Sep 7, 2018 | Managed Care Friday
1. 84: Percent of primary care providers in our poll of 406 PCPs, OBGYNs, physician assistants and nurse practitioners under the age of 35 who say the number one condition they see in patients today….stress. 2. Physicians Finishing 2nd: In youth sports, all the kids get trophies and cupcakes, even kids like mine who score for the other team sometimes or little Bobby who spends the entire game offsides yet celebrates as though he’s Pele or Messi after every goal. In healthcare, breaking the rules and then celebrating them is a problem but giving one over to the other team (like discharging a...
Sep 5, 2018 | Legislation/ Budgets/ Macro, Medicaid
After failed attempts by Republicans in Congress to repeal and replace the ACA in 2017, attempts to expand Medicaid in several states have gained momentum. Virginia already expanded coverage in June, and several states could expand coverage in the near term depending on elections and voter referendums set to take place this November. In this brief, we discuss recent developments regarding Medicaid expansion. Click to read more.
Aug 31, 2018 | Managed Care Friday
1. 45: Dr Karens felt a bit like Larry David did during that classic Curb Your Enthusiasm scene when a woman got called in to see the doctor before Larry, only because she signed in first, even though Larry’s appointment was earlier. ‘I call Shenanigans!’ Larry argued. Dr. Karens, a pediatrician at a busy practice in the northeast I’ve known for about a decade, told me this week that she had to cancel our monthly chat because she lost her two best NPs to the local hospital and was knee deep in patient visits for sniffles and ‘the angry mob of helicopter moms’ whose children’s ‘red finger...
Aug 30, 2018 | Legislation/ Budgets/ Macro, Physician Fee Schedule
For years, physicians have had to be mindful of two major Medicare restrictions: the so-called “Stark law” which limits physician self-referral and the anti-kickback statute which prohibits physicians from receiving remuneration for referrals. While those have been basic compliance cornerstones of the fee-for-service Medicare world, both are now being questioned by CMS and the OIG as new payment models come online. Click to read more.
Aug 29, 2018 | Drugs, Medicare Advantage, Part D, Payers
Since implementation in 2006, the Medicare Part D program has been relatively stable, popular with beneficiaries, and seen relatively few structural changes. Recently, CMS announced that for the second year in a row, basic Part D premiums are actually expected to decline. However, there are several trends below the hood which are raising concerns and may lead to reforms in the not too distant future. Click to read more.
Aug 28, 2018 | DMEPOS, Physician Fee Schedule, Physicians, Substance Abuse
Every year, CMS releases Comparative Billing Reports (CBRs) to about 10-12 provider groups. CBRs are issued in the form of letters sent to individual providers which analyze and compare individual provider billing patterns with other similar providers in their state and nationally. Typically, CBRs are inspired by past or pending OIG reports or other concerns raised about basic billing patterns, so they effectively put providers on alert that their specialty is being given extra attention, and makes them aware if they are outliers among billers in their specialty. In this brief, we have...
Aug 27, 2018 | 340B, Hospitals
The 340B Drug Discount Program has come under increased scrutiny in recent years from government agencies and others who note the negative impact the program may have on the broader market for pharmaceuticals. This impact is in part due to the program’s increasing size relative to the overall pharmaceutical market. Since 2010, the program has expanded at an average annual growth rate of 21 percent and has grown by 114 percent in the last three years alone. In May 2018, the Health Resources and Services Administration (HRSA) reported that in 2017, 340B covered entities purchased more than $19...
Aug 24, 2018 | Managed Care Friday
1. 64: That’s the percentage of Americans who reported they would attend an appointment via video telehealth, according to an American Well Telehealth study. The Council of Accountable Physician Practices and the Electronic Data Interchange released new documents designed to help healthcare providers in developing and launching telelhealth and telemedicine services. These documents, called “A Roadmap to Telehealth Adoption: From Vision to Business Model,” contain information designed to help identify resources of federal and state regulations as well as policies, pilot programs and use...
