The Silent Drug Epidemic of Older Addicts The Silent Drug Epidemic of Older Addicts

…shows that people covered by Medicare — the federal health care program for people 65 and older and those with disabilities — have “among the highest… end up in a hospital from a fall or serious alcohol-related health problems. When elderly alcohol addicts are referred to treatment, they often end…

governing.com

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Medical Cannabis Saves $165 Million Annually for Medicare – Culture Magazine – Cannabis Lifestyle and News Magazine Medical Cannabis Saves $165 Million Annually for Medicare – Culture Magazine – Cannabis Lifestyle and News Magazine

…by ireadculture | July 22, 2016 A new study published in the Health Affairs journal looked at Medicare data between 2010-2013 to discover if patients…

ireadculture.com

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CMS uses quality metrics to revamp hospital ratings system CMS uses quality metrics to revamp hospital ratings system

…ready for prime time.” Hospitals are assessed a rating based only on the measures for which they submit data, which includes Medicare beneficiary data… and some data from the general patient population regardless of the payer. “For example, measures on deaths, readmissions and use of medical imaging…

healthdatamanagement.com

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More Minnesotans in Medicare health plans More Minnesotans in Medicare health plans

…A report this month from the Kaiser Family Foundation finds that 55 percent of Minnesotans in Medicare get their benefits through private health… in 2015. Among Medicare health plans that include prescription drug benefits, the weighted average for premiums in Minnesota is $138 per month…

startribune.com

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Revenue Recovery Service — Barnett & Associates, LLC Revenue Recovery Service — Barnett & Associates, LLC

…for their services.  In addition, Commercial health plans and at risk managed care organizations including HMO, Managed Medicare and Medicaid, ACO… claims and payments data files, we help maximize the revenue returned to the appropriate organizations by identifying potential revenue leakage…

barnettandassoc.com

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Big Pharma prescriptions including painkillers, antidepressants plummeting as seniors turn to medical cannabis Big Pharma prescriptions including painkillers, antidepressants plummeting as seniors turn to medical cannabis

…researchers from the University of Georgia and published in the journal Health Affairs. The researchers found that Medicare prescriptions fell for conditions… Medicaid, the federal-state insurance program for low-income people. Preliminary data from that study show an even larger drop in pharmaceutical…

naturalnews.com

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Medicare’s Million Hearts Initiative Aims to Reduce Cardiac Disease Medicare’s Million Hearts Initiative Aims to Reduce Cardiac Disease

…Under a new population health program, CMS will pay providers to reduce the absolute risk for heart disease or stroke among high-risk Medicare… beneficiaries. With the help of 516 inaugural participating healthcare providers nationwide, federal officials are harnessing data to rise to a pair of…

healthleadersmedia.com

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Small New Insurers Making Big Payments to Blues Plans Under ACA Small New Insurers Making Big Payments to Blues Plans Under ACA

…under the Affordable Care Act, a Standard and Poor’s study finds. Data from the Centers for Medicare & Medicaid Services on payments some health insurers….” The CMS released the data June 30 (127 HCDR, 7/1/16). The risk adjustment program is critical to ensuring that health plans are able to cover people…

bna.com

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$1 billion Medicare fraud conspiracy alleged in Miami $1 billion Medicare fraud conspiracy alleged in Miami

…charges stemmed from a data-driven investigation. According to the indictment, Philip Esformes, 47, ran the massive scheme by billing Medicare and Medicaid… sending patients to community mental health centers, home health care providers and other medical facilities who also participated in the conspiracy…

modernhealthcare.com

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Health care moves toward preventative model amid industry shake-ups | BizTimes Media Health care moves toward preventative model amid industry shake-ups | BizTimes Media

…results of a study conducted by the Health Care Cost Institute that analyzed claims data from three of the nation’s largest insurers found medical… data on patients enrolled in United’s Medicare Advantage plans. Wauwatosa-based Children’s Hospital and Health System owns an insurance plan that…

biztimes.com

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Reefer Madness! Medical Marijuana Is Already Saving $165M Per Year For Medicare Reefer Madness! Medical Marijuana Is Already Saving $165M Per Year For Medicare

…This news will give anti-marijuana crusaders fits. A new study in the journal Health Affairs looked in great detail at prescription drug usage in U.S…. states that have legalized medical marijuana. Researchers Ashley Bradford and David Bradford collected Medicare data for the period 2010-2013 to…

infowars.com

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Is Value based healthcare even possible?

As I get ready for @HIMSS 2016, I’ve been thinking a lot about value-based healthcare.  The New England Journal of Medicine defines as value-based healthcare as the ability to improve outcomes per dollar spent.  In theory, this idea means that physicians should be able to devote more time to patients as the doctor’s financial performance is linked to the patient’s outcome (not the number of times the doctor sees the patient).

My hypothesis is that the implementation of value-based healthcare will be tough because providers are used to a system that rewards them on the number of transactions they conduct.   I also believe that the investment into cutting edge health care technology is a function of how much revenue (e.g., transactions) a provider can generate.

To see if I could validate my hypothesis I chose simple X-rays provided Medicare and Medicaid physicians.  I selected a simple x-ray machinexray

(show below).  According to the author this machine new retails for about $200,000.  Given that a provider must invest $200, 000 for the machine and probably another 25% annually for maintenance, the machine has an upfront cost of $250,000 and a yearly cost of $50.000.  The average cost of a radiologist (according to Glassdoor) is another $290,000.  Now I would agree that not all providers would have a radiologist, but for our purposes let’s assume that they do.  If one adds the staff to support the radiology activity, let’s suppose that staff adds another $100.000.  So all in, in the first year the radiology investment is $250k for equipment +$390 for staff.

Now the next step to understanding the impact or possibility of value-based health care is to look at the number of x-rays conducted by CMS practitioners.  I chose the states of TX, FL, SC, and CT as representative states to analyze.  According to my analysis more than 912 x-rays only were conducted in these jurisdictions (see graphic). What this graphic depicts is the total number of x-rays claimed in these four states and the many locations where they were given.

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So the next question I asked was how many beneficiaries were provided x-rays, how much the providers submitted claims for those x-rays, and how much CMS paid on those claims.

posttlywl81

So in these four states alone in the calendar year of 2012 CMS paid more than $1.8m in reimbursements.  Now the tricky question is how many of the facilities within these states have actual x-ray equipment and to what degree of technical status the equipment is.  Based CMS data it is not easy to determine if providers provide enough x-rays to pay for the equipment and staff.  It is possible, however, to determine if a provider were to use simple equipment and read the x-rays them selves then it is possible that most providers requesting more than $10,000 in CMS x-ray reimbursements may have enough transactions to support the use of an x-ray machine.

What is evident from the CMS data (certainly having private insurance data available would help) is that most providers who invest in x-ray machines need to generate volume to pay for the equipment and supporting staff.  If value-based care impacts the number of x-rays, they take how do they support the use and implementation of such conventional diagnostic equipment?

I invite anyone reading this blog to comment and provide alternative ideas.