April 11, 2014 |
Among the weapons to treat the "wet" form of macular degeneration in 2012 were two potent drugs that are injected into the eye. Studies have found the two to be equally effective, yet Medicare pays doctors less than $50 to administer one and about $320 to inject the other. Which do you think doctors used more often? The costlier one, by far. Local ophthalmologists say that money isn't a factor in their decisions and that there are medical reasons to use the more expensive Lucentis for some patients.
April 6, 2014 |
Crozer-Keystone Health System and Cigna-HealthSpring are in a dispute over a Medicare Advantage contract that expires April 30. It's not unusual for negotiations between hospitals and health insurers to go down to the wire, but in this case, Crozer, Delaware County's biggest health system, insists HealthSpring, a unit of Cigna, has ended the Crozer contract. "Cigna-HealthSpring terminated our participation when we did not agree to their demand that we accept rates below Medicare rates and significantly below our cost to provide care to their members," Crozer said.
March 11, 2014 |
NORRISTOWN Montgomery County on Thursday sold the Parkhouse nursing-home complex - which officials said was eating up millions of taxpayer dollars annually - to a private operator. Mid-Atlantic Health Care, a Maryland company, bought the 227-acre Royersford facility for $41 million. Under the agreement, some of the county-owned land in the vicinity will be preserved as open space. The transaction was effective as soon as officials for both sides signed papers during a two-hour break in the county commissioners' meeting.
March 5, 2014 |
Frustrated by a large number of small, fraudulent competitors, two of the largest Philadelphia-area ambulance operators recently joined forces. "The last couple of years have been really difficult for both companies. It's a very tough market," said Steve Barr, president and chief executive of Keystone Quality Transport Co., which has taken over the management of rival EMStar L.L.C. Company officials described the deal - which took effect Feb. 9, shortly after federal regulators launched an intensified crackdown on ambulance fraud in the Philadelphia region - as an alliance rather than a merger of the two privately owned medical transportation companies.
March 3, 2014 |
Citing a "significant potential for fraud, waste, and abuse," federal Medicare officials put a moratorium on the enrollment of new ambulance operators in Philadelphia and six surrounding counties. The Philadelphia moratorium, which took effect Jan. 31, is just the second time officials at the Centers for Medicare and Medicaid Services have exercised this new power under the Affordable Care Act. It is intended to root out fraud. A similar moratorium, which blocks new ambulance companies from getting paid by Medicare and Medicaid, was ordered in Houston last summer and has been extended for six months, authorities said.
January 26, 2014 |
Year after year, the same area hospitals perform the most hip and knee replacements - a good indicator if you subscribe to the surgeon's credo that practice makes perfect. Yet new Medicare data suggest that some of those same high-volume hospitals, which generally have good reputations, also have the highest rates of readmissions and complications. Are these popular facilities not the best places to go for joint-replacement surgery? Officials at the hospitals warn that the reality behind the data, released for the first time in December, is complicated.
January 15, 2014 |
THERE'S A SPECIAL place in hell for the people whose bureaucratic BS put Meredith Gill in the middle of busy John F. Kennedy Boulevard in a broken wheelchair. Gill, a quadriplegic, was crossing the boulevard earlier this month when her motorized wheelchair suddenly stopped. Luckily she had the green light, so she was able to lurch it back to life long enough to get to the sidewalk. By the time she got to her job at Hahnemann University Hospital, with her chair jolting to a stop every few feet, Gill was in tears.
December 22, 2013
Coach's impact spans decades I cannot imagine what swimming coach Dick Shoulberg possibly could have done to deserve such disrespectful treatment after his long and successful career at Germantown Academy ("GA swim coach to return, but only in limited role," Dec. 17). Maybe he fostered too much happiness by enabling hundreds of swimmers to confidently access their full potential. Perhaps the life lessons learned in the pool inspired too many of his swimmers to become teachers, doctors, lawyers, leaders, coaches, and outstanding citizens.
November 6, 2013
DURING A recent workshop with seniors at my church, a debate broke out concerning Medicare Part D. That's the program that helps pay for prescription drugs. Medicare offers the coverage to all enrollees, and if you elect to get the coverage, you pay a monthly premium. If you do not sign up for Part D when you're first eligible for Medicare Part A and/or Part B, and you didn't have prescription-drug coverage that met Medicare's minimum standard, you may have to pay a late-enrollment penalty if you eventually decide to join the plan.
November 1, 2013
WITH SO much fuss and frustration over the open enrollment for the health-care marketplaces, some people might be missing important information about another open-enrollment season. Open enrollment for the exchanges is overlapping and overshadowing the importance of the Medicare open-enrollment period, which started Oct. 15 and ends Dec. 7. It is during this period that those covered by Medicare can change their health plan and prescription-drug coverage for 2014. Although the Medicare open-enrollment process runs smoothly, it is still a complicated system with its alphabet plans - Part A is hospital insurance, Part B is medical insurance, Part C is Medicare Advantage (offered by private companies approved by Medicare such as an HMO)