Medicare Compliance & Reimbursement

1.  CMS patted itself on the back for slowing down spending on physician services. The country spent $421.2 billion on doctor services in 2005, 7.0 percent more than in 2004.
 
Medicare physician spending still grew a whopping 9.5 percent in 2005, compared to an even faster 10.4-percent growth rate in 2004. Medicaid spending slowed down more, thanks to "cost-containment efforts," including payment freezes and cuts.

In general, U.S. health care spending grew 6.9 percent, compared to 7.2 percent in 2004 and 8.1 percent in 2003, according to a CMS report published in Health Affairs. This is the slowest growth rate since 1999, but total spending reached nearly $2 trillion.

2.  Miami Beach physician Clark Mitchell, already in prison for defrauding Medicaid, pleaded guilty to a health care fraud that cheated investors out of almost $1 billion, the Miami Herald reports.

Mitchell and other doctors promised investors in a viatical scheme that patients with AIDS had a short life-expectancy so those investors would buy out those patients' life-insurance policies. Mitchell also pleaded guilty to defrauding Medicare by submitting false claims for treating AIDS patients. 

3.   Now's your chance to sound off on your carrier's or Medicare Administrative Contractor's performance. CMS is mailing out surveys for this year's Annual Medicare Contractor Provider Satisfaction Survey. If you receive a form, make sure to send it back with your feedback. More details are at www.cms.hhs.gov/MCPSS.

4.   Pay-for-performance (P4P) programs now affect 20.2 percent of doctors, up from 17.6 percent in 2000-2001. But a whopping 70 percent of doctors receive financial rewards for productivity, according to an "issue brief" from the Center for Studying Health System Change.

5.  The law that reversed the 5-percent cut to your Medicare payments for 2007 will cost the government an extra $5 billion from 2007 to 2010, the Congressional Budget Office predicts.

6.   More than 90 percent of primary care physicians (PCPs) believe that doctors should play public roles, according to a new survey.

Two-thirds of PCPs say they are actively involved in political work, community activities or advocacy, researchers revealed in a new Journal of the American Medical Association article, called "Public Roles of U.S. Physicians: Community Participation, Political Involvement, and Collective Advocacy." The study examined physicians' feelings of social responsibility outside their practices.

7.  The number of patients who visit publicly funded community health centers (CHCs) is likely to grow, a new Health Affairs study says. And although CHCs provide care that is "on par" with care quality in other care settings, "gaps in quality exist, particularly for uninsured patients," according to the study, "The Quality of Chronic Disease Care in U.S. Community Health Centers." CHCs treat more than 15 million Americans, including many minority patients.

8.  As mortality rates continue to decline for bariatric surgery, more obese individuals are seeking the surgical procedure as a weight loss solution, AHRQ finds.

Since 1998, bariatric surgeries for patients between 55 and 64 years of age in the United States has increased dramatically from 772 surgeries to 15,086 in 2004, according to AHRQ's new report. AHRQ also found a 726-percent increase in bariatric surgeries among patients aged 18 to 54.

AHRQ believes that these extreme increases in the number of bariatric surgeries that doctors are performing are due to greatly improved mortality outcomes. "The national death rate for patients hospitalized for bariatric surgery declined 78 percent, from 0.9 percent in 1998 to 0.2 percent in 2004," the agency says.

Patients ages 18 to 54 account for 85 percent of bariatric surgeries, and women accounted for 82 percent of the total bariatric surgeries, AHRQ reports.