Healthcare Finance

CMS announced that it will cut Medicare and Medicaid reimbursement rates by 5.1 percent in 2007. Hospitals, meanwhile, will get a 3 percent raise for outpatient care on the condition that they submit data proving that they're following guidelines for improving patient care. CMS head Mark McClellan says the cuts are due to more treatments being given to each patient, which doesn't necessarily improve outcomes. That is why hospitals won't receive higher reimbursements unless they submit …

The healthcare industry isn't exactly known for its attention to customer service, but with the advent of consumer-driven healthcare, providers can't afford to run a practice that doesn't impress patients. That's why some physicians have turned to "mystery shoppers"--paid employees who pose as patients and evaluate the quality of the service they received. Mystery shoppers are commonly used in the retail and hotel industries, but using their services in the healthcare industry is a fairly …

Joining the recent roll-out of a number of P4P programs, Pennsylvania-based Unison Health Plan, a Medicare and Medicaid provider, has begun enrolling doctors in Unison Gold Star. The program will measure efficiency of medical practice, patient satisfaction and other commonly used quality measures. This is the state's first P4P program aimed at Medicare and Medicaid providers. Eight hundred practices are eligible …

After a stressful seven-month battle that included bitter public statements and a couple of lawsuits, plus a month-long contract gap that left patients scrambling for providers, Piedmont Healthcare and Blue Cross Blue Shield of Georgia have finally come to a new three-year agreement. Specific details are confidential. In a joint press release, both parties magnanimously invite those enrollees who …

Clinical information may still be confidential, but what you think is competitive business information might be public property. In Connecticut, four managed care organizations are fighting--so far unsuccessfully--to keep details of their state Medicaid contracts out of the realm of the Freedom of Information Act. Healthcare advocates want to get the organizations' preferred drug lists, after Medicaid recipients said they were going home from pharmacies empty-handed because of the …

Blue Cross of California is paying 178 physician groups an extra $65 million this year under a pay-for-performance program that rewards high quality in a number of areas, including patient satisfaction, waiting times for appointments, number of complaints and grievances, and review of medical group or IPA functions. Performance in clinical areas was tracked, too, including managing chronic diseases such as asthma and diabetes and adherence to screening guidelines for breast and cervical …

Five Staten Island doctors are suing the Health Insurance Plan of New York, claiming that HIP has interfered in their relationships with their patients. Their practice, the Staten Island Medical Group, was dissolved in May after being taken over by PivotHealth, a Brentwood, TN-based physician practice management company. PivotHealth, on contract with HIP, was providing administrative services to Staten Island Medical. The practice was subsequently re-formed as the Staten Island Physicians …

Big changes in Rhode Island's Medicaid formulary are raising big concerns among mental health advocates. The General Assembly authorized the state Department of Human Services to create a preferred drug list that would limit the drugs covered by Medicaid and switch patients to generics whenever possible. The DHS sought public feedback in a hearing last week. Advocates for the mentally ill pleaded to exclude mental-illness medications from the new regulations. A preferred drug list could …

The federal government has OK'ed Massachusetts's proposed universal health insurance plan by granting a Medicaid waiver for the program and agreeing to continue providing $385 million per year in Medicaid funding for the next two years. The agreement also includes an additional $225 million to expand Medicaid coverage, says this article in The Boston Globe. The program will offer a combination of subsidized and low-cost insurance plans, expanded Medicaid coverage and incentives …