Medicare

Inclusivity for those with chronic disease or differing abilities is gaining momentum as a fashion trend. And it is about time, for all of the innumerable obvious reasons. In an industry uniquely positioned to raise awareness at levels the public health sphere never could, the newest campaign by American Eagle’s Aerie line, devoted to body positivity through unretouched imaging or use of “real” women, showcases lingerie models replete with their respective personal medical devices, albeit an ostomy bag, insulin pump or wheelchair.

This is good for humanity. For fostering improved functionality in clothing design for...

Accountable care organizations, are a new organization of healthcare, combining some aspects of insurance and health systems. They are collaborations which are paid a capitated rate, based on risk, and provide all care to these beneficiaries. If they show savings beyond what they are paid, they receive about half as an “incentive.” Savings cannot be achieved at the cost of patient safety and outcomes, so that “quality measures” must be met. For those showing greater costs, losses, what happens is less clear. The federal plan was to have these ACOs move from the safe environment where losses carried no real consequences, to a risk-based approach where there was “skin in the game,” and you might lose money. Oddly enough, few ACOs are moving from phase one where there are only incentives...

In the not-so-new realm of nontraditional health coverage, the Centers for Medicare and Medicaid Services (CMS) is expanding their Medicare Advantage plan to include benefits that meet patients “unique health needs” and improve “their quality of life.” Behavioral economics is in full swing these days and now being put to the test by this recent roll out set to take effect in 2019.

Based on the premise that social determinants can drive poor health outcomes and increase costs, equalizing these factors through non-emergent medical transportation (NEMT) as a means to reduce barriers thereby improving care access, providing air conditioners for high risk populations and specific foods for those with diabetes could impact healthcare spending with a hope of yielding greater dividends...

Just a quick note. I have written previously about the Independent Payment Advisory Board. The budget legislation signed today, permanently repeals its existence. To return to my original metaphor, the final stake has been driven into its heart. 

Created as part of the Affordable Care Act, and part its continuing structural dismantling by the Trump administration it was a cost-control mechanism designed to maintain individual beneficiary costs of Medicare within certain guidelines. It's appointed members had no accountability and could recommend significant payment cuts. Those decisions will now rest with the newly confirmed Secretary of Health and Human...

United Healthcare, the largest provider of Medicare Advantage (MA plans) services, is being sued by the Department of Justice (DOJ) for fraud. To give you a sense of United Healthcare’s size consider that just their third quarter revenue was $46.3 billion, up 11.6 per cent from the same period a year earlier, and the bulk of the growth was billing services and data analysis for healthcare groups, which ws up 34 percent since the beginning of 2016.

And to get a sense of the concern about the DOJ joining a whistle-blower lawsuit, consider this

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In the last week, the Center for Medicare and Medicaid Services (CMS) posted a final regulation [1] initiating a demonstration project involving the bundling of care for two new diagnostic categories. First, acute myocardial infarctions (AMI) – heart attacks including their medical and minimally invasive treatment (coronary artery angioplasty and stents) and second, coronary artery bypass grafting (CABG) – surgery to improve/restore circulation to the heart arteries.

And I should care why?  For two reasons. First Congressman Tom Price the presumptive new Health and Human Services Secretary feels the...

Are you shocked by this news?  Me, not so much.  But, hats off to the Harvard research team and their new approach to tackling gender inequality in medicine by getting back to the basics:  Let the evidence speak for itself.  And, it does (to a certain extent).

Since all most people care about is who lives and dies or patient outcomes, why not study if the physician’s gender plays a critical role in the all-important realm of survival?

Ok, so for full disclosure, this article brings me joy.  For so many reasons.  On so many levels.  Mainly, for the chuckle and laughter I already have enjoyed in response to some reactionary, knee-jerk posts on social media and in person that range from dismissing the publication as another feminist attack that would never be granted in the...

  Welcome to my first in a new series entitled:  The Shackling of the Physician.  It was that or “limitless inane continuous regulations and impositions imparted on the doctor against his/her will without his/her input that serve to embattle him/her and detract from patient care and personal well-being.”  The former seemed more effective with respect to search engine optimization, but the latter is what emanates from my soul.

  Since this topic, alone, is boundless in possibilities, I will focus the discussion today on absurd, oops, I mean illogical and impractical and often utterly hilarious and completely inefficient costly diagnostic coding measures - a sampling of which is at the end of this article.  Yes, it is intellectually edifying to know how many get struck by macaws...

Credit: ShutterstockCredit: Shutterstock

A recent TIME magazine article highlighted a study which declared that Medicare pays nearly $19,000 less to female doctors. Since the government has stressed equal pay, this sounds alarming.

But is it accurate? The paper by Tejas Desai et al., in Post Graduate Medical Journal, looked at thirteen medical...

DocHousePerhaps the doctor is not in the house. Image: Shutterstock

As I was in the waiting room of my physician's office today, I overheard a phone call that reminded me of something that I already knew. Chances are, you know it, too. But hearing it in person made the message even more disturbing. It was: Don't get old. Because if you do, good luck finding a doctor who will take Medicare. They are becoming harder to find. And it's virtually impossible to blame them for their decision.

The following is (more or less) the discussion I had with...