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Showing posts with label Kaiser Family Foundation. Show all posts
Showing posts with label Kaiser Family Foundation. Show all posts

Friday, August 22, 2014

Are Your Medical Records Vulnerable To Theft?

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

This KHN story also ran in . It can be republished for free. (details)
A decade ago almost all doctors kept paper charts on every patient. That is changing quickly as laptops become as common as stethoscopes in exam rooms. Recent hacking attacks have raised questions about how safe that data may be.  Here are some frequently asked questions about this evolution underway in American medicine and the government programs sparking the change.
Are my medical records stored electronically?
At least some of the information you share with your doctor or any hospital or clinic where you’ve been treated is probably stored on a computer. It's pretty common for most hospitals, clinics and doctors’ offices to digitally store your basic information including your name, address and insurance company, the same way many retailers do.


It's also likely that at least some information about your specific medical conditions is linked to that data. Health care providers have been using computers to help them get paid for decades. That means many computer-generated bills sent to you and/or your insurance company contain medical details like the conditions you were treated for, prescriptions and referrals to specialists.
Where things are really changing quickly is in the use of electronic records for day-to-day patient care. Until recently, most doctors used paper charts to record information generated during patient visits. But the 2009 economic stimulus package offered doctors and...
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Wednesday, August 20, 2014

Questions About Who Should Perform In-Office Surgeries

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

One of the hopes embedded in the health law was to expand the role of nurse practitioners and physician assistants in addressing the nation’s shortage of primary care providers. But a new study questions whether that’s actually happening in doctors’ offices.
Of the more than 4 million procedures office-based nurse practitioners and physician assistants independently billed more than 5,000 times in a year to Medicare – a list including radiological exams, setting casts and injecting anesthetic agents – more than half were for  dermatological surgeries.

That’s not surprising, according to Ken Miller, president of the American Association of Nurse Practitioners, because when patients are older, skin problems such as “boils, skin tags and warts” are pretty  typical.
“I think that’s where you’re going to see the majority of procedures that are occurring both in primary care and in some of the other specialties like geriatric clinics,” he said.
The Aug. 11 study, published in the JAMA Dermatology analyzing 2012 Medicare claims, is suggesting that nurse practitioners and physician assistants should face higher regulation if performing surgical procedures.
The study’s lead author, Dr. Brett Coldiron, a dermatologist and clinical assistant professor at the University of Cincinnati, said while the “intent for...

Thursday, July 31, 2014

Medicare Experiment Could Signal Sea Change For Hospice

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

Diane Meier is the director of the Center to Advance Palliative Care, a national organization that aims to increase the number of palliative care programs in hospitals and elsewhere for patients with serious illnesses. Meier is also a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York City. We spoke about a recently launched pilot program under the health law that allows hospice patients participating in the pilot to continue to receive life-prolonging treatment. This is an edited  version of that conversation.
Q. There’s a lot of confusion about how hospice care differs from palliative care. Maybe we should start by clearing up what those terms mean. 
A. The short, quick elevator answer is that all hospice care is palliative care -- but not all palliative care is hospice. Palliative care is a team-based type of care focused on maximizing the quality of life for people and their caregivers at any stage of illness. It focuses on treating the pain, stresses and symptoms of serious illness. The emphasis is on need, not prognosis or how long you might have to live.
In contrast, the hospice benefit, which was written into the Medicare statutes about 25 years ago, had a number of limits in it to control spending.
Diane Meier (Photo courtesy of Mount Sinai Hospital)
...
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Sunday, July 20, 2014

Biggest Insurer Drops Caution, Embraces Obamacare

Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org

UnitedHealthcare, the insurance giant that largely sat out the health law’s online marketplaces’ first year, said Thursday it may sell policies through the exchanges in nearly half the states next year.

insurance computer 300

“We plan to grow next year as we expand our offering to as many as two dozen state exchanges,” Stephen Hemsley, CEO of UnitedHealth Group, the insurance company’s parent, told investment analysts on a conference call. He was referring to coverage sold to individuals.
The move represents a major acceleration for the company and a bet that government-subsidized insurance, sold online without regard for pre-existing illness, is here to stay. UnitedHealthcare sells individual policies through government exchanges in only four states now.
Even analysts who follow the company closely seemed surprised.
“You’re making a really big move,” Kevin Fischbeck, an analyst for Bank of America, told the company’s executives. “You’re going to do a couple dozen states. You’ve really moved in. What’s giving you the confidence … that it’s going to be stable next year?”
The answer, the bosses said, is that the marketplaces look sustainable, even without some of the reinsurance and risk-spreading backstops put in place for carriers in the first few years. They know the prices now, they said. They know the regulations. They know how consumers are...
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Monday, January 6, 2014

CMS Takes a New Direction in the Proposed MSP Appeal Process

The Centers for Medicare and Medicaid services (CMS) has proposed rules for the Medicare Secondary Payer (MSP) appeals process that will target the “applicable plan” as the primary responsible party for recovery. 

Medicare, in pursuing recovery directly from the applicable plan, removes the beneficiary, as well as the provider or supplier, as the responsible party to initial a re-determination and all subsequent levels of the administrative process that could culminate in judicial review.

Docket ID:CMS-2013-0270
Topic(s):Administrative Practices and Procedures, Health Facilities, Health Professions, Kidney Diseases, Medical Devices, Medicare, Reporting and Recordkeeping Requirements, Rural Areas, X-Rays
Document Type:Proposed Rule
Received Date:Dec 27, 2013
Start-End Page:78802 - 78807
Comment Start Date:Dec 27, 2013
Comment Due Date:Feb 25, 2014


Sunday, January 5, 2014

Comments Medicare Program: Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web Portal


Summary
This interim final rule with comment period specifies the process and timeline for expanding CMS' existing Medicare Secondary Payer (MSP) Web portal to conform to section 201 of the Medicare IVIG and Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act). The interim final rule specifies a timeline for developing a multifactor authentication solution to securely permit authorized users other than the beneficiary to access CMS' MSP conditional payment amounts and claims detail information via the MSP Web portal. It also requires that we add functionality to the existing MSP Web portal that permits users to: notify us that the specified case is approaching settlement; obtain time and date stamped final conditional payment summary forms and amounts before reaching settlement; and ensure that relatedness disputes and any other discrepancies are addressed within 11 business days of receipt of dispute documentation.

Docket ID:CMS-2013-0199
Topic(s):Kidney Diseases, Medicare, Physician Referral, Reporting and Recordkeeping Requirements
Document Type:Rule
Received Date:Sep 20, 2013
Start-End Page:57800 - 57806
Comment Start Date:Sep 20, 2013
Comment Due Date:Nov 19, 2013

Comments submitted included those of:
-Progressive Medical
-AAJ
-Property Casualty Insurers of America
-Crowe Paradis
-Franco Signor
-MARC
-CA State Compensation Fund
-NAMSAP
-DRI
-Allsup
-RIMS
-FCC
-Garretson Resolution Group
-AIA
-UWC


Thursday, December 26, 2013

Does Knowing Medical Prices Save Money? CalPERS Experiment Says Yes

Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org

The fact that the cost of a hip replacement can ring up as $15,000 or $100,000 — depending on the hospital — makes a lot of people uncomfortable. But that’s only if they know about the wide price tag variations.


In an effort to raise awareness and rein in what can seem like the Wild West of health care, the California Public Employees’ Retirement System (CalPERS), the second largest benefits program in the country, and Anthem Blue Cross started a “reference pricing” initiative in 2011. The initiative involved a system to guide their enrollees to choose facilities where routine hip and knee replacement procedures cost less than $30,000.


Here’s how it works: The CalPERS program designated certain hospitals that met this cost threshold, and enrollees who chose among these facilities pay only the plan’s typical deductible and coinsurance up to the out-of-pocket maximum. Patients who opted for other in-network hospitals were responsible for regular cost sharing and “all allowed amounts exceeding the $30,000 threshold, which are not subject to an out-of-pocket maximum,” noted the report.

The results tallied savings of $2.8 million for CalPERS, and $300,000 in patients’ cost sharing, according to research released Thursday by the Center for Studying Health System Change for the non-profit group National Institute for Health Care Reform.
Researchers found that patients who received “intensive...
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Wednesday, December 25, 2013

Consumers Beware: Not All Health Plans Cover A Doctor's Visit Before The Deductible Is Met

Will these types of medical plans encourage a medical deductible for workers' compensation coverage? Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

If you buy one of the less expensive insurance plans sold through the health law’s marketplaces, you may be in for a surprise. Some plans will not pay for a doctor visit before you meet your annual deductible, which could be thousands of dollars.
"This could be the next shoe to drop, as people don't realize that if they're buying a bronze plan, they may have to pay $5,000 out of pocket before it contributes a penny," said Carl McDonald, senior analyst with Citi Investment Research, speaking at a Washington, D.C., conference last month.
Experts worry that some enrollees will be discouraged from seeing doctors if they have to pay the full charge, rather than simply a copayment.
Those who’ve bought their own insurance have always had to pay a set annual sum, called a deductible, before policies begin paying their claims.  But first-time insurance buyers may not realize they’re on the hook for additional costs before benefits kick in, and may choose a plan based solely on the monthly premiums.
Bronze and silver plans -- which have lower monthly costs but typically, higher deductibles -- are the most likely to require consumers to spend that amount themselves before the insurer pays any claims. There is no nationwide data on how many do that. But in seven major cities, half of bronze plans on average require policyholders meet the deductible before insurers help with the cost of a doctor visit, according to an analysis by...
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Wednesday, December 18, 2013

In Hollywood, Health Coverage Presents Unique Challenges

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org


Inside the Fox Studios in Century City, crews are shooting the latest episodes of some of television’s biggest shows, including “Modern Family,” “How I Met Your Mother” and “Bones.” Just outside the lot, crew members on breaks are lining up at a mobile health clinic in a converted Winnebago, seeking treatment for both chronic diseases and common ailments.
The Hollywood film and television industry relies heavily on freelancers and independent contractors who are rarely offered health insurance from an employer. Throughout Southern California, producers, writers, actors, editors, camera operators and prop makers move from gig to gig and hold numerous jobs each year. Some get insurance through the industry’s unions – after paying hefty fees and dues and working enough hours on union jobs. Others pay for private policies – or simply go without.
The nation’s health law will offer financial help for those who buy policies through new insurance marketplaces and whose incomes are within the limits. But contract workers, freelancers and seasonal employees in a variety of industries will fall in and out of eligibility for subsidies, causing confusion and possible tax consequences at the end of the year.
Entertainment workers face an additional challenge on top of the constant job turnover and temporary nature of their employment. Crew members often work long hours rigging lights, moving gear and building sets, which can...
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Saturday, December 14, 2013

Congress Moves Closer To Changing How Medicare Pays Doctors

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org


Key House and Senate committees approved legislation Thursday to repeal the Sustainable Growth Rate, the formula officials use to pay doctors who treat Medicare patients. KHN’s Mary Agnes Carey and Politico Pro’s Jennifer Haberkorn discuss.

>> Click here to download audio of the conversation.

MARY AGNES CAREY: Congress is one step closer to repealing the Sustainable Growth Rate, or SGR, Medicare's physician payment formula. Today key House and Senate committees approved legislation to repeal the formula and replace it with a different way to pay doctors who treat Medicare beneficiaries.
Politico Pro's Jennifer Haberkorn is covering that story and joins us now. Thanks for being with us.
JENNIFER HABERKORN, POLITICO PRO: Thanks so much for having me.
Today the Senate Finance Committee and, in the House, the Ways and Means Committee voted on a bipartisan basis to repeal the Medicare physician payment formula, also known as the SGR. How are those aproaches the same, and how do they differ?
JENNIFER HABERKORN: These bills are very similar. Both of them change the way that doctors are paid under Medicare and eliminate the Sustainable Growth Rate. That's the old formula under which Medicare pays doctors. Neither of them are paid for, which is going to be a significant issue, particularly for Republicans. And one of the big differences in the bills is that there's a permanent fix to a series of provisions that come up...
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New York Data Show Hospital Charges All Over The Map

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

New York State has pulled back the curtain on hospital charges with a new database showing what each hospital charges for 1,400 different procedures.

The differences can be dramatic: At Bellevue Hospital, the median charge for an uncomplicated birth  is $6,330, and at NYU Langone Medical Center next door, the median charge is $12,222.

Lutheran Medical Center in Sunset Park, Brooklyn, typically charges $5,686 and Maimonides Medical Center, a dozen miles away, $14,763.
Patterns can be difficult to discern, and can vary from procedure to procedure. Overall, academic medical centers are more costly because of the additional staff needed for medical training, the greater use of technology, and the severity and complexity of patients.

But those factors do not account for why at Westchester Medical Center, the median charge for a vaginal delivery is $22,143, and at New York Presbyterian Weill Cornell Medical Center, it is $11,900.

The Greater New Hospital Association said the information is “complex and can be confusing,” because “hospital charges do not reflect the far lower payments hospitals actually receive for the services they provide.” Medicare and Medicaid reimburse much less than what hospitals charge, and insurers and managed care companies also negotiate rates that have little to do with what hospitals ask to be paid.

People without insurance, however, are subject to these sticker prices. In practice, hospitals typically...
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Tuesday, December 10, 2013

Rehospitalization Rates Fell In First Year Of Medicare Penalties

Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org

During the first eight months of this year, fewer than 18 percent of Medicare patients ended up back in the hospital within a month of discharge, the lowest rate in years, the government reported Friday. This drop occurred during the first year that Medicare financially penalized hospitals for their readmission rates, and the government seized on the decrease as evidence the incentives are having an effect.

revolving door300
The government is targeting rehospitalizations as a significant indicator of gaps in medical quality in the nation’s hospitals. While some elderly patients inevitably return to the hospital, the government and some researchers believe many of those returns are avoidable if hospitals monitor patients after their release to ensure they get appropriate medications and follow-up visits with doctors.
In the first year of the program, which began in August 2012, Medicare fined 2,213 hospitals—about two-thirds of those it evaluated— for higher than anticipated readmission rates. Last August, Medicare issued a second year of penalties against 2,225 hospitals. The maximum penalties created by the health law have risen from 1 percent of regular Medicare payments to 2 percent, and they will increase for a third and final time next August to 3 percent.
The new data reported by Medicare show that readmission rates for the first eight months of 2013 dropped below 18 percent, half a percentage point below 2012’s rate of 18.5 percent. From 2007 to...
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