Eligible organizations would be granted access to Medicare billing information in order to develop physician report cards that the public can use, according to a newly proposed rule by the Centers for Medicare & Medicaid Services.
What Other Organizations Have Access to This Data?
The health system reform law made it possible for Medicare claims information to be accessed by a limited number of outside organizations that meet specific criteria. These outside organizations would bring Medicare billing information together with private information related to hospitals, doctors and other healthcare professionals, according to CMS Administrator Donald M. Berwick, MD.
Berwick said, “Making more Medicare data available can make it easier for employers and consumers to make smart decisions about their health care.” He also said, “Performance reports that include Medicare data will result in higher-quality and more cost-effective care. And making our health care system more transparent promotes competition and drives costs down.”
Why Do They Need This Information?
Along with the American Medical Association, members of organized medicine are looking over the guidelines. They will offer comments on the subject by August 8, 2011. The American Medical Association backs the use of physician information to create valuable performance reports. However, this is only if specific safeguards are put into place to make sure the information is accurate and valid, according to the American Medical Association President Cecil B. Wilson, MD.
Wilson said, “For example, before reports are made public, physicians must have the opportunity to review their data, and adequate, well-tested risk-adjustment and attribution models must be incorporated during the development of quality performance reports.” He continued, “Currently, we are reviewing this new regulation to determine if CMS has appropriately interpreted the application of these critical safeguards.”
With the newly proposed rule in place, doctors and other professionals in the healthcare industry would be able to look over and make corrections to the information prior to it being released to the public.
Two are pushing to overturn a 32-year-old court injunction barring the government from revealing the amount earned from Medicare by individual physicians.
The information is stored in the database for Medicare claims, which is seen by many as an ideal tool for locating abuse and fraud in the federal health insurance program for disabled and elderly citizens.
Republican Senator Charles Grassley of Iowa along with Democratic Senator Ron Wyden of Oregon recently introduced the Medicare Data Access for Transparency and Accountability Act, also known as the DATA Act. Both senators serve on the Senate Finance Committee, which currently holds jurisdiction over Medicare.
Exposing Abuse of Medicare
Alongside the nonprofit Center for Publix Integrity, the Wall Street Journal was able to obtain limited access to the database in 2010. It published a series of articles exposing doctors and other medical professionals who unethically used Medicare to increase their personal income.
The Journal identified one physical therapist, Aleksandr Kharkover, as having billing patterns that were suspicious. Kharkover was indicted in February 2011 and charged with defrauding Medicare, to which he pleaded not guilty.
The judge responsible for issuing the privacy injunction over three decades ago ruled that the privacy of the doctors was more important than any interest the public may have in the spending of tax dollars. The judge relied on a privacy provision that is included in the Freedom of Information Act.
The new bill will unambiguously exempt data related to doctor Medicare billing from that provision.
In addition, the legislation will also force the Department of Health and Human Services to release the information free of charge. However, the identities of all of the patients will remain confidential.
J.D. Power and Associates 2011 U.S. Member Health Insurance Plan Study was recently conducted. For the past two years in a row, the members of Kaiser Permanente of Georgia have rated the health plan of the organization with the highest level of member satisfaction in the South Atlantic Region, which is made up of Georgia, South Carolina and North Carolina.
Kaiser Permanente of GA Rating System
On a point scale of one to a thousand, Kaiser Permanente of Georgia earned a total of seven hundred forty-seven points, which is forty-seven points higher than the average in the South Atlantic Region. The organization received the highest rank in Information and Communication, Coverage and Benefits, Customer Service and Statements.
The president of Kaiser Permanente of Georgia, Peter Andruszkiewicz said, “We are very pleased that our focus on providing coordinated, high quality health care delivered with exceptional customer service continues to be recognized by our members.” He also said, “It is particularly meaningful to us that the J.D. Power rankings are a measure of member satisfaction relative to all other health plans and insurers.”
The executive medical director for Kaiser Permanente of Georgia, Rob Schreiner, MD said, “Kaiser Permanente’s integrated model puts our members at the center of all that we do.” He added, “It enables us to better coordinate care to maintain their health and also care for them when they are ill.”
The health plan services of Kaiser Permanente of Georgia are complemented by the delivery of health care over the phone, online or in person. With web tools that are simple to use, the members of the organization are able to access valuable information, communication tools and medical records. Registered members are able to go online to take care of several important tasks, such as ordering prescription refills or scheduling appointments. In addition, members also have 24/7 access to eligibility and benefit information, lab results and their children’s immunization records.
Hundreds of small business owners in New York are appealing to the regulators in the state in demand of a rollback of the double-digit hikes in health insurance premiums, which they claim are outright criminal, according to the New York Post.
Fuming small business owners are writing letters to insurance carriers and the New York State Insurance Department in which they are asking Albany to do something to reduce these horrendous small business insurance premium hikes with a new law that gives the agency a wider oversight of the cost of insurance premiums.
One employer wrote to Independent Health stating, “I recently received a notification by mail that you have submitted a proposed rate increase on our health insurance of more than 37%. Are you kidding me?” He also wrote, “If this new rate prevails, we will not be able to afford our health insurance and will be forced to drop coverage… We have a very high deductible plan! This type of rate is criminal — since there isn’t really any other option in my market place.”
New Law Places Restrictions on Insurance Rate Hikes
Under this new law, health insurance providers have to get prior approval from the state insurance department before the rate hikes take effect in 2011. In addition, customers are also able to submit comments to the regulators in association with the review.
New subsidies and insurance pools are offered by federal health care reform (including health exchanges), in order to help make it more affordable for individuals and small businesses to obtain health care coverage. However, there will not go into effect for several more years from now.
The New York Health Plan Association’s Leslie Moran defends the insurance premium hikes, saying that besides medical inflation, the Legislature and the governor raised taxes on health care the previous year, and costly new benefits have been added by federal health care reform to begin immediately.
The uptake rate on Health Savings Accounts (HSAs) has been steadily on the rise in recent times. To ensure you know all the necessary information on these accounts, here are the top five things to keep in mind when considering an HSA.
1 – Employers Favor the HSA Option
It is important that you take independent advice on whether a HSA is right for you or not. That is, do not just take the opinion of your employer in to account. HSAs are a great option for employers, because it places the onus of your wellbeing back on you. They could equally be as useful for you (the employee) because of the 10 – 40 percent health insurance premium discount which applies to those with HSAs linked an employer’s provided health insurance plan. However, the downside is that the deductible on these health insurance plans is often sky high – requiring more financial input from you for every health claim you make. This is the trade-off that you need to take into consideration.
2 – Not As ‘Cheap’ As They Appear
If you’re young and healthy, an HSA could be an ideal way to save money on health insurance coverage. As we already mentioned, policy premiums are 10 to 40 percent cheaper with HSAs linked in. However, the major factor here which could actually make the plan far more expensive than a traditional health care policy is the deductible. On plans with a HSA in place, the minimum deductible for individuals is $1,200 and for families, $2,400. The draw card for many when it comes to HSAs is the tax-free nature of the savings account. All withdrawals from the ‘fund’ are completely tax-free.
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photo credit: Vegansoldier
Two are pushing to overturn a 32-year-old court injunction barring the government from revealing the amount earned from Medicare by individual physicians.
photo credit: anolobb
Hundreds of small business owners in New York are appealing to the regulators in the state in demand of a rollback of the double-digit hikes in health insurance premiums, which they claim are outright criminal, according to the 
The uptake rate on Health Savings Accounts (HSAs) has been steadily on the rise in recent times. To ensure you know all the necessary information on these accounts, here are the top five things to keep in mind when considering an HSA.
