Medicare

United Healthcare, the largest provider of Medicare Advantage (MA plans) services, is being sued by the Department of Justice (DOJ) for fraud. I think they may be right. They are gaming a system designed to protect Medicare beneficiaries and taxpayers from excessive cost and they are very profitable. Did your revenue go up by 11.6% last year? Theirs did.
In the last week, the Center for Medicare and Medicaid Services (CMS)  initiated 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?  ... the presumptive new Health and Human Services Secretary is expected to cancel the demonstration, but it is more important to look at the underlying economics CMS envisions because they are the savings part of Obamacare.
Are you shocked by this news in the headline? Us here, not so much. But hats off to the Harvard research team for its new approach to tackling gender inequality in medicine. And the researchers did it by getting back to basics: Let the evidence speak for itself. And to a certain extent, it does.
Enjoy the first installment of a new series entitled The Shackling of the Physician, about inane and laborious diagnostic coding excesses. Bitten by orca? Opera house as place of occurrence of external cause? Pecked by chicken? You have to be kidding ... Can anyone say #physicianburnout?    
A recent study claims Medicare is discriminating against female doctors in payments. Here is what's really going on.
It has become increasingly tricky for Medicare recipients to find doctors who will accept them as patient. The paperwork is crazy, and the reimbursement is also crazy, but in the other direction. Something's gotta break. How will this play out?
Medicare announced that the program the federal insurance coverage for over-65s will reimburse caregivers for end-of-life planning discussions. Can we just discuss this without falling prey to that old death panel hysteria c. 2009?
Another apparently-beneficial screening program lung CT scans for smokers becomes controversial, when Medicare officials decide it should be covered, contradicting its own coverage advisory committee s recommendation. Who needs it? The scan, that is.
Why do healthcare expenditures in the U.S. tower over those of other wealthy countries? And why are the health benefits we receive not commensurate with all those billions spent? Dr. Atul Gawande has some thoughts on this in The New Yorker.
Lung cancer kills about 435 people in the United States every day, making it the leading cancer killer of both American men and women.
Lung cancer is the leading cancer killer in both American men and women, causing more deaths than colon, breast, and pancreatic cancers combined. According to the American Lung Association, almost 160,000 Americans are expected to die from lung cancer in 2014.
Seems like old times: a few expensive new drugs (although money-saving in the long-term) lead to renewed calls for negotiated prices for Medicare patients price controls. Short-term savings are short-sighted however: politicians think long-term is the next election.