Monthly Archives: October 2016

MIPS breakdown: 6 must-know parts of the MACRA final rule

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http://www.beckershospitalreview.com/finance/mips-breakdown-7-must-know-parts-of-the-macra-final-rule.html

OR Efficiencies

The Medicare Access and CHIP Reauthorization Act final rule is here. As industry experts begin to dig into the 2,400-page document released Friday, a few details are emerging that will be critical for providers who plan to practice fee-for-service medicine in 2017.

Physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists who bill more than $30,000 a year or provide care for at least 100 patients under traditional, fee-for-service Medicare will be subject to MACRA’s Merit-Based Incentive Payment System beginning Jan. 1.

Becker’s caught up with two experts who have already started reading — Tom Lee, PhD, founder and CEO of SA Ignite, and Dan Golder, DDS, principal at Impact Advisors — to determine a few details providers should heed in preparation for MIPS next year.

Here are seven takeaways based on the initial findings of Drs. Lee and Golder.

STDs Hit Historic High: CDC

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http://www.medpagetoday.com/InfectiousDisease/STDs/60900?isalert=1&uun=g885344d5310R7095614u&xid=NL_breakingnews_2016-10-19

Image result for STDs

The number of cases of a sexually transmitted disease reported in the U.S. reached an all-time high last year, the CDC is reporting.

The combined total of reported chlamydia, gonorrhea, and syphilis cases was more than 1.8 million in 2015, the agency said in its annual Sexually Transmitted Disease Surveillance Report.

Those numbers are probably an underestimate, the agency said in a release, since most STD cases are undiagnosed and untreated. But the treated cases have reached an all-time — and expensive — high: the agency said it estimates the annual cost of therapy at nearly $16 billion.

The reported incidence of all three conditions rose from 2014 — by 5.9% for chlamydia, 12.8% for gonorrhea, and a whopping 19% for primary and secondary syphilis.

The Top 4 Challenges Facing Leaders Today

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Join Thousands Who Have Used the Leadership Freedom Checklist – See Inside

Leadership Freedom Checklist

 

Healthcare Triage: Medicaid has a Huge Return on Investment

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Healthcare Triage: Medicaid has a Huge Return on Investment

Image result for Healthcare Triage: Medicaid has a Huge Return on Investment

As we pass the 3-year anniversary of the opening of the insurance exchanges, most news seems to focus on the private insurance people can purchase there. In recent months, many have complained about private insurers exiting the exchanges, networks being narrowed, premiums rising, and competition dwindling out of existence.

But it’s important to remember that many, if not most, of the newly insured are part of the Medicaid expansion. As of today, 19 states have still refused to participate in that program. Some cite reports and news that Medicaid offers poor quality and little choice of providers. But most seem to cite the cost of Medicaid, claiming that its growing cost will eventually bankrupt states.

Such declarations only consider one side of the equation, though. In most ways, Medicaid offers an excellent return on investment. That’s the topic of this week’s Healthcare Triage.

The 10th Annual ReviveHealth Trust IndexTM reveals an alarming gap

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http://thinkrevivehealth.com/topic/trust/

Health system pie chart

13% VALUE • 87% VOLUME

During the course of calendar year 2016, what percentage of your total commercial revenues will be based on volume versus value?

Health plan pie chart

44% VALUE • 56% VOLUME

During the course of calendar year 2016, what percentage of your the total claims you pay for commercially insured patients will be based on volume versus value?

http://thehealthcareblog.com/blog/2016/10/18/the-trust-gap-in-healthcare-findings-from-the-2016-healthcare-trust/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=36101369&_hsenc=p2ANqtz-_H0Xd8-bph-4E1P_WuxQu3NWoe27IIu9jELumbhG553MdbewO3LayeOY_kls9URzaeO2A3QdFRz3z9QbtCg88S-9F-NQ&_hsmi=36101369

 

 

Medicare shouldn’t pay more for drugs when others pay less

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https://www.statnews.com/2016/10/18/medicare-drug-prices/?_hsenc=p2ANqtz–zfLIsv2nEEzVlLISqrp28lPm5ANNScP2_qYXJZI-DenazQvHTSROulTck5xdVsR5KMAzBoOaUWrYMEPSR1ZxAyLybMQ&_hsmi=36101369

Hillary Clinton and Donald Trump don’t see eye-to-eye on much. But they do agree that drug costs are spiraling out of control at the public’s expense. Both the Democratic and the Republican candidates for president have said that Medicare should be able to negotiate drug prices, something that currently isn’t allowed by law. Letting Medicare do that — which the Department of Veterans Affairs and other countries have been doing for years — has the potential to transform health care.

Most developed nations, including Canada and the United Kingdom, negotiate with pharmaceutical companies to determine how much they will pay for medications. In the US, health care is covered by many different payers, with Medicare being the largest by far. The federal government never gave Medicare the power to negotiate drug prices. Instead, that’s done by the many private insurers that manage Medicare drug plans.

Giving Medicare the power to negotiate drug prices would immediately save billions of dollars. The implications would also reach far beyond the 37 million Americans covered by the Medicare drug benefit (Part D), because commercial insurers often follow Medicare’s lead.

 

 

Four areas of unnecessary senior healthcare

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http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/four-areas-unnecessary-senior-healthcare?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=19102016

The number of seniors in the United States is projected to nearly double over the next 34 years—from 43 million in 2012 to nearly 84 million by 2050. During that time period, the number of seniors 85 and older is expected to jump from nearly 6 million to 19 million.

“Our Parents, Ourselves: Health Care for an Aging Population,” a report issued by the Dartmouth Atlas Project, a program of The Dartmouth Institute for Health Policy and Clinical Practice, also reveals that the number of seniors in Medicare private health plans such as Medicare Advantage increased from 6.4 million beneficiaries in 1999 to nearly 12 million in 2011—and that number continues to rise.

Because seniors are likely to experience frequent, complex interactions across many providers in the healthcare system, often there’s no single healthcare provider coordinating all of their care, according to the report, which was released in early 2016.

In addition, the American Geriatrics Society’s Choosing Wisely guidelines, which were released in 2013 and updated in 2015, provide geriatrics-specific recommendations to the American Board of Internal Medicine Foundation’s Choosing Wisely campaign. The campaign advances a national dialogue on avoiding wasteful or unnecessary medical tests, treatments, and procedures.

Here are four areas of elderly care—highlighted in the report and guidelines—that healthcare systems and health plans should be aware of to ensure that elderly patients aren’t receiving unnecessary care.