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HHS Dumps 2.2% Cuts to Private Medicare Advantage Plans; However Due to Sequester Doctor Compensation from Medicare Drops 2% Tod

Posted Apr 01 2013 7:03pm

Of course this is good news on the private Medicare plans as it would only stand to hurt the subscribers as we all know how insurers operate, right out of the pocket of patients so that was a good move.  On the the other side of the coin not good news for doctors with the 2% automated “algorithmic” change taking place today.  This is that IT Infrastructure I always talk about..it’s on all on auto pilot and doctors will begin feeling the crunch.

You know what, my other in Arizona just had some recent emergency surgery and you know what being I do this blog, I made sure I thanked her surgeon for still seeing Medicare patients…think about that sometimes..it’s not a bad idea if you are a patient as they never hear that and yet are beat up every which way today.  I will say this though you have not lived through a bunch of red tape until you have a Medicare admit via the ER room as I was there the entire time.  The hospital was great, no medical records and only a McKesson CPOE medication tracker and whiteboards.  It’s better than zero though I’ll say. 

Yes I just keep watching all of this activity on budgets and I realize that a lot of it can be trial and error but so much of what we see ends up being “swapping spit” as I call it.  HHS has their software going now that detects patterns and is helping identify a lot of fraud and it’s there now and could have been around years ago to help but we can’t go backwards.  It just amazes me to see all the efforts spent on doctors and hospitals with incentives, which were a good thing and now we want consumers to get involved in their care, which is also a good effort for sure as it’s becoming a matter of survival but will we see any type of “REC” centers to help consumers?  Haven’t heard a peep yet and of course we don’t even know if the Surgeon General uses the Surgeon General’s PHR do we?  Maybe they are shy but we never seem to get much in the way of patient role models out of government. 

They need some help with their math for sure and it’s not all their fault but like everywhere they have folks that get duped with algorithmic formulas and people running such departments that don’t understand the mechanics of how all this works, it makes a difference as without this, you get sucked in a few too many times. Poor hospitals here are struggling with this penalty for re-admissions and you have heard of personalized medicine, well for something like this to work we might just need some “personalized penalties”, either that or come up with a new plan or reporting system with criteria as some hospitals are just eating it. 

“Dead Patients Can’t Be Readmitted” As Relates to HHS and CMS and the Elusive Search for Some Penalty Assessing Algorithm Fairies…

Medicare also stopped paying for a lot of lab tests too, because they don’t have any policy…they need some algorithmic help here again.  There’s a lot of good Quants who have worked on Wall Street that could offer a lot of help here with talent as some have said a lot of the code they wrote could have some good healthcare applications and models with a little modification, once the profiteering part of the code is removed:)

Not Receiving Reimbursement on Some Molecular and Other Diagnostic Lab Tests From Medicare, They Didn’t Develop a New Algorithmic Payment Guideline System, So It Came To A Halt

They all want mHealth to grow, well do something about some transparency here and give the consumer something, like knowledge with who sells what kind of data to who.  Why in the heck we have HHS sitting there like a lame duck watching insurers buying our Master Card and Visa credit card and debit records to see if we are buying clothes a size larger is beyond me. They might just have all of this worked into their MLR too and nobody would know the difference without a look at a business model would they?  I just don’t get it as HHS is trying to protect consumers from higher premiums but does nothing to stop or prohibit what expenses drive them up besides claims.  Those aren’t going away and of course need auditing, but geez…I would think someone in HHS might get a little upset finding out that they too might be scrutinized by an insurance carrier in this fashion.  No pro-active just re-active it seems and by that time they are behind the 8 ball on a lot of it.  Some of the analytics are over kill and you have to deal with people on an ethical basis and not just slam algorithms out there so really…are we going to venture on to the Gestapo Algorithms next?  Remember a lot of this is flawed data too…we need to use data wisely. 

If you want mHealth and other technologies to grow and help consumers, do something that helps consumers and patients in this area as banks and corporations are just making a killing selling data…ahemm…while doctors are getting cut by 2 percent beginning today.  I like the comments that come out too wanting all to “hurry up”…what is one going to do, water board developers to get the code out of them faster?  It’s just those out of touch news items that make you go “yuk”…

mHealth and Other Technologies in Healthcare Experience Slow Growth Is As the Data Selling Epidemic for Shear Profit in the US Continues to Grow Leaps and Bounds Leaving Manufacturing in the Hole and Non Competitive

It scares the daylights out of me to watch some of our government entities just lead around by the nose when it comes to business models and math, gutless because we don’t seem to have the equivalents on the government side that the banks and private industry has and thus they can Algo Duped to the hilt and make billions in profits.  Again I know some of it is not controllable but a lot is and we don’t get government agencies that acknowledge business models and algorithms…instead we get crap like abortion talk and women’s health…”the vagina syndrome” as it might better be called.  Again with this knowledge and with doing this blog, there was no way I was going to miss thanking the surgeon taking care of my mother for still continuing to see Medicare patients with all they have flying at them.  Don’t complicate their claims either if you can avoid it.  Even if this goes retroactive if things change, it’s still one heck of a night mare with fixing everything with claims, been there and done that. 

Also I wonder how this happens…speaking of insurers?   How do they get to pay doctors less than Medicare…or are they off the hook now that doctors will be paid 2% less:)  BD

The AAFP Confronts United Healthcare On Reimbursements, Some Are Below Medicare Rates In Parts of the US–Payment Algorithms/Formulas Calculated Deep Within IT Infrastructures Do the Job

The insurance industry won a major lobbying victory Monday as the federal Medicare agency scrapped a proposed cut to Medicare Advantage plans. 

The Health and Human Services Department announced Monday that it will not follow through on a proposed cut to Medicare Advantage plans, which are administered by private insurers.

The change comes after a fierce lobbying campaign from the insurance industry, which ran TV ads protesting the cuts and organized a massive letter-writing campaign among members of Congress.

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