Nearly every expert and group that has looked at how to control U.S. medical cost growth says more Americans should fill out advance directives to help reduce costly futile care at the end of life. In 2009, there was some bipartisan support in Congress for having Medicare pay physicians for their time in counseling patients on living wills and end-of-life care. Sen. Johnny Isakson (R-Ga.) pushed for inclusion of the provision in the healthcare reform legislation.
But Sarah Palin and other conservatives twisted this into “death panels,” accusing President Barack Obama and the Democrats of trying to throw granny off the cliff. Terrified Democratic sponsors of the reform legislation yanked the provision. But the death panel myth helped fuel the rise of the Tea Party and the Republican takeover of the House in 2010.
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The Obama administration is conducting targeted audits of hospitals to find possible upcoding of medical services related to use of electronic health records.
Don White, a spokesman for the HHS Office of the Inspector General, said the OIG is conducting audits of “specific institutions” on EHR-related overbilling.
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Republican and Democratic leaders on the House Energy and Commerce Committee released the latest version of a draft bill to repeal Medicare's sustainable growth-rate formula calling for a five-year period of stable payment increases as physicians transition into new payment models. But lawmakers still offered no way to offset the cost of the repeal.
Totaling 70 pages, the bill is a work in progress, as the panel's health subcommittee will mark up the legislation next week. Committee members—along with members of the House Ways and Means Committee—have worked throughout the year to craft a bill incorporating comments from more than 80 stakeholders. As before, this version of the bill gives providers the option of leaving traditional Medicare fee-for-service to try new payment models that emphasize better quality and lower costs.
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Should hospitals focus on the specific diseases that lead to the most readmissions, or should they look at internal issues that may be driving their overall readmission rates higher? It's a crucial question as hospital leaders search for ways to improve outcomes and avoid rising Medicare penalties for high readmission rates.
A new study suggests a disease-based focus on heart failure readmissions—one of the biggest drivers of high readmission rates—returns modest benefits at best.
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More ailing joints, hearts and other chronic medical conditions may be to blame for higher spending by Medicare in some communities compared with others, new research suggests.
The study, published by the journal Health Services Research, analyzed Medicare spending across 60 communities for two acute conditions and eight chronic conditions, including heart disease, diabetes and joint degeneration in the knee, lower leg, neck or back.
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Being a cardiologist in the 21st century means knowing that your Medicare claims are likely to get a lot of scrutiny. So cardiologists have to pay a lot more attention to documenting what they do in the electronic health record.
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The sailing term is luffing. When a boat points too close to the wind, its sails flap with little power and its forward progress slows.
Incentive payments for physicians and other eligible professionals to implement electronic health records moved forward in May, according to the latest report from the CMS. But after four straight months of records for the number of payments made, the May figures are rather flappy.
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Dr. Peter Bach, an oncologist at Memorial Sloan-Kettering Cancer Center in New York, is calling for a radical revamp of Medicare's cancer drug payment program. "The current financing method for physician-administered oncology drugs is unsustainable," he writes in an online Viewpoint on the Journal of the American Medical Association website.
Oncology practices currently operate by charging a mark-up on the retail sales price of chemotherapy drugs. Previously set at 6%, the federal budget sequester dropped that to 4.2%, and the CMS is talking about further lowering it to 3% to hold down costs as the price of the latest cancer drugs soars. The average sales price system provides oncologists with bigger margins if they choose the most expensive drugs, which they are under increasing pressure to do because of the cuts. Responding to oncologists' protests, at least 91 sponsors in the U.S. House of Representatives have signed onto legislation restoring the 6% mark-up.
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Healthcare fraud may be growing, but the number of fraud cops who work to stop it is shrinking.
The Center for Public Integrity reports that HHS' Office of the Inspector General, which generates an $8 return for every dollar invested in battling fraud, is shedding staff members by the hundreds because of recent budget cuts.
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McDermott
Rep. Jim McDermott (D-Wash.) wants to reduce organized medicine's role in setting Medicare fees. But such legislation is likely to face stiff resistance from the American Medical Association and subspecialist physician groups, who are heavily represented in the fee-setting process.
McDermott has introduced legislation that he said will address “the lack of transparency and fairness” in setting the Medicare fee schedule and lessen the CMS' reliance on guidance from the AMA's Specialty Society Relative Value Scale Update Committee—commonly referred to as “the RUC.”
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Watch out for a French person talking about revolution.
“The patient is the revolutionary in healthcare these days,” said Dr. Bettina Experton, a French-born oncologist turned U.S. citizen and health IT entrepreneur. “That is why I think Blue Button is revolutionary.”
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