News 2020
Medicare to save $73.4B with surgery in ASCs through 2028: 5 things to know
Content provided by Becker's ASC Review
A new report from the Ambulatory Surgery Center Association shows performing surgery on Medicare patients in ASCs instead of hospital outpatient departments saved $4.2 billion in 2018, and the savings are expected to climb significantly in the next decade.
KNG Health Consulting conducted an analysis of Medicare payment data from 2011 to 2018 on outpatient surgical procedures in ASCs and hospital outpatient departments. The analysis estimated historical and potential savings with a focus on total knee replacements.
Five key points:
1. Medicare saved $28.7 billion from 2011 to 2018 from surgeries performed in ASCs instead of hospital outpatient departments. The report projects Medicare will save $73.4 billion from 2019 to 2028, with $12 billion saved in 2028 alone.
2. The percentage of total knee replacement and knee mosaicplasty is expected to grow from 13.4 percent of all procedures in ASCs in 2020 to 18 percent in 2028, a 3.7 percent annual growth. Based on that projection, ASC savings for Medicare total knee replacements would be $2.95 billion from 2020 to 2028.
3. Most of the savings in the last decade are attributed to high-volume procedures, including cataract surgeries and colonoscopies, but the report estimates procedures such as endocrine, cardiovascular and orthopedic surgery will drive most of the $73.4 billion savings through 2028.
4. The following five specialties are expected to save Medicare $1 billion per year by being performed in the ASC:
5. There are more than 5,800 Medicare-certified ASCs in the U.S., with the most common procedures today being cataract surgery, colonoscopy, upper GI endoscopies and pain management procedures.
Click here to read more.
Content provided by Becker's ASC Review
A new report from the Ambulatory Surgery Center Association shows performing surgery on Medicare patients in ASCs instead of hospital outpatient departments saved $4.2 billion in 2018, and the savings are expected to climb significantly in the next decade.
KNG Health Consulting conducted an analysis of Medicare payment data from 2011 to 2018 on outpatient surgical procedures in ASCs and hospital outpatient departments. The analysis estimated historical and potential savings with a focus on total knee replacements.
Five key points:
1. Medicare saved $28.7 billion from 2011 to 2018 from surgeries performed in ASCs instead of hospital outpatient departments. The report projects Medicare will save $73.4 billion from 2019 to 2028, with $12 billion saved in 2028 alone.
2. The percentage of total knee replacement and knee mosaicplasty is expected to grow from 13.4 percent of all procedures in ASCs in 2020 to 18 percent in 2028, a 3.7 percent annual growth. Based on that projection, ASC savings for Medicare total knee replacements would be $2.95 billion from 2020 to 2028.
3. Most of the savings in the last decade are attributed to high-volume procedures, including cataract surgeries and colonoscopies, but the report estimates procedures such as endocrine, cardiovascular and orthopedic surgery will drive most of the $73.4 billion savings through 2028.
4. The following five specialties are expected to save Medicare $1 billion per year by being performed in the ASC:
- Eye and ocular adnexa
- Cardiovascular
- Nervous system
- Digestive system surgery
- Musculoskeletal surgery
5. There are more than 5,800 Medicare-certified ASCs in the U.S., with the most common procedures today being cataract surgery, colonoscopy, upper GI endoscopies and pain management procedures.
Click here to read more.
Virtual Learning Dilemmas, Keeping Staff Socially Distanced Off-Hours, Enforcing Mask Policies, and Staying Sane in the Midst of a Global Pandemic
Content provided by: AAOE
Each month, AAOE is hosting an Ask Me Anything Series where attorneys and consultants answer your questions to help you stay on top of the ever-evolving COVID-19 climate. It’s a safe space where you can come together with your peers to get the information you need, hear what other practices are doing, and sometimes just connect with the only people who understand what you’re going through.
Below are the takeaways from the August 6 Ask Me Anything call.
How do you ensure staff are social distancing in their personal lives? What’s the line between protecting your patients and staff, and respecting their personal lives?
What can or should you do for staff whose children are required to do virtual learning and who have positions where they’re unable to work from home?
Click here to read the full article.
2021 Medicare Physician Fee Schedule and Quality Payment Program Proposed Rule Summary
On August 4th, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule for the 2021 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP). Comments are due to CMS no later than October 5, 2020.
Click here to read the full summary.
CMS to Reimburse for Regenerative Orthopedic Product in ASCs
CMS updated the reimbursement calculation for Wright Medical's Augment regenerative solutions to allow for Medicare beneficiaries to undergo procedures with the product in ASCs and hospital outpatient departments.
Click here to read more.
CMS Delays Full Implementation of Appropriate Use – Again
As anticipated would happen by many in the industry, the Centers for Medicare & Medicaid Services (CMS) announced this week it is pushing back the mandate for referring providers to use appropriate use criteria (AUC) and clinical decision support (CDS) tools. Now, the testing period for physicians who order advanced imaging scans has been extended through the end of 2021.
Click here to read more.
Cuts Proposed to Surgical Services in 2021 Medicare Physician Fee Schedule
Last week, the Centers for Medicare & Medicaid Services (CMS) released the highly anticipated Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) proposed rule. In the months prior to the release of the rule, AAOS had advocated against the proposed 5.4% cut to the work relative value units for hip and knee arthroplasty, as well as changes to the Evaluation and Management Office/Outpatient visit codes that were not extended to global surgical codes--which would lead to an overall 5% reduction to all orthopaedic surgical services. CMS has formally proposed these changes in the rule, and AAOS will continue to advocate against them through the rule’s comment period. Other changes proposed include making permanent some of the telehealth provisions implemented during the Covid-19 public health emergency, broadening the scope of practice for non-physician practitioners, pharmacists, and physical therapy assistants, as well as the introduction of the Alternative Payment Model Performance Pathway for the 2021 performance year. Members should be on the lookout for a grassroots opportunity soon to engage on this issue
Click here to read more.
Content provided by: AAOE
Each month, AAOE is hosting an Ask Me Anything Series where attorneys and consultants answer your questions to help you stay on top of the ever-evolving COVID-19 climate. It’s a safe space where you can come together with your peers to get the information you need, hear what other practices are doing, and sometimes just connect with the only people who understand what you’re going through.
Below are the takeaways from the August 6 Ask Me Anything call.
How do you ensure staff are social distancing in their personal lives? What’s the line between protecting your patients and staff, and respecting their personal lives?
- Susan Childs, Founder of Evolution Healthcare, shared that her clients are struggling with staff who aren’t wearing masks or social distancing outside of the office. This poses an obvious risk to patients an other staff, but what can you legally require outside working hours?The rest of the panel advised against creating an unenforceable policy.
- Jeana Singleton, an attorney at Brennan, Manna, & Diamond, explained that staff education is your best plan of attack. She recommended continuing to educate your staff on your state’s mandates regarding masks and travel restrictions.
- Ryan Smith, an attorney at the Fredrikson & Byron law firm, echoed Singleton’s advice, stressing the importance of educating your staff about the guidelines in place to keep their coworkers and the practice’s patience safe. He added that your focus should be on what you can control: reducing the chance of transmission within the practice itself.
What can or should you do for staff whose children are required to do virtual learning and who have positions where they’re unable to work from home?
- This is a difficult and complicated issue, with no clear answer. Childs recommended sitting down one on one with staff who are affected to understand each of their individual needs, as a blanket policy likely won’t accommodate everyone. This is one more area that has caused uncertainty in our current environment, so the most important thing you can do is remain flexible and transparent with your employees.
Click here to read the full article.
2021 Medicare Physician Fee Schedule and Quality Payment Program Proposed Rule Summary
On August 4th, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule for the 2021 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP). Comments are due to CMS no later than October 5, 2020.
Click here to read the full summary.
CMS to Reimburse for Regenerative Orthopedic Product in ASCs
CMS updated the reimbursement calculation for Wright Medical's Augment regenerative solutions to allow for Medicare beneficiaries to undergo procedures with the product in ASCs and hospital outpatient departments.
Click here to read more.
CMS Delays Full Implementation of Appropriate Use – Again
As anticipated would happen by many in the industry, the Centers for Medicare & Medicaid Services (CMS) announced this week it is pushing back the mandate for referring providers to use appropriate use criteria (AUC) and clinical decision support (CDS) tools. Now, the testing period for physicians who order advanced imaging scans has been extended through the end of 2021.
Click here to read more.
Cuts Proposed to Surgical Services in 2021 Medicare Physician Fee Schedule
Last week, the Centers for Medicare & Medicaid Services (CMS) released the highly anticipated Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) proposed rule. In the months prior to the release of the rule, AAOS had advocated against the proposed 5.4% cut to the work relative value units for hip and knee arthroplasty, as well as changes to the Evaluation and Management Office/Outpatient visit codes that were not extended to global surgical codes--which would lead to an overall 5% reduction to all orthopaedic surgical services. CMS has formally proposed these changes in the rule, and AAOS will continue to advocate against them through the rule’s comment period. Other changes proposed include making permanent some of the telehealth provisions implemented during the Covid-19 public health emergency, broadening the scope of practice for non-physician practitioners, pharmacists, and physical therapy assistants, as well as the introduction of the Alternative Payment Model Performance Pathway for the 2021 performance year. Members should be on the lookout for a grassroots opportunity soon to engage on this issue
Click here to read more.
CMS Just Released the New Advance Beneficiary Notice (ABN)
Content provided by: Karen Zupko & Associates
CMS just released the updated ABN CMS-R-131. The ABN should only be used for Medicare beneficiaries when a procedure or service might not be covered. The updated ABN goes into effect August 31, 2020 but you can begin using it now.
CMS added specific notifiers to the ABN instructions to include specific notifiers
CMS also added updated information to the form instructions.
Keep in mind if the procedure or service is never covered by Medicare obtaining the ABN is not required but is optional.
Do
Do Not
The updated ABN forms are available in PDF and Word format and are available in English and Spanish. There is also a separate ABN sample form for labs. The new forms along with the instructions can be found here. You should also reference CMS Publication 100-4, Chapter 30 of the Medicare Claims Processing manual which can be located here.
Content provided by: Karen Zupko & Associates
CMS just released the updated ABN CMS-R-131. The ABN should only be used for Medicare beneficiaries when a procedure or service might not be covered. The updated ABN goes into effect August 31, 2020 but you can begin using it now.
CMS added specific notifiers to the ABN instructions to include specific notifiers
- Physicians, providers (including institutional providers like outpatient hospitals), practitioners and suppliers paid under Part B (including independent laboratories);
- Hospice providers and religious non-medical health care institutions (RNHCIs) paid exclusively under Part A
- Home health agencies (HHAs) providing care under Part A or Part B
CMS also added updated information to the form instructions.
Keep in mind if the procedure or service is never covered by Medicare obtaining the ABN is not required but is optional.
Do
- Understand the instructions and guidelines for completing and executing a valid ABN.
- Have the patient complete the form prior to obtaining the procedure or service.
- Allow the patient adequate time to review the ABN and understand the procedure or service recommended may not be paid by Medicare for the specific circumstance.
- Make sure the ABN is complete and the patient or patient’s representative signs the ABN
- Provide a copy of the signed ABN to the patient or representative.
- Always retain a copy in the beneficiary’s records.
Do Not
- Have the patient sign an ABN when checking in for his/her appointment
- Have the patient sign a blanket ABN. A specific reason must be documented in Box E of the ABN form.
The updated ABN forms are available in PDF and Word format and are available in English and Spanish. There is also a separate ABN sample form for labs. The new forms along with the instructions can be found here. You should also reference CMS Publication 100-4, Chapter 30 of the Medicare Claims Processing manual which can be located here.
CMS proposes cutting Medicare payments for some specialty surgeries 6%-9%
Content provided by: Becker's ASC Review
CMS released its Medicare Physician Fee Schedule proposed rule for 2021 Aug. 3, which made several drastic cuts to payment rates for both general and specialty surgeons.
What you should know:
1. The rule would drop the conversion factor by $3.83 to $32.26. The current conversion factor is $36.09.
2. General surgeons will see their Medicare reimbursement rates cut by 7 percent under the proposed rule.
3. The following specialties will see the biggest impacts to their reimbursement rates:
4. The American College of Surgeons and the Surgical Care Coalition are among the groups that objected to the proposed fee schedule. ACS Executive Director David Hoyt, MD, said: "Today's proposed rule from [CMS] is a big disappointment for patients and surgeons. … All we ask is that Congress protect America's surgeons so we can continue to do our jobs."
5. The Surgical Care Coalition is lobbying Congress to waive Medicare's budget neutrality requirements for these E/M adjustments and increase all 10- and 90-day global code values.
6. In a recent survey conducted by the SCC, private surgical practitioners said the proposed rule would likely force surgeons to take fewer Medicare patients.
7. The rule also solidified the COVID-19-related temporary changes made to increase access to telehealth. The proposed rule would make those temporary changes permanent.
Read more here.
Content provided by: Becker's ASC Review
CMS released its Medicare Physician Fee Schedule proposed rule for 2021 Aug. 3, which made several drastic cuts to payment rates for both general and specialty surgeons.
What you should know:
1. The rule would drop the conversion factor by $3.83 to $32.26. The current conversion factor is $36.09.
2. General surgeons will see their Medicare reimbursement rates cut by 7 percent under the proposed rule.
3. The following specialties will see the biggest impacts to their reimbursement rates:
- Cardiovascular surgeons: 9 percent
- Thoracic surgeons: 8 percent
- Vascular surgeons: 7 percent
- Neurosurgeons: 7 percent
- Ophthalmologists: 6 percent
4. The American College of Surgeons and the Surgical Care Coalition are among the groups that objected to the proposed fee schedule. ACS Executive Director David Hoyt, MD, said: "Today's proposed rule from [CMS] is a big disappointment for patients and surgeons. … All we ask is that Congress protect America's surgeons so we can continue to do our jobs."
5. The Surgical Care Coalition is lobbying Congress to waive Medicare's budget neutrality requirements for these E/M adjustments and increase all 10- and 90-day global code values.
6. In a recent survey conducted by the SCC, private surgical practitioners said the proposed rule would likely force surgeons to take fewer Medicare patients.
7. The rule also solidified the COVID-19-related temporary changes made to increase access to telehealth. The proposed rule would make those temporary changes permanent.
Read more here.
State Hits Medicaid Plans for Contract Breaches
Content provided by: The News Service of Florida
Managed care plans were sanctioned 187 times and paid more than $2 million in damages during the 2019-2020 state fiscal year for breach of Medicaid contracts, according to information released by the state. The Florida Agency for Health Care Administration website shows that during the fiscal year, which ended June 30, 13 Medicaid managed-care health plans, one Medicaid specialty plan and three managed dental plans faced sanctions for failing to adhere to contract requirements. Staywell Health Plan, which has the largest market share in the state’s Medicaid managed-care system, had the most sanctions with 24 and the largest amount of liquidated damages with $668,150, according to the data, which was made publicly available Friday. Eight of the sanctions against the company stemmed from “provider services” violations, which included issues related to network adequacy, payment, credentialing and contracting and untimely or inaccurate reporting. For those eight violations, Staywell paid $261,750 in damages. Overall, provider services accounted for nearly one-third of the total number of sanctions during the fiscal year, with the state assessing $673,250 in liquidated damages against plans for 61 violations. In terms of dollars, though, state regulators assessed $732,050 in damages when managed care plans failed to follow contract requirements for covered services and authorizations. The state has contracts with 13 managed care companies to offer health services to poor, elderly and disabled people. The state also has contracts with five managed care plans to provide specialty services --- such as mental health services, care for people with HIV and AIDS and care for children with chronic medical conditions—and contracts with three managed dental-care companies.
Click here to read more. (News Service of Florida subscription required)
Content provided by: The News Service of Florida
Managed care plans were sanctioned 187 times and paid more than $2 million in damages during the 2019-2020 state fiscal year for breach of Medicaid contracts, according to information released by the state. The Florida Agency for Health Care Administration website shows that during the fiscal year, which ended June 30, 13 Medicaid managed-care health plans, one Medicaid specialty plan and three managed dental plans faced sanctions for failing to adhere to contract requirements. Staywell Health Plan, which has the largest market share in the state’s Medicaid managed-care system, had the most sanctions with 24 and the largest amount of liquidated damages with $668,150, according to the data, which was made publicly available Friday. Eight of the sanctions against the company stemmed from “provider services” violations, which included issues related to network adequacy, payment, credentialing and contracting and untimely or inaccurate reporting. For those eight violations, Staywell paid $261,750 in damages. Overall, provider services accounted for nearly one-third of the total number of sanctions during the fiscal year, with the state assessing $673,250 in liquidated damages against plans for 61 violations. In terms of dollars, though, state regulators assessed $732,050 in damages when managed care plans failed to follow contract requirements for covered services and authorizations. The state has contracts with 13 managed care companies to offer health services to poor, elderly and disabled people. The state also has contracts with five managed care plans to provide specialty services --- such as mental health services, care for people with HIV and AIDS and care for children with chronic medical conditions—and contracts with three managed dental-care companies.
Click here to read more. (News Service of Florida subscription required)
Administration considering ban on “surprise” medical bills
Politico (5/27, Luthi, Roubein) reports the administration is “floating a plan that would outlaw health care providers from putting patients on the hook for thousands of dollars in expenses” as part of “surprise” medical bills, but the plan has not mandated “how doctors and hospitals would recover their costs from insurers, according to administration officials, Capitol Hill aides and industry lobbyists familiar with discussions.” However, “powerful doctors groups,” such as the American Medical Association, are “wary of a policy that only bans the practice and doesn’t include a way to resolve payment disputes,” contending “the approach would leave health insurers with too much leverage.” AMA President Patrice A. Harris, M.D., M.A., said in a statement, “As there is no balance billing for COVID testing and treatment under most types of insurance, there is no need to rush these significant policy changes as part of the next COVID relief package.”
Politico (5/27, Luthi, Roubein) reports the administration is “floating a plan that would outlaw health care providers from putting patients on the hook for thousands of dollars in expenses” as part of “surprise” medical bills, but the plan has not mandated “how doctors and hospitals would recover their costs from insurers, according to administration officials, Capitol Hill aides and industry lobbyists familiar with discussions.” However, “powerful doctors groups,” such as the American Medical Association, are “wary of a policy that only bans the practice and doesn’t include a way to resolve payment disputes,” contending “the approach would leave health insurers with too much leverage.” AMA President Patrice A. Harris, M.D., M.A., said in a statement, “As there is no balance billing for COVID testing and treatment under most types of insurance, there is no need to rush these significant policy changes as part of the next COVID relief package.”
Strategic Alliance Provides a Wealth of Resources for Physician Practices
Cobbe Consulting & Management (CCM) and Acevedo Consulting Incorporated (ACI) today announced a strategic partnership to provide coding, compliance and regulatory training for our physician practices.
This partnership will make multiple programs available for our members that cover topics such as CPT, HCPCS, ICD-10-CM, third-party billing rules, reimbursement, as well as other services necessary to navigate the complex world of healthcare. Acevedo Consulting Incorporated specializes in coding, compliance, appeals, due diligence, HIPAA, education, physician and staff training, and more. All consultants at ACI are credentialed by the AAPC, Health Care Compliance Association and/or AHIMA.
The healthcare industry is ever evolving and so are the guidelines that practices must follow. Working in such a highly regulated industry requires strict adherence for regulatory compliance. Cobb Consulting is working to ease that burden for its members by providing access to a firm that specializes in compliance. The partnership between CCM and ACI helps ensure that physician practices have a trusted resource to help them navigate regulatory compliance.
“Acevedo Consulting Incorporated is known for their professional expertise and does phenomenal work for their clients. This partnership will help us better serve our members by giving them access to such a great firm,” said Fraser Cobbe, CEO of Cobbe Consulting & Management.
About Cobbe Consulting & Management
Cobbe Consulting & Management is an Association Management Company that specializes in representing medical associations across the country with a strong presence throughout the State of Florida. With over 20 years of experience in organized medicine, CCM represents some of the largest and historically significant organizations in the state including: Bones Society of Florida, Dade County Medical Association, Duval County Medical Society, Florida Orthopaedic Society, Florida Society of Nephrology, and the Physicians Society of Central Florida. CCM specializes in delivering unique programs and services and educational opportunities to the thousands of physicians and medical executives they represent in their family of organizations.
About Acevedo Consulting Incorporated:
Our consulting staff is nationally recognized for its expertise and our consultants are credentialed by the Health Care Compliance Association (HCCA), American Academy of Professional Coders (AAPC) and/or the American Health Information Management Association (AHIMA). The consultants’ 100+ years of combined and varied experience in the health care field are invaluable to the firm’s clients. Besides the requisite coding and compliance credentials and expertise, our consultants’ experiences range from serving in upper-level administrative and compliance positions for large hospital-based physician organizations and health plans. Members of our team are often lecturing at national organization and specialty society conferences, serving as an Investigative Consultant for the Department of Justice (DOJ) and as the IRO for organizations under a CIA. Acevedo Consulting often serves as an expert witness, renders opinions on expected fraudulent billing, assists with overpayment appeals, and conducts pre-acquisition and pre-employment Due Diligence.
Cobbe Consulting & Management (CCM) and Acevedo Consulting Incorporated (ACI) today announced a strategic partnership to provide coding, compliance and regulatory training for our physician practices.
This partnership will make multiple programs available for our members that cover topics such as CPT, HCPCS, ICD-10-CM, third-party billing rules, reimbursement, as well as other services necessary to navigate the complex world of healthcare. Acevedo Consulting Incorporated specializes in coding, compliance, appeals, due diligence, HIPAA, education, physician and staff training, and more. All consultants at ACI are credentialed by the AAPC, Health Care Compliance Association and/or AHIMA.
The healthcare industry is ever evolving and so are the guidelines that practices must follow. Working in such a highly regulated industry requires strict adherence for regulatory compliance. Cobb Consulting is working to ease that burden for its members by providing access to a firm that specializes in compliance. The partnership between CCM and ACI helps ensure that physician practices have a trusted resource to help them navigate regulatory compliance.
“Acevedo Consulting Incorporated is known for their professional expertise and does phenomenal work for their clients. This partnership will help us better serve our members by giving them access to such a great firm,” said Fraser Cobbe, CEO of Cobbe Consulting & Management.
About Cobbe Consulting & Management
Cobbe Consulting & Management is an Association Management Company that specializes in representing medical associations across the country with a strong presence throughout the State of Florida. With over 20 years of experience in organized medicine, CCM represents some of the largest and historically significant organizations in the state including: Bones Society of Florida, Dade County Medical Association, Duval County Medical Society, Florida Orthopaedic Society, Florida Society of Nephrology, and the Physicians Society of Central Florida. CCM specializes in delivering unique programs and services and educational opportunities to the thousands of physicians and medical executives they represent in their family of organizations.
About Acevedo Consulting Incorporated:
Our consulting staff is nationally recognized for its expertise and our consultants are credentialed by the Health Care Compliance Association (HCCA), American Academy of Professional Coders (AAPC) and/or the American Health Information Management Association (AHIMA). The consultants’ 100+ years of combined and varied experience in the health care field are invaluable to the firm’s clients. Besides the requisite coding and compliance credentials and expertise, our consultants’ experiences range from serving in upper-level administrative and compliance positions for large hospital-based physician organizations and health plans. Members of our team are often lecturing at national organization and specialty society conferences, serving as an Investigative Consultant for the Department of Justice (DOJ) and as the IRO for organizations under a CIA. Acevedo Consulting often serves as an expert witness, renders opinions on expected fraudulent billing, assists with overpayment appeals, and conducts pre-acquisition and pre-employment Due Diligence.
Bill Correctly for Medicare Telehealth
A recent report, the Office of Inspector General (OIG) determined that the Centers for Medicare & Medicaid Services (CMS) improperly paid practitioners for some telehealth claims associated with services that did not meet Medicare requirements. CMS released the Medicare Telehealth Services video to help you bill correctly.
Additional resources:
Source: CMS
A recent report, the Office of Inspector General (OIG) determined that the Centers for Medicare & Medicaid Services (CMS) improperly paid practitioners for some telehealth claims associated with services that did not meet Medicare requirements. CMS released the Medicare Telehealth Services video to help you bill correctly.
Additional resources:
- Telehealth Services (PDF) Medicare Learning Network Booklet
- Medicare Claims Processing Manual, Chapter 12 (PDF), Section 190
- Medicare Telehealth Payment Eligibility Analyzer
- List of Covered Telehealth Services webpage
- CMS Paid Practitioners for Telehealth Services That Did Not Meet Medicare Requirements OIG Report
Source: CMS
Over 1,500 health care organizations hit with successful ransomware attacks since 2016, report says
HealthIT Security (2/13, HealthITSecurity) reports “more than 1,500 health care organizations have been hit with successful ransomware attacks since 2016, costing the sector over $160 million during that time, according to a recent report from Comparitech, a company that provides consumers with privacy information, tools, and comparisons.”
HealthIT Security (2/13, HealthITSecurity) reports “more than 1,500 health care organizations have been hit with successful ransomware attacks since 2016, costing the sector over $160 million during that time, according to a recent report from Comparitech, a company that provides consumers with privacy information, tools, and comparisons.”
House Ways and Means Committee releases legislation on surprise medical bills
The Hill (2/7, Sullivan) reported the House Ways and Means Committee “released their legislation to protect patients from getting massive, surprise medical bills, as congressional action on the subject intensifies.” Reps. Richard Neal and Kevin Brady, the committee’s leaders, both support the legislation, which “would protect patients from getting bills for thousands of dollars when they go to the emergency room and one of their doctors happens to be outside their insurance network.”
The Hill (2/7, Sullivan) reported the House Ways and Means Committee “released their legislation to protect patients from getting massive, surprise medical bills, as congressional action on the subject intensifies.” Reps. Richard Neal and Kevin Brady, the committee’s leaders, both support the legislation, which “would protect patients from getting bills for thousands of dollars when they go to the emergency room and one of their doctors happens to be outside their insurance network.”
Iowa’s liability climate is changing – for worse
Source: Protect Patients Now | November 2019
The Iowa Medical Society (IMS) highlighted how the state’s medical liability climate is shifting and threatening access to care in the Fall edition of Iowa Medicine.
In 2017, a series of reforms including certificate of merit and expert witness requirements were implemented to drive down the number of meritless lawsuits filed in the state. Unfortunately, at the time, reasonable limits on non-economic damages were included only as a “soft cap,” allowing the limit to be waived by a jury in certain instances.
MaryGrace Elson, MD, MME, FACOG, President of IMS and an OB/GYN from Iowa City, highlights the outcome of the soft cap in the edition’s feature story, “Our Medical Liability System in Crisis.”
“In the past three years, Iowa’s medical liability climate has shifted dramatically,” she notes. “… Iowa’s trial bar has begun cherry-picking cases where there is no dispute that a medical error occurred. Employing questionable tactics that play to juries’ emotions and drive up award expectations, we have seen a string of high-dollar verdicts against physicians and facilities.”
Over the past two years, just five lawsuits have led to awards of $63 million in noneconomic damages, and impacted patient access to care.
“One of the rural facilities involved in a high-dollar obstetrical judgment even made the difficult decision to close its obstetrical unit,” Elson writes.
IMS expects to make limits on non-economic damages a focus of its 2020 legislative agenda. To read Dr. Elson’s column in full, click here.
Source: Protect Patients Now | November 2019
The Iowa Medical Society (IMS) highlighted how the state’s medical liability climate is shifting and threatening access to care in the Fall edition of Iowa Medicine.
In 2017, a series of reforms including certificate of merit and expert witness requirements were implemented to drive down the number of meritless lawsuits filed in the state. Unfortunately, at the time, reasonable limits on non-economic damages were included only as a “soft cap,” allowing the limit to be waived by a jury in certain instances.
MaryGrace Elson, MD, MME, FACOG, President of IMS and an OB/GYN from Iowa City, highlights the outcome of the soft cap in the edition’s feature story, “Our Medical Liability System in Crisis.”
“In the past three years, Iowa’s medical liability climate has shifted dramatically,” she notes. “… Iowa’s trial bar has begun cherry-picking cases where there is no dispute that a medical error occurred. Employing questionable tactics that play to juries’ emotions and drive up award expectations, we have seen a string of high-dollar verdicts against physicians and facilities.”
Over the past two years, just five lawsuits have led to awards of $63 million in noneconomic damages, and impacted patient access to care.
“One of the rural facilities involved in a high-dollar obstetrical judgment even made the difficult decision to close its obstetrical unit,” Elson writes.
IMS expects to make limits on non-economic damages a focus of its 2020 legislative agenda. To read Dr. Elson’s column in full, click here.
Kansas liability ruling could have ripple effect for patients, lawsuit abuse
Source: Protect Patients Now | June 2019
Striking down medical liability reforms in Kansas may just be the first domino to fall in the state’s health care system, with side effects that impact patients and access to care while fueling meritless lawsuits.
Earlier this month, the state’s Supreme Court ruled 4-2 that limiting non-economic damages was unconstitutional.
Physicians and health care providers worry that without these limits, there is no way to hold down insurance costs that are ultimately passed on to patients, nor to safeguard against activist juries that award huge verdicts of non-economic damages.
Jon Rosell, the executive director of the Kansas Medical Society, believes that higher medical malpractice insurance premiums might make it too expensive for some doctors to practice in Kansas’s rural communities.
“We think that this decision begins a series of dominos that will fall where ultimately the Kansas patient will be impacted,” he said.
Without federal medical liability reforms, rulings such as this one in Kansas will continue to play out across the country due to the powerful political influence of the personal injury lawyer lobby.
To read more about the Kansas ruling and its effects on the state health care system, click here.
Source: Protect Patients Now | June 2019
Striking down medical liability reforms in Kansas may just be the first domino to fall in the state’s health care system, with side effects that impact patients and access to care while fueling meritless lawsuits.
Earlier this month, the state’s Supreme Court ruled 4-2 that limiting non-economic damages was unconstitutional.
Physicians and health care providers worry that without these limits, there is no way to hold down insurance costs that are ultimately passed on to patients, nor to safeguard against activist juries that award huge verdicts of non-economic damages.
Jon Rosell, the executive director of the Kansas Medical Society, believes that higher medical malpractice insurance premiums might make it too expensive for some doctors to practice in Kansas’s rural communities.
“We think that this decision begins a series of dominos that will fall where ultimately the Kansas patient will be impacted,” he said.
Without federal medical liability reforms, rulings such as this one in Kansas will continue to play out across the country due to the powerful political influence of the personal injury lawyer lobby.
To read more about the Kansas ruling and its effects on the state health care system, click here.
310 ASCs with total joint replacements
Source: Becker's Healthcare | Written by Laura Dyrda | April 29, 2019
Total joint replacements are moving to the outpatient setting, with more than 300 ASCs across the country including total knee and hip procedures.
Here is a list of those centers.
To add a center to this list, contact Laura Dyrda at ldyrda@beckershealthcare.com.
Source: Becker's Healthcare | Written by Laura Dyrda | April 29, 2019
Total joint replacements are moving to the outpatient setting, with more than 300 ASCs across the country including total knee and hip procedures.
Here is a list of those centers.
To add a center to this list, contact Laura Dyrda at ldyrda@beckershealthcare.com.
Senators Introduce Legislation To Prevent Surprise Medical Bills
The Hill (9/18, Sullivan) reports senators from both parties are “unveiling a draft measure to crack down on surprise medical bills, which they say have plagued patients with massive unexpected charges for care.” The legislation “would prevent a health care provider that is outside of a patient’s insurance network from charging additional costs for emergency services to patients beyond the amount usually allowed under their insurance plan.” In addition, insurers, not patients, “would have to pay additional charges, which are limited under the proposal.”
Source: AMA Morning Round
The Hill (9/18, Sullivan) reports senators from both parties are “unveiling a draft measure to crack down on surprise medical bills, which they say have plagued patients with massive unexpected charges for care.” The legislation “would prevent a health care provider that is outside of a patient’s insurance network from charging additional costs for emergency services to patients beyond the amount usually allowed under their insurance plan.” In addition, insurers, not patients, “would have to pay additional charges, which are limited under the proposal.”
Source: AMA Morning Round
August 8 2018
Employers contracting directly with hospitals, providers to lower health care costs, survey indicates
CNN Money (8/7, Luhby) reports more and more “companies are contracting directly with hospitals and providers to take care of their employees, according to an annual survey released Tuesday by the National Business Group on Health.” Data show about 11 percent of companies intend to do this in 2019, compared to three percent in 2018. The article says, “Also becoming more popular are direct contracts between companies and providers to handle certain pricey conditions, such as cancer, cardiovascular disease, fertility treatments and orthopedic needs.” The survey revealed that about “18% of companies said they are negotiating these deals for 2019, up from 12% this year.”
Modern Healthcare (8/7, Livingston, Subscription Publication) reports that according to the survey, large companies and their employees will pay more for health care next year. Data indicate companies will “pay $14,800 per employee for health coverage in 2019, an increase of 5% from $14,099 this year.” Companies are expected to pay approximately 70 percent of the costs, while employees will cover the remaining 30 percent.
Employers contracting directly with hospitals, providers to lower health care costs, survey indicates
CNN Money (8/7, Luhby) reports more and more “companies are contracting directly with hospitals and providers to take care of their employees, according to an annual survey released Tuesday by the National Business Group on Health.” Data show about 11 percent of companies intend to do this in 2019, compared to three percent in 2018. The article says, “Also becoming more popular are direct contracts between companies and providers to handle certain pricey conditions, such as cancer, cardiovascular disease, fertility treatments and orthopedic needs.” The survey revealed that about “18% of companies said they are negotiating these deals for 2019, up from 12% this year.”
Modern Healthcare (8/7, Livingston, Subscription Publication) reports that according to the survey, large companies and their employees will pay more for health care next year. Data indicate companies will “pay $14,800 per employee for health coverage in 2019, an increase of 5% from $14,099 this year.” Companies are expected to pay approximately 70 percent of the costs, while employees will cover the remaining 30 percent.
July 18, 2018
Missouri received 1.6 billion opioids in 6-year period
Sen. Claire McCaskill (D-Mo.) released a report indicating that Cardinal Health, McKesson Corp., and Amerisource Bergen shipped approximately 1.6 billion prescription opioids to Missouri pharmacies between 2012 and 2017. This quantity accounts for approximately 260 opioid pills for every person in the state during the six-year period. The report showed that the highest number of suspicious order reports occurred in rural Missouri counties, many of which border other states. Missouri is the only state that does not have a prescription drug monitoring program, which allows healthcare providers to flag overprescribing and suspicious prescriptions. The report also showed that the number of suspicious orders the companies reported to the Drug Enforcement Administration varied.
Read more…
Missouri received 1.6 billion opioids in 6-year period
Sen. Claire McCaskill (D-Mo.) released a report indicating that Cardinal Health, McKesson Corp., and Amerisource Bergen shipped approximately 1.6 billion prescription opioids to Missouri pharmacies between 2012 and 2017. This quantity accounts for approximately 260 opioid pills for every person in the state during the six-year period. The report showed that the highest number of suspicious order reports occurred in rural Missouri counties, many of which border other states. Missouri is the only state that does not have a prescription drug monitoring program, which allows healthcare providers to flag overprescribing and suspicious prescriptions. The report also showed that the number of suspicious orders the companies reported to the Drug Enforcement Administration varied.
Read more…
July 9, 2018
OK Supreme Court Rules On AMA Guide; PPD
By Dara Barney
Source: WCI Weekly from Workers Compensation Institute
The Oklahoma Supreme Court ruled in a 5-4 opinion Wednesday that the latest edition of the AMA Guide should determine the parameters of permanent partial disability.
The decision, which stemmed from Robert Hill v. American Medical Response, approves the legislature's mandate that determinations should come from the AMA Guides to Evaluation of Permanent Impairment, Sixth Edition, and rejected arguments that mandatory use of the latest edition of the guide violates the Oklahoma constitutional guarantee of due process, equal protection and access to a remedy. Read more.
OK Supreme Court Rules On AMA Guide; PPD
By Dara Barney
Source: WCI Weekly from Workers Compensation Institute
The Oklahoma Supreme Court ruled in a 5-4 opinion Wednesday that the latest edition of the AMA Guide should determine the parameters of permanent partial disability.
The decision, which stemmed from Robert Hill v. American Medical Response, approves the legislature's mandate that determinations should come from the AMA Guides to Evaluation of Permanent Impairment, Sixth Edition, and rejected arguments that mandatory use of the latest edition of the guide violates the Oklahoma constitutional guarantee of due process, equal protection and access to a remedy. Read more.
Advocates in Arkansas for liability reform
This November, voters in Arkansas will have an opportunity to help shape the future of health care in their state through a referendum on tort reform.
Issue 1, as the initiative is known, would amend the state constitution to limit attorney contingency fees and cap noneconomic damages in cases claiming personal injury, property damage or wrongful death. While the issue often has its share of adversaries, luckily for patients, there are a number of strong advocates across the state working to educate voters on the need for reform.
Working on behalf of Arkansans for Jobs and Justice to highlight the need for reasonable limits on attorney’s fees and non-economic damages, Carl Vogelpohl is leading the charge to help Arkansas grow jobs and recruit the doctors that Arkansans need to care for their families.
“Arkansas is ranked 50th in terms of environment for emergency care and the American College of Emergency Physicians has said, ‘to help combat its workforce shortages and improve overall access to emergency care, Arkansas should enact medical liability reforms,’” Vogelpohl emphasized.
The advocacy group was formed from a wide range of industries and organizations, including the Arkansas State Chamber of Commerce, the Arkansas Medical Society, the Poultry Federation, Arkansas Health Care Association and Arkansas Trucking Association, with the intention of creating a better environment for companies to grow and patients to receive affordable care.
Senate passage brought the bill one step closer to bringing fairness and efficiency to Kentucky’s medical liability system, and the legislation now moves on to the state House for a vote.
To read more about advocates supporting the constitutional amendment in Arkansas, click here.
Source: Protect Patients Now
This November, voters in Arkansas will have an opportunity to help shape the future of health care in their state through a referendum on tort reform.
Issue 1, as the initiative is known, would amend the state constitution to limit attorney contingency fees and cap noneconomic damages in cases claiming personal injury, property damage or wrongful death. While the issue often has its share of adversaries, luckily for patients, there are a number of strong advocates across the state working to educate voters on the need for reform.
Working on behalf of Arkansans for Jobs and Justice to highlight the need for reasonable limits on attorney’s fees and non-economic damages, Carl Vogelpohl is leading the charge to help Arkansas grow jobs and recruit the doctors that Arkansans need to care for their families.
“Arkansas is ranked 50th in terms of environment for emergency care and the American College of Emergency Physicians has said, ‘to help combat its workforce shortages and improve overall access to emergency care, Arkansas should enact medical liability reforms,’” Vogelpohl emphasized.
The advocacy group was formed from a wide range of industries and organizations, including the Arkansas State Chamber of Commerce, the Arkansas Medical Society, the Poultry Federation, Arkansas Health Care Association and Arkansas Trucking Association, with the intention of creating a better environment for companies to grow and patients to receive affordable care.
Senate passage brought the bill one step closer to bringing fairness and efficiency to Kentucky’s medical liability system, and the legislation now moves on to the state House for a vote.
To read more about advocates supporting the constitutional amendment in Arkansas, click here.
Source: Protect Patients Now
May 10, 2018
QPP Group Eligibility Status Now Available
The Centers for Medicare and Medicaid Services (CMS) has announced that physician practices/groups may now log into the CMS QPP website to check their 2018 eligibility for Medicare’s Merit-based Incentive Payment System (MIPS). After groups log in, they will be able to click into a details screen to see the eligibility status of every clinician in the group ( based on their National Provider Identifier or NPI) to find out whether they need to participate during the 2018 performance year for MIPS.
Unfortunately, CMS will not be sending out letters to advise physicians of their eligibility status this year so checking on the QPP participation status look-up tool is the only way to determine or verify eligibility status. Eligibility rules in 2018 are different than in 2017 so status this year may be different than last. Also as is indicated in the look-up tool, exempt individual clinicians still will need to report if their group is eligible and chooses to report as a group.
The look-up tool can be found at https://qpp.cms.gov/participation-lookup
Unfortunately, CMS will not be sending out letters to advise physicians of their eligibility status this year so checking on the QPP participation status look-up tool is the only way to determine or verify eligibility status. Eligibility rules in 2018 are different than in 2017 so status this year may be different than last. Also as is indicated in the look-up tool, exempt individual clinicians still will need to report if their group is eligible and chooses to report as a group.
The look-up tool can be found at https://qpp.cms.gov/participation-lookup
Show me liability reform
A recent push for liability reform in Missouri could show patients how a reduction in medical lawsuit abuse can improve access to care across the states.
Building on Governor Greitens’ emphasis on the need for changes to the state’s liability system, a new bill would bring an efficient resolution to those with legitimate claims. The latest bill, introduced by State Senator Dan Hegeman, allows physicians to address claims promptly by redefining the statute of limitations to three years.
“Missouri has not amended the five-year statute since 1939,” Hegeman told the Senate government reform committee. “While five years may have made sense in an age when transportation and communication were more challenging, there is no reason today for an injured person to need so much time to file the action.”
The shorter statute of limitations gives physicians peace of mind that any claims of negligence are addressed quickly, and deserving patients benefit from a system that better separates meritless lawsuits from rightful claims for damages.
To read more about Missouri’s efforts to further reform their liability system for patients and physicians, click here.
A recent push for liability reform in Missouri could show patients how a reduction in medical lawsuit abuse can improve access to care across the states.
Building on Governor Greitens’ emphasis on the need for changes to the state’s liability system, a new bill would bring an efficient resolution to those with legitimate claims. The latest bill, introduced by State Senator Dan Hegeman, allows physicians to address claims promptly by redefining the statute of limitations to three years.
“Missouri has not amended the five-year statute since 1939,” Hegeman told the Senate government reform committee. “While five years may have made sense in an age when transportation and communication were more challenging, there is no reason today for an injured person to need so much time to file the action.”
The shorter statute of limitations gives physicians peace of mind that any claims of negligence are addressed quickly, and deserving patients benefit from a system that better separates meritless lawsuits from rightful claims for damages.
To read more about Missouri’s efforts to further reform their liability system for patients and physicians, click here.
2018 AMA Economic Impact Study
New AMA study shows physicians bring economic health to our communities
New AMA study shows physicians bring economic health to our communities
The American Medical Association has just released the 2018 AMA Economic Impact Study that shows the extent to which physicians drive the national and state economies and support their local communities. Offering a clear picture of the vast network of local jobs and local investments that physicians support, the study’s findings include:
Physicians create an economic ripple effect in their communities
Supporting physicians benefits local economies
In a health care environment that is currently undergoing many changes, this study underscores and quantifies for lawmakers, regulators and policymakers the importance of supporting the physician workforce. Communities benefit directly from a positive practice environment for physicians, and it is critical to protect and improve the programs and policies that help support physician practices.
To learn more about the economic contributions physicians make in your state and across the country, view the 2018 AMA Economic Impact Study online.
Source AMA
- Economic activity: Physicians generate $2.3 trillion in economic output, comprising 13 percent of the national economy.
- Jobs: Physicians’ economic investment supports 12.6 million jobs nationwide—more than 17 jobs for each physician on average.
- Wages and benefits: Physicians contribute $1 trillion in total wages and benefits paid to workers across the country, empowering a high-quality, sustainable workforce.
- State and local tax revenue: Physicians and the workforces they support generate $92.9 billion in state and local tax revenue for their communities—revenue that enables community investments.
Physicians create an economic ripple effect in their communities
- Every dollar applied to physician services supports an additional $1.84 in other business activity.
- An additional 11 jobs—above and beyond the clinical and administrative personnel that work inside the physician practices—are supported for each 1 million dollars of direct output produced by a physician’s practice.
- Physicians contribute more to the national economy than legal services, home health care, higher education, and nursing home and residential care.
Supporting physicians benefits local economies
In a health care environment that is currently undergoing many changes, this study underscores and quantifies for lawmakers, regulators and policymakers the importance of supporting the physician workforce. Communities benefit directly from a positive practice environment for physicians, and it is critical to protect and improve the programs and policies that help support physician practices.
To learn more about the economic contributions physicians make in your state and across the country, view the 2018 AMA Economic Impact Study online.
Source AMA
AAOS Online Newsroom
2017 Midwest AAOE Scholarship Winner:
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November 2017
How the CMS final rule will affect orthopedic ASCs: 5 key notes On Nov. 2, CMS received the 2018 final payment rule, providing a 1.2 percent increase in ASC reimbursement next year. The final rule also addressed several issues pertaining to orthopedic procedures in ASCs, including total joint replacements and spine procedures. Here are five ways the final rule will affect orthopedic ASCs, according to guidance from ASCA: Read more Source: Becker's Hospital Review Oklahoma Supreme Court ruling could lead to medical lawsuit abuse Patients and physicians in Oklahoma could face a deteriorating liability climate in the coming years, as the state Supreme Court recently ruled against an effective liability reform. Read more here. Source: Protect Patients Now Arkansas grassroots group pushes for true liability reform A grassroots group in Arkansas has kicked off an effort for a ballot initiative on a tort reform constitutional amendment, giving voters – and patients – the chance to enact real reforms of the state’s liability system. Read more here Source: Protect Patients Now October 2017 Health Plans Can No Longer Charge Providers Egregious Fees for Electronic Fund Transfers A recent survey by the Medical Group Management Association (MGMA) showed that 1 in 6 practices are paying fees for Electronic Fund Transfer (EFT), due to the payor using what is called a "Virtual Credit Card (VCC)" in order to accept electronic payments. These fees range from 2%-5% of the medical services payment. MGMA has been working with CMS to change this and require that plans charge a more reasonable fee for EFT. This week, CMS released guidance on this issue. Here's What You Need to Know 1. Health plans that are sending VCC payments must stop if a practice notifies the payor it wants to receive payments via EFT. 2. Plans cannot charge unsanctioned fees for the use of EFT. The amount must be similar to bank transaction fees - which are usually about 34 cents per transaction. Signing up for EFT doesn't allow the plan to deduct funds from your account unless you have entered into a contract with the plan that allows them to do this. Read more FAQs about EFT and VCCs on theCMS web site. If you are an MGMA member, access the MGMA member-benefit EFT/ERAGuidefor more information and a sample letter to request payment via EFT. Source: KarenZupko & Associates July 13, 2017
CMS looks to drop payment for off-campus services by half The CMS wants to drop by half what Medicare pays when patients receive healthcare at medical facilities that are owned by hospitals but located off their campuses. The Obama administration last year finalized a rule that paid hospital off-campus facilities the same as hospital-based outpatient departments if they started billing Medicare after Nov. 2, 2015. The proposal, outlined in the proposed 2018 physician fee pay rule released Thursday, would drop that rate from 50% to 25% of what they would have been paid under outpatient rates. "At a time when the nation is moving toward value-based payments, this proposal makes no sense. In essence, it removes all incentives to provide care out in the communities rather than at the hospital, and ultimately will lead to higher overall Medicare spending," said Blair Childs, senior vice president of public affairs for Premier, a consulting firm. The prioir, more generous payment made to off-campus facilities has led to hospitals acquiring physician practices at a rapid clip. But hospitals say the facilities, while increasing their operating costs, allow them to provide greater access to healthcare, especially in underserved areas. The Trump administration's proposed changes would save $25 million next year. Among the services affected would include pain management treatment, some x-rays and radiation therapies as well as some behavioral health services. "The CMS proposal will result in an unsustainable payment rate that will further reduce access for people in chronically underserved communities, health care deserts, and the hospitals on which they rely," Dr. Bruce Siegel CEO of America's Essential Hospitals said in a statement. Congress passed what's called the site-neutral policy after a 2013 Medicare Payment Advisory Commission report that found Medicare was paying 141% more for a echocardiogram in an outpatient setting than for the same procedure in a doctor's office. Comments on the proposed rule are due by Sept. 11. Source: Modern Healthcare |
Oklahoma weighs steep cuts to provider pay, Medicaid benefits
By Rachana Pradhan
04/10/2017 03:47 PM EDT
Oklahoma’s Medicaid agency is considering slashing provider reimbursement rates by 25 percent and eliminating several optional benefits amid ongoing budget woes, officials said today.
This is the second straight year that Oklahoma is considering a 25 percent cut to provider rates. Oklahoma ultimately avoided painful cuts to provider rates and benefits last year, but a dire outlook for fiscal year 2018 is forcing the state to reconsider.
Oklahoma will consider eliminating or reducing benefits related to pharmacy, behavioral health treatment, dialysis, adult organ transplants, hospice services and private duty nursing services, among others.
Cutting provider reimbursement rates by 25 percent would put physician payment levels at 65 percent of Medicare rates, officials said. The reductions would affect all provider types, including hospitals, nursing facilities and pharmacy.
“While we don’t know our final appropriation, we must be prepared for a reduction," Oklahoma Medicaid agency CEO Becky Pasternik-Ikard said in a statement. "In order for us to meet our obligations to the federal government, we have to get the process started,”
Oklahoma, one of 19 mostly GOP-led states that has refused Medicaid expansion, last year briefly weighed joining the optional Obamacare program to help fill the state's budget hole.
To view online:
https://www.politicopro.com/health-care/whiteboard/2017/04/oklahoma-weighs-steep-cuts-to-provider-pay-medicaid-benefits-086173
By Rachana Pradhan
04/10/2017 03:47 PM EDT
Oklahoma’s Medicaid agency is considering slashing provider reimbursement rates by 25 percent and eliminating several optional benefits amid ongoing budget woes, officials said today.
This is the second straight year that Oklahoma is considering a 25 percent cut to provider rates. Oklahoma ultimately avoided painful cuts to provider rates and benefits last year, but a dire outlook for fiscal year 2018 is forcing the state to reconsider.
Oklahoma will consider eliminating or reducing benefits related to pharmacy, behavioral health treatment, dialysis, adult organ transplants, hospice services and private duty nursing services, among others.
Cutting provider reimbursement rates by 25 percent would put physician payment levels at 65 percent of Medicare rates, officials said. The reductions would affect all provider types, including hospitals, nursing facilities and pharmacy.
“While we don’t know our final appropriation, we must be prepared for a reduction," Oklahoma Medicaid agency CEO Becky Pasternik-Ikard said in a statement. "In order for us to meet our obligations to the federal government, we have to get the process started,”
Oklahoma, one of 19 mostly GOP-led states that has refused Medicaid expansion, last year briefly weighed joining the optional Obamacare program to help fill the state's budget hole.
To view online:
https://www.politicopro.com/health-care/whiteboard/2017/04/oklahoma-weighs-steep-cuts-to-provider-pay-medicaid-benefits-086173
New DEA registration renewal policy creates new headaches for doctors
Effective Jan. 1, 2017, the DEA will eliminate the informal grace period for physicians to renew their registration - and doctors who miss their renewal deadline face daunting consequences:
Further, physicians will receive only one renewal notice to their "mail to" addresses.
Click here to read more about this policy change and the AMA's opposition.
Source: FMA News
Effective Jan. 1, 2017, the DEA will eliminate the informal grace period for physicians to renew their registration - and doctors who miss their renewal deadline face daunting consequences:
- Online registration after the expiration date will no longer be available.
- Paper renewal applications will not be accepted the day after the expiration date.
- Physicians who miss their expiration date will have to complete new registration applications.
Further, physicians will receive only one renewal notice to their "mail to" addresses.
Click here to read more about this policy change and the AMA's opposition.
Source: FMA News
Signature CEO Jan Vest to Retire; Schwartzkopf, Sackman Get Expanded Roles
ST. LOUIS, Jan. 19, 2017 /PRNewswire/ -- Jan Vest, the longtime CEO and founding member of the Signature Medical Group Board of Directors, is retiring Dec. 31. In addition, two senior executives will be expanding their roles in the company immediately, Vest has announced.
Andrew Schwartzkopf, general counsel, will become chief administrative officer, handling many of Vest's duties, and Chad Sackman, senior vice president of operations, will be chief operating officer. Vest said the remaining executive team members will remain intact.
Vest said he is proud to be leaving Signature in a strong position among healthcare providers in the Midwest.
Read More
ST. LOUIS, Jan. 19, 2017 /PRNewswire/ -- Jan Vest, the longtime CEO and founding member of the Signature Medical Group Board of Directors, is retiring Dec. 31. In addition, two senior executives will be expanding their roles in the company immediately, Vest has announced.
Andrew Schwartzkopf, general counsel, will become chief administrative officer, handling many of Vest's duties, and Chad Sackman, senior vice president of operations, will be chief operating officer. Vest said the remaining executive team members will remain intact.
Vest said he is proud to be leaving Signature in a strong position among healthcare providers in the Midwest.
Read More
Congressional Action AlertCMS Action on Global Payments
Missouri says Aetna-Humana merger is anticompetitive Missouri insurance officials have issued a preliminary order against the merger between health insurance giants Aetna and Humana, the first state to find a problem with the massive transaction. Source: Modern Healthcare |
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