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The Doctor's Prescription For Restoring Health To Medicare

The Doctor's Prescription For Restoring Health To Medicare | #HITsm | Scoop.it

An important, in-depth article in Forbes on why ACOs aren't likely to curb Medicare costs, plus valuable recommendations of what would work.

 

How does Medicare accomplish this? First Medicare must make greater use of existing capabilities to manage, in an evidence-based way, the appropriate use of prescription drugs, of expensive diagnostic imaging, and of expensive therapeutic interventions. There is a large benefits management industry in this country with a proven track record in managing these powerful but expensive components of health care. While Medicare has taken some advantage of pharmacy benefits managers (PBMs), optimal use of PBMs along with radiology benefits management and initiation of management of other expensive procedures and interventions (only as best medical evidence dictates) should be able to shave $10 billion or more off annual Medicare spending.

 

How much could this save? Estimates range from as low as 10-15% to as high as 25-30% of all healthcare expenditures. For fee-for-service Medicare this could mean from $40 to $120 billion per year.

 

Is this possible? It is already being achieved within the well-performing Medicare Advantage plans where primary care physicians are delivering quality care, gaining reimbursement of 150-200% of fee-for-service Medicare, and controlling unnecessary resource utilization.

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HHS extends Stage 2 Meaningful Use deadline to 2014

HHS extends Stage 2 Meaningful Use deadline to 2014 | #HITsm | Scoop.it

HHS has extended until 2014 the compliance date for Stage 2 meaningful use for those hospitals, physicians and other eligible professionals that qualify as Stage 1 meaningful users in 2011.


Under the current rules for the Medicare portion of the electronic health-record system incentive program created under the American Recovery and Reinvestment Act of 2009, hospitals, doctors and other eligible professionals who qualified for incentive payments as Stage 1 meaningful users in 2011—the program's first year—would have to meet new and expectedly more stringent Stage 2 standards in 2013.


But according to HHS' statement, if those providers had delayed participation until 2012, "they could wait to meet these new (Stage 2) standards until 2014 and still be eligible for the same incentive payment."

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