With the multi-billion-dollar, four-month enroll-a-thon for Florida’s Statewide Medicaid Managed Care program now complete, totals show WellCare Health Plans still on top. The Tampa company’s Staywell plan now has more than 600,000 Florida Medicaid members. That’s 23 percent of the state’s roughly 3.3 million residents with Medicaid coverage, according to calculations by Citigroup Global Markets’ analyst Carl McDonald.
via WellCare, Centene Medicaid Winners | Health News Florida.
How Much Your Doctor Received From Medicare
Use the form below to find a doctor or other medical professional among the more than 800,000 health care providers that received payments in 2012 from Medicare Part B, which covers doctor visits, tests and other treatments. APRIL 9, 2014
via How Much Your Doctor Received From Medicare – NYTimes.com.
Small Slice of Doctors Account for Big Chunk of Medicare Costs
Top 1% of Medical Providers Accounted for 14% of Billing, Federal Data Show
By CHRISTOPHER WEAVER, TOM MCGINTY and LOUISE RADNOFSKY
Updated April 9, 2014 9:17 a.m. ET
A tiny sliver of doctors and other medical providers accounted for an outsize portion of Medicare’s 2012 costs, according to an analysis of federal data that lays out details of physicians’ billings.
The top 1% of 825,000 individual medical providers accounted for 14% of the $77 billion in billing recorded in the data.
The long-awaited data reveal for the first time how individual medical providers treat America’s seniors—and, in some cases, may enrich themselves in the process. Still, there are gaps in the records released by the U.S. about physicians’ practice patterns, and doctors’ groups said the release of such data leaves innocent physicians open to unfair criticism.
Medicare paid 344 physicians and other health providers more than $3 million each in 2012. Collectively, the 1,000 highest-paid Medicare doctors received $3.05 billion in payments.
One-third of those top-earning providers are ophthalmologists, and one in 10 are radiation oncologists. Both specialties were singled out in a late 2013 report by the inspector general for the Department of Health and Human Services urging greater scrutiny of doctors who consistently receive large Medicare payments.
via Small Slice of Doctors Account for Big Chunk of Medicare Costs – WSJ.com.
A Quiet ‘Sea Change’ in Medicare
For years we have advised clients to appeal decisions that deny rehabilitation at nursing homes for those patients that have plateaued. This recent New York Times article covers last years CMS settlement over the wrongful termination of services due to a patients skill plateauing.
CNN is reporting that with Medicare reforms Doctors are going broke. As a counter point, accountable care organizations start this month, Doctors may seek shelter in these practices. ACO may offer more compensation to those providers if they can keep patients from needing expensive care. This is part of great effort to rewrite our social contract of care. If all the doctors roll into ACOs and this approach fails then we will start to head in a single provider system. We will need to keep an eye on this.
Health Care Reform has been attempted by seven presidents. Obama’s administration with the Affordable Care Act, has put forth meaningful change. Even it’s detractors will state that it is legislation that is significant and can’t be ignored. There is strong argument that this is a mixed public policy debate on how to spend limited resources and survive in the political arena.
Whoever provides medical care or pays the costs of illness stands to gain the good will of the sick and their families. The prospect of these good-will returns to investment in health care creates a powerful motive for governments to intervene in the economics of medicine. Political leaders since Bismarck . . . have used insurance against the costs of sickness as a means of turning benevolence to power. Similarly, employers often furnish medical care to recruit new workers and instill loyalty to the firm. Unions have used the same means to strengthen solidarity. To be the intermediary in the costs of sickness is a strategic role that confers social and political as well as strictly economic gains. Paul Starr, The Social Transformation of Medicine
The quote above is a bit stale in today’s marketplace of medicine. Health Care services will always follow the streams of payment from whatever sources are available. With state governments unable to afford federal matching funds for entitlement programs the infrastructure of our community’s health care structure is truly at risk.
As the true cost of this health care infrastructure becomes more of a local government issue, limited funding may cause consolidation at the Hospital Level. Special Taxing Districts may increase to fund Hospitals. As the debate becomes more local a closer look a medical outcomes and cost of care will be fought at our doorsteps. We need to be watchful of this issue.
What a powerful speaker. Ira Magaziner is one of the smartest policy wonks on health care. Worth the time to get the gems of his knowledge.
The Wall Street Journal, today, states on its editorial page the definite and imperative need for Medicare reform in one sentence. “The brutal math is that Medicare spending has been growing about three percentage points faster every year than the overall economy for the last quarter-century and is now the main driver of the financial crisis.” Legislative leadership is shifting to a stipend approach. This may cap the Federal Government’s financial exposure. With a stipend one often finds not enough payment to cover the choice you prefer.
How will Health Care marketplace respond to this change of focus? How will consumer directed care be better served?
These questions and many others will reframe the debate about health care entitlements. It is probably time to reframe the debate, the boomers are not their parents elders. Choices and alternatives to traditional long term care approaches are desired by the boomers. Life style and personal preferences are key to the boomers making these choices. As the role of the patient changes into a health care consumer the market place and pricing for care will respond. The Boomer who desires to create a supportive care environment that does not financial exhaust may find satisfaction with the flexibility that a market driven choice could provide.
Keep you eyes on the ball, the politics of Medicare is an interesting game.