" The Voice Of Interventional Pain Management "

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April 3, 2013


  1. Medicare Advantage Insurers Win Round
  2. CMS Changes Course, Will Raise 2014 Medicare Advantage Payments
  3. Image Sharing Seeks to Reduce Repeat Scans
  4. NCCI Edits 2nd Quarter Edits Available
  5. Sequestration: Medicare 2% Physician Payment Cuts Due Monday
  6. Justice Department Files Motion to Dismiss Antitrust Lawsuit Against Blue Cross Blue Shield of Michigan After Michigan Passes Law to Prohibit Health Insurers from Using Most Favored Nation Clauses in Provider Contracts
  7. Implementation of the Affordable Care Act--More Evidence That Rate Shock is Coming
  8. California Board of Regents Agrees to Pay $1.2 Million to Resolve Claims of Improper Supervision of Anesthesia Services at University of California-Irvine
  9. Healthcare Reform Law Creates 111M Hours of Paperwork: Study
  10. NYC Doctor Charged in $10M Oxycodone-Trafficking Ring
  11. White House Warns Cutting Medicare will Shift Costs
  12. Corporate Intelligence Blog: America's Doctors Feel the Heat
  13. Legislation Would Ramp Residency Slots
  14. Health Insurers Warn on Premiums
roundMedicare Advantage Insurers Win Round


Health insurers stand to get significantly more money for running Medicare Advantage plans next year than they had feared, according to new government rates announced late Monday.


The final announcement appeared to significantly improve on a mid-February proposal that featured unexpectedly sharp cuts and prompted a busy lobbying effort from health insurers. Companies that sell the plans, such as Humana Inc., HUM +5.45% warned that cutting funding too much would hurt benefits for seniors while driving plans out of some markets.



Wall Street journal

CMSCMS Changes Course, Will Raise 2014 Medicare Advantage Payments


WASHINGTON - Under a withering barrage of pressure from the insurance industry, seniors groups and Congressional members from both sides of the aisle, CMS on Monday did an about face and significantly raised its 2014 growth percentage estimate for the Medicare Advantage program.


Significantly, CMS now expects a growth rate of 3.3 percent in 2014, a rate it had initially estimated in mid-February would decrease by 2.2 percent. The revision means that the private companies running the Medicare Advantage plans won't absorb an estimated total reduction of nearly 8 percent in payments in 2014 - reductions that many feared would be disruptive to the program.



Healthcare Finance News

imageImage Sharing Seeks to Reduce Repeat Scans


When 5-year-old Piper Gibson was hospitalized in Oklahoma City last summer with frightening strokelike symptoms, her father, Chris, got a same-day second opinion on her brain scan from another neurologist-in Boston.


Mr. Gibson was able to get the second opinion with unusual efficiency by taking advantage of a secure electronic network that can transfer medical images in minutes. It is one of a growing number of image-exchange services that eliminate many of the hassles patients encounter in transferring CT-scans, MRIs, X-rays and ultrasounds whenever they seek a second opinion, consult a specialist or start seeing a new doctor.


Wall Street Journal

ncciNCCI Edits 2nd Quarter Edits Available

Effective from 4/1/2013 to 6/60/2013 . These new edits have been effective since April 1, 2013 and will be effective through June 30, 2013.

For detailed analysis of NCCI for most commonly used interventional techniques, please follow link

sequestSequestration: Medicare 2% Physician Payment Cuts Due Monday


Sequestration will set into full effect on Monday, cutting Medicare payments by 2 percent, according to a Medscape report.

Congress failed to roll back sequestration across-the-board spending cuts that would have extended government funding through Sept. 30, and has been unable to compromise on a 2014 budget plan. The amount patients are responsible for paying to physicians is not impacted by sequestration.

According to the report, the payment reduction will likely remain intact, as lawmakers are on spring break.


Becker's ASC Review

justiceJustice Department Files Motion to Dismiss Antitrust Lawsuit Against Blue Cross Blue Shield of Michigan After Michigan Passes Law to Prohibit Health Insurers from Using Most Favored Nation Clauses in Provider Contracts


The Department of Justice today filed a motion to dismiss its antitrust lawsuit against Blue Cross Blue Shield of Michigan (BCBSM) after the state of Michigan passed a law that prohibits health insurers from using most favored nation clauses (MFN) in contracts with health care providers. In its lawsuit, the department challenged BCBSM's use of MFNs, alleging that its agreements with hospitals raised hospital prices charged to other insurers, prevented insurers from entering local markets and discouraged discounts. The department said the combination of the new law and a previous order by the Michigan Insurance Commissioner that prohibits MFN clauses in health insurer's provider contracts provides the relief the department sought in its lawsuit against BCBSM, rendering further proceedings unnecessary.


US Justice Department

implementationImplementation of the Affordable Care Act--More Evidence That Rate Shock is Coming

The Society of Actuaries is out with another estimate of health insurance rate increases as a result of implementation of the Affordable Care Act ("Obamacare").

While there is a great deal of difference between states, they are estimating an average increase of 31.5% on account of the new underwriting reform and benefit expansion requirements of the health law.


Health and Market Blog spot

californiaCalifornia Board of Regents Agrees to Pay $1.2 Million to Resolve Claims of Improper Supervision of Anesthesia Services at University of California-Irvine


LOS ANGELES, March 27, 2013 /PRNewswire/ -- A federal qui tam whistle-blower lawsuit filed in 2008 by former University of California-Irvine (UCI) Professor and Anesthesiologist Dr. Dennis O'Connor triggered a multi-year investigation by the United States Department of Justice, resulting in an agreement by the California Board of Regents to pay the United States $1.2 Million.


The False Claims Act lawsuit alleged that anesthesia was routinely administered at UCI by Certified Registered Nurse Anesthetists (CRNAs) or residents when there was no supervisory anesthesiologist present or immediately available, in violation of federal regulations. The complaint alleged that, in many instances, the supervisory anesthesiologist would be in a completely different building at the time, and that anesthesia records would be "pre-filled" to make it appear that the anesthesiologist was present. The complaint also alleged that required post-operative evaluations would routinely be performed by unsupervised and/or unlicensed residents, in violation of federal regulations, increasing the likelihood that post-operative complications would be missed.


PR Newswire

reformHealthcare Reform Law Creates 111M Hours of Paperwork: Study


The Patient Protection and Affordable Care Act has imposed approximately 111.4 million hours of paperwork, according to a new study from American Action Forum, a conservative think tank.

Based on that finding, the AAF said it would take 55,742 employees working 2,000 hours in a year to complete the red tape required in the PPACA. Some of the most time-consuming provisions of the law, according to the AAF, are:

* Final inpatient prospective payment - 6.84 million hours
* Final outpatient prospective payment - 1.01 million hours
* Final billing for skilled nursing facilities - 0.91 million hours


The law has also imposed approximately $30.8 billion in costs, according to the study. Some of the most costly provisions of the law, according to the AAF, are:

* Proposed menu labeling - $757.1 million
* Final shared savings program - $451 million
* Proposed vending machine labeling - $423.1 million


Becker's ASC Review


nycNYC Doctor Charged in $10M Oxycodone-Trafficking Ring


NEW YORK - A New York City doctor was charged with running an interstate smuggling ring that trafficked $10 million worth of oxycodone across several states, including Pennsylvania, where the investigation resulted in the largest prescription drug-related mass arrest in the state's history, authorities said Thursday.


Authorities said 49 people were arrested Tuesday, including the leaders of two major drug trafficking networks in Pennsylvania, after an undercover 15-month investigation conducted by the city's special narcotics unit.

Dr. Hector Castro, who ran the Itzamna Medical Center in Manhattan, pleaded not guilty to 39 counts of criminal sale of a prescription for a controlled substance in Manhattan's state Supreme Court.


Fox News

whiteWhite House Warns Cutting Medicare will Shift Costs


WASHINGTON - If Congress addresses the nation's budget deficit by cutting Medicare, that will simply shift health care costs to the private sector and not address the underlying issues, Obama administration officials said Tuesday at a White House briefing.


"If you only focus on Medicare, you shift the costs," Health and Human Services Secretary Kathleen Sebelius said, adding that Medicare and Medicaid are not the reason health costs are going up. Costs in these programs are increasing at a slower pace than private-sector health care costs, she said. "You don't do anything about the trajectory the U.S. is on ... unless you concentrate on the underlying costs."



USA Today

blogCorporate Intelligence Blog: America's Doctors Feel the Heat


Steven Brill's cover story on the Looking Glass world of healthcare pricing may be the longest article Time Magazine has ever published, but more importantly, it is a fresh sign that the medical-industrial complex should be worried as the deadline for launching Obamacare rolls closer.


Mr. Brill is far from the first journalist to scrutinize why one tablet of Tylenol costs $1.50 when dispensed at a hospital. To cite just a few examples: Consumer Reports magazine last year ran a piece headlined: "That CT scan costs how much? Health Care prices are all over the map, even within your plan's network."



Wall Street Journal

rampLegislation Would Ramp Residency Slots


A new bill introduced March 14 by U.S. Representatives Allyson Schwartz (D-Pa.) and Aaron Schock (R-Ill.) would address the nation's physician shortage by creating 15,000 new Graduate Medical Education (GME) slots over five years.


"The United States is on the cusp of a crisis in access to both specialty and primary care physicians. We have an urgent need to take action to ensure Americans have access to quality, well trained doctors," said Schwartz in a statement announcing the Training Tomorrow's Doctors Today Act.


"While there will be more than 74 million American seniors in need of healthcare services within 20 years, experts estimate that 130,000 new physicians will be necessary to eliminate the workforce shortage by 2025. This bipartisan legislation is critical," she explained.



Phys Biz Tech

warnHealth Insurers Warn on Premiums


Health insurers are privately warning brokers that premiums for many individuals and small businesses could increase sharply next year because of the health-care overhaul law, with the nation's biggest firm projecting that rates could more than double for some consumers buying their own plans.


The projections, made in sessions with brokers and agents, provide some of the most concrete evidence yet of how much insurance companies might increase prices when major provisions of the law kick in next year-a subject of rigorous debate.


The projected increases are at odds with what the Obama Administration says consumers should be expecting overall in terms of cost. The Department of Health and Human Services says that the law will "make health-care coverage more affordable and accessible," pointing to a 2009 analysis by the Congressional Budget Office that says average individual premiums, on an apples-to-apples basis, would be lower.


Wall Street Journal




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