Medicare Compliance & Reimbursement

Plus: Quality guidelines paid off for chronic patients.

The right time to start slashing Medicare spending was "ten years ago," Federal Reserve Chairman Ben Bernanke told Congress recently.

But unless Congress starts playing catch-up and fixing the program, the cuts will have to be "more severe" and "more draconian."

Demographic wave: The 78 million baby boomers will drive Medicare costs through the roof, Bernanke warned. In the process, "the U.S. economy could be seriously weakened," he added.

Spending on Medicare, plus Social Security and Medicaid, will skyrocket during the next decade, doubling the programs' share of the gross domestic product by 2030.

Bernanke didn't offer specific suggestions, just dire alarms.

You Could See A Reimbursement Boost--But Also More Quality Guidelines

Researchers from the RAND Corp. and UCLA found better outpatient care improved health outcomes for non-elderly patients. Patients whose care followed treatment guidelines were likelier to maintain health and had better quality of life, according to the study, published in the February Health Affairs.

Researchers studied 963 adults from three states who had suffered from heart disease, asthma, emphysema or diabetes.

They evaluated the care the patients received over a 30-month period based on 120 measures of medical care they took from previous studies and panels of medical experts.

All of the patients declined in health. Patients who received better quality care experienced the smallest decline in health, delaying some of the effects of aging, researchers said. In particular, patients who received better quality care were better able to perform activities involving exertion.

Solo Practices Fall Short When Treating Heart-Attack Patients

When it comes to preventing future problems and treating chronic ailments, individual practice associations lag behind integrated medical groups, a new study says.

The close collaboration and centralized decision making in integrated medical groups may be behind the better quality of care, according to the study, "Do Integrated Medical Groups Provide Higher-Quality Medical Care than Individual Practice Associations?" The study appeared in the Annals of Internal Medicine.

In a related Health Affairs article, researchers say that heart attack patients don't fare as well when receiving treatment from a solo physician practice as opposed to a larger practice.

Studying more than 116,000 patients' records, researchers from Arizona State University discovered that heart-attack patients receiving treatment from attending solo practitioners were less likely to have cardiac catheterization and angioplasty within 24 hours of a hospital admission and more likely to die than other patients in the same hospital, the article says.

One-day angioplasty rates for larger physician practice's patients were 10 to 26 percent higher and one-day catheterization rates were 10 to 12 percent higher than patients attended by physicians from solo practices, the researchers reveal.

Resource: To view an abstract of this article, go to http://content.healthaffairs.org/cgi/content/abstract/26/1/195.

In Other News:

· The Centers for Medicare & Medicaid Services awarded a contract for its electronic data center (EDC) for claims processing to Companion Data Services, a subsidiary of Blue Cross Blue Shield of South Carolina, and Electronic Data Systems.