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Fla. Medicaid reform pilot: More efficiency or less care?

New evaluations of Florida's Medicaid reform program found that it reduced or held spending in check during its first two years. But it's not clear if the program improved efficiency or simply reduced the amount of care provided. Florida is in the middle of a five-year Medicaid pilot project designed to encourage enrollees to take a more active role in their health care and to achieve more predictable cost increases. Qualifying enrollees in five counties are offered a choice of health plans with varying benefits. These plans include HMOs and provider service networks, which are owned by physicians and hospitals. More than 200,000 people had enrolled in pilot plans as of June 1. A series of evaluations have criticized the implementation and structure of the Medicaid pilot. In June, the Florida Office of Program Policy Analysis & Government Accountability -- the Legislature's watchdog agency -- advised lawmakers not to expand the pilot until data demonstrate that it has improved bo ...

Practices see slow progress in instant claims adjudication

Real-time adjudication, which allows a claim to be submitted to an insurer and settled before a patient leaves the office, seems like something physicians, patients and insurers can support. Physicians who use it can shorten the revenue cycle and reduce bad debt. Patients like it because they don't get a surprise bill weeks after receiving care. Even insurers like it, because administrative costs of billing and handling inquiries about claims are reduced. But real-time claims adjudication has barely made an impact. By at least one insurer's reading, fewer than 2% of claims are settled this way. While real-time claims adjudication sounds simple, implementing it can be complicated and can require a physician's office to change how it handles billing and collections. Those submitting claims for real-time adjudication find that in almost half the cases, the claim cannot be processed immediately and is handled later by the insurer. Although this might not require additional work ...

Consumer group that wanted Medicare data launches physician ratings site

The same group that unsuccessfully sued the government for access to raw Medicare claims data for individual physicians has launched a patient ratings site that grades individual physicians and uses methodology that the group's president says he hopes will set physicians' minds at ease. Consumers' Checkbook, a Washington, D.C.-based organization that also rates things like auto repair shops, electricians and movers, in July launched physician ratings for Denver; Memphis, Tenn.; and Kansas City, Mo. Consumers' Checkbook President Robert Krughoff said the effort to see Medicare claims data was totally unrelated to developing the new ratings, and he said the group was interested in offering a ratings site that patients and doctors could trust. "My great hope in this is that doctors will appreciate the rigor of this survey and take this survey seriously," he said. Physicians' scores are based on surveys of patients who have seen the physician in question within the last year, a ...