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Standards ensuring that consumers have access to sufficient networks of health care professionals on federally operated health insurance exchanges need to be tightened, the American Medical Association wrote in a March 15 letter to the Obama administration.
In his correspondence to acting Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner, AMA Executive Vice President and CEO James L. Madara, MD, specified what information qualified health plans on these marketplaces should be providing. Insurance regulators and consumers need to be able to make informed decisions on whether a plan’s network has an adequate supply of primary care and specialty physicians, he stated.
Dr. Madara was responding to guidance CMS issued March 1 to insurance companies that will be offering qualified health plans in federally facilitated or partnership health insurance exchanges. These are the companies CMS will be working with, as both the federal and partnership models involve a ...
Mental health professionals and other participants at a recent congressional forum said a dearth of trained physicians and the presence of too many regulatory barriers are some of the main factors preventing severely mentally ill children from getting the medical help they need.
The March 5 bipartisan forum was convened by Rep. Tim Murphy (R, Pa.), who chairs the House Energy and Commerce oversight and investigations subcommittee, to discuss what federal resources might be needed to prevent another incident such as the mass killings at Sandy Hook Elementary School in Newtown, Conn. The forum focused on severely mentally ill individuals who could be prone to violence but who often don’t receive the timely treatments available to those with other medical emergencies.
“Why do we treat the head differently from the rest of the body?” asked Pete Earley, an author and the parent of a son with mental illness, during the forum. These disparities often mean that mentally ill patient ...
Instituting a geographically based value index in Medicare that would change payment rates for physicians and other health professionals based on how much program spending is incurred by different regions could lead to serious adverse effects on the system, according to preliminary research by the Institute of Medicine.
In 2009, Congress requested that the IOM investigate evidence of wide disparities in Medicare spending among different regions of the U.S. that appear to have little correlation to patients’ health outcomes — evidence that many experts say indicates wasteful program spending in some parts of the country. Lawmakers asked the IOM specifically to consider whether adopting a regional value index, which would alter pay rates based on a given region’s composite cost and quality measures, could help encourage higher-value care.
In an interim report released by an IOM committee on March 25, the research organization said making such regional pay adjustments would no ...