CMS states it wants to increase pay to primary care physicians.  And while we might quarrel with their strategies or with the speed of achieving the goal, few would quarrel with the goal itself.  In recent years, CMS has developed HCPCS codes and adopted CPT codes, some limited to primary care and some not specialty restricted but all likely to be reported by primary care practices. Meanwhile, although payment systems ...

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A recent article suggested that the use of observation status for a hospitalized veteran was a dishonor to his years of service to our country because observation was going to subject him to higher out of pocket costs. This post created quite a lot of discussion and debate. While I agree with the author and commenters that observation is confusing to all and that there has to be ...

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A few weeks ago I wrote a piece about my hero patient, a World War II veteran who landed on Normandy beach, and how he had been left in a difficult position by the whole observation versus inpatient situation while he was hospitalized. My intention was to draw attention to these types of scenarios and how they cause intense anxiety and concern to our elderly. It’s a horrible and ...

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The observation versus inpatient distinction is rightly getting more media and public attention with each passing month. In a nutshell, for anyone reading who is not familiar with what this is all about, it’s essentially a way of categorizing people when they get admitted to hospital. You are either deemed an inpatient (basically a more complex case) or an observation (a less serious case). The individual reasons and checkboxes that have ...

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Because hospitals are expensive and often cause harm, there has been a big focus on reducing hospital use.  This focus has been the underpinning for numerous policy interventions, most notable of which is the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals for higher than expected readmission rates.  The motivation behind HRRP is simple:  the readmission rate, the proportion of discharged patients who return to ...

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Health care in America is fracturing right down the middle, and doctors are going to have to figure out if or how long they can straddle the divide between what patients want and what the government and corporate America want them to have. Up until this point, the momentum has been with the payers, Medicare, and the insurance industry. But the more heavy-handed they become, the more inevitable the public backlash ...

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All of us who care for the poor, the illiterate, the poorly educated, the immigrant, the frail, and the abused know this: caring for them involves many challenges that aren’t picked up by Medicare computers or big data. Simplistic calculations about quality metrics such as hospital readmission rates have been way off the mark at capturing the complexities of caring for these patients. A recent study from researchers in Boston ...

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Dear patients, This is a hard letter to write, but it is important that you know about a major change that is coming for both of us in 2017, just a short year away. As you recall, last year I left a large hospital group practice and opened my own office, and I want to thank you for your faithfulness in following me to my new location.  With the newfound freedom of ...

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Transparency in medicine is a good thing When the Center for Medicare and Medicaid services (CMS) publically disclosed the 2012 CMS reimbursements to physicians, the response was immediately felt throughout the medical community.  As a practicing physician, we were warned of this day.  Can’t say we prepared for it, but we sure did brace for it. And sure enough, on April 9, 2014, the New York Times published on their website a ...

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A long, long time ago, hospitals existed to admit patients when they were sick, treat them with medicines or surgery and good nursing care, and discharge them after they became well. Hospital care was at one time a charity, which evolved into a nonprofit service, before it became a very big business. In olden days, nonprofit hospitals charged patients straightforward fees for their services. Then, when you were just a young whippersnapper ...

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