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2 Hospital Networks Agree to Merge, Raising Specter of Costlier Care

by by Anemona Hartcollis  from from The New York Times

Posted 08/29/2013

Two major New York City hospital networks have agreed to merge, creating the largest private hospital system in the city, raising the prospect of higher prices for consumers, and positioning the new system to take advantage of coming changes under the federal health care law. The boards of the two hospital systems, Mount Sinai Medical Center and Continuum Health Partners, a network of community-oriented hospitals that includes Beth Israel and the two St. Luke’s-Roosevelt campuses, approved the merger in consecutive votes on Monday and Tuesday. The decision came after a year of courtship and after Mount Sinai, with a last-minute offer, scuttled a deal between Continuum and a competitor, NYU Langone Medical Center, that would have threatened its position. The new enterprise would have more than 3,300 beds at seven campuses spread through Manhattan, Brooklyn and Queens, making it the largest hospital system in New York City outside of the public hospital system. It would eclipse the reigning giant, NewYork-Presbyterian Hospital, with 2,600 beds, and would become one of the country’s largest nonprofit systems. Click here to read the rest of the article.

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Doctors Bail Out on Their Practices

by by Parija Kavilanz  from from CNN

Posted 08/29/2013

Doctors who own private practices are looking for a way out. Fed up with their rising business expenses and shrinking payouts from insurers, many are selling their practices to hospitals. It's happening nationwide and has picked up pace, said Tony Stajduhar, president at Jackson & Coker, a physician recruitment firm. Experts say the number of physicians unloading their practices to hospitals is up 30-40% in the last five years. Doctors who sell typically become employees of the hospital, as do the people who work for them. The reasons for the trend vary. Doctors are tired of the hassle of filing insurance claims and collecting payments from patients and want to only focus on medicine again, Stajduhar said. Obamacare has also created more fear of the unknown. Doctors are worried that new regulations will add to their administrative work and require them to pour more money into their businesses, Stajduhar said. Click here to read the rest of the article.

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Sell Your Practice to a Hospital? Read This First

by Neil Chesanow and Jeffrey J. Denning  from Medscape

Posted 06/04/2013

With the future of healthcare uncertain and many physicians, particularly soloists and those in small groups, feeling vulnerable, this may seem like the perfect time to sell your practice to a hospital or insurer. Both are in the midst of a shopping spree for physician practices.


In 2011, a survey sponsored by MedSynergies found that 70% of responding national hospitals and health systems planned to employ more physicians in the next 12-36 months. Physician groups being snapped up by community and regional hospitals have become a staple of local news.


What's going on? And what -- if anything -- should you do about it? For answers, Medscape spoke with practice management consultant Jeffrey J. Denning, a partner in the Practice Performance Group in La Jolla, California, about the risks and rewards for a small or solo physician practice in selling to a hospital in the current market.


Denning advises even doctors who are having trouble paying the bills to refrain from acting precipitously. Instead, he urges you to pause, take a hard look at why you want to sell, and take an equally hard look at who you want to sell to rather than allow yourself to be ruled by herd instinct, as happened in the late 1990s, with unhappy results for both the hospitals and the doctors involved. Here's his perspective on what to do today.

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For New Doctors, 8 Minutes Per Patient

by Pauline W. Chen, M.D.  from The New York Times

Posted 06/04/2013

At a social gathering not long ago, a colleague and I exchanged stories about residency training, fondly remembering the patients who had helped us grow both as doctors and as people.


A doctor-in-training we both knew listened intently to our conversation, but when we asked him about his experiences with patients, he looked lost and struggled for a response.


“My generation is different from yours,” he finally said, and then told us about getting “caught” sneaking back to the hospital earlier that year to talk with a couple of patients. He had already officially signed out for the night, but even going back just to say hello would count toward and push him over his 80-hour weekly work limit. Such a violation could cause his residency program to lose its accreditation.


“My generation is different because we can’t have the same relationships with patients as you did,” the young man said. “We just don’t have the time.”

His comment unnerved me then and for a long time afterward. I knew he was being honest about his own experiences, but I couldn't believe that the same held true for all doctors-in-training. After all, most people I knew became doctors because they wanted to interact with patients.

Now a new study confirms what the young doctor told us: doctors-in-training are spending less time with patients than ever before.

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Don't Just Blame the Doctors: Physician Payment Reform Report

by Deborah Walker Keegan, PhD, MBA  from Medscape

Posted 04/10/2013

Most suggestions for reducing the nation's healthcare costs focus on physician payment. Those that recently came from the Report of the National Commission on Physician Payment Reform, March 2013 will probably arouse strong emotion.


What About Patient Engagement?

What is missing from the recommendations regarding payment reform is the role that patients play in driving up healthcare costs. In fact, this lack has been notable among many of the past year's proposals for cutting the costs of healthcare in the United States.


One of the critical ingredients for a reduction in healthcare costs is patient engagement and activation in his or her own health. The health status of the US population is also a function of the patient, the patient's health choices, and our "just fix it" mentality.

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Job Prospects Are Dimming for Radiology Trainees

by Nina Bernstein  from The New York Times

Posted 04/02/2013

For years, medical students who chose a residency in radiology were said to be on the ROAD to happiness. The acronym highlighted the specialties — radiology, ophthalmology, anesthesiology and dermatology — said to promise the best lifestyle for doctors, including the most money for the least grueling work.


Not anymore. Radiologists still make twice as much as family doctors, but are high on the list of specialists whose incomes are in steepest decline. Recent radiology graduates with huge medical school debts are having trouble finding work, let alone the $400,000-and-up dream jobs that beckoned as they signed on for five to seven years of relatively low-paid labor as trainees. On Internet forums, younger radiology residents agonize about whether it is too late to switch tracks.

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Medicare Pay Cut From Sequester Goes Into Effect March 1

by Mark Crane  from Medscape

Posted 04/01/2013

The US Senate rejected 2 competing proposals today that would have replaced the "sequester" — $85 billion worth of automatic, across-the-board budget cuts set to take effect March 1.


Barring some last-minute rescue, that means Medicare reimbursement for physicians and other healthcare providers will decrease by 2%.


The scheduled 2% reduction in Medicare reimbursement to physicians and other providers presumably would apply to all services rendered, beginning March 1. The Centers for Medicare & Medicaid Services had no comment as yet on how the pay cut would be implemented.


Judging by what occurred in previous planned pay cuts, it is likely the effects will not be felt for 14 days while Medicare administrative contractors temporarily sit on electronic claims.

Read the full article here

Health Insurance Companies Get in Shape for 2014

by Reed Abelson  from The New York Times

Posted 03/15/2013

Since Patrick J. Geraghty arrived here a year and a half ago to lead the state’s largest health insurer, Florida Blue, he has expanded its operations in Medicare and Medicaid, entered arrangements with hospitals and doctors, bought a medical group, and dabbled with a new private sector marketplace that allows employees to choose plans from different insurance companies.


At the same time, he is preparing Florida Blue, a nonprofit Blue Cross and Blue Shield plan, for 2014, when most of the requirements of the federal Affordable Care Act go into effect. Insurers will have to offer a policy to anyone who wants one, regardless of their health, and will not be allowed to charge more in premiums to people with expensive medical conditions. The plans the companies offer will be highly regulated through government-run exchanges that are still getting their final regulatory touches.


Insurance companies across the country, whether national profit-making players like WellPoint and UnitedHealth Group or nonprofit Blue Cross plans in states like Arizona and Michigan, are undergoing radical change as a result. After years of focusing on selling plans to employers, rather than individual consumers, the insurers must alter course.

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$120 Million Aetna Settlement Creates Physician Payday

by Robert Lowes  from Medscape

Posted 03/10/2013

Thousands of physicians stand to collect some cash from a proposed $120 million settlement that Aetna reached last week with organized medicine, Aetna beneficiaries, and other plaintiffs in a class-action lawsuit over rates paid to out-of-network providers.


The pay-out will range from a few hundred dollars to possibly $5000 or more, depending on how physicians choose to participate in the settlement, which awaits approval from a federal district judge in Newark, New Jersey.


The plaintiffs in the case, including the American Medical Association (AMA) and 10 state medical societies, accused the giant insurer of systematically underpaying physicians and other clinicians who were out-of-network providers. Such providers are entitled to the lesser of either their billed charges or the "usual, customary, and reasonable" (UCR) fee for the particular service rendered. Unlike network providers, who must accept the insurer's reimbursement rate as payment in full, non-network providers are free to bill patients for the balance of their charge after subtracting what the insurer paid.

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Congress Passes Legislation to Prevent Medicare Physician Cuts

from Medical Society of the State of New York (MSSNY)

Posted 03/02/2013

As has been widely reported, a nearly 30% cut in Medicare physician payments was averted yesterday when the US House of Representatives passed H.R,. 8 the American Taxpayer Relief Act. The Senate approved the package on New Years Eve by a vote of 89-8.


In addition to preventing the impending 26.5% SGR cut for all of 2013, the bill also defers the impending sequestration cuts for two months that would have further cut Medicare physician payments by 2%. The delay in the 2% sequestration cuts (which impact all Medicare health care providers) will end at the beginning of March, at which point proposals to prevent these cuts will be considered along with proposals to address increases in the nation’s debt ceiling.


Please read the summary prepared by the AMA of the health provisions in the package, as well as a summary of the offsets for preventing the SGR cut. As noted, the $25 billion cost just for the SGR patch and additional expenses for other Medicare extender provisions were offset with an array of provisions. On a positive note, proposals to eliminate the increase in Medicaid payments for primary care services starting in 2013 were not adopted (MSSNY had worked with the federation of medicine and AMA to advocate to assure that the Medicaid primary care increases could go forward). However, the legislation did include other problematic provisions as “pay-fors”, including reduced payments for advanced imaging services based on a change in assumptions regarding the utilization of equipment, extending the statute of limitations from 3 to 5 years for recoupment of overpayments and elimination of unobligated funds for health insurance co-ops authorized by the Affordable Care Act.     

Read the full article here

Important Alert Regarding Fiscal Cliff Impasse

from Medical Society of the State of New York (MSSNY)

Posted 02/28/2013

All physicians should be aware regarding the impact of the impasse on “fiscal cliff” negotiations on physicians and patients, as reported recently by the American Medical Association. MSSNY’s President Dr. Robert Hughes yesterday issued a press statement that has been shared with the entire New York Congressional delegation calling upon Congress to immediately address this problem. The AMA reported that:


  “The negotiations between Speaker Boehner and President Obama on the Lame Duck tax and deficit reduction package are at an impasse. There is a very real threat of the 26.5 percent Medicare physician payment cut taking effect on January 1, 2013, at least temporarily."


If Congress does adjourn without addressing the payment cut being induced by the sustainable growth rate (SGR) formula, the Administration announced today that the Centers for Medicare and Medicaid Services will follow normal claims processing procedures. That is, claims will not be held and Medicare carriers will process payments for physician services provided after December 31 under the normal 14-day cycle required by law. Payment for these claims would be based on the new, lower fee schedule conversion factor of $25.0008, as opposed to the current rate of $34.0376.

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FDA Adds Warnings to Statin Label

by Reed Miller  from Medscape

Posted 02/26/2013

Taking a statin can raise blood sugar and glycosylated hemoglobin HbA1c levels, according to a new labeling change approved by the Food and Drug Administration (FDA) today for the entire drug class.


As reported by heartwire, recent studies of popular statins showed a significant increase in the risk of diabetes mellitus associated with high-dose statin therapy. The Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) trial showed a 27% increase in diabetes mellitus in patients taking rosuvastatin compared to placebo. Also, the Pravastatin or Atorvastatin Evaluation and Infection Therapy: Thrombolysis In Myocardial Infarction 22 (PROVE-IT TIMI 22) substudy showed that high-dose atorvastatin can worsen glycemic control.

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Recoupment of Medicare Payments for Illegal Alien Beneficiaries

from National Government Services

Posted 02/24/2013

The Office of Inspector General (OIG) of the Department of Health and Human Services advised in the 2013 OIG Work Plan that they would be reviewing payments for Alien Beneficiaries Unlawfully present in the United States. The OIG will determine whether Medicare payments were made on behalf of beneficiaries who were unlawfully present in the United States on the dates of services. Medicare payment may not be made for items and services furnished to alien beneficiaries who were not lawfully present in the United States. (The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual, Medicare Claims Processing Manual (100-04), Chapter 1, § Medicare prohibits payment for services rendered to individuals who are not "qualified aliens." (Personal Responsibility and Work Opportunity Reconciliation Act of 1996, § 401.)


These audits that have been conducted by the OIG have resulted in overpayments to providers across the country, including the National Government Services states of business being identified. As a result of these audit findings, the OIG and the CMS have charged National Government Services to begin the process of recouping those overpayments. The first tier of this process has now begun and we have generated the first round of those overpayment adjustments. As with any overpayment situation letters have also been generated. These letters will begin to be mailed on Monday, December 10. The listing of the claims impacted by this action that you will receive with your letter will indicate that; "This claim adjustment was due to a mass adjustment." The detailed description of the adjustment can be found on Fiscal Intermediary Standard System. The letters will contain the guidelines for applying for an extended repayment plan so that you may research that option if necessary.


If you receive one of these overpayment letters it will be of major importance for your facility/office to review it and plan appropriately. All normal overpayment options apply and will be described completely in the letter. It will be important for you to be aware so that your facility/office can stay on top of the overpayment situation and work with National Government Services to control how your overpayment is repaid.

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Enhanced Medicaid Reimbursement Rates for Primary Care Services

from the American College of Physicians

Posted 02/23/2013

To prepare the primary care workforce for the influx of new Medicaid-eligible patients, the Patient Protection and Affordable Care Act (ACA) increases payment rates for certain primary care services to the level of Medicare. The provision was included because primary care physicians, including general internists, will be particularly affected by the Medicaid expansion since millions of new patients will enter the health care system and many will have complex health care needs. Primary care physicians and subspecialists are not required to participate in Medicaid, and many practices do not accept Medicaid patients because reimbursement rates are relatively low and the administrative barriers are significant. Further, people who are currently eligible for Medicaid but not enrolled will likely enroll in Medicaid coverage to comply with the individual mandate, adding more beneficiaries to the program. Many of these new Medicaid patients will be adults who seek care from internists.

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CMS Nails Down Medicaid, Medicare Raises for Primary Care

by Rob Lowes  from Medscape

Posted 02/23/2013

The Centers for Medicare & Medicaid Services (CMS) has nailed down raises that it had promised primary care physicians in each program next year, but they will resemble hors d'oeuvres on the Titanic if Congress does not avert a 26.5% Medicare pay cut set for January 1.

Read the full article here

Settlement Eases Rules for Some Medicare Patients

by Robert Pear  from The New York Times

Posted 02/21/2013

WASHINGTON -- Tens of thousands of people with chronic conditions and disabilities may find it easier to qualify for Medicare coverage of potentially costly home health care, skilled nursing home stays and outpatient therapy under policy changes planned by the Obama administration.

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PHQ-9 Depression Screening

Click here to download the PHQ-9 depression screening in English and Chinese.

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