May 16, 2014 |
Martha Little says her patients are among the sickest of the sick. She is a psychiatrist in name, but at her Cheltenham practice she coordinates care for a wide range of conditions in her older patients, many of whom have dementia and cannot reliably describe what ails them. As a result, she almost always bills Medicare for the most complex level of office visit on a five-point scale - one of several hundred Pennsylvania and New Jersey physicians who do so. "Any move I make is complex," Little said.
May 12, 2014 |
If you're facing retirement with financial anxiety - and who isn't? - chances are you worry about the adequacy of your savings and investments, and perhaps about the reliability of a pension. Both those pillars of American retirement look disturbingly wobbly nowadays. By all rights, you should be much less concerned about the third pillar, Social Security. Surprisingly, that's not what the evidence suggests. Ask a sampling of millennials whether they expect to get Social Security when they retire, and 9 of 10 will say either no or with reduced benefits, according to a recent Pew study of those who came of age in the shadow of 9/11 and the Great Recession.
April 17, 2014
Smoke and glamor If we really wanted smoking cessation, or at least a dramatic reduction, we could achieve it ("Pa. to get back $120M in tobacco ruling," April 11). Jurisdictions that enjoy the revenue from smokers, however, are not about to turn off the spigot. That's why so many well-touted efforts are no more than smoke screens (pun intended). I was a three-pack-a-day smoker. If we are serious about the health effects of smoking, there is only one way: Cut out blatant promotion of smoking in movies and on TV. The all-time classic movie smoking scene remains Sharon Stone in that short white dress, lighting her cigarette and taunting police.
April 17, 2014 |
The Einstein Healthcare Network joined in two civil lawsuits against Medicare administrators alleging that a new rule on what qualifies as an inpatient hospital admission is arbitrary and should be dropped and that a related 0.2 percent cut in Medicare payments to hospitals should be revoked. The rule, adopted in August by the Centers for Medicare and Medicaid Services, says that a patient has to be in the hospital at midnight on two consecutive days for the hospital to receive an inpatient payment rate.
April 11, 2014 |
It doesn't take many customers to build an ambulance business, according to Medicare payment data released Wednesday by federal regulators. For example, Red Cross Ambulance, which is based in Huntingdon Valley and operates two ambulances, state data show, collected $395,601 from Medicare for a dozen patients in 2012. That amounted to an annual average of nearly $33,000 per patient. It's not clear how many trips Red Cross made or whether it provided service to those patients for the full year.
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.