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White House exceeded authority with Medicare Advantage project, GAO says

The agency administering the Medicare program lacks the statutory authority to boost payments to certain Medicare Advantage plans under a nationwide demonstration project that rewards insurers for average performance, federal auditors said. A July 11 letter from the Government Accountability Office stated the Centers for Medicare & Medicaid Services has failed to provide evidence that its Medicare Advantage demo complies with federal statute. The demonstration does not need to result in increased efficiency or economy, but it must follow the principles established in enabling legislation, the 2010 health system reform law. These provisions authorized incentives to improve quality and cost-effectiveness. CMS chose to run a program that differs from the one outlined in the reform law by testing whether a tiered bonus structure would produce better results. The $8 billion Medicare Advantage program began rewarding the private plans under the three-year demonstration starting this ye ...

Lou Gehrig home-run ball helps put dent in doctor’s student debt

With a swing of his bat, baseball legend Lou Gehrig helped reduce the student debt of Michael Gott, MD. A home-run ball smashed by Gehrig in game 2 of the 1928 World Series sold at auction for $62,617 on July 10 — nearly 84 years later. The ball was expected to sell for between $100,000 and $200,000, money the Gott family planned to use to erase Dr. Gott’s $200,000 in medical school debt. The Gotts didn’t get the windfall they wanted, but they’re still satisfied. “It’s very difficult to be disappointed at any money at all,” said Dr. Gott, a fifth-year orthopedic resident at North Shore-Long Island Jewish Hospital in New York. “Sixty thousand dollars is great and, hopefully, that will make a big dent in my high-interest loans.” On Oct. 5, 1928, the New York Yankees were playing the St. Louis Cardinals in the second game of the Series. Grover Cleveland Alexander was pitching in the first inning when Gehrig stepped to the plate. With runners Babe Ruth on firs ...

High Medicaid population state reports record low access

It’s becoming more difficult for Texas Medicaid patients to find a doctor. A survey released July 9 by the Texas Medical Assn. reported that regulatory burdens and other administrative hassles are forcing physicians to reduce the number of patients on government health care programs whom they will accept. “This is not about physicians wanting to abandon Medicaid patients,” TMA President Michael E. Speer, MD, said. He said Medicare and Medicaid “have more and more paperwork and more and more rules,” which results in less time to see patients. Medicaid patient access is the hardest hit, the survey found. The portion of Texas physicians available to treat new Medicaid patients has dropped from 42% in 2010 to 31% this year, “an all-time low,” according to the survey. The Medicaid program in Texas covers 3.4 million people. Cuts to Medicaid payment rates of 2% in 2010 and 2011 have made it difficult for physicians to practice, as payments now cover less than half of ...