November 15th, 2010 by KevinMD in Better Health Network, Health Policy, News, Opinion
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The bipartisan debt commission appointed by President Obama recently released its recommendations on how to pare the country’s debt.
Of interest to doctors is the suggestion to change the way doctors are paid. Physician lobbies have been advocating for removal of the Sustainable Growth Rate (SGR) formula — the flawed method by which Medicare, and subsequently private insurers, pays doctors. According to this method, physicians are due for a pay cut of more than 20 percent next month.
According to the commission:
The plan proposes eliminating the SGR in 2015 and replacing it with a “modest reduction” for physicians and other providers. The plan doesn’t elaborate on what constitutes a “modest reduction” in Medicare reimbursement.
Meanwhile, the Centers for Medicare and Medicaid Services (CMS) should establish a new payment system — one that rewards doctors for quality, and includes accountable care organizations and bundling payments by episodes of care, the report said.
The commission also said in order to pay for the SGR reform, medical malpractice lawyers should be paid less, there should be a cap on noneconomic damages in medical malpractice cases, and that comprehensive tort reform should be adopted.
There’s little question that associating physician reimbursements with the number of tests and treatments ordered is a major driver of health costs. Removing that incentive, and better valuing the time doctors spend with patients, is a positive step in the right direction. Read more »
*This blog post was originally published at KevinMD.com*
November 15th, 2010 by DavidHarlow in Better Health Network, Health Policy, News, Opinion
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In October, the Office of Inspector General (OIG) issued a report on Fraud and Abuse Training in Medical Education, finding that 44 percent of medical schools reported giving some instruction in the anti-kickback statute and related laws, even though they weren’t legally required to do so. (As an aside, do we really live in such a nanny state? Over half of all medical schools don’t teach their students anything about this issue — because nobody’s making them — even though it is an issue that looms large in the practice of medicine.)
On a more positive note, about two-thirds of institutions with residency programs instruct participants on the law, and 90 percent of all medical schools and training programs expressed an interest in having dsome instructional materials on the subject of the anti-kickback statute, physician self-referrals (Stark) rules and the False Claims Act.
So in November, the OIG released a Roadmap for New Physicians – A Guide to Avoiding Fraud and Abuse, available on line and as a PDF. It’s a good 30-page primer on the subject. While some of the examples given are specific to newly-minted physicians, anyone in the health care industry would benefit by reading it. The document offers a window into the thinking of the OIG, its perspective on the wide range of issues summarized within, and is a good touchstone for any individual or organization seeking to structure a relationship that needs to stay within the bounds of these laws. Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
November 10th, 2010 by Richard Cooper, M.D. in Better Health Network, Health Policy, News, Opinion
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In a high-profile paper in the September issue of Health Affairs, Thorson and coworkers showed that the care at St. Mary’s Hospital in Grand Junction, CO was superior to that of 20 other unnamed hospitals. Grand Junction is, of course the smal town in SW Colorado that became famous when President Obama visited there during the health care reform debates during the summer of 2009, and here’s what he said:
“Hello, Grand Junction! It’s great to be back in Southwest Colorado. Here in Grand Junction, you know that lowering costs is possible if you put in place smarter incentives; if you think about how to treat people, not just illnesses. That’s what the medical community in this city did; now you are getting better results while wasting less money.”
So, Grand Junction, a town of 58,000 people located in SE Colorado, where there are virtually no blacks and fewer Native Americans but where family practice rules, is supposed to be the model for the nation. Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
November 8th, 2010 by Bryan Vartabedian, M.D. in Better Health Network, Health Policy, News, Opinion
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I didn’t need the Wall Street Journal to tell that the days of “private practice” are numbered. According to recent numbers, fewer and fewer medical practices are under the ownership of physicians. Even in my corner of the economically secure State of Texas, small practices are folding faster than beach chairs at high tide.
I was driven out of private practice in 2004 by rising malpractice premiums and plummeting reimbursement. In Texas at the time the trial attorneys ran the place and medmal insurance carriers simply couldn’t keep up with the greed.
Medical practices are just too expensive to run and the services that physicians provide are dangerously undervalued. You do the math. Sure it’s a complicated issue. But the end result is institutionally-employed doctors with institutional pay and the risk of institutional service. Read more »
*This blog post was originally published at 33 Charts*
November 8th, 2010 by Happy Hospitalist in Better Health Network, Health Policy, Opinion
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Are you wondering about a glaring unintended consequence of healthcare reform? Read on to learn how everyone becomes a criminal.
By now you’ve all heard of the government reports of Medicare fraud being three times higher than 17 billion dollars a year previously thought. How you ask? Because an illegible doctor signature is considered fraud and Obama is out to make things right and transparent and accurate. You can pretty much count on every physician in this country being a fraudster.
But what about Medicaid? Does the same fraud problem exist with the Medicaid system? Probably, but you also have to worry about the patient abuse aspect as well. Here’s an angle of unintended consequences you may not have considered with healthcare reform by making pre-existing conditions a thing of the past.
I have been told Happy’s hospital has a handful of repeat offenders using their family member’s Medicaid card to get free healthcare services in the ER. Why is that possible and why would anyone let their family member use their insurance card? The question you should ask is not “why,” but “why not?” Why wouldn’t every family with Medicaid share their card? Read more »
*This blog post was originally published at The Happy Hospitalist*
