In an earlier post, I presented some data on which kind of physicians in the United States are most and least likely to see new patients who receive Medicaid, the state/federal program to pay healthcare costs for low income people. Now a recent study lays out some reasons why many physicians are so reluctant to see such patients. Not surprisingly, it starts with low reimbursement rates. Medicaid pays about 61% ...

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Congress is closer than ever to repealing Medicare’s sustainable growth rate (SGR) formula. Competing plans, with traction, are on the table. The leaders of American medicine are convening this weekend in our nation’s capital. The Coalition of State Medical Societies -- representing nearly 160,000 members in nine states -- calls on Congress to act decisively, but not rashly. Congress must act now to repeal the flawed SGR formula used to pay physicians ...

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Recently, the New England Journal of Medicine published a perspective by Lawrence Casalino, MD titled, “Professionalism and Caring for Medicaid Patients – The 5% Commitment.” In the piece, Casalino argues that physicians should commit a portion of their practice to the Medicaid population as a matter of professional obligation. Yet this got me thinking: if physicians don’t respond to the professionalism argument and, instead, insist on being completely market-driven actors, then how can ...

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Recently, the chairs and ranking members of the Senate Finance and House Ways and Means committees released a bipartisan, bicameral plan to repeal the Medicare SGR and reform physician payments.  And this time, it looks like the effort could actually succeed: never before has there been agreement between the House and Senate, Republicans and Democrats, on a plan to repeal the SGR, never mind on what they would replace it ...

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Although you may speak of a "routine" Medicare audit, there is really no such creature. This is like saying you have a "routine IRS audit." The fact is that there is some item you have claimed as a Medicare provider or the amount of claims Medicare has paid in a certain category that has caused you or your practice to be audited. Having too many claims for level five CPT codes ...

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There are just a few key reasons why Medicare has become inordinately expensive. There is no end in sight for cost escalation. But there are some obvious solutions and they all begin with chronic illnesses. Chronic illnesses -- diabetes, heart failure, cancer, chronic lung disease, etc. -- are increasing at exponential rates; are caused largely by lifestyle behaviors; and consume 70-85% of all claims paid. Medicare enrollees tend to have chronic ...

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HealthCare.gov doesnt need a tech surge, it needs better primary care The Affordable Care Act is off to a rocky start, to say the least. Attention has been focused on HealthCare.gov, where those without employer-provided insurance can shop for health plans.  Finger pointing abounds, with the Centers for Medicare & Medicaid Services and contractors blaming each other. A story in the Wall Street Journal chronicles the debacle:

The contractors said each of their pieces ...

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A 100-year-old woman is brought to the emergency room by a concerned friend because she can no longer get out of bed to get food or go to the bathroom. Other than being unwashed and a little confused, she is fine. Her electrolytes are pristine, her electrocardiogram the definition of normal, her blood count and chest x-ray perfectly mirror the expected physiology for her age. Even her urinalysis is normal. ...

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With the implementation of health insurance exchanges in October 2013 and the beginning of the Affordable Care Act (ACA), also known as Obamacare, there is tremendous risk for the American public to be worse off. Certainly the millions of Americans who currently are uninsured because their employers do not offer insurance coverage and those with pre-existing conditions unable to purchase affordable individual coverage, will benefit. It is those with employer-based ...

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The Centers for Medicare and Medicaid (CMS) sets the rates all physicians get paid and insurance companies base their rates on the same formula. So who creates the formula? Well, it’s the doctors, silly! Or at least some of the doctors. Here’s how it works. A 31-member committee formed by the American Medical Association is made up of representatives from the various specialty societies. This Relative Value Update Committee (RUC) meets ...

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