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Updated: 18 min 41 sec ago

CMS: No ICD-10 Audit Claims for Specificity in Year One

11 hours 56 min ago

For one year after implementation of ICD-10, CMS will not deny or audit claims just for specificity, as long as the code is from the appropriate family of ICD-10 codes. Similarly, physicians will not be penalized for the value-based payment modifier or Meaningful Use due to specificity of diagnoses.

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Aetna's $37B Humana Acquisition Has Providers Wary

12 hours 27 sec ago

Market consolidation by health insurers is raising the specter of anti-competitive behavior and fears of patient harm among physicians, hospitals, and health systems.

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Audit: Doctors are overprescribing drugs to get Medicare cash

12 hours 8 min ago

A Medicare program designed to offset costs at hospitals serving the poor is likely prompting doctors to over-prescribe drugs to their patients, according to a new federal audit. Hospitals that participate in Medicare's 340B Drug Pricing Program are either prescribing more drugs or more expensive drugs to their patients compared to hospitals that don't qualify for the program, investigators found. Spending is about $144 per patient at the 340B hospitals — more than twice the $60-per-patient spending at hospitals without the program. And the differences in treatments could not be "readily explained by hospital characteristics or patients' health status," the report finds.

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Medicare expected to pay for end-of-life talks

12 hours 10 min ago

Advocates for better end-of-life care expect Medicare to soon announce that it will start paying physicians for having advanced-care planning conversations with patients — reviving the widely misunderstood provision that gave rise to "death panel" fears and nearly sank the Affordable Care Act. The new policy could be part of an annual Medicare physician payment rule, which could be released any day. Advocates say they expect it to be included, but they note that it's no sure thing and that they've been disappointed before. Such a policy shift would come six years after former vice presidential candidate Sarah Palin's wild charges of "death panels" triggered near-hysteria that bureaucrats might begin to withhold medical care from older Americans.

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Finding which doctors are in Obamacare networks is difficult

12 hours 13 min ago

When economist Dan Polsky set out to study how many doctors were in the health-insurance networks available to Obamacare customers, he found out it was hard - even for him. How hard? "Nine out of 10," said Polsky, executive director of the University of Pennsylvania's Leonard Davis Institute of Health Economics. He concluded that many of the 10.2 million people who have bought insurance through the Affordable Care Act marketplace probably don't realize they are giving up access to many physicians and hospitals in order to get lower premiums. He and colleague Janet Weiner learned that 41 percent of health plans at the midrange "silver" level included fewer than 25 percent of physicians in their area, making them "narrow networks.''

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Poll: Childhood disease outbreaks raise support for vaccines

12 hours 15 min ago

Sometimes a crisis can spark a shift toward safety. A new nationwide poll from the University of Michigan, C.S. Mott Children's Hospital, says that more parents express positive views about vaccines following the resurgence of some common childhood diseases in the past year. "Media coverage of outbreaks over the past year, accompanied by messages about vaccines for whooping cough and measles, may be swaying parents' opinions toward stronger beliefs in the positive aspects of vaccines," Dr. Matthew M. Davis, M.D., professor of Pediatrics and internal medicine in the Child Health Evaluation and Research Unit at the University of Michigan Medical School said in a statement.

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Industry payments to nurses go unreported in federal database

12 hours 17 min ago

A nurse practitioner in Connecticut pleaded guilty in June to taking $83,000 in kickbacks from a drug company in exchange for prescribing its high-priced drug to treat cancer pain. In some cases, she delivered promotional talks attended only by herself and a company sales representative. But when the federal government released data Tuesday on payments by drug and device companies to doctors and teaching hospitals, the payments to nurse practitioner Heather Alfonso, 42, were nowhere to be found. That's because the federal Physician Payment Sunshine Act doesn't require companies to publicly report payments to nurse practitioners or physician assistants, even though they are allowed to write prescriptions in most states.

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Knowing how doctors die can change end-of-life discussions

12 hours 19 min ago

Dr. Kendra Fleagle Gorlitsky recalls the anguish she felt performing CPR on elderly, terminally ill patients. It looks nothing like what we see on TV. In real life, ribs often break and few survive the ordeal. "I felt like I was beating up people at the end of their life," she says. "I would be doing the CPR with tears coming down sometimes, and saying, 'I'm sorry, I'm sorry, goodbye.' Because I knew that it very likely not going to be successful. It just seemed a terrible way to end someone's life." Gorlitsky now teaches medicine at the University of Southern California and says these early clinical experiences have stayed with her.

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Study: When new doctors 'train' during surgery, risks don't rise

12 hours 21 min ago

People undergoing brain or spine surgery are at no greater risk if doctors-in-training -- called residents -- assist during the operation, a new study suggests. Researchers found that residents are supervised and their assistance doesn't increase the risk for complications or death. "Patients often ask whether a resident is going to be involved in their case, and they're usually not looking to have more residents involved," Dr. Mohamad Bydon, a resident in neurosurgery at the Johns Hopkins Hospital in Baltimore, said in a hospital news release. "Some people have a fear of being treated in a hospital that trains doctors."

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Doctors often work while sick, putting patients at risk

12 hours 22 min ago

What happens when the people who take care of the sick get sick themselves? A new survey finds that they often feel obligated to show up to work anyway. The pressure to work while sick carries special risks when it comes to health care providers because they can pass on infections to patients, many of whom already have compromised immune systems. The survey, conducted at The Children's Hospital of Philadelphia and published Monday in JAMA Pediatrics, included responses from 280 attending physicians and more than 250 advanced practice clinicians (APCs), a category that includes certified registered nurse practitioners, physician assistants, clinical nurse specialists, and other highly trained health care providers.

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Massachusetts Bill Seeks to Limit Private Hospital Payments

Mon, 07/06/2015 - 07:05

A proposal to set a floor and a ceiling on health insurance payments is an effort to eliminate disparities, but the Massachusetts Hospital Association's noard of trustees calls the bill "overly simplistic."

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2016 OPPS Proposed Rule Updates Two-Midnight Rule

Mon, 07/06/2015 - 06:56

CMS proposes that for stays expected to last less than two midnights, an inpatient admission would be acceptable on a case-by-case basis. Enforcement of the two-midnight rule would shift to quality improvement organizations from recovery auditors.

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In health law, a boon for diet clinics

Mon, 07/06/2015 - 06:50

Dr. Michael Kaplan looked across his desk at a woman who had sought out his Long Island Weight Loss Institute and asked the question he often poses to new patients: "Where do you think you go wrong with food?" The 38-year-old patient was about 20 pounds overweight and, as she described it, desperate. Weight Watchers, nutritionists — she had tried them all in vain. A physician like Dr. Kaplan, she reasoned, might be the only one left who could help her. "I'm really tired of it," the woman said one recent afternoon, declining to give her name to a reporter. "I feel like something is off with me."

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Patients, doctors team up to transform healthcare

Mon, 07/06/2015 - 06:47

Ask Aldo Ciccotelli to describe how he sees the transformation of America's health system, and he tells the tale of two diabetic patients. The middle-age professionals both suffered the same symptoms: frequent urination, fatigue, and thirst. "Both were intelligent and well-educated," said Ciccotelli, a family physician who also is vice president and chief medical officer for Langhorne Physician Services at St. Mary Medical Center. One patient "kept his appointments, took his medications, changed his diet, and started exercising. He saw a diabetes educator." Today, John Henry is thriving, enjoying his healthy new lifestyle. "I wanted to live," the Langhorne man says in describing his motivation to change.

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How the ACA is changing chronic care at hospitals

Mon, 07/06/2015 - 06:45

Healthcare professionals say the landmark health reform law, the Affordable Care Act, is accelerating changes in how hospitals treat patients with chronic conditions like diabetes, heart failure and obesity. Successfully treating those patients, who use many more healthcare services, have higher rates of hospitalization and more frequent emergency department visits, is challenging because many of their conditions are aggravated by unhealthy eating habits and inactivity. Chronic disease rates increase steadily as patients age, making this issue particularly key to the Medicare program. Medicare has been paying a set amount for each hospital admission, regardless of the length of stay or the outcome.

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Aetna and Humana: Justifying the prize

Mon, 07/06/2015 - 06:44

With a deal to buy Humana for $37 billion, including debt, Aetna has its prize. There is now just the small matter of making it work. The deal marks a 29% premium to Humana's share price in late May, when The Wall Street Journal first reported a sale was likely. Just over half the price paid will be in cash. Buying Humana accomplishes some important goals for Aetna, such as bulking up its Medicare Advantage program. Some 56% of the combined company's revenue will come from government sources, up from 38% previously. [Subscription Required]

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Rural KS hospitals search for ways to survive

Mon, 07/06/2015 - 06:38

A lot of the hospitals in rural Kansas are called "critical access hospitals." It's an important designation that the federal government created to maintain access to health care in rural areas. But many Kansas critical access hospitals are in financial trouble. Although Medicare requires them to offer 24-hour emergency services, most don't have enough ER patients to justify that cost, said Melissa Hungerford, senior vice president for health care leadership at the Kansas Hospital Association. "Keeping staff and supplies and equipment and buildings and all of the facilities that it takes to deliver that around-the-clock, quality inpatient care is an expensive system," she said.

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TX hopes to attract more mental healthcare workers

Mon, 07/06/2015 - 06:36

Desperate to attract mental health care workers, clinics in rural and other underserved parts of Texas have gotten creative in their hiring tactics — touting benefits like fresh air and low crime rates. Soon the state of Texas will offer another incentive: cash. Lawmakers this year created a program —at a cost of nearly $3 million over the next two years — that will help pay off mental health professionals' student loans if they practice in an underserved area. The loan forgiveness program seeks to alleviate the state's shortage of mental health professionals — including social workers, psychologists, counselors and psychiatrists — by luring them to parts of the state that have significant need for health care but may not be attractive to graduates of expensive professional schools.

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Opinion: Collaborations on the rise between Utah and French healthcare systems

Mon, 07/06/2015 - 06:35

The U.S. health care system is often compared to European systems in unflattering terms, yet European countries are also under increasing pressure to increase their quality of care and efficiency. Many are looking to the United States for innovative, proven solutions. There is much that we can learn from each other. A newly formed collaboration involving Utah's Intermountain Healthcare and the French government is providing one vehicle for that learning. Last February, senior leaders from Intermountain were invited to France to meet with that nation's top health care officials, including the French vice-minister of health, senior government health policy leaders, physicians, and the leader of health insurance for the Paris region.

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Behind Higher Physician Fees, a Big Problem Lurks

Thu, 07/02/2015 - 10:40

Joining forces with a like-minded, larger medical practice may afford economies of scale, but physicians should be aware that it could be at the expense of patients, who are becoming more cost-conscious.

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