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Weekly News, Analysis, and Commentary

Reimbursement Features & News

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Nine Rules for Physicians When Discussing CMS’s New Data Dump

Source:  Photo creation by RRY Publicaitons LLC and logo courtesy of Department of Health and Human Services
Source: Photo creation by RRY Publicaitons LLC and logo courtesy of Department of Health and Human Services

CMS just released the mother lode of payment and billing data to the public. Now lawyers, payers, bookkeepers and reporters can see what CMS claims surgeons did and how much they were paid. But watch out. Here are 15 essential facts every surgeon should know and prepare for.

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Did Obamacare Fuel Fourth Quarter Knee Sales?

Image provided by RRY Publications, LLC / Photography courtesy: Andrew Huth
Image provided by RRY Publications, LLC / Photography courtesy: Andrew Huth

Knee sales rose almost 7% in the fourth quarter. Wall Street analysts wanted to know why and asked physicians–73% of surveyed docs said patient behavior changed during the quarter; 35% attributed the changes in behavior to the “Pull-Forward” theory resulting from concerns about Obamacare. The device chiefs also weighed in. Read it here.

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Device Tax and Physician Pay: Congress’ Chew Toys

Image created by RRY Publications LLC / Sources: Wikimedia Commons and TheAgency/Morguefile
Image created by RRY Publications LLC / Sources: Wikimedia Commons and TheAgency/Morguefile

The momentum to replace the SGR and repeal the device tax has never been stronger. Lawmakers from both sides have voted over and over for replace and repeal. A new budget delays physician cuts and gives lip service to dumping the tax. Will this year be different? The political calendar and climate say don’t bet on it.

Fearless Predictions for 2014

Image created by RRY Publications, LLC / Source: Wikimedia Commons and Prahhu Namgyel
Image created by RRY Publications, LLC / Source: Wikimedia Commons and Prahhu Namgyel

2014 will be the year of the knee. One of spine’s faster growing young companies will be acquired. Orthopedic equity valuation will grow, but at sharply lower rates than in 2013 (three companies, however, will have a great stock year). Finally, the Medical Device Tax will not be repealed but physician pay will be reformed.

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Medicare’s Smoke Signals

Source: Wikimedia Commons and John Mix Stanley
Source: Wikimedia Commons and John Mix Stanley

Can the U.S. healthcare system do what it does for 40% less than it charges now? There may be a homeless person shuffling around the subways of New York hearing voices who would say “yes.” But Medicare is hoping that administrators, manufacturer executives and physicians could somehow also get to “yes”. And soon.

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Dr. Robert Haar’s Declaration of Independence

Image created by RRY Publications, LLC / Sources: Wikimedia Commons, Currier & Ives and Dr. Robert Haar
Image created by RRY Publications, LLC / Sources: Wikimedia Commons, Currier & Ives and Dr. Robert Haar

“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.

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Looming Medicare Cuts for Hip and Knee Surgeons?

Source: Flickr and taxcredits.net
Source: Flickr and taxcredits.net

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.

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Who’s in Charge of Safety: The FDA or Anthem Blue Cross?

Image crated by RRY Publications, LLC
Image crated by RRY Publications, LLC

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.