October 24th, 2011 by BobDoherty in Health Policy
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“HERE is the dirty little secret of health care in America for the elderly, the one group we all assume has universal coverage thanks to the 1965 Medicare law: what Medicare paid for then is no longer what recipients need or want today.”
So argues New York Times reporter Jane Gross in a provocative op-ed in last Sunday’s New York Times. She makes the case that too much of Medicare is going to medical treatments and drugs of little value to the elderly, and nearly nothing on long-term care, citing the case of her own family’s experience:
“In the case of my mother, who died at 88 in 2003, room and board in various assisted living communities, at $2,000 to $3,500 a month for seven years, was not paid for by Medicare. Yet neurosurgery, I later learned was not expected to be effective in her case, was fully reimbursed, along with two weeks of in-patient care. Her stay of two years at a nursing home, at $14,000 a month (yes, $14,000) was also not paid for by Medicare. Nor were Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
October 13th, 2011 by RyanDuBosar in Research
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Hospitals that provide the lowest quality care at the highest cost care for more than twice the proportion of elderly minority and poor patients as the nation’s best performers, researchers found. And patients at the “worst” institutions are more likely than patients elsewhere to die of certain conditions, such as heart attacks and pneumonia.
These hospitals and their patients may be the ones most at risk under new Medicare payment arrangements that could cut payments to hospitals that fail to meet quality metrics, reported researchers from the Harvard School of Public Health.
The researchers examined how quality, costs and patients served correlated among 3,200 hospitals nationwide. They then identified 122 “best” hospitals, those that were in the highest quartile of quality and lowest quartile of risk-adjusted costs, and 178 “worst” hospitals, those in the lowest quartile of quality and the highest quartile of costs.
Hospital quality and performance data were Read more »
*This blog post was originally published at ACP Hospitalist*
October 7th, 2011 by BobDoherty in Health Policy, News
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Last week, Medicare’s Center for Medicare and Medicaid Innovation announced a Comprehensive Primary Care (CPC) Initiative, which asks private payers and state Medicaid programs to join with Medicare to “help doctors work with patients to ensure they:
1. Manage Care for Patients with High Health Care Needs;
2. Ensure Access to Care;
3. Deliver Preventive Care;
4. Engage Patients and Caregivers; and,
5. Coordinate Care Across the Medical Neighborhood,”
according to an email from CMS’s press office. The initiative will provide qualified practices with risk-adjusted, per patient per month care managements payments, in addition to traditional fee-for-service payments, along with the opportunity to share in savings achieved at the community level.
I believe that the Initiative is a potential game-changer in helping to support and sustain primary care in the United States. But Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
October 2nd, 2011 by Dinah Miller, M.D. in Health Policy
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Over on Shrink Rap News, Roy wrote a post about proposed Medicare cuts. He continued the conversation here on Shrink Rap.
I want to expand on the discussion in what I hope will be easy-to-understand terms. Why would anyone who is not a doctor even care what Medicare reimburses their docs? Let me tell you why you might care.
Doctors all have one of four designated categories within the Medicare system:
1) The doc participates and accepts Medicare assignment. The fee for the service is set by Medicare, the patient makes a co-pay and the doctor bills Medicare and gets the rest of the fee from Medicare.
2) The doctor is “non-participating” –which is a deceptive term, because non-participating docs are within the Medicare system. The fee for the service is set by Medicare and is typically 5% less then the fee for participating docs, but the patient pays the Medicare fee in full to the doctor, the doctor files a claim with Medicare, and Medicare reimburses the patient for a portion of the fee.
3) The doctor has formally opted-out. In this case, Read more »
*This blog post was originally published at Shrink Rap*
September 28th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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I have opposed Medicare’s use of claims data to evaluate the quality of medical care. Quality medical care is the goal that must be achieved. However, no one has described the measurement of quality medical care adequately.
Physicians recognize when other physicians are not performing quality medical care. Physicians recognize when another physician is just testing and performing procedures to increase revenue.
These over testing physicians are a small minority of physicians in practice.
Quality medical care is not about doing quarterly HbA1c’s on patients with Diabetes Mellitus. Quality medical care is about helping patients control their blood sugars so their HbA1c becomes normalized. It is about the clinical and financial results of treatment.
The clinical and financial results depend on both patients and physicians. Patients must be responsible for Read more »
*This blog post was originally published at Repairing the Healthcare System*
