HealthLeadersMedia.com - Daily News & Analysis

Medicare Physician Payment Rule Factors in GPCI

Fri, 10 Feb 2012 12:53:00 GMT

The final 2012 Medicare physician payment rule from the Centers for Medicare & Medicaid Services includes an adjusted fee schedule for the Geographic Practice Cost Index. The adjustment prevents large cuts this year and will help California physicians in the future.

Feds Release Final Rules on Health Plan Language

Fri, 10 Feb 2012 12:26:00 GMT

Under the new rules, information provided to consumers about healthcare insurance eligibility and benefits must clearly specify a plan's deductibles, annual limits, and other details so that consumers can understand them.

Parkland Keeping Consultant's Analysis Under Wraps

Thu, 09 Feb 2012 12:44:00 GMT

Citing legal concerns, Parkland Memorial Hospital's board has decided not to release a consultant's report that details ongoing problems at the Dallas facility. But the Centers for Medicare & Medicaid Services is expected to decide whether the gap analysis will be released to the public.

Getting to the Heart of Cardiology Alignment

Thu, 09 Feb 2012 11:00:00 GMT

Healthcare leaders are considering prospects for new payment systems and for value-based efficiencies. One physician alignment model is an integrated plan, such as a professional services agreement in which a hospital or health system operates a physician clinic and contracts with an independent group to provide professional services.

Emergency Surgery Needs Distinct Code Registry, Researchers Say

Wed, 08 Feb 2012 12:31:00 GMT

Oversight of emergency surgery might work better if it operated a lot more like how the national and regional trauma systems function, with their own separate patient registries, surgical researchers suggest.

Keeping Readmission Rates Low with Treatment Guidelines

Wed, 08 Feb 2012 11:00:00 GMT

Hospitals are developing treatment guidelines with the aim of reducing readmissions. At one facility, guidelines are both diagnosis-based and procedure-based, and are created by an interdisciplinary team with a physician champion.

Engineering a High-Performance Emergency Department

Tue, 07 Feb 2012 12:47:00 GMT

A revamped staffing model for nurses and a boost to physician compensation and accountability are among the operational and clinical improvements documented in our case study of Cambridge Health Alliance's internal transformation.

Essential Health Benefits Bulletin Draws Fire

Tue, 07 Feb 2012 12:31:00 GMT

A federal move to put states in charge of decisions regarding essential health benefits for health insurance exchanges is drawing generally negative public reaction.

Healthcare Continues Strong Job Growth

Mon, 06 Feb 2012 12:32:00 GMT

Figures from the Bureau of Labor Statistics show continued growth at a robust pace in the healthcare sector during the month of January, and a medical economist explains why he believes "the healthcare economy is recession-proof."

5010 Deadline Extended, But Threat Remains, Says AMA

Mon, 06 Feb 2012 12:27:00 GMT

The Centers for Medicare & Medicaid Services has extended the 5010 HIPAA transaction standards deadline to March 31. The delay is meant to enable more physician practices to implement the billing coding standard without incurring penalties. But the American Medical Association says CMS should do more.

Hospital HCAHPS Scores Beat Expectations

Fri, 03 Feb 2012 12:52:00 GMT

Hospitals have been scurrying to improve their patient experience scores under Medicare's value-based purchasing rules. Those efforts are paying off, Hospital Consumer Assessment of Healthcare Providers and Systems survey responses show.

Don't Give Up on Dead Claims

Fri, 03 Feb 2012 12:27:00 GMT

Denials can wreck a provider’s revenue stream, but physician practices often give up on payment too soon, says an attorney. "Providers have a lot more leverage than they realize," he says.

Medicare Advantage Enrollment Grows, Premiums Shrink

Thu, 02 Feb 2012 12:52:00 GMT

Medicare Advantage plans are showing a 10% increase in enrollment from a year ago, says U.S. Health and Human Services Secretary Kathleen Sebelius, but the insurance industry warns of dramatic declines in the future.

Primary Care Docs Weigh Advantages of PCMH

Thu, 02 Feb 2012 12:34:00 GMT

An insurer's plan to increase reimbursements for primary care physicians who transition to patient-centered medical homes could signal a tipping point in the move toward the new care management model.

Breast Cancer Reexcision Rates Vary Widely

Wed, 01 Feb 2012 12:38:00 GMT

A breast cancer surgery patient's likelihood of enduring a second surgery varies depending on her choice of hospital, surgeon, and even her clinical profile, a study suggests.

Outpatient Care Expansion Comes Under Scrutiny

Wed, 01 Feb 2012 11:00:00 GMT

Even the most ardent proponents of outpatient care say its pace of growth may slow, depending on a community's need for integrated care and specific demand for multidisciplinary approaches.

Medicare Advantage Overpayments May Top $3B

Tue, 31 Jan 2012 12:30:00 GMT

The Centers for Medicare & Medicaid Services overpaid Medicare Advantage plans between $1.2 billion and $3.1 billion in 2010, and likely overpaid even more in 2011, analysis released by the Government Accountability Office shows.

Disclosure Report Could Reveal HIPAA Breaches

Tue, 31 Jan 2012 11:00:00 GMT

A proposed rule would give patients the right to get a report on who has electronically accessed their protected health information. Some legal experts worry this could pose problems for healthcare providers.

TX Strikes Out on MLR Waiver Request

Mon, 30 Jan 2012 12:28:00 GMT

The Centers for Medicare & Medicaid Services has rejected what has become a standard argument among waiver applicants, that the 80% medical loss ratio requirement would destabilize the state's individual market and cause insurers to withdraw.

Outpatient Move Saves Hospital

Mon, 30 Jan 2012 11:00:00 GMT

An expanded physical therapy program helps save a 22-licensed-bed critical access hospital in Illinois, a facility that nearly shut down because of fiscal and management problems.