Medicare/ Medicaid

Adding yet another wrinkle to the agency's complex relationship with doctors, CMS may begin profiling physicians and targeting those it deems inefficient sometime next year. Herbert Kuhn, acting deputy administrator of CMS, told a House subcommittee that the agency will have the data and computer capacity available to do the tracking as soon as mid-2008. To monitor efficiency, CMS would compare levels of tests physicians order for certain types of patients to tests ordered by other …

Cut or keep reimbursement at a flatline, increase paperwork, and doctors will like Medicaid even less. That's what's been happening in Florida since authorities kicked off a new pilot program moving beneficiaries into HMOs, according to new research by the Georgetown University Health Policy Institute. In 2005, former Florida governor Jeb Bush (R) signed a law creating the pilot program, which also caps spending growth at 8 percent over five years. Since that time, it appears that …

The largest U.S. makers of artificial knees and hips are facing an investigation by federal prosecutors, who say that the companies illegally paid off surgeons with vacations, gifts and no-show consulting jobs in an effort to win their business. Manufacturers targeted include Johnson & Johnson subsidiary DePuy Orthopaedics, Zimmer Holdings, Biomet, Stryker and Smith & Nephew. Federal prosecutors suggest that such payments constitute a kickback, as they're provided solely to buy …

Sometime around 2011, a huge wave of aging baby boomers will turn 65 and become eligible for Medicare or Medicaid. And they'll need the coverage, as many can't afford the higher premiums that private health plans charge for those facing a long list of age-related chronic conditions. However, many will face obstacles in getting to physicians who, increasingly, are turning away patients with these types of coverage. To address the problem, hospitals are engaged in aggressive physician …

A new federal measure--sure to take some heat from lobbying groups--would allow Medicare to withhold payments from physicians and other providers who haven't paid federal taxes. The proposal follows a federal investigation which concluded that 21,000 providers owed $1.3 billion in back taxes just for the first nine months of 2005. Meanwhile, these providers were still receiving Medicare payments. The bill was introduced by Sens. Norm Coleman (R-MN) and Carl Levin (D-MI), who are ranking …

Connecticut legislators continue to debate a measure which would force the state's Medicaid HMOs to share more information on rates and services, though the bill has been watered down since it was filed. The Medicaid HMOs have fought this measure every step of the way, arguing that these data points are trade secrets. And they seem to be having some success: while the original bill would have defined HMO contracts with the state as subject to freedom of information laws, making …

CMS may be instituting a $690 million boost in Medicare nursing home payments for 2008. Nursing facilities would get a 3.3 percent increase in payments under the new adjustments to the skilled nursing facility prospective payment system. Right now, payments are based on a "market basket" of services calculated in 1997, but the new initiative would adjust the rates to reflect 2004 costs. The change would result in an increase for room, board, medical care and other nursing home expenses. …

Not sure where you stand on pay-for-performance schemes? It seems that many of your peers have made up their mind. A new survey, conducted at the Fourth Annual World Health Care Congress in Washington, DC, found that about half of health purchasers and providers would like to see P4P use move ahead more quickly. Sixty-nine percent of the event's attendees said that the federal government should be moving more quickly into P4P-based reimbursement.

That doesn't mean the entire …

In some states, it's been a very long time since Medicare hospice programs got a checkup. An new investigation by the HHS inspector general's office (IG) has found that a substantial number of programs hadn't been reviewed by state inspectors in as long as nine years. California, Illinois and Michigan accounted for 41 percent of the past-due certifications. In all, Medicare payments to hospices which hadn't been inspected recently averaged $2.7 million each during 2004, the IG's office …

CMS is putting its foot down when it comes to emergency care. New guidance from CMS says that like it or not, the majority of hospitals who accept Medicare must provide emergency services. The only hospitals exempt from offering initial treatment and transfers are small, rural hospitals. Otherwise, even facilities such as specialty hospitals must fall into line, even if they don't have emergency departments. Before getting this feedback, some hospitals have relied on the crude expedient …