S.G.R. More than 99 percent of Americans have no idea what these three letters stand for. And yet they are extremely valuable: worth about $140 billion. This week, a House committee will finally take up the issue. The S.G.R., or the Sustainable Growth Rate formula, was enacted as part of the Balanced Budget Act of 1997 to restrain the inevitable increase in Medicare's annual spending on physician services. It set a reasonable target for each year's increase, and Medicare was supposed to spend less than that amount. If it failed, then the per-service payments to physicians in the following year would be reduced to hit the target. Nice idea in theory. Never worked out in practice.
Tammy Spencer did a double take when she read the address on her paper and looked at the house in front of her. Spencer, a volunteer with the nonprofit Enroll America, was spending a hot and humid Saturday morning knocking on doors in Boca Raton, a mostly posh South Florida city, looking for people without health coverage. She wanted to let them know about new online insurance marketplaces that open for enrollment Oct. 1. The spacious house was on the Intracoastal Waterway, complete with its own boat dock. The woman who answered the door said she already had coverage through Medicare, and Spencer went on to the next house.
The success of Medicare depends on accurately assessing the impact of constant advances in science and technology on patient care. There is simply no substitute for physicians' clinical expertise when gauging how much work and resources go into one medical service compared with another. No one knows more about what is involved in providing services to Medicare patients than the physicians who care for them. An AMA-convened committee of independent physicians has taken the initiative to evaluate medical services and recommend adjustments to Medicare that have decreased payments, freeing more than $2.5 billion to be redistributed to other services.
Financially speaking, patients soon will find visits to North Carolina hospitals less painful and mystifying. Under laws passed by the General Assembly, they'll get more protection from aggressive bill-collection practices. Hospitals will be prohibited from putting liens on the houses of some patients, and will have to give written notice before sending accounts to a collection agency. Patients will also find it easier to comparison shop. Starting next June, hospitals must post prices for common procedures, as well as their charity care policies. And they'll have to put their bills in plain, easy-to-understand language without obscure codes and medical jargon.
The Miami Beach Community Health Center has sued its former leader in an attempt to recoup $7 million she plundered from the organization. The center has also partially settled a lawsuit against its auditors, claiming they failed to notify the board of directors about the years-long theft. Before she was caught, Kathryn Abbate won accolades for her leadership of the center, which caters to the poor and uninsured throughout Miami-Dade County. Her reputation changed in 2012, when she was charged with embezzling millions of dollars from the non-profit organization to feed what her lawyer described as a gambling and drug addiction.
MIAMI – For the first time in history, federal health officials said Friday they will ban certain types of Medicare and Medicaid providers in three high-fraud cities from enrolling in the taxpayer-funded programs for the poor as part of an effort to prevent scams. The strict moratoriums, which start Tuesday, give federal health officials unprecedented power to choose any region and industry with high fraud activity and ban new Medicare and Medicaid providers from joining the programs for six months. They wouldn't ban existing providers. The administrator of the Centers for Medicare and Medicaid Services said the agency is targeting providers of home health care in eight counties in the Miami and Chicago areas.