The latest on managing care, value-based care, insurance markets, payers & providers

Headlines On Deadline …

More than a third of Americans who need to be screened for colon or breast cancer have not been screened, according to the latest report from the Centers for Disease Control and Prevention. But overall, more people are being screened than ever before. “We are encouraged by a significant increase in colon cancer screening rates over recent years,” says CDC director Thomas Frieden, MD.... In the UK, the new coalition government will eliminate a layer of financial managers and ask physicians to decide how the bulk of the National Health Service’s £105 billion annual budget should be spent.... The Centers for Medicare and Medicaid Services is proposing changing the way physicians are paid for treating patients with synthetic skin grafts. The change involves the 90-day global period of service — once a physician applies the first treatment, Medicare cannot be billed for subsequent treatments within a 90-day window. There are two treatments — Dermagraft and Apligraf. Dermagraft typically involves eight treatments during those 90 days. Apligraf has just a 10-day global period of service. Its treatment generally calls for five doctor visits over 12 weeks, so doctors are able to bill for each visit. Doctors who use Dermagraft get around the billing restriction by using a “modifier-58,” which tells CMS to ignore the 90-day billing window. CMS plans to reduce the global period of service for both skin substitutes to zero, allowing doctors to bill for each visit.

Subscribe to Our Newsletters

Monthly table of contents

Be notified as each issue of Managed Care is available online.

Biweekly newsletter

Recent topics have included:

  • Doug Jones and the ACA, Epic misses a White House meeting, and man caves for man-flu sufferers
  • CVS-Aetna deal may trigger merger mania, Johns Hopkins criticized for lack of asthma prevention, & Columbia sees free-ride future for all of its med students

PTCommunity news

New drug approvals, clinical trials, drug management. Three times per week.