Looking back fourteen years ago, Y2K was all a buzz and everyone, especially the IT department, was busy waiting for the impact of Y2K to reveal itself. The ball dropped in 2000 and nothing happened. No planes fell out of the sky, computers did not crash. All of the preparation and expenditure for naught, or was it? What did we learn from the Y2K experience? Even though the impact was negligible, preparation was the key. We know that had something occurred, some were not prepared and many were well prepared.
Let’s fast-forward to 2014. ICD-10 is this years’ Y2K. Rest assured, ICD-10 will have a profound effect on providers; in fact, it is the largest modification ever to hit the healthcare arena. Providers who delay or ignore their implementation process will suffer a negative financial impact whereas those who work to prepare should be able to steer themselves through the issues...
When it comes to Medicare payments to physicians, plus ça change, plus c’est la même chose. Last week Congress adopted the 17th “patch” to prevent the huge cut mandated by the Sustainable Growth Rate (SGR) formula from going into effect for another year. The legislation also kept in place the antiquated ICD-9 coding system until at least October 1, 2015.
Larger sectors of the healthcare economy are evolving in interesting directions, however. Shrinking revenues from traditional sources as well as increasing awareness of where the quality/cost relationship, i.e., “value,” can be improved are driving changes that anesthesiologists and others should keep in mind as they seek new roles and opportunities.
Hospitals and health systems are expanding their activities into areas beyond the traditional furnishing of acute care services. Two of these new areas are post-acute care (PAC) and the payer function. The specific roles for anesthesiology groups in connection with...
More than one-third of the total cost of a hip or knee replacement can be attributable to the cost of the implantable device used in the procedure. In some cases, the device may account for up to 87 percent of the cost, according to a recent Health Affairs article that has attracted a good deal of attention (Okike K., O’Toole RV, Pollak AN, Bishop JA, McAndrew CM, Mehta S, Cross WW, Garrigues GE, Harris MB, Lebrun CT. Survey Finds Few Orthopedic Surgeons Know the Costs of the Devices They Implant. Health Aff (Millwood). 2014; 33(1):103-109. DOI: 10.1377/hlthaff.2013.0453).
The variation in price of functionally equivalent devices is just as impressive. The average per-case cost of the implant alone ranged from $1,797 to $12,093 for total knee replacement procedures and from $2,392 to $12,651 for total hip replacement procedures in a 2012 study based on 2008 data published in the Journal of Bone and...
The Affordable Care Act, which last week was the object of a fiftieth attempt at repeal in Congress, is moving the healthcare system toward greater integration of providers. Classic antitrust law, however, aims to increase competition and the number of competitors. The conflict between the two values finds it most recent expression in the January 24, 2014 decision in the St. Luke’s antitrust litigation in Boise.
The U.S. District Court for the District of Idaho ruled that St. Luke’s Health System, Ltd. must unwind its acquisition of the 40-physician multispecialty Saltzer Medical Group, after finding that the deal violated federal and state antitrust laws—despite its determination that the integration of the physicians with the hospital system was intended primarily to improve patient outcomes.
The Federal Trade Commission (FTC) and the Idaho Attorney General filed their joint complaint in March 2013, alleging that St. Luke’s acquisition of Saltzer was in violation of...
Have you checked how your information appears on Medicare’s Physician Compare website? Is it accurate?
What Is Posted on Physician Compare—From Physician Demographics to Quality Measures
Mandated by the Patient Protection and Affordable Care Act, launched in 2010 and redesigned in 2013, the Physician Compare website is intended to serve a two-fold purpose:
To provide information for consumers to encourage informed healthcare decisions; and
To create explicit incentives for physicians to maximize performance.
(http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/physician-compare-initiative/Physician-Compare-Overview.html.) The website provides the public with the following information for all physicians, nurse anesthetists, anesthesiologist assistants and certain other healthcare professionals:
Names, gender, addresses, and phone numbers;
Physicians’ primary and secondary specialties;
Group practice affiliations;
Medical and clinical training information;
Written/spoken languages other than English;
Hospital affiliations, which link to the hospitals’ profile on Hospital Compare “when possible;”
American Board of Medical Specialties (ABMS) board certification information;
Whether physicians and other healthcare professionals accept Medicare Assignment;
2012...