BREAKING @CMSgov released a proposed #Medicare #Physician #Fee #Schedule for 2025, with an estimated reduction of at least 2.8% to physician payments. https://ow.ly/pbpi50Sz9Zn
American Academy of Ophthalmology’s Post
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Chairman Of Board - Revenue Cycle Coding Strategies/The Oncology Group/RC Billing and Regents Health Resources 👍🏻
Interesting article! : “Physician practices cannot continue to absorb rising costs while their payment rates dwindle,” https://lnkd.in/gQkGCkXW #physician #medicare #paymentcuts #healthcarefinance #wemustchange
Latest proposed cut—2.8%—shows need for Medicare pay reform
ama-assn.org
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#Congress punts on site-neutral #Medicare payment reform. #Hospitals win. Independent #physician groups loose. More unfortunate tradeoffs in a resource-limited world. #HealthcareReform #HealthcareTransformation #CMS #HHS #Capitation #TripleAim #QuadrupleAim #Healthcarecosts #PatientCenteredCare No #PublicPrivatePartnerships #PublicPrivatePartnership
Congress Hits Pause on Site-Neutral Hospital Payment Reform Amidst Intense Lobbying
medriva.com
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"Anaesthetist Joanna Sutherland, who chairs the Safety and Quality Committee of the Australian and New Zealand College of Anaesthetists (ANZCA), described the anaesthesia billing system as unfit for purpose and said it was open to misinterpretation and misapplication." Another excellent article that supports the need for greater transparency in the Medicare system. What is true is that the whole system, not just anaesthesia billing lacks transparency, checks and balances. This is now beyond dispute. For example, one patient's health fund and Medicare was billed (and paid) for an anaesthetic that didn't happen because there was no surgery. Now ultimately, whether this was deliberate or an error is irrelevant. With a pressured health budget, it has to stop. We cannot continue to tolerate misuse by some impacting trust for all - and that is why transparency is in the best interest of doctors and patients. Dr Sutherland, Dr Peck and I have called on the government to give the Professional Services Review Agency (the Medicare watchdog) more powers to conduct sweeping national medical records audits. Australian Broadcasting Corporation (ABC) | Private Healthcare Australia | Rachel David | Mark Butler MP | Joanna Sutherland https://lnkd.in/eeTb7cT6
'I feel violated, I trusted them': Patients appalled after being shown the true nature of their medical bills
abc.net.au
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Recently, a physician colleague shared a thought-provoking insight: “The best healthcare system in the world is one that systematically creates a deep connection between patient and doctor.” Traditionally, physicians would admit patients, closely follow their progress throughout the hospital stay, and, if necessary, continue their care in an outpatient setting, especially if the patient did not have a primary care physician (PCP). However, the landscape has evolved towards a model where physicians, particularly internists, are employed by hospitals and work in shifts. Why such a change? Probably because of: 1. Increased operational efficiency 2. Control over patient care to potentially reduce hosptial length of stay. 3. Theoretically, better physician work-life balance. However, these changes have inadvertently led to fragmented care. James Goodwin’s research article (linked below) brings up some consequences of this trend: the 7-on/7-off and similar shift models have led to a scenario where patients admitted for medical illnesses are likely to be cared for by more than one general internist during their stay. This fragmentation has been linked to higher post-discharge costs, increased readmission rates, and a notable decline in satisfaction among both patients and physicians. The traditional care model placed physicians in independent, autonomous systems, fostering a competitive environment where physician reputation and patient outcomes mattered deeply, thereby nurturing strong patient-physician relationships. In contrast, the new system abstracts physicians from their patients, with care being the hospital’s responsibility during the physician’s shift. Today, the problem is even larger than most people think. Even if a primary care group wanted to see their admitted patient, they can’t because hospitals are preventing them from doing so. They want their employed doctors to admit them. But that’s a topic for another time. Why did we deviate from the traditional model? It naturally supports care continuity and strengthens the doctor-patient bond, directly addressing the problems shift work exacerbates. And if this was all about improving physician burnout (like some have suggested in online articles) then why has perceived burnout continued to climb in hospital settings? Why not go back to the old system and just admit less patients to more doctors? #physician #healthcare #valuebasedcare
Continuity of Care Matters in All Health Care Settings
jamanetwork.com
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🔴USBD Hospitalists&Consultants 🔴News Letter March 2024 Dear All Today’s highlight: ♦️How to counsel and manage SHAME: Concept is not difficult to understand, but counseling and management of someone who has been shamed feeling ashamed is not easy. Of the varied reasons for this difficulty is internal untreated or semi treated mental health issues which makes shame to handle even more difficult 🔴Hospitalists Corner: ♦️Artificial intelligence: use it, or lose it As artificial intelligence is marching forwards more and more electronic medical records are having them integrated to search and compile data and intricate in the current records Like every new learning, it will have a curve. Sooner we embrace artificial intelligence, the better control we will have over it. Engineers are continuously working, behind-the-scenes to customize it with your help so that you can personalize your own artificial intelligence to be used in your EMR screen. ♦️Improper use of weight loss drugs: Like any chemical weight loss drugs, have severe side effects if used improperly. Remember to consider new medication or weight loss drugs if your patient presents with clinical scenarios that does not fit the usual picture. ♦️BLood Sugar monitoring: Many patients admitted to hospital, have their own blood sugar monitoring system, which we can use without pricking them for checking blood sugars. In course of time this may add value to patients experience in hospital. ♦️Prevent DVT/PE: Current recommendation is to focus on risk factors for DVT in healthcare facilities before assigning the prophylaxis in EMR It is always risk versus benefit 🔴Society of hospital medicine: All Hospitalists adult and pediatric are strongly encouraged to become a member of society of hospital medicine unless they’re already a member as you will only appreciate the benefits of this membership once you become a member 🔴USBD Tele Housecalls: www.usbdhousecalls.com Senior Care professionals: Many many Florida seniors are snowbirds, and Timm is coming for them to return to their state of origin. If you are taking care of a snowbird senior, please make sure you have their contact information and they have your contact information in case they need to come in contact with Florida Healthcare system while they are in Florida so that we do not have to chase blindly to figure out which patient has been with home health agency, which nursing facility, etc. 🙏 Shaheen.Faruque MD FACP.FHM VP.USBD Hospitalists & Consultants,Inc
USBD Hospitalists and Consultants
usbdhousecalls.com
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CMS issued the 2025 Medicare Physician Fee Schedule Proposed Rule, and as expected it reflects a conversion factor decrease for the fifth consecutive year. Check out this recap of key provisions in the proposed rule, their expected impact, and legislative responses that are underway. #cms #physician #medicare #reimbursement
CY 2025 Medicare Physician Fee Schedule Proposed Rule
jtaylor.com
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Expect more focus on proceduralists with reports such as this one noting more declines. Doing more with less has become the rule and we know what this does. Remember how much organized effort was mounted against recent efforts to increase primary care payments - and it came from organized proceduralist groups. Budget neutrality, Regulatory Capture, and lobbying are tough to address with 1.4 trillion in spending a year against basic health access = especially with close position both to the feeding trough and to the design trough. Both positionings are essential for survival. "Inflation-adjusted reimbursement per beneficiary increased 9.9% over the 2005 to 2021 period; this trend encapsulated a 64.8% increase in RVUs per beneficiary, offsetting a 33.6% inflation-adjusted conversion factor decline. RVU changes per beneficiary varied widely across clinicians (+45.5% for physicians to +328.2% for non-physician practitioners) and by specialty (−36.1% for cardiac surgery to +1106% for nurse practitioners). Given RVU increases, conversion factor decreases, and inflation combined, reimbursement per beneficiary decreased 2.3% for physicians and increased 16.3% for limited-license physicians and 206.5% for non-physician practitioners. Overall, increased RVU volume per beneficiary has offset conversion factor declines within the budget neutral system. Substantial redistribution has occurred across provider types, with reimbursement declining slightly for physicians while tripling for non-physician practitioners. Certain specialties, particularly procedural specialties, have declined most.." https://lnkd.in/gi3U4CSq
Medicare Volume Growth and Shift in Payments From Physicians to Non-Physician Practitioners Under Statutory Budget Neutrality - Eric W. Christensen, Gregory N. Nicola, Elizabeth Y. Rula, Lauren P. Nicola, Joshua A. Hirsch, 2024
journals.sagepub.com
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Medicare Part B Premium and Deductible Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A. Each year, the Medicare Part B premium, deductible, and coinsurance rates are determined according to provisions of the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $174.70 for 2024, an increase of $9.80 from $164.90 in 2023. The annual deductible for all Medicare Part B beneficiaries will be $240 in 2024, an increase of $14 from the annual deductible of $226 in 2023. The increase in the 2024 Part B standard premium and deductible is mainly due to projected increases in health care spending and, to a lesser degree, the remedy for the 340B-acquired drug payment policy for the 2018-2022 period under the Hospital Outpatient Prospective Payment System. Beginning in 2023, individuals whose full Medicare coverage ended 36 months after a kidney transplant and who do not have certain other types of insurance coverage can elect to continue Part B coverage of immunosuppressive drugs by paying a premium. For 2024, the standard immunosuppressive drug premium is $103.00.
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Eligible adults age 55+ who participate in PACE, the Program of All-Inclusive Care for the Elderly—a combined Medicare and Medicaid program—are able to access a comprehensive range of services, including medical and dental care, physical therapy, prescription drugs, and long-term services and supports. PACE has demonstrated success in improving the health and well-being of participants. It has high satisfaction among family caregivers and is cost effective. Still, many states don’t have the program. A new report from AARP’s Public Policy Institute discusses the challenges and opportunities for expanding and enhancing the program, including ensuring equitable access and leveraging technology. #LTSS #Medicare #Medicaid #OlderAdults https://lnkd.in/gxJJJq5f
How the PACE Model Integrates Medical Care With Long-Term Services and Supports
ltsschoices.aarp.org
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Physicians in the healthcare industry are facing a critical issue where hospitals attempt to suspend them. This article, prepared by my partner, Dan Frier, reveals the shortcomings of fair hearings in these cases, highlighting the need for reform and transparency within the medical community. #FrierLevitt #Healthcare #Physicians
Fair Hearings Often Fail to Live Up to Their Name When Hospitals Try to Suspend Physicians
frierlevitt.com
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