Want to earn a bonus and avoid paying a penalty in 2015 under the Physician…
Reimbursement Features & News
Walter Eisner • Mon, December 2nd, 2013
Will physicians accept a 30% cut to treat patients enrolled through state health exchanges? About 20 million new patients are expected to be enrolled via exchanges by 2016. But most physicians aren’t aware of the coming changes. Maybe they need to buy a clue.
Physician-owned hospitals that want to keep their “whole hospital” or “rural providers” exceptions to the…
Robin Young • Fri, November 22nd, 2013
“Let me just tell you something. Insurance companies aren’t watching your back, hospitals aren’t watching your back, the government is not watching your back. Guess what: we’re going to take this healthcare mess and we’re going to fix it.” Read more of what Dr. Haar is doing to fix healthcare on the upper east side of New York City. He’s not alone by any means.
The second year of Medicare’s Hospital Value-Based Purchasing Program (HVBP) will not be kind to…
Walter Eisner • Tue, November 19th, 2013
The AMA’s secret payment advisory committee (RUC) has made recommendations to Medicare that could cut payments to hip and knee surgeons. Industry, Wall Street and clinicians are raising the alarm bells. What will it mean? Biomet’s CEO Jeff Binder predicts less access to surgery. Wall Street’s Raj Denhoy isn’t so sure. Here are the details.
John Steinmann, D.O. • Thu, November 7th, 2013
John Steinmann, D.O., says everyone, including himself, has an agenda when it comes to PODs. The recently released OIG study on PODs continues a device industry and media narrative that “Doctors in Business is Bad.” He gets on the record to tell the rest of the OIG report and POD story.
Robin Young • Thu, October 3rd, 2013
Anthem Blue Cross recently issued guidance to physicians to use lumbar artificial discs only in patients with spondylolisthesis and degenerative disc disease—which contradicts FDA safety guidelines. Who’s in charge here? So serious is this issue that Jack Zigler, M.D., author of more than 60 clinical articles, penned an Open Letter to the FDA.
Walter Eisner • Tue, October 1st, 2013
Hip and knee implants are getting cheaper. That’s the finding of a new AdvaMed report. One data guru says that’s true, but the data was “tortured” and overstates its case. The numbers tell the story. Read the details here.
AdvaMed, the medical device industry’s trade association, has announced a new ad campaign to push…
Walter Eisner • Tue, September 24th, 2013
Four major systems run by surgeons have formed the first ortho/spine physician hospital organization (PHO) to catch the wave of value-based reimbursement. They promise employers a one-stop-shop for their employees. Read about PHOs and learn about these ortho leaders.
The American Medical Association/Specialty Society Relative Value Scale Update Committee’s (RUC) meets behind closed doors…
To MRI or not to MRI—that is the question. In a study conducted at Duke…
Walter Eisner • Mon, September 9th, 2013
A Florida judge has ruled that Medicare may disclose its payments to individual physicians. Since the Carter Administration, CMS was prevented by privacy laws from disclosing payments to specific physicians. No more. CMS has to figure out if and how it discloses this sensitive data. Physicians are divided. Here’s what we found.
Medicare pays for hospital stays. Medicare also counts how many patients are readmitted within 30…
Walter Eisner • Mon, August 12th, 2013
An OIG warning, sensational news articles of physicians behaving badly, and recent hospital purchasing decisions are calling into question the viability and future of PODs. Are PODS down for the count? Or will they rise to fight again?
Robin Young • Thu, August 8th, 2013
The New York Times took orthopedic implant manufacturers and surgeons to task last week for allegedly overcharging, price gouging and generally acting selfishly. As we’ve seen with the Times before, their writers are often reluctant to let a few facts get in the way of a good story. We do our best this week to sort fact from fiction and straighten out The New York Times.
Walter Eisner • Mon, August 5th, 2013
Controlling costs is the single biggest challenge to reforming health care. Whose job is it? A group from the Mayo Clinic surveyed thousands of physicians to see what they think about that question. The overwhelming response? “It’s not my job.” Read it here.
Walter Eisner • Fri, July 12th, 2013
Who are the best and worst payers for physicians in America? Are denials going up or down? What can you do? The data knows. Read what athenahealth’s PayerView found out after reviewing millions of claim for 40,000 physicians. Humana takes the top spot.
Medicare’s prospects are looking up. In their 2013 report, Medicare trustees projected…
Private health insurers want to dump fee-for-service payments systems. The only thing holding them back…
Walter Eisner • Thu, May 16th, 2013
As if orthopedic device sale reps don’t have enough to worry about, Wright Medical’s CEO, Robert Palmisano announced on April 30, that the company would now be marketing and selling their orthopedic devices directly to the hospital’s paymasters. Read the details here.
Improving federal government finances may open a brief window to overhaul Medicare’s flawed physician payment…
The nation’s health care piggy bank is looking a little better. Health care spending growth slowed in the U.S. by more than $500 billion between 2003 and 2012. If trends continue for the next decade, current projections of spending may be too high by $770 billion.
On May 8, 2013, the Department of Health and Human Services (HHS) released data showing significant variation across the country and within communities in what hospitals charge for common inpatient services, including orthopedic services.
Robin Young • Fri, May 10th, 2013
Three aspects of CMS’ proposed payment system stand out to us. First orthopedics did ok, not great, but ok. Second the quality police are coming and 25% of all hospitals can expect to be penalized. And finally, the definition of “inpatient” is being tweaked. Oh, oh.
Is the PILD procedure for LSS (percutaneous image-guided lumbar decompression for lumbar spinal stenosis) reasonable…
Walter Eisner • Mon, April 15th, 2013
Physicians, device makers, hospitals and insurers are all spending big bucks in Washington to influence where healthcare dollars are spent in the next federal budget. Money buys influence. Who is spending the most and getting results? We looked at the numbers.
On April 9, 2013, the biggest insurer in the U.S. and a large chain of…
The cumulative benefit to U.S. volume surgical procedures due to Obamacare will increase 3.6% by 2022 and will likely offset the 2.3% medical device tax under the new healthcare law. That’s not the political rhetoric of a partisan political pundit, but the result of a new analysis from one of Wall Street’s top orthopedic analysts, Larry Biegelsen of Wells Fargo Securities. And we don’t think Larry was kidding, even though he announced the new analysis on April 1, 2013.