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Increase in 2012 Medicare premiums will be less than expected
Washington -- Patient fees under the Medicare program for 2012 will be restrained by lower utilization rates of physician and other health services, according to Centers for Medicare & Medicaid Services officials. The lower-than-expected utilization means Medicare outpatient premiums will rise more modestly in 2012, CMS announced Oct. 27. Standard Part B premiums had been projected to increase to $106.60 a month, but instead will rise to $99.90 next year. The standard premium is $96.40 in 2011. Standard premiums are set so that they cover 25% of projected Medicare costs. Higher-income seniors pay higher premium amounts based on a sliding scale. At the same time, the Medicare Part B deductible will decrease to $140 in 2012 from $166 in 2011. The deductible is set by Medicare law to reflect one-half of the total estimated per-enrollee cost of benefits and administrative expenses. The calculations also assume that Congress will override a nearly 30% cut to Medicare physician pay [Read more]
Detailed disclosures would clarify financial links between doctors and industry
Clear, specific requirements for what needs to be disclosed when physicians have relationships with medical device and pharmaceutical manufactures will be essential to evaluating conflicts of interest inherent to such relationships, a study concludes. Researchers examined data from a Dept. of Justice settlement with the five largest joint implant manufacturers and found complex payment patterns to orthopedic surgeons. The settlement required the companies to release details on the number of orthopedic surgeons receiving payments, the size of the payments, the aggregate dollar amount and the proportion going to academically affiliated orthopedic surgeons in 2007 and 2008. Study authors said the number of orthopedic surgeons receiving payments declined substantially after disclosure was required under the settlement in 2007: 526 received payments in 2008, down from 939 in 2007. For three firms that continued to report in 2009 and 2010, the numbers began to rise again, but not to wh [Read more]
Massachusetts struggles with cost control after reducing uninsured
Health system reforms in Massachusetts may have reduced its uninsured population to the smallest of any state, but the effort has not controlled growth in health care costs -- at least not yet. Five years after Massachusetts launched its groundbreaking health reform initiative, health care costs continue to grow, emergency department visits have increased, and many more residents have high-deductible health plans, according to a critique released on Oct. 25 by Physicians for a National Health Program, an advocacy group with 18,000 members who support a single-payer health system. These trends could become a national story under the health system reform law, which largely was based on Massachusetts' reforms, Benjamin Day said. He is the report's lead author and executive director of "Mass-Care: The Massachusetts Campaign for Single-Payer Health Care." The state's health insurance exchange offers health plans with income-based subsidies, while a Medicaid expansion covers virtually [Read more]
170 million shots available for flu season
Washington -- Health professionals say now is the time to get vaccinated for the 2011-12 influenza season, and they are attempting to lead by example. Federal officials and physicians rolled up their sleeves for flu shots and waved immunization records proving they've been vaccinated during a Sept. 21 news conference to promote the vaccine at the start of the 2011-12 flu season. A majority of Americans are expected to receive the vaccine, with about 170 million doses set to be available this season, officials said. An estimated 123.3 million received the vaccine during the last flu cycle. The vaccine contains the same three strains as in the previous season's vaccine, but nearly everyone is being encouraged to be vaccinated again before flu activity starts increasing in October. Studies have shown that a vaccine's effectiveness wanes over time, said Thomas Frieden, MD, MPH, director of the Centers for Disease Control and Prevention. "This is a great time to get vaccinated -- t [Read more]
States embracing Medicaid managed care
Washington -- A nationwide survey of Medicaid managed care programs found that access to care under the plans is a perceived problem but that many states use managed care as a vehicle to coordinate care. Managed care includes Medicaid primary care case management programs and comprehensive and single-benefit Medicaid health plans, both nonprofit and for-profit. Of Medicaid's 54 million beneficiaries in 2010, half were enrolled in a managed care plan. An additonal 16% were in a primary care case management program, and the remaining 34% were in Medicaid fee-for-service, according to the survey, released Sept. 13 by the Kaiser Family Foundation and Health Management Associates, a research and consulting firm. The report is based on information valid as of October 2010. Medicaid directors said managed care is an attractive option because it enables states to improve accountability and restructure the delivery system to ensure access and measure quality better, said Vernon Smith, PhD [Read more]
Demand drives more hospitals to offer alternative therapies
The number of hospitals offering complementary and alternative medical services has tripled since 2000, driven principally by patient demand for low-risk therapies such as massage, guided imagery, meditation and the "healing touch" practice known as Reiki. Forty-two percent of the 714 hospitals surveyed said they provide unconventional therapies, and executives listed patient demand as the top criterion in choosing which therapies to offer, according to a report released in September by the American Hospital Assn.'s Health Forum and the Samueli Institute, a think tank that supports alternative medicine. In 2000, just 14% of hospitals told AHA researchers that they provided complementary therapies. "They are responding to the needs of their patients and the communities they are serving, while trying to differentiate themselves in the marketplace," said Sita Ananth, a Samueli Institute researcher who wrote the report. "These hospitals are really trying to see how they can address t [Read more]
Delaware Blues fined for denying cardiac tests
Delaware's insurance commissioner has fined the state's Blues plan $325,000 over what the commissioner deemed inappropriate denials of nuclear cardiac imaging tests. Blue Cross Blue Shield of Delaware "acknowledged deficiencies in claims handling" but denied violating state law. It agreed to pay the fine and spend an additional $300,000 over three years on a program developed by the American College of Cardiology to guide the appropriate use of advanced cardiac imaging tests. The news was welcomed by the ACC, which credited its Delaware chapter with helping to broker the agreement. "We hope Delaware will be a model for managing medical costs by focusing on patient-centered decision making and quality care," ACC Chief Executive Officer Jack Lewin, MD, said in a statement. "More importantly, we hope this proactive solution will prevent future cardiovascular patients from being denied the right care at the right time." The ACC program, called FOCUS, for Formation of Optimal Ca [Read more]
Medicare sign-up question about accepting new patients becomes optional
Washington -- The agency overseeing the Medicare program will not require physicians to report whether they are accepting new Medicare patients or providing advanced imaging care. The change comes after the American Medical Association wrote the Centers for Medicare & Medicaid Services about two new mandatory questions added to the program's enrollment applications in July. One question on paper and online versions of the application asks physicians, "Do you accept new Medicare patients?" Another question found only on the Web-based application asked, "Are you, or will you be, providing advanced diagnostic imaging services?" "Committing to make these fields optional is an important step to help alleviate some of the challenges physicians face during the enrollment process, and we will continue to monitor the forms to ensure the action is completed," AMA President Peter W. Carmel, MD, said in a statement. In an Aug. 4 letter, the AMA asked CMS to remove both questions from the [Read more]
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