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ACOs must choose how to cover potential losses

Accountable care organizations going for higher bonuses from the Centers for Medicare & Medicaid Services are having to consider various mechanisms to cover losses that may result. ACOs can set aside cash reserves in escrow, establish a line of credit, have the amount deducted from future fee-for-service payments or purchase reinsurance to repay the agency if the cost of caring for a patient population grows beyond a certain point, according to the Medicare shared savings program’s final rule. This is required of so-called Track 2 ACOs that will earn 60% of any money saved if quality metrics are met, but would be required to repay the agency if expenses go up more than 2%. The possible charge can run in the hundreds of thousands of dollars and may result if a small number of patients suddenly experience expensive illnesses or go out of the ACO for care. Marketing has begun in earnest by those pitching various options to ACOs. The issue is an important consideration for physi ...

Washington state suspends Medicaid emergency department limits

Washington state emergency physicians are claiming a victory with the governor’s decision to suspend a zero-tolerance Medicaid emergency department payment policy that was scheduled to kick in on April 1. The American College of Emergency Physicians praised Gov. Chris Gregoire for putting a hold on the implementation of the policy, which would have denied Medicaid payment for ED care given to patients diagnosed with one of about 500 conditions deemed by the state to be nonurgent. State legislators approved the limits as a way to cut down on paying EDs for care that patients should be receiving in physician offices or other less costly settings. ACEP and its state chapter warned that the exclusion list was too broad and would apply to many patients who legitimately believed they were dealing with emergency situations when they showed up at EDs. A prohibition on paying for the treatment of sprains in the ED, for instance, would affect Medicaid patients who needed to rule out the ...

Nation’s nutrition is good, but some disparities remain

Deficiencies in nutrients and vitamins often vary by age, gender, race and ethnicity, according to a recent report by the Centers for Disease Control and Prevention. The most significant deficiency involves blacks and vitamin D. Thirty-one percent of that population has insufficient levels of the vitamin, compared with 12% of Mexican-Americans and 3% of whites. The findings were released April 2 in the CDC’s second national report on biochemical indicators of diet and nutrition in the U.S. The study did not examine causes of the reported deficiencies. However, it is known that higher concentrations of melanin in dark skin tend to block the sun’s ultraviolet rays, said internist Raul Seballos, MD. As a result, people with dark skin do not convert as much UV rays into vitamin D as do individuals with lighter skin, which can lead to a deficiency in the nutrient, said Dr. Seballos, vice chair of preventive medicine at Cleveland Clinic. Patients and physicians should be awar ...