medicare reimbursement
St. Barnabas racketeering suit dismissed
Despite its having engaged in a massive Medicare scam costing the federal government at least $630 million, St. Barnabas Health Care System did not prevent other hospitals from getting fair reimbursement.
That's the conclusion of a federal judge, who ruled that despite the fraud, St. Barnabas had not engaged in racketeering. Two small hospitals in Maine and Colorado filed the suit, alleging St. Barnabas' over billing was so extreme it distorted CMS's Medicare reimbursement …
... Read more...ALSO NOTED: Senate questions hospital Medicare cuts; Public favors health reform; and much more...
> Senate Finance Committee leaders told CMS this week that they are concerned about the impact of proposed reductions in Medicare reimbursement for hospitals during 2008 and 2009. Article
> A Kaiser Family Foundation poll has found that healthcare is top domestic issue the public wants presidential candidates to address. Executive summary …
... Read more...AMA fights physician Medicare cuts
The American Medical Association has begun its latest no-holds-barred campaign to make Congress cancel a scheduled Medicare reimbursement cut. As part of its campaign, AMA is publicizing the results of its survey of 9,000 physicians, which found that more than half would to limit the number of Medicare patients they accept if the planned 10 percent cut is implemented. (Sure, there's a bit of grandstanding going on here--but the pain is real, too.) Patients aren't the only ones who would …
... Read more...AMA group endorses quality measures
A group of medical societies brought together by the American Medical Association continued last week to define its approach on quality measurement. The consortium, which includes more than 100 specialty and state medical societies, has developed 184 physician quality measures to date. The 184 measures address conditions that represent 80 percent of Medicare reimbursement, including asthma, hypertension and heart failure. Now the group, the Physician Consortium for Performance …
... Read more...Study: Dialysis chains profit from higher Epogen use
A new study published in the Journal of the American Medical Association has concluded that patients in for-profit dialysis chains routinely get higher doses of the antianemia drug Epogen. These larger doses, while lucrative for the chains, can sometimes boost red blood cells above FDA levels. Part of the reason for the higher doses is financial. Medicare reimbursement encourages use of the drug, and clinics take in about 25 percent of their revenue through Epogen payments. …
... Read more...ALSO NOTED: UnitedHealthcare, Health Alliance of Greater Cincinnati in contract dispute; Independent hospitals in PA disappeari
> UnitedHealthcare may end its relationship with the Health Alliance of Greater Cincinnati because the two sides have been unable to negotiate a new contact. Up to 300,000 customers would be affected if the insurer and health system can't come to an agreement. Report
> In Pittsburgh, many residents are dismayed by the shrinking number of independent hospitals. …
... Read more...IOM recommends P4P for Medicare
The Institute of Medicine (IOM) recommends that the federal government focus less on quantity and more on quality when it comes to treating Medicare patients. The current system reimburses doctors a set amount for performing particular medical services. The IOM finds that this system doesn't do anything to encourage doctors to administer high-quality care. Instead, the report recommends instituting a pay-for-performance system, and it even suggests how to pay for such a program. The IOM …
... Read more...ALSO NOTED: SmartCare opens clinics in Wal-Marts; Medicare reimbursement cuts draw near; and much more...
> SmartCare Family Medical Centers will open clinics in a number of Denver-area Wal-Mart stores. The firm plans to open 1,050 clinics within the next five years. Report
> The AMA is running out of time to prevent the proposed Medicare reimbursement cuts from becoming a reality next year. …
... Read more...AMA addresses Medicare reimbursement cuts
In a Q&A with UPI, William Plested III, president of the AMA, discusses the impact of Medicare reimbursement rate cuts on physicians. He says that their primary concern is that physicians--particularly geriatricians--won't be able to afford taking on more elderly patients if Medicare doesn't reimburse them properly. According to an AMA study, 45 percent of physicians say the cuts will …
... Read more...GAO looks at DRG changes, exec compensation
The Government Accountability Office issued two hospital-related reports Friday. The first praises proposed changes in Medicare reimbursement for hospitals. The second says large not-for-profit hospital systems are doing better at overseeing executive compensation. CMS is considering adjusting inpatient DRG payments using national average cost-to-charge ratios, rather than basing them strictly on cost data as is done for outpatient payments, a strategy that the GAO says makes sense. CMS's …
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