Health care these days has encountered a genuine Catch-22 with a spiral downward effect: Declining real reimbursement rates push practices to increase patient volume to maintain revenue; higher volume compresses time for thorough documentation; and inadequate or incomplete documentation then…
Health care these days has encountered a genuine Catch-22 with a spiral downward effect: Declining real reimbursement rates push practices to increase patient volume to maintain revenue; higher volume compresses time for thorough documentation; and inadequate or incomplete documentation then triggers payer audits, denials, and clawbacks (recoupments) of already-paid claims, which feeds into declining reimbursement. Multiple sources discussed below, from Medicare data, physician surveys, CMS actuarial analyses, industry reports, …
In 2024, Medicare cut every physician's rates about 2 percent to fund a code that 3 out of 4 of them never billed. The cut was automatic. The code has to be claimed by hand. The code is G2211. CMS…
In 2024, Medicare cut every physician’s rates about 2 percent to fund a code that 3 out of 4 of them never billed. The cut was automatic. The code has to be claimed by hand.
The code is G2211. CMS calls it a visit complexity add-on. In plain words, it pays for office visits where you are the patient’s ongoing doctor, either as the continuing focal point for all their care …
American medicine has a peculiar definition of generosity. We will spend enormous sums treating a seriously ill older person: an ambulance, an emergency-room visit, scans, intravenous medications, surgery, and days in hospital. We may then pay to send a profoundly…
American medicine has a peculiar definition of generosity. We will spend enormous sums treating a seriously ill older person: an ambulance, an emergency-room visit, scans, intravenous medications, surgery, and days in hospital. We may then pay to send a profoundly frail patient to a skilled-nursing facility for “rehabilitation.”
But suppose what that patient really needs is someone to help her out of bed, make breakfast, and keep her safe at home. …
In my primary care practice, few moments carry as much quiet weight as when an older patient leans in and says, "Doctor, I'm worried about my memory." That moment is increasingly common, given that an estimated 42 percent of adults…
In my primary care practice, few moments carry as much quiet weight as when an older patient leans in and says, “Doctor, I’m worried about my memory.” That moment is increasingly common, given that an estimated 42 percent of adults who reach age 55 will develop dementia in their lifetime, so nearly every family will face a version of it. It takes courage to say those words out loud, …
This month, the Centers for Medicare & Medicaid Services (CMS) took an important patient-centered step by proposing rules requiring faster, more transparent prior-authorization decisions for prescription drugs. Regulators are finally signaling recognition of a truth pharmacists have known for years:…
Medicare for All keeps dying in Congress. So what would actually get the major players to agree on universal coverage? Health care journalist Ken Terry returns to lay out a different model, one that keeps insurance companies in the system…
Medicare for All keeps dying in Congress. So what would actually get the major players to agree on universal coverage? Health care journalist Ken Terry returns to lay out a different model, one that keeps insurance companies in the system while putting primary care doctors back in charge of basic care. …
A 30 to 40 percent Medicare cut just hit the doctors who keep your local hospital running, and the policy meant to stop hospital monopolies is accelerating them instead. John Birkmeyer, president of the medical group at Sound Physicians and…
A 30 to 40 percent Medicare cut just hit the doctors who keep your local hospital running, and the policy meant to stop hospital monopolies is accelerating them instead. John Birkmeyer, president of the medical group at Sound Physicians and a former Dartmouth health services researcher, discusses the KevinMD article “Medicare practice expense cuts will hurt patients.” You’ll hear …
Imagine being penalized for delivering good care to your frailest patients. Medicare's quality scoring program was built for healthy outpatients, not the elderly residents of nursing homes, but it is the system doctors who round in skilled nursing facilities are…
Imagine being penalized for delivering good care to your frailest patients. Medicare’s quality scoring program was built for healthy outpatients, not the elderly residents of nursing homes, but it is the system doctors who round in skilled nursing facilities are forced to play. Steve Buslovich, a physician executive and geriatrician, discusses the KevinMD article “How Medicare’s MIPS impacts skilled …
Medicare Advantage covers more than half of seniors, and the debate over what it really costs is stuck in two camps. Timothy Bulat, a senior consulting actuary who spent nearly two decades leading Medicare Advantage analytics inside a major insurer,…
Medicare Advantage covers more than half of seniors, and the debate over what it really costs is stuck in two camps. Timothy Bulat, a senior consulting actuary who spent nearly two decades leading Medicare Advantage analytics inside a major insurer, raises a question the loudest voices keep avoiding: who actually pays for the program, and is the value being shared …
Walk into any independent primary care practice and ask the nurse what she did on her lunch break. There's a good chance she'll tell you she was on the phone with the daughter of a dementia patient, calling the dialysis…
Walk into any independent primary care practice and ask the nurse what she did on her lunch break. There’s a good chance she’ll tell you she was on the phone with the daughter of a dementia patient, calling the dialysis center to sort out a transportation problem, or following up on the discharge med rec for the COPD patient who landed in the ED again last week. None of it …
Patient care is getting squeezed. For years now, the Medicare Physician Fee Schedule has failed to give doctors the resources they need to keep up with rising costs and deliver high-quality care. The result is real strain on practices, especially…
Patient care is getting squeezed. For years now, the Medicare Physician Fee Schedule has failed to give doctors the resources they need to keep up with rising costs and deliver high-quality care. The result is real strain on practices, especially smaller and independent ones, and growing risks for patients who rely on Medicare.
Policy changes eventually become operating decisions Most coverage of Medicare payment changes stops at reimbursement. A practice reads that a rule changes payment for certain services, then asks the obvious question: How much revenue is at risk? That question matters,…
Policy changes eventually become operating decisions
Most coverage of Medicare payment changes stops at reimbursement. A practice reads that a rule changes payment for certain services, then asks the obvious question: How much revenue is at risk?
That question matters, but it is not the only operator question. Medicare practice expense and related Physician Fee Schedule changes also affect the billing-service decision. If the practice outsources billing, the policy change does not …
In my years as an ICU nurse, I learned to recognize a pattern. The patients I cared for in trauma surgical intensive care often arrived after a cascade of preventable events. A missed medication. A symptom that went unaddressed. A…
In my years as an ICU nurse, I learned to recognize a pattern. The patients I cared for in trauma surgical intensive care often arrived after a cascade of preventable events. A missed medication. A symptom that went unaddressed. A follow-up appointment that never happened. By the time they reached my unit, the question was no longer how to keep them well at home. It was how to bring them …
Recent federal cuts to how Medicare pays physicians are likely to deliver significant negative consequences to independent medical practices. The Centers for Medicare and Medicaid Services' (CMS) final rule for the 2026 Medicare Physician Fee Schedule imposes a dramatic reduction…
Recent federal cuts to how Medicare pays physicians are likely to deliver significant negative consequences to independent medical practices.
The Centers for Medicare and Medicaid Services’ (CMS) final rule for the 2026 Medicare Physician Fee Schedule imposes a dramatic reduction in payment rates for medical services performed in hospital settings by independent clinicians.
The payment reduction fails to account for the true resource costs incurred by independent physician practices, creating an …
Ten years ago, I quit my job and started a solo office-based practice in rural Washington. I serve patients like Mr. G, an elderly gentleman who drove over 70 miles through mountain passes and rural highways to receive care for…
Ten years ago, I quit my job and started a solo office-based practice in rural Washington. I serve patients like Mr. G, an elderly gentleman who drove over 70 miles through mountain passes and rural highways to receive care for gangrene of his foot, as nearby hospitals were either too full or too far away. But Medicare’s broken payment system is endangering practices like mine, quietly dismantling access to affordable …
On October 1, unless Congress acts, millions of Americans will lose access to telemedicine. A proven tool that has kept patients safe, doctors present, and costs down will vanish not because it failed, but because lawmakers failed to make it…
On October 1, unless Congress acts, millions of Americans will lose access to telemedicine. A proven tool that has kept patients safe, doctors present, and costs down will vanish not because it failed, but because lawmakers failed to make it permanent. That would not just be bad policy. It would be malpractice by Congress.
I think of a patient of mine in northeast Georgia who lives 90 minutes from my clinic. …
Brian Whorley, a health care executive, dives into the groundbreaking Medicare Prescription Payment Plan (MPPP), exploring its potential to revolutionize medication adherence and patient outcomes. With 54 million beneficiaries eligible, this initiative promises to alleviate cost barriers, reduce hospital readmissions,…
Brian Whorley, a health care executive, dives into the groundbreaking Medicare Prescription Payment Plan (MPPP), exploring its potential to revolutionize medication adherence and patient outcomes. With 54 million beneficiaries eligible, this initiative promises to alleviate cost barriers, reduce hospital readmissions, and save billions annually. Join the conversation to learn how providers …
Medicare is planning to stop coverage for telehealth in 2025—unless Congress acts by the end of 2024. According to Medicare's website: Absent Congressional action, beginning January 1, 2025, the statutory limitations that were in place for Medicare telehealth services prior…
Medicare is planning to stop coverage for telehealth in 2025—unless Congress acts by the end of 2024.
According to Medicare’s website:
Absent Congressional action, beginning January 1, 2025, the statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 PHE will retake effect for most telehealth services.
This means most telehealth visits will not be covered by Medicare in 2025, unless Congress acts by the end of December 2024.
Starting January 1, 2025, the Medicare Prescription Payment Plan (MPPP) will give providers a powerful way to address one of the biggest barriers to effective care: cost-related medication nonadherence. With 54 million Medicare beneficiaries eligible, this program has the potential…
Starting January 1, 2025, the Medicare Prescription Payment Plan (MPPP) will give providers a powerful way to address one of the biggest barriers to effective care: cost-related medication nonadherence. With 54 million Medicare beneficiaries eligible, this program has the potential to improve adherence, reduce hospital readmissions, and ensure better health outcomes on a large scale. By helping patients access the program, providers can play a pivotal role in transforming patient …
Jessica is a 67-year-old woman having her very first visit with her new primary care clinician, Dr. Jackson. Jessica is accompanied by her husband, Daniel, and comes in with recent laboratory results from her previous clinician, whom she could no longer see because her clinic stopped accepting Jessica’s …
