ObamaCare created a Medicaid time bomb

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Because of the low reimbursement, and the red tape that accompanies any government program, many doctors limit the number of Medicaid patients they serve, or even refuse to take Medicaid patients at all. An analysis published in Health Affairs found that only 69% of physicians accept Medicaid patients. A study published in the New England Journal of Medicine found that individuals posing as mothers of children with serious medical conditions were denied an appointment 66% of the time if they said that their child was on Medicaid (or the related CHIP), compared with 11% for private insurance — a ratio of 6 to 1.
Source: nypost.com

Video: New York: Medicare Fraud Summit Consumer Panel

Queens, N.Y. Pharmacist Charged With Multimillion Medicare Fraud |

A pharmacist with a business in Queens, N.Y., was charged December 12, with defrauding Medicare of millions of dollars. Purna Chandra Aramalla was arrested Dec. 12 morning and presented in Manhattan federal court before U.S. Magistrate Judge Debra Freeman. A preliminary hearing is scheduled for January 13. Aramalla was charged with engaging in a scheme to defraud Medicaid and Medicare through the sale of illegally diverted prescription drugs, as well as with a related money laundering offense. From October 2010 to August 2012, he is alleged to have purchased approximately $1.7 million from two legitimate, licensed wholesalers but during that same period, he received approximately $4.3 million in reimbursements from Medicare and Medicaid for those same drugs, an amount far in excess of what he would have been entitled to had he only sought reimbursement for the legitimately obtained drugs, investigators said in a release from the office of the U.S. Attorney for the Southern District of New York. According to the allegations in the Criminal Complaint unsealed Dec. 13, Aramalla, who operates A Fair Deal Pharmacy Inc. in Queens, New York, and Quality Health Drug Inc. in Bronx, New York, used these pharmacies, to allegedly carry out a multimillion-dollar scheme to defraud New York State Medicaid and Medicare programs, purchasing pharmaceuticals, including high-cost HIV medications, from patients, repackaging them, and reselling them to his customers. He then requested and received reimbursement from Medicaid and Medicare in connection with these sales. He is alleged to have also obtained reimbursement for pharmaceuticals that were never actually dispensed to patients.
Source: newsindiatimes.com

Medicare Identifies 97 Best And 95 Worst Hospitals For Hip And Knee Replacements

Of the 95 hospitals where knee and hip surgery patients experienced difficulties after the operation, nine were rated having both high readmissions and high complication rates. Those hospitals were: Froedtert Hospital in Milwaukee; Grant Medical Center in Columbus, Ohio; Mercy St. Anne Hospital in Toledo, Ohio; Northwestern Memorial Hospital in Chicago; the Pennsylvania Hospital of the University of Pennsylvania Health System in Philadelphia; Peterson Regional Medical Center in Kerrville, Texas; Reston Hospital Center in Reston, Va.; Shannon Medical Center in San Angelo, Texas, and Southside Regional Medical Center in Petersburg, Va.
Source: kaiserhealthnews.org

New York lags nation on hospital quality test, costing city millions in aid

The quality incentive program follows a carrot-and-stick principle: the Centers for Medicare and Medicaid Services pools 1.25 percent of the value of its annual payments into a $1.1 billion pot, and redistributes it unevenly to hospitals nationwide depending on performance. Hospitals are evaluated on measures that range from clinical procedures to mortality rates and satisfaction among their Medicare patients. Improvement compared to the last evaluation is also rewarded. Winners receive bonus funds, while losers get penalized on their Medicare payments, up to 1.25 percent of a hospital’s Medicare income.
Source: thenewyorkworld.com

Medicare Patients’ Access to Physicians: A Synthesis of the Evidence

In every state and DC, a very small share of beneficiaries—less than 5 percent in both traditional Medicare and Medicare Advantage—report that they encounter major problems and are “never” able to schedule timely appointments with a doctor for either routine care or specialty care, according to the CAHPS surveys (Appendix Tables 2 and 3).  Among beneficiaries in traditional Medicare, the share who report either “never” or only “sometimes” being able to schedule timely appointments for routine care ranges from 8.4 percent in Oregon to 16.5 percent in New Mexico.  With regard to specialty care, the percentage of beneficiaries who report that it is either “never” or only “sometimes” easy to get appointments with specialists ranges from 3.8 percent in Nebraska to 13.5 percent in New Mexico.  Further analysis is needed to assess the causes and effects of variations observed across states, and to examine within-state variations at a more granular level to assess the extent to which access problems vary by local health markets.
Source: kff.org

Hill Staffers Head to Medicare Proxy War in New York

Back in April, a little special election in Wisconsin became a proxy war for Republicans’ and Democrats’ fight over union power. Now next week’s special election to Rep. Chris Lee has become a proxy war over Medicare. The race, in one of New York’s most conservative districts, has become surprisingly competitive as Democrat Kathy Hochul hammers Republican Jane Corwin over Paul Ryan’s plan to overhaul entitlements, and Tea Party candidate Jack Davis takes votes from Corwin. Outside groups, like Karl Rove’s American Crossroads, have poured hundreds of thousands of dollars into ad campaigns in the district, and an army of Republican Capitol Hill staffers are headed upstate to get out the vote, Roll Call’s Steve Peoples reports.
Source: thewire.com

20 percent of Medicare's graduate medical education funds go to New York; 29 states get less than 1 percent

“Such imbalances play out across the country and can affect access to health care,” said lead author Fitzhugh Mullan, MD, the Murdock Head Professor of Medicine and Health Policy, a joint position at SPHHS and the GW School of Medicine and Health Sciences. “Due to the rigid formula that governs the GME system, a disproportionate share of this federal investment in the physician workforce goes to certain states mostly in the Northeast. Unless the GME payment system is reformed, the skewed payments will continue to promote an imbalance in physician availability across the country.”
Source: sciencecodex.com

No More Mister Nice Blog: Medicare For All — or how Democrats can throw their own monkey wrenches into the works if Republicans ever come back into power

Medicare For All, otherwise known as single payer healthcare, would make the United States government the one and only healthcare insurance company. It works great for us old-timers who are of Medicare age. It would work even better for everybody under the age of 65, because it would cover so many young and healthy people who are less of a drain on our healthcare system, that costs would come down even further.
Source: blogspot.com

Medicare’s Failure to Track Doctors Wastes Billions on Name

“At some point, I think we have to hold prescribers accountable for their prescribing,” said Dr. Nancy Morden, an associate professor at the Dartmouth Institute for Health Policy and Clinical Practice, which has studied Part D. “I just don’t see how that’s different from holding them accountable for the quality of care in the exam room or in the operating room.”
Source: propublica.org