reimbursements
Aetna limits anemia drug payments
Anemia drug sales have taken a beating since Medicare tightened rules to limit when it would pay for them. Now, Aetna has set limits on anemia drug reimbursements too, issuing new rules that follow... Read more...
Despite fears, Medicare cuts didn't harm cancer care
When Congress changed the way Medicare paid oncologists in 2003--cutting reimbursements by 30 to 40 percent--critics charged that patients would have less access to care. However, a new study... Read more...
ALSO NOTED: Highmark questions cardiac surgery reimbursement report; Indiana examines never events; and much more...
> Health plan Highmark is vigorously questioning a recent report noting large differences in reimbursements for cardiac surgeries in the Pittsburgh area. 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...MD groups seek new Medicare rate formula
The current system Medicare used to gradually bump up reimbursement rates for physicians isn't fair, and should be replaced by one which takes physician practice costs into account, a group of 87 medical organizations told Congress. The group, which includes the American Medical Association, notes that hospitals and nursing homes are paid based on their costs. However, physicians are paid based on a formula known as the sustainable growth rate (SGR), tied to the U.S. economy, which has …
... Read more...Doctors protest low Gardasil reimbursements
While many public health officials are excited about the Gardasil's potential to prevent cervical cancer, doctors are increasingly refusing to offer it to patients--including the pediatricians and gynecologists who are its most likely prescribers. These doctors say that reimbursements for the expensive vaccine are not high enough to justify the stocking and administrative costs of carrying it. For example, some insurance companies are reimbursing doctors $122 per shot, or just $2 more …
... Read more...Medicare may boost nursing-home rates
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. …
... Read more...ALSO NOTED: Medicaid coverage varies widely; Antidepressants OK for children?; and much more...
> New research by public advocacy firm Public Citizen has concluded that Medicaid coverage varies substantially from state to state. Article
> A study by Ohio researchers has concluded that only one in 100 children under 19 will become suicidal when placed on antidepressants. …
... Read more...New Orleans health plan costs mount
State health planners must be exasperated. With plans for the redesign of the New Orleans health system still on the drawing board, projected costs have already hit $500 million, a whopping 43 percent higher than they'd projected only one month ago. The new estimates take healthcare inflation into account, and also include $125 million to raise reimbursements for physicians who'd …
... Read more...Medicare cuts service fees for MDs
In a move that's sure to please few--other than the bean counters at CMS--the agency said yesterday that it will be cutting fee-for-service rates for physicians, while boosting payments for office visits. Office visit reimbursement will go up about one-third, but service reimbursements should drop an average 6 to 20 percent, according to estimates from the American Medical Association. The idea, according to CMS, is to …
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