quality data

Aetna has changed its reimbursement procedures to make billing and payment  simpler for doctors. The insurer is expanding the ability of physicians to submit claims electronically, and more significantly, is setting up a program that allows plan members to pay out-of-pocket expenses automatically through their debit or credit card. (While this would apply to small co-pays, the real point is to make sure doctors don't end up with huge unpaid bills under high-deductible plans.) Aetna …

> Purdue Pharma, maker of OxyContin, has been slapped with $634.5 million in fines for misrepresenting the risks of using the drug. Article (sub. req.)

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> Louisiana health planners continue to …

Right now, either hospital medical records departments or medical group practice administrators typically end up collecting quality data, a costly and time-consuming exercise which only gets more taxing from year to year as health plans, state and federal regulators demand more. According to a new study by the Agency for Healthcare Research and Quality (AHRQ), the right information technology could ease the strain, but only if all of the stakeholders agree on common data standards. In the …

This week, Michael Leavitt announced plans to establish "value-based" health quality exchanges nationwide. The idea, which is …

HHS is taking its efforts to foster the use of quality data to a new level. The agency announced yesterday that as part of its efforts to make quality information readily available, it was planning to create local groups which would share health quality data for a region.

These "value exchanges," which would include doctors, nurses, hospitals and health systems, health plans, employers and unions, would be run by existing regional health collaboratives. The groups ultimately share …

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 …

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 …

HHS head Mike Leavitt is asking employers to commit to a set of four goals which aim to make cost and quality data more accessible to consumers. The goals include adopting health IT standards in order to make health information systems interoperable, increasing quality transparency, increasing pricing transparency, and offering rewards to encourage efficient, high-quality care. HHS has begun to develop specific quality and cost specs for employers to use in implementing the goals. The …

A New Jersey family has sued Aetna for failing to cover the full costs of their daughter's anorexia treatment. The couple has incurred about $100,000 in medical bills for their daughter's 101 days of inpatient treatment of anorexia, mortgaging their house to meet the tab. But the Aetna U.S Healthcare HMO has only agreed to cover 35 of those days, citing limits on mental health conditions that aren't "biologically based." NIMH researchers dispute the claim that anorexia has no physical …