The program, made available through a website called LiveHealth Online, is an extension of a previously announced plan that would allow WellPoint members to have online video consultations with any physician in their state who is contracted by the health insurer. The company said the program would be launched in California and Ohio over the first half of 2013 and would be expanded to other states later. Physicians would be hooked up to the system for free, and would be paid an unspecified fee for each visit. But they would be required to pay an undisclosed licensing fee to do online video consults with established patients. WellPoint would pay doctors for each consult, with the claim automatically generated through LiveHealth Online. The patient fee would be based on an [Read more]
ACA multistate plans must not fly under regulatory radar, AMA says
To protect physicians and patients, multi-state plans offered on upcoming health insurance exchanges should be held to the same regulatory standards as other private insurance offerings, the American Medical Association wrote in a Jan. 4 comment letter to the U.S. Office of Personnel Management. The Multi-State Plan program was established by the Affordable Care Act to promote competition and encourage the availability of high-quality, affordable products in the insurance exchange marketplaces. At least two multi-state plans, one of which should be from a nonprofit insurer, must be offered on the exchanges starting in 2014. Such plans would be able to offer insurance to small businesses that operate in — or families that reside in — more than one state. In November 2012, the Office of Personnel Management issued a proposed rule establishing standards for these multi-state plans and sought public comment from stakeholders. In the AMA’s letter, Executive Vice President and [Read more]
IOM stresses: Vaccine schedule for children is safe
A new Institute of Medicine report confirms what many primary care physicians have been telling parents for years — it’s safe to follow the recommended childhood immunization schedule. Under the schedule, children receive as many as 24 vaccines by their second birthday and get up to five injections during a single doctor’s visit, the IOM said. The immunizations are timed to protect children from 14 pathogens by inoculating them at a point in their lives when they are most vulnerable to disease, according to the IOM. But some parents worry that administering the immunizations in such a short period could cause negative health effects in their children. The IOM report, issued Jan. 16, said there is no evidence that the schedule, recommended by the Centers for Disease Control and Prevention, is unsafe. “The evidence repeatedly points to the health benefits of the recommended schedule, including protecting children and communities from serious and life-threatening disea [Read more]
Death certificates present final medical complication
Death certificates are vital documents that serve as the primary source of information for families, insurance companies and authorities about a patient’s cause of death. The information also helps policymakers set public health goals and research funding priorities. But signing a death certificate is not always a straightforward process. Physicians often face uncertainties about an individual’s cause of death or how to answer the portions of certificates they are responsible for. Although the basic format has changed little in the last few decades, doctors face difficulties as some states attempt to convert from paper to electronic certificates. Doctors need to recognize the importance of the documents and be as specific as possible, said Gregory McDonald, DO, chief deputy coroner of Montgomery County in Pennsylvania. Information on death certificates is reported to the CDC and used in compiling national mortality data. “Their duty doesn’t end when the patient die [Read more]
Unresolved liability suits cast long shadow over physicians
The average physician spends nearly 11% of his or her career with an unresolved medical liability claim, says a study in the January Health Affairs. Speciality plays a significant role in how long a claim remains open, according to the study, which examined claims data for about 40,000 physicians covered by an unidentified national insurer. Neurosurgeons spent 27% of their careers with an open claim — the longest of the specialties studied. Psychiatrists had the shortest span — 3% of their careers with an unresolved claim. Internists had an open claim for 10% of their career, while family/general physicians had one for 8%. A doctor’s average career is 40 years. The findings are unfortunate, considering that the majority of medical liability claims end in favor of physicians, said Richard E. Anderson, MD, chair and CEO of The Doctors Company, a physician-owned liability insurer in Napa, Calif. “It is a national disgrace that physicians must bear the enormous cost [Read more]
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