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Medicare Reimbursement: A 23 Percent Cut Soon To Come?

 

“It will never happen.”

“They know better than to do it.”

“They realize the disaster it would be if they let it pass.”

That’s what I hear. I hear that the upcoming SGR adjustment, the one that will cut Medicare reimbursement by 23 percent, won’t go through.

In case you missed it, the SGR is a formula coming from the Balanced Budget Act of 1997 that does automatic cuts to Medicare reimbursement. This year we witnessed a legislative game of chicken in congress, with both sides agreeing that it was a bad idea to screw physicians in a time that they are trying to fix healthcare. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

When Doctors Opt Out Of Medicare

I opted out of Medicare several years ago. This means I don’t see Medicare patients other than in the emergency room when I’m on unassigned call. I don’t submit bills to Medicare or to those patients. I just let it slide.

Last Wednesday I received the following letter from a large radiology group in my home town:

September 2010

RE:  PECOS Enrollment

To our referring physicians and their office managers:

At __________we have begun a project to identify ordering physicians who are not enrolled in Medicare’s Provider Enrollment, Chain and Ownership System (PECOS).  Our purpose is to remind physicians of the importance of enrollment to them and to us.

Beginning in January, 2011 those providers filing Medicare claims listing an NPI number on the claim of an unenrolled provider will have their claims denied.  This would apply to any claim you send in and to any claim we submit for services provided to your patients because we are required to list your NPI number on our claims.  This applies both to patients referred to our private offices and the hospitals where we provide radiology professional interpretations or services.

So, you can see our effort is not purely altruistic.  We have a financial interest in reminding you of the importance of PECOS enrollment.  In trying to ascertain whether you are enrolled, we are using an online program you can find at www.oandp.com/pecos.  Simply enter your NPI number in the entry block and press enter.  If you enter a valid NPI number, your name will appear and beside it will be a symbol indicating where Medicare recognizes your PECOS enrollment.

Since Medicare is continually updating the files, we may have accessed the system before your enrollment was completed.  We will continue to monitor the situation in hopes you will enroll if you intend to continue seeing Medicare patients.  If you have already enrolled or have no plans to enroll, please excuse our intrusion.

Sincerely,

This bothers me. It is not likely that I will be sending them any patients from my office, but that doesn’t mean there won’t be the occasional patient with my name on their chart in the ER. If I need to take a Medicare patient to the operating room from the ER, will the hospital not get paid? Will the anesthesiologist not get paid?

Will my non-participation in Medicare affect my fellow healthcare providers receiving payment? If so, that is just not right. I voiced this concern to Senator Blanche Lincoln shortly after receiving this letter. She agrees with me. Read more »

*This blog post was originally published at Suture for a Living*

Charitable Hospitals Being Sold To For-Profits To Survive

More than one-fifth of hospitals are government-owned, but states and counties are out of cash to keep them open. So, charitable hospitals are being sold to for-profit groups or facing closures. Rising costs and more uninsured patients run smack into falling Medicare and Medicaid reimbursement. When bonds come due, there’s little chance of states and counties paying them back. And the facilities are often standalones, and they can’t fall back on corporate backing. This year, 53 hospitals have been sold in 25 arrangements. While the deals often stipulate that care for the poor continues, no one is certain exactly how or even whether such services will continue.

That said, other charitable hospitals are making big profits. What are they doing differently? First, they’re competing for patients, so they’re increasing room sizes, offering amenities and even investing in high-end procedures such as robotic surgery. They continue to offer community care, but they’re acting more like for-profit institutions to cover their charitable missions. But this conflicts with an old-fashioned view of what charitable care is supposed to be.

Stepping into the breach is the Centers for Medicare and Medicaid Services, which is offering one solution, by increasing reimbursement for inpatient services in rural areas. The agency is expanding a pilot program by increasing reimbursement for inpatient services. Facilities are eligible if they offer care to rural areas in the 20 states with the lowest population densities, have fewer than 51 beds, provide emergency-care services and are not a critical-access hospital. (Wall Street Journal, Washington Post, Modern Healthcare)

*This blog post was originally published at ACP Internist*

Primary Care Doctors Rewarded For Time With Patients?

Abraham Verghese is a professor of medicine at Stanford University and one of the most articulate physician-writers today. He recently wrote an op-ed highlighting primary care’s plight, and focuses on the scarcity of time:

The science of medicine has never been more potent – incredible advances and great benefits realized in the treatment of individual diseases – yet the public perception of us physicians is often one of a harried individual more interested in the virtual construct of the patient in the computer than in the living, breathing patient seated on the exam table.Time is the scarcest commodity of all. Patients, particularly when it comes to their routine, day-to-day care, want a physician who has time to understand them as people first, and then as patients.

It’s been frequently discussed on this blog, with solutions ranging from paying physicians per hour to cash-only practices.

There’s no easy answer, and worse, money isn’t even the root of the problem. Often left unaddressed is the burnout that primary care doctors face, practicing in unpalatable environments where the doctor-patient relationship is obstructed by bureaucracy and paperwork. Read more »

*This blog post was originally published at KevinMD.com*

For Medicare Patients, “The Doctor Is Out”

In a last-minute shocker, the Senate voted Thursday against postponing a scheduled 21-percent cut in Medicare reimbursement to physicians and other healthcare providers. Sixty senators were needed to end filibuster debate and stop the cuts under Senate rules. Fifty six voted in favor, while 40 opposed. There was no Republican support. (And, of course, no support from Senator Lieberman, who is a Republican in disguise.)

Another consequence of the vote is that tens of thousands of Americans who have exhausted their jobless benefits would not be eligible for more. In addition, new taxes on wealthy investment managers would not be imposed, along with an increase in liability taxes on oil companies, leading Democrats to contend that Republicans were protecting Wall Street and the oil industry, according to the New York Times.

“We’re not going to give up,” said Senator Harry Reid, the Nevada Democrat and majority leader. “We know the American people only have us to depend on.” Read more »

*This blog post was originally published at EverythingHealth*

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