Medicare/ Medicaid

Now that the battle over the 5 percent Medicare fee cut is finished, evidence continues to filter in that physicians aren't so thrilled with the compromise that spared them the cut. When the House Ways and Means Committee reached out to physician groups to ask for letters of support, only a few agreed to do so. In particular, the American Medical Association conspicuously declined to issue the letter of support, and what's more, rejected an offer from Ways and Means Chairman …

Better late than never, I guess. Several months after Kaiser Permanente announced its closure, a group that oversees the nation's transplant system has officially condemned the health plan's doomed kidney transplant program. Concluding that Kaiser had denied patient access to transplants and threatened safety for wait-listed patients during 2004 and 2005, the United Network for Organ Sharing yanked the group's "good standing" rating. The move did little to please critics, however, who say …

Physicians are understandably pleased that CMS won't be cutting back Medicare payments by 5 percent next year. And a 1.5 percent incentive payment in exchange for reporting quality data sounded good at first, too. But no sooner did Congress approve these measures than industry figures began fretting. Some trade association leaders, for example, are suggesting that quality reporting will …

In using quality ratings, patients and health purchasers may feel they're getting some assurance that they can predict the outcome of their care. Well, in this case, apparently they can't--at least not yet. According to new research, there seems to be little difference in hospital death rates for three common conditions (heart attack, heart failure and pneumonia) regardless of how the hospitals rank on Medicare hospital performance measures. The study, by the University of Pennsylvania's …

Following up on the deal which won physicians a reprieve from the dreaded 5 percent Medicare fee cutback, two Senators have jointly introduced a bill including Medicare quality reporting for physicians. CMS will begin discussing possible quality measures as soon as January 2007, but doctors will not begin to report quality data in 2008, when final measures are expected to be in place. …

For advocacy groups like the AMA, it's "mission accomplished" for another year. Though a final vote has not yet taken place, Congress appears to have agreed in principle upon a bill that will eliminate a scheduled Medicare cutback that would slice an average of 5 percent from physician payments. The agreement, which is part of a larger tax bill, also kicks off a 1.5 percent incentive payment plan for doctors who agree to report quality data to CMS. Canceling the 5 percent cut is expected …

In 2003, Congress raised rates to encourage private HMOs to jump into the Medicare program. The idea was that even at higher than they'd budgeted for fee-for-service rates, private HMOs would increase efficiency and lower costs over the long term. Well, a few years later, the evidence suggests otherwise. The move is costing taxpayers $5.2 billion per year, or 12.4 percent more than FFS Medicare, according to a study by the Commonwealth Fund. Right now, the feds pay managed care plans …

A Connecticut court has ruled that under Freedom of Information rules, the HMOs running the state's Medicaid program must disclose the rates that they pay cardiologists and gastroenterologists. They're also being required to disclose the number of times patients were denied prescriptions due to lack of prior approval, and whether those patients were given temporary supplies. The FOI case, which was originally brought by Yale professor Kari Hartwig and the New Haven Legal Assistance …

CMS is beginning a crackdown on poorly performing organ transplant centers, starting with programs in North Carolina and New York. The idea is to convince facilities nationwide that CMS is serious about enforcement, said Dr. Barry Straube, Medicare's chief medical officer. CMS has told heart transplant programs at Wake Forest University Baptist Medical Center in North Carolina and Montefiore Medical Center in New York that they are going to lose CMS funding. Wake Forest's one-year patient …

A new study suggests that the federal government's formula for calculating its share of Medicaid matching funds has a significant flaw that undermines the program. Because Medicaid upper payment limit matching funds for hospitals are based on fee-for-service payments, rather than capitated arrangements, states paying capitations can lose millions in upper payment limit funds, according to a study by The Lewin Group. The report, which was funded by the Medicaid Health  Plains of …