Medicare

Responding to changes in the Medicare auditing system, which gave a bonus payment to audit teams that found questionable admissions, hospitals started holding patients in "observation" status even though the patients thought they had been admitted.

It leaves patients owing a lot more for their hospital stay, and -- worst case -- the entire nursing home bill if they are transferred to one. A number of Medicare patients and consumer groups are suing to get the problem solved, but so far it hasn't been.

Florida has the second-highest rate of uninsured adults under 65 in the nation, second only to Texas, the Naples Daily News reports. U.S. Census figures from 2011 show nearly 25 percent of Floridians under 65 don’t have health insurance -- a total of about 3.8 million residents, the Miami Herald reports.

A blog by St. Petersburg cardiologist and author David Mokotoff published in Kevin MD talks about how the length of a hospital stay has changed over the years depending on how Medicare pays.  The stays used to be too long, then they were too short. Now Medicare is penalizing hospitals if they don't get patients on the road to recovery before sending them home.

At his blog Our Health Policy Matters, consultant Paul Gionfriddo has his own measuring stick to compare states on how healthy they are.  He gives extra weight to prevention and public health, since those are disproportionately important in affecting community health.

Even though he lives in Florida, Gionfriddo doesn't place the state in the top 10.

Florida’s Agency for Health Care Administration has reported to federal officials -- who control the purse strings for Medicare -- that Halifax Hospital poses an “immediate and serious threat to the health and safety of patients,” the Orlando Sentinel reports. The hospital has to demonstrate it has cleaned up its act in order to ward off financial penalties.

Scott Keeler / Tampa Bay Times

With Congress on a five-week recess, members are rallying the troops around the state. And the troops are responding. As the South Florida Sun-Sentinel reports, U.S. Rep. Debbie Wasserman Schultz introduced Leslie Sheffield of Fort Lauderdale, a cancer survivor who cares for her 92-year-old mother. Sheffield told a crowd that she and her husband both got sizeable rebate checks on their health insurance this year because of the health law. Wasserman Schultz is a Democrat from Weston. 

In response to a billion-dollar whistleblower suit that alleges Halifax Health violated federal laws prohibiting kickbacks to doctors, hospital officials say they were merely serving the public by making sure they paid enough to keep good doctors. The bonuses they paid to certain physicians were needed to ensure they would stay at the safety-net hospital, the Daytona Beach News-Journal reports.

The newest wave in health care may be as close as your computer.  More hospitals and doctors are using technology, such as Skype, to treat patients, the South Florida Sun-Sentinel reports.  This can benefit patients who live too far from needed specialists, as well as allowing doctors to consult colleagues when dealing with complex cases.

Tampa-based WellCare Health Plans exceeded expectations on Wall Street for the second quarter, the Associated Press reports.

www.dmh.org

Medicare has stepped up the top rate of pay cuts for hospitals that have high readmission rates, Kaiser Health News reports. In Florida, about four out of five hospitals will have a penalty in their Medicare reimbursement rate. The average penalty across the state was 0.35 percent, which means about one-third of one percent of their Medicare payments will be withheld in the coming year. 

Data Dive Finds Doctors For Rent

Aug 5, 2013

Silly me. I thought "rent-seeking" was something only landlords did.

But economists have their own way of looking at the world. To them, rent-seeking is a term for describing how someone snags a bigger share of a pie rather than making a pie bigger, as the venerable Economist explains it.

So, a drugmaker can be seen as a rent-seeker if it cajoles doctors to prescribe more of a particular brand of medicine at the expense of a rival pharmaceutical company's wares.

In a column in the Miami Herald, former Miami Heat star Alonzo Mourning, who received a kidney transplant in 2003, laments a proposal to cut Medicare payments for kidney dialysis, the live-saving treatment for those who suffer kidney disease but don’t have access to a transplant. In Florida alone, Mourning writes, about 25,000 people rely on dialysis. 

Federal health officials will enact strict moratoriums on certain types of Medicare and Medicaid providers in the Miami area, Medical Daily reports. The stronger bans start Tuesday, and will affect new home health providers looking to join the programs.

Kaiser Health News

After three years and $8.5 million, a team of economists has come to the conclusion that geographic differences in health-care spending are real, both for Medicare and commercial insurers. 

In other words, the gap can't be explained by variations in income, the level of illness, or some other rational factor, the report says. For example, Medicare patients aren't sicker in super-expensive South Florida than anywhere else.  There are just more bills being sent to Medicare from South Florida than most places.

JSA Care Partners, a St. Petersburg-based multi-site physician group, was among seven Accountable Care Organizations that are leaving the high-risk “Pioneer” ACO group, federal officials announced last week).

The U.S. attorney’s office has joined a whistleblower lawsuit against a South Florida home health care company accused of padding its payroll to obtain more Medicare referrals.  The suit says that A Plus Home Health Care paid at least seven doctors’ wives and one boyfriend while expecting almost no work from the group in an attempt to lure physicians’ Medicare referrals, the South Florida Sun-Sentinel reports.

Associated Press

After weeks of bruising attacks on the Affordable Care Act by House Republicans and other opponents, Democrats Thursday retaliated with a one-two punch.

Pinellas County Sheriff's Office

Rather than run separate summaries on the various misdeeds, here’s a roundup:

While Floridians ask how health-care reform will affect them, Florida CHAIN’s Greg Mellowe is in a position to be able to answer those questions.  The nonprofit’s policy director has been following news of the health-care reform, and has some solid answers for Floridians, according to the Orlando Sentinel.

At his website Our Health Policy Matters, Paul Gionfriddo takes a look at which columns attract the fewest readers.  According to Gionfriddo, readership drops when he posts about Medicare, long term care and House Majority Leader Eric Cantor. 

Broward Sheriff's Office

When the cops arrested Jorge Castillo at his Miami Lakes home on Monday, they found he lived well, with two Maseratis, a Range Rover and a boat. Small wonder, as the South Florida Sun-Sentinel reports.  Prosecutors say Castillo, 43, bought pharmaceutical drugs for AIDS, cancer, psychosis and other conditions from criminals.

Accountable Care Organizations, new Medicare payment arrangements aimed at improving coordination of care for the chronically ill, are really taking off in Florida, according to MedPage Today. Florida has more ACOs than any other state, even the much more populous California.

www.healthcare.gov

Enrollment in Medicare Advantage plans is booming at 14.4 million nationally, according to the Kaiser Family Foundation. In Florida, enrollment increased 10 percent last year to 1.3 million; that represents 36 percent of Florida Medicare patients. 

Continuing its pressure on the hospital system to make the pricing structure more sensible, the Obama administration on Monday released data on charges for outpatient care. They showed Floridians are charged nowhere near the same amount for similar procedures, depending on their choice of hospital outpatient site.

The data release for 30 common outpatient procedures showed, for example:

In 1979, a federal court in Tampa granted an injunction that ordered federal health officials to keep secret the  amount that Medicare pays doctors.  Now that ruling has been overturned.

That secrecy has reigned nationwide all these years -- even after the Wall Street Journal crunched data and published articles that showed certain physicians were almost certainly committing fraud and collecting unearned sums at taxpayers' expense.

Florida’s seniors may be able to breathe a little easier, knowing that the Medicare hospital trust fund will be financially sound longer than projected because health spending has moderated, the South Florida Sun-Sentinel reports. Government trustees reported that Medicare’s hospital fund should run short around 2026, two years later than projected in 2012. 

Eye Associates of Fort Myers, Naples

The number of eyelid lifts charged to Medicare tripled over a decade, even though the federal health-care program is not supposed to pay for cosmetic surgery, the Center for Public Integrity reports.

El Nuevo Herald

The Medicare Fraud Strike Force arrested 34 people in Florida as part of a nationwide sweep.  

According to an investigation by ProPublica and The Washington Post, Medicare is failing to properly monitor the drugs prescribed under Part D coverage. Analysis of the data shows doctors are overprescribing, and in some cases, giving seniors drugs that are potentially harmful or addictive. 

The health-care system was already complex enough, and it's getting more confusing as the main portions of the Affordable Care Act  are about to go into effect Jan. 1.  This is the time when con men can take advantage of the confusion, particularly targeting senior citizens.

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