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.
Managed Care’s Top Ten Articles of 2016
There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.
They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?
A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.
More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.