Medicare

American physicians dole out lots of unnecessary medical care to their patients. They prescribe things like antibiotics for people with viral infections, order expensive CT scans for patients with transitory back pain, and obtain screening EKGs for people with no signs or symptoms of heart disease. Some critics even accuse physicians of ordering such services to bolster their revenue. So what happens when uninsured patients make it to the doctor’s office ...

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I am a terrible coder. I think I am a pretty good doctor, but when it comes to coding, the process of figuring out which billing code to pick to assign to a bill for an office visit, I am hopeless. No matter how many times I have had the rules explained to me, or how much feedback I have been given about specific visits, or which “pocket guide” to ...

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The word “historic” is often used by PR professionals to hype something that is, well, pretty run-of-the-mill.  They figure that no one is going to read a news release that announces “[Name of organization] proposes small change that really won’t make much of a difference.”  The problem is that when something is done that really measures up to being historic, the recipient is less likely to believe it, kind of ...

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Until genuine rights are extended to all patients, the ongoing health-care-reform saga perpetrated by Congress and executive leadership will continue to fail the American people. Many Americans have suffered and died because of a broken health-care-delivery system. One of us lost a 19-year old son due to lack of certain patient rights – specifically the right to evidence-based medicine and the right to a complete discharge plan from his hospital. ...

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The tide is finally rising under the idea of health care for all in America. It is no longer possible to tar this simple and ubiquitously implemented idea as a bid to “take away our freedom” or “destroy the free market.” Hearteningly, the debate is shifting towards the harder questions of when, and how. One popular idea is to expand Medicare to cover all Americans — essentially turning the government into ...

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From the CMS website, October 30, 2017, “Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma discussed the agency’s efforts to streamline quality measures, reduce regulatory burden, and promote innovation … We need to move from fee-for-service to a system that pays for value and quality -- but how we define value and quality today is a problem. We all know it: Clinicians and hospitals have to report ...

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Quality-based Medicare payment is far from a new concept. However, the Quality Payment Program (QPP), created by the Medicare Access and CHIP Reauthorization Act (MACRA), introduces a new vocabulary, complex requirements and fast-approaching deadlines. Physicians have little time left to successfully navigate the program and avoid penalties for 2017. A recent survey by the American Medical Association (AMA) ...

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Reformers have expended considerable effort to change the way Medicare buys health care for millions of Americans, finding a wide range of support across the political spectrum. But Medicare’s current structure may doom these reforms. Some primary care doctors fear that the skewed incentives in Medicare’s pricing system will get built into any new system, whether it is “accountable,” “affordable,” or “value-based.” This fear is well-founded. If special interests buy ...

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I was browsing the latest issue of the Journal of the American Medical Association, as I often do, and an article by one Andy Slavitt, MBA, and Gail Wilensky, PhD, titled “Reforming Medicaid,” caught my eye. From 2015 to 2017, Mr. Slavitt served as the Acting Administrator for the Centers for Medicare & Medicaid Services (CMS). In that role, he oversaw the government’s awful Meaningful Use EHR program, and helped ...

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