November 23rd, 2009 by DrWes in Better Health Network, Health Policy, News, Opinion
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Should there be a premium added to physician compensation for on-call coverage after hours, or are Medicare rates enough?
This appears to be the central question between two competing hospitals in Longview, Texas where a $300,000 stipend was paid to a cardiology group by one hospital and not the other for cardiology on-call coverage.
Guess which one the doctors are promoting now? Read more »
*This blog post was originally published at Dr. Wes*
October 7th, 2009 by DrRob in Better Health Network, Health Policy, Opinion
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Dear Mr. Obama and all of you congress folks:
I know you have been arguing about how to fix our system (and it really does need fixing). I know there is not much you can all agree on. I know it wasn’t all that much fun to face those yelling people at the town hall meetings. The press hasn’t been nice, and the polls aren’t good either. You guys are having a rough go of it.
So I am going to do you a big favor.
What you need right now are some quick wins – some things you can do that will make people happy quickly, and things that can be done without much cost. This is low-hanging fruit that can be picked without a high ladder; it is fruit that will sweeten things and make swallowing the more bitter pills a little easier. Here is what you need to do first:
1. Allow Medicare Patients to Use Drug Discounts
Read more »
*This blog post was originally published at Musings of a Distractible Mind*
September 30th, 2009 by DrWes in Better Health Network, Health Policy, Opinion
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It’s the holy grail of physician payment reform: ending fee-for-service payments to doctors and, instead, pay doctors based on the quality of care they perform. Remarkably, Congress feels they’ve found the answer:
Thus, the new language in the Senate Finance bill would finally connect Medicare reimbursements to quality, as opposed to volume.
The measure gives the secretary of Health and Human Services, working with the Centers for Medicare and Medicaid Services, the power to develop quality measurements and a payment structure that would be based on quality of care relative to the cost of care. The secretary would have to account for variables that include geographic variations, demographic characteristics of a region, and the baseline health status of a given provider’s Medicare beneficiaries.
The secretary would also be required to account for special conditions of providers in rural and underserved communities.
Additionally, the quality assessments would be done on a group-practice level, as opposed to a statewide level. Thus, the amendment would reward physicians who deliver quality health care even if they are in a relatively low quality region.
The secretary of Health and Human Services would begin to implement the new payment structure in 2015. By 2017, all physician payments would need to be based on quality.
Wow. That sounds great! But there’s just one problem…
… how do we define “quality?”
Read more »
*This blog post was originally published at Dr. Wes*
September 3rd, 2009 by Shadowfax in Better Health Network, Health Policy, True Stories, Uncategorized
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File this under utterly predictable:
Aetna tightens payment policies on hospital errors – Modern Healthcare (sub req)
Aetna has established new, tighter policies dictating when it will and will not reimburse for medical care related to errors made by providers.
Under the policies, Aetna has broken errors into two categories: “never events”—three events involving surgery: wrong patient, wrong site and wrong procedure—and 25 serious reportable events as defined by the National Quality Forum. Providers will not be reimbursed for a case involving one of the three never events, under the new payment policy. Of the 25 events, eight will be reviewed by Aetna to determine whether reimbursement should be withheld. The rest of the events will also be reviewed under Aetna’s new policy, but they will not be considered eligible for adjustments to reimbursement, the spokeswoman said.
This of course follows on the heels of Medicare’s decision not to pay for such events. The good news is that, as far as I can tell, Aetna has not extended the policy as far as Medicare has. Medicare, you may recall, also decided not to pay for certain (arguably) preventable conditions, such as foley-catheter-associated urinary tract infections, and surgical wound infections. Aetna, at least for the moment, is limiting its policy to the more black-and-white “never events” as defined by the National Quality Forum: items such as wrong-patient surgery or death due to contaminated medications.
I mention this not to rail against these standards or against the notion of incentivizing hospitals financially to avoid errors, but to highlight how rapidly and directly Medicare policies are aped by private insurers to the point that they become industry standards.
*This blog post was originally published at Movin' Meat*
August 25th, 2009 by KevinMD in Health Policy
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One of the storylines in the health reform debate is how the Medicare population is fighting the current reform efforts.
It’s ironic, in a way, since if the status quo continues, fiscally sustaining current Medicare benefits will be a near-impossibility.
In his regular column, The New York Times’ Ross Douthat provides some insight as to the mindset of the Medicare recipient. He says, rightly, that, “At present, Medicare gives its recipients all the benefits of socialized medicine, with few of the drawbacks. Once you hit 65, the system pays and pays, without regard for efficiency or cost-effectiveness.”
When reformers talk about savings, it “sound[s] a lot like ‘cuts’” to the elderly, and hence, their apprehension. Arguments that many of the tests and treatments can be reduced without sacrificing quality of care will not resonate. With the prevailing mentality equating better care with more care, any attempt to introduce serious cost-saving measures will meet a determined resistance from the American public.
*This blog post was originally published at KevinMD.com*
