News & Information
Insurers Push Back Against Growing Cost of Cancer Tx
Written by Editor   
Thursday, June 19, 2014 06:31 AM

As the cost of medication rises insurers are "pushing back" creating reimbursement programs that attempt to reimburse based upon what the insurance company believes should have been paid if a physician remained independent instead of working in a hospital.  Patient groups express concern that standardized drug regimens and flat payments may encourage providers "to make treatment decisions based on cost and less on the evidence,"  while the drug industry fears a loss of innovation that could lead to the development of new drugs.  This article focuses upon what has become the center point of healthcare in our current times – money.

Some cancer patients and their insurers are seeing their bills for chemotherapy jump sharply, reflecting increased drug prices and hospitals' push to buy oncologists' practices and then bill at higher rates.  

Like other insurers, Highmark found that when hospital systems bought doctors' practices, chemotherapy costs rose because physicians' offices were then deemed "hospital outpatient centers" and could charge more for overhead.  A 2013 study documented chemotherapy costs in hospital outpatient settings ran as much as 53% higher than in doctors' offices.

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Patients Struggle with Health Insurance
Written by Editor   
Thursday, June 19, 2014 12:00 AM

Insurance is often perplexing even to savvy consumers. Patients have been confused about health insurance for a long time. The new health law "just adds another layer on top of that."  Acronyms abound: HMOs, PPOs, ACOs. Letters arrive in the mail saying "this is not a bill" yet appear to be just that. Some detail exorbitant prices that have nothing to do with what is actually owed.  Language and cultural barriers add to the confusion.  It's a big problem. About one in 10 people in the U.S. have a proficient level of health literacy, according to an assessment by the U.S. Department of Education -- that is, they could understand and use health-related information in daily activities.  More than 40 percent of Americans couldn't explain a deductible -- the amount patients owe for health services before insurance kicks in. The authors found that those likely to benefit most from the health law -- uninsured and low-income Americans -- had the least awareness.

Health officials have spent much of the past year promoting the Affordable Care Act and enrolling people in coverage. Now they need to help consumers understand the basics of health insurance and how to use their policies, healthcare providers and researchers say.

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Insuring High Drug Prices
Written by Editor   
Thursday, June 19, 2014 12:00 AM

In the U.S., rising prescription drug prices are the law.  The FDA approves drugs on the basis of efficacy and safety, but is not allowed -- by law -- to consider price, which in any case is not usually set until after the regulatory OK.

On the other hand, once a drug is approved the Centers for Medicare and Medicaid Services (CMS) must cover it, but is not allowed to negotiate lower prices.  "That's very strange.  Where else in a free market society do you see the largest customer unable to negotiate for a better price?"

Those two factors combine to skew the market so that prices rise inexorably.

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MedPAC Wants Congress to Extend Bonus Pay to Primary Care
Written by Editor   
Wednesday, June 18, 2014 12:00 AM

The Medicare Payment Advisory Commission (MedPAC) wants Congress to continue bonus payments to primary care physicians, now set to expire in 2015.  

MedPAC recommends changing the current 10% bonus payment for primary care services now paid as an add-on to claims into a per beneficiary payment that could be paid monthly or annually.

"The current fee for service (FFS) approach encourages volume. A per beneficiary approach could help encourage care coordination," the report said.  Because Medicare undervalues primary care services, average compensation for specialists can be more than double what primary care practitioners earn.

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AMA Policies Adopted
Written by Editor   
Wednesday, June 18, 2014 12:00 AM

At the AMA 2014 Annual Meeting delegate approved two new policies.  One would support telemedicine provided it is covered by medical liability insurance.  The other strongly objects allowing new physicians who have not be "matched" to a residency program to practice as an assistant to another physician.  Their concern was that it would "counter the efforts being made to curtail the expansion of the scope of practice of non physicians."

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