Medicare Payments Concentrated in Few Specialties

Medicare’s 2012 payments to providers were largely concentrated in a few specialties, according to recent disclosures.

An analysis of federal physician billing data illustrates that 14 percent of disbursements went to the top one percent of physicians, with the bulk of payments concentrated in oncology and ophthalmology.

Without information about individual patient cases, though, physicians argue that the raw data lacks the necessary context to be applied effectively. Billing data was off-limits from 1979 until 2013 due to an injunction filed by the AMA for this reason, among others. Many physicians are also concerned that patient and physician privacy could be at risk now that billing data is available.

That oncology and ophthalmology top the list of highest-paid specialties is unsurprising given that Medicare patients aged 65 and older are their primary demographic. Much of the money paid out to ophthalmologists covered many common eye drugs that the physicians purchase up front and prescribe for little profit. On the other hand, last year CMS reduced payments for cataract surgery to reflect updates to the procedure.

Economists hope to use billing data to identify physicians who perform high-revenue procedures with little value to the patient in order to increase their billing. The greatest concern posed by the information as presented is the possibility that some seniors may go through unnecessary treatment simply for a higher paycheck. The AMA cautions that the data released do not illustrate the value of services provided, however.

PRN Funding is a leading provider of invoice factoring services to healthcare providers. To learn more about healthcare factoring, visit our Web site and fill out an easy online application.

Enhanced by Zemanta

AMA Declares Obesity a Disease – The Impact for Employers

The American Medical Association has voted to reclassify obesity from a condition to a disease “requiring a range of medical interventions to advance obesity treatment and prevention,” according to an AMA statement. Essentially, physicians will be professionally obligated to diagnose and treat obesity.

Obesity increases risk factors for many serious conditions like heart disease, high blood pressure, stroke and type 2 diabetes. Nearly 30 percent of US adults are considered obese. Since most forms of insurance don’t cover obesity, the policy could improve access to obesity treatment such as nutritionists and trainers. Insurance may even begin to reimburse the time doctors spend talking to patients about nutrition and exercise. The bill would also increase obesity treatment options for Medicare patients and expand the types of providers allowed to offer obesity counseling.

Not only will the AMA decision impact patient care, it may also impact the staffing and employment industry. As of now, the Americans with Disabilities Act (ADA) does not prohibit employers from discriminating on the basis of weight. Staffing agencies should watch carefully as the ADA deems nearly all diagnosed medical conditions as “disabilities.” Could it mean that employers will have to make reasonable accommodations for employees who fall into the obese category? Could obese employees seek additional protection from discrimination and terminations based on weight? An article on believes so.

According to Forbes magazine, the new classification may even make employers more hesitant to hire obese workers, especially since health insurance coverage is required under the Affordable Care Act. Some employers may also try to lower wages to offset the higher health insurance costs of obesity. It also may impact workplace wellness programs that offer financial incentives tied to weight management and obesity.