What would you think if I told you that Medicare will require laboratories to disclose to CMS payment rates from private insurers? Or that they will identify physicians who order a high volume of CT tests and require them to pre-authorize those tests in 2020?  How about that CMS will begin its own analysis of the time and cost of providing services in order to determine RVUs, a job currently ...

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My home hospital is small. In a town of just over 20,000 people, this hospital has 25 beds and is designated "critical access" by Medicare because it is felt to be necessary to the health care of the community. Critical access is a designation which was introduced in 1997 when modernization of Medicare payment systems threatened to close a large proportion of hospitals in small communities which were unable to ...

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AMA: Urge Congress to repeal the SGR nowA guest column by the American Medical Association, exclusive to KevinMD.com. It’s crunch time for our nation’s physicians. After an 11-year battle, we stand closer now than ever before to repealing Medicare’s fatally-flawed sustainable growth rate (SGR) formula. With the introduction of the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 last month, Congress took a critical step toward reforming ...

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Medicare’s Sustainable Growth Rate (SGR) payment formula has hung like an annual albatross around the necks of physicians, Congress, and medical associations for more than a decade. Finally, we have a realistic opportunity to fling that albatross into the sea. Three congressional committees -- from both the House and the Senate, with both Democratic and Republican support -- have crafted the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, ...

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In describing why Cooper Union, a unique college that offers absolutely free education to students, would effectively die if it starts charging tuition, Kevin Slavin wrote:

For many of us, Cooper wasn't even the cheapest way to go to school...So the question is: why did we go? We went not because of the financial value of free--that is, zero tuition--but rather, because of the academic value of free. At Cooper Union ...

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A primary criticism of the Affordable Care Act is that it creates incentives for employers to hire fewer full-time employees. One of the House’s attempts to repeal the ACA even referenced it as the “job-killing healthcare law.” It’s true that there are some provisions in the ACA that employers may exploit in order to minimize the cost of doing business. At the same time, it’s also true that the ...

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Two decades ago, a decision was made by Medicare policymakers that carotid endarterectomies would not be allowed. Their claim was too many were being done costing Medicare money. The following year, data revealed a sharp rise in debilitating strokes, so wisely, surgical criteria was developed recommencing the use of this quality-of-life saving operation. For years, there have been other misjudgments against Medicare patients that are only now becoming apparent. Let me clarify ...

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I wonder, sometimes, are physicians valued professionals, or merely problems to be solved?  Are we skilled clinicians vital to the well-being of our patients?  Or are we merely assetts to be managed?  It occurs to me as I walk around hospitals these days, and see the overgrowth of people with clip-boards, people with undue authority over our lives and practices, people trained in business and management but untrained in either ...

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Certain medical stories are irresistible to the popular press: ICD-10 external cause codes that are ridiculous (W61.43XD, pecked by a turkey, subsequent encounter) or medical practices using their electronic health records in a way that increases their revenue. A recent headline was eye-catching, as headlines are meant to be, “Report finds more flaws in digitizing patient files.”  The New York Times reported that the Office of Inspector General (OIG) ...

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Recently, another installment was published from the research team of the Oregon Health Insurance Experiment. The major finding -- Medicaid coverage results in a 40% increase in emergency department (ER) use. Many of the health care pundits quickly sifted through the scientific results to support their opinions. You can read some of them here: Sarah Kliff reports the facts: Expanding Medicaid doesn’t reduce ER trips. It increases them. Scott Gottlieb claims that 
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