News & Information
Medicare Websites Get a Scathing Review
Written by Editor   
Wednesday, November 26, 2014 04:36 PM

The Department of Health and Human Services (HHS) is failing to meet its goal of making healthcare costs more transparent, according to a federal audit.  Five websites meant to help inform Medicare patients about treatments and providers have “critical weaknesses” that make it nearly impossible to calculate out-of-pocket costs, let alone compare quality, the nonpartisan Government Accountability Office (GAO) has found.

The websites, which are run by the Centers for Medicaid and Medicare (CMS), allow users to compare physicians, hospitals, nursing homes, dialysis providers and home healthcare.  But because of data gaps, poor design and unclear language, the GAO has found it too difficult for users to find the best prices or quality.

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Burnout an Escalating Crisis for Neurologists
Written by Editor   
Tuesday, November 18, 2014 02:24 PM

Burnout is a "neurologic crisis," experts say, with the prevalence of burnout currently exceeding 50% among neurologists, higher than among other specialist groups.  But many neurologists suffer burnout during their career and may not even realize it.  

Burnout "impacts career satisfaction, but more importantly it has a deleterious impact on patient care."  Further, burned-out physicians "lack empathy and make errors." Burnout has been linked to higher rates of depression and suicidal thoughts and behaviors.  Hallmarks of physician burnout are loss of interest and enthusiasm for work (emotional exhaustion), feelings of cynicism (depersonalization), and a diminished sense of personal accomplishment (career dissatisfaction).

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Not All CPR Is Equal
Written by Editor   
Tuesday, November 18, 2014 01:56 PM

The effectiveness of performing cardiopulmonary resuscitation (CPR) in cardiac arrest cases may have influenced the outcomes in one clinical trial, researchers suggested.  Only about 40% of patients in the trial who performed CPR were guideline compliant in delivering proper compression rate, compression depth and compression fraction.  Research suggested that while performing chest compression at a rate of 80 to 120 compressions a minute was within guidelines, the failure to compress to a depth of more than 4-6 centimeters would make the number of compressions performed moot.  Similarly, if the compression fraction was less than 50% it would negate the compression rate and compression depth. All three factors had to be within guidelines in order to have quality CPR.

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Supreme Court to Hear Case on ACA Subsidies
Written by Editor   
Saturday, November 08, 2014 10:55 AM

The Supreme Court announced Friday that it will consider a controversial case involving subsidies paid to people participating in federally run health exchanges under the Affordable Care Act.

The case, known as King v. Burwell, is similar to a more well-known case called Halbig v. Burwell. In both cases, the plaintiffs argue that the subsidies being issued in the federally run exchanges to help people pay their insurance premiums are illegal because of the wording allowing for the subsidies in the ACA.

Section 36B of the law says that "The 'premium assistance amount' is based on the cost of a 'qualified health plan ... enrolled in through an Exchange established by the State under [section] 1311 of the [ACA].'"

It is the mention of only state-established exchanges -- and similar wording in other parts of the provision -- that is at issue. The plaintiffs contend that the wording means that only consumers who purchase insurance in state-run exchanges are eligible for subsidies, which would leave out consumers in the 34 states that have defaulted to the federally run exchange.

The defendant -- the federal government -- says it's clear from the general context of the law, as well as wording in yet other parts of it, that the ACA's intent was to make consumers in federal as well as state-run exchanges eligible for the subsidies.

A lot of money is at stake in the decision. Subsidies paid on the federal exchanges amount to about $10 to $12 billion per year.

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More Scrutiny Coming
Written by Editor   
Thursday, November 06, 2014 10:20 AM

Federal officials are planning a wide range of audits into billing and government spending on managed health care in the new fiscal year, ranging from private Medicare Advantage groups that treat millions of elderly to health plans rapidly expanding under the Affordable Care Act.

“Prior OIG reviews have shown that medical record documentation does not always support the diagnoses” (used to bill Medicare),” the Inspector General said. “Efforts for FY 2015 and beyond may include additional work examining the soundness of rates and risk and payment adjustments,” the Inspector General said.  Federal officials concede that billions of tax dollars are misspent every year because some Medicare health plans exaggerate how sick their patients are, a practice known as “upcoding.” At least six whistleblower lawsuits alleging that Medicare health plans inflated risk scores to overbill the government are pending in federal courts.

The Inspector General is continuing to pursue allegations of billing fraud and abuse by doctors, hospitals and medical suppliers, such as ambulance companies and sellers of diagnostic gear. But it appears to be placing more emphasis on managed care than in the past.

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