medicare patients

CMS says doctors earned $16.7M on P4P demo

Anne Zieger — Fri, 15 Aug 2008 10:43:11 -0400

You've gotta love it when CMS gives out money above and beyond the usual reimbursement rates--and it's even better when the bonuses involved work out for pretty much everyone involved. That's the cheery outcome for the second year of CMS's pay-for-performance demonstration project, under which 10 physician groups earned a total of $16.7 million in incentive payments. Under the terms of the demonstration project, which addresses the quality of care for heart patients and diabetics, physician groups were asked not only to improve outcomes for Medicare patients, but also to coordinate their care.

The groups involved were strikingly successful at meeting CMS's goals. All of the groups involved in the Physician Group Practice Demonstration met performance goals on at least 25 of 27 quality markers for patients with diabetes, coronary artery disease and congestive heart failure. Five of the groups, including Forsyth Medical Group, Geisinger Clinic, Marshfield Clinic, St. John's Health System and the University of Michigan Faculty Group Practice--achieved all 27 performance goals.

To learn more about the P4P payouts:
- read this Modern Healthcare piece (reg. req.)

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Case study: How TN physicians are changing their practice

Anne Zieger — Tue, 22 Jul 2008 15:07:20 -0400

With Medicare cuts looming, many physicians vowed that they'd stop accepting Medicare patients entirely if and when the cuts went through. The thing is, even though Medicare cuts have been held off, large numbers of physicians are dropping out anyway. One example of this comes in Tennessee, where doctors are increasingly dropping out of the program. Not only are many refusing new Medicare patients, some are thinking about dropping current Medicare patients too. That's because in some cases, doctors aren't even getting paid enough to cover their expenses, they say.

The steady drop in Medicare physicians is putting a painful squeeze on the state's health system, which already includes an above-average number of Medicare beneficiaries and a below-average number of doctors who are willing to accept them. Given the current conditions, patients there may need to make dozens of calls--and wait months to be seen--to be cared for by a physician who takes Medicare.

Ultimately, Medicare will have to adjust its payment formula, physicians say. But that won't happen without intervention from Congress, which set the current system in place in 1997. (Perhaps our new president will make some changes next year?)

To learn more about this trend:
- read this piece in The Tennessean

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Almost half of TX doctors opting out of Medicare

Anne Zieger — Wed, 09 Jul 2008 10:53:01 -0400

In Texas, it appears that officials' worst fears about Medicare acceptance are coming to pass. According to a recent survey by the Texas Medical Association, only 58 percent of doctors in the state now accept new Medicare patients, down from approximately 90 percent before 1990. Worse, given policymakers' desire to offer patients medical homes, only 38 percent of primary care physicians are Medicare-friendly. The physicians are struggling with a 20 percent cut in inflation-adjusted dollars that has hit Medicare over the last seven years. Some Texas doctors are so frustrated with Medicare reimbursement rates that they're calling it "the new Medicaid," particularly given the looming 10.6 percent cut that will go into effect if Congress doesn't avert it.

If the planned Medicare cut does take place, Texas physicians would lose $860 million treating Medicare patients, or $18,000 per doctor, over the next 18 months, the medical association projects. At that point, the flight from Medicare is likely to accelerate dramatically, observers say.

To learn more about this situation:
- read this Houston Chronicle piece

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Louisiana MDs win legal battle over patient record disclosure

Fri, 18 Apr 2008 06:59:56 -0400

A group of Louisiana physicians have won their battle to keep their patients' records out of the hands of a pharmaceutical company--though they may face future challenges on the issue. The dispute comes as part of the Louisiana attorney general's suit against Janssen Pharmaceutic, which the state says has been illegally promoting off-label uses of Risperdal. The AG also is arguing that in so doing, Janssen defrauded the state's Medicaid program. Though no doctors or patients are parties to the suit, Janssen got a court order allowing it to subpoena physicians for the medical records of up to 6,000 Medicaid beneficiaries who received Risperdal prescriptions. The order also allowed the pharma to depose individual doctors on their Risperdal prescription decisions. However, the state's physicians contested the order, with judges concluding that Louisiana's laws governing medical privacy would invalidate the request.

To learn more about the case:
- read this AMNews article

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Medicare lab test pilot on hold

Tue, 15 Apr 2008 06:59:56 -0400

Medicare has been forced to put a pilot program designed to cut the cost of lab tests on hold after losing a battle in court. CMS had asked labs to bid competitively on prices to provide 303 standard tests to Medicare patients in San Diego County, but three healthcare companies objected and filed suit to stop the program. The companies--Sharp Healthcare, Internist Laboratory and Scripps Health--contended that they'd be forced to cut their workforce and slash medical services if they lost their guaranteed Medicare lab test income. Now, the agency is pondering its options. It's not clear whether it will go ahead with a redesigned pilot of some kind, or drop the idea entirely.

To learn more about the pilot and the controversy:
- read this Associated Press article

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Study: Errors caused 200K+ deaths from '04 to '06

Wed, 09 Apr 2008 06:59:55 -0400

The story doesn't get any prettier the more often its told. This set of data, from the fifth annual Patient Safety in American Hospitals study, makes a point often made elsewhere--that preventable deaths are far too common. In this case, it found that from 2004 through 2006, patient safety errors resulted in 238,337 potentially preventable deaths of U.S. Medicare patients and cost the program $8.8 billion. The study, published by healthcare ratings organization HealthGrades, found that if a patient was treated by a top-performing hospital, they were on average 43 percent less likely to experience an error than patients at the worst-performing hospitals. The overall error rate was 3 percent for all Medicare patients, which is equivalent to about 1.1 million safety incidents during the three years studied.

For more data from the study:
- read this HealthDay News item

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Medicare releases volume, customer satisfaction data

Mon, 31 Mar 2008 07:59:58 -0400

For the first time, Medicare has released volume and payment information for a list of selected conditions, along with the results from its new consumer satisfaction survey, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Medicare already posts hospital quality data for heart attack, heart failure, pneumonia and surgical care to its Hospital Compare website. The agency now will add information showing how often Medicare patients were admitted to hospitals for a set of conditions, as well as what Medicare paid for treatments to the site and HCAHPS data. The HCAHPS data includes feedback from more than 2,500 hospitals participating in the program's launch.

To learn more about Medicare's plans:
- read this Modern Healthcare article (reg. req.)

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Senators ask CMS to keep disease-mgmt program

Tue, 18 Mar 2008 07:59:56 -0400

Last month, CMS decided to discontinue its planned three-year Medicare Health Support program--aimed at managing chronic diseases more effectively--arguing that initial results hadn't met quality, cost and beneficiary-satisfaction goals. But four U.S. Senators involved in health policy, including Sens. Lamar Alexander (R-TN), Bob Corker (R-TN), Edward Kennedy (D-MA) and John Kerry (D-MA) are calling on CMS to change its mind, arguing that CMS hasn't gathered enough data yet to make sure a decision. Right now, Aetna Health Management, Green Ribbon Health, Health Dialog Services Corp., Healthways and XLHealth provide advice, education, med management and personal services for 150,000 Medicare patients with heart disease or diabetes. Healthways, for its part, is contending that the program would meet or even exceed the program's goals despite some initial problems with patient selection.

To learn more about the debate over this program:
- read this Modern Healthcare piece

Related Articles:
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Congress targets MD-owned specialty hospitals

Fri, 07 Mar 2008 06:59:57 -0500

For a while new, some key members of Congress have been gearing up to impose new regulations on physician-owned specialty hospitals, particularly since a Texas incident where a patient died at a specialty hospital after elective surgery. Now, legislation has been filed that would place some significant restrictions on such facilities. Not surprisingly, the trade group representing these hospitals is outraged, while the American Hospital Association--whose members lose revenue to physician-owned ventures like these--supports it.

The House version of the pending mental health parity bill, which passed this week, would require such hospitals to submit annual reports outlining their ownership structure. It also would bar physician-owners from picking up more than an aggregate 40 percent of the total value of the investment interest in the hospital--or even an entity whose assets include the hospital. Meanwhile, individual doctors couldn't invest more than 2 percent in a hospital. (Since all of this is structured to impact only hospitals that take Medicare, in theory it appears that hospitals could escape the limits by declining Medicare patients.)

On top of all of that, if such a facility admits a patient but doesn't have a doctor available, it would be required to let the patient know. Interestingly, it doesn't seem to do anything beyond that to address the issue of patient safety, which legislators have said is a key concern. Let's see if that happens in future iterations of the bill, or if this really is all about who gets the profits here.

To learn more about these limits:
- read this Modern Healthcare piece
- read the text of this provision in the legislation

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MGMA: MD groups limit Medicare patient access

Fri, 07 Mar 2008 06:59:56 -0500

When reading this, bear in mind that a group practice trade association has its own motives in publicizing such a study. That being said, the following data is worth a look. According to recently published data from the Medical Group Management Association (MGMA), group practices across the U.S. have begun to limit access for Medicare-covered patients, concerned about pending cuts to reimbursement.

The study, which surveyed more than 1,000 group practice professionals from an MGMA network focused on policy issues, found that almost 24 percent of respondents said that they'd begun limiting or not accepting new Medicare patients. If and when the scheduled 10.6 percent Medicare cut takes effect, 46 percent said they'd stop accepting or limit the number of Medicare insureds they'd treat.

In addition to limiting Medicare patients, practices said that if the planned cuts take place, more than half would consider cutting administrative or clinical staff (or limit hiring for such positions), and postpone IT and equipment investments.

To learn more about the study:
- read this MGMA press release

Related Articles:
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Hot topics at the MGMA. Editorial