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Health Management Technology News
  April 9, 2014
In this issue:

 Health Management Technology’s Resource Guide sign-up

 Data uncover nation’s top Medicare billers

 Healthcare cuts canceled after Dem complaints

 What American healthcare can learn from Germany

 The human side of healthcare

 VC firm Split Rock moves away from healthcare deals

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Data uncover nation’s top Medicare billers

The Medicare program is the source of a small fortune for many U.S. doctors, according to a trove of government records that reveal unprecedented details about physician billing practices nationwide. The government insurance program paid nearly 4,000 physicians in excess of $1 million each in 2012, according to the new data. Those figures do not include what the doctors billed private insurance firms.

The release of the information gives the public access for the first time to the billing practices of individual doctors nationwide. Consumer groups and news outlets have pressured Medicare to release the data for years. And in doing so Wednesday, Medicare officials said they hope the data will expose fraud, inform consumers and lead to improvements in care.

The American Medical Association and other physician groups have resisted the data release, arguing that the information violates doctor privacy and that the public may misconstrue details about individual doctors.

Among the highest billers were a cardiologist in Ocala, FL, who took in $18.1 million, mainly putting in stents. A New Jersey pathologist who received $12.6 million performing tissue exams and other tests. And a Michigan vascular surgeon who got $10.1 million.

Some of the highest billing totals may simply reflect a physician who is extremely efficient or who has an unusually large number of Medicare patients. The highest numbers also may reflect a physician who specializes in procedures that require costly overhead, and in those cases, a large portion of the money may wind up not with the doctor but with pharmaceutical companies or makers of medical devices.

But in some instances, the extremely high billing totals could signal fraudulent doctor behavior, as government inspectors have previously found. Indeed, three of the top 10 earners already had drawn scrutiny from the federal government, and one of them is awaiting trial on federal fraud charges.

Visit the Washington Post for the full article  

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Healthcare cuts canceled after Dem complaints

The Obama administration announced Monday that planned cuts to Medicare Advantage would not go through as anticipated amid election-year opposition from congressional Democrats.

The cuts would have reduced benefits that seniors receive from health plans in the program, which is intended as an alternative to Medicare.

Under cuts planned by the administration, insurers offering the plans were to see their federal payments reduced by 1.9 percent, which likely would have necessitated cuts for customers.

Instead, the administration said the federal payments to insurers will increase next year by .40 percent.

The healthcare law included $200 billion in cuts to Medicare Advantage over 10 years, in part to pay for ObamaCare.

The Centers for Medicaid and Medicare Services (CMS) on Monday said changes in the healthcare market meant it did not need to make those cuts to Medicare Advantage this year.

It cited an increase in healthy beneficiaries under Medicare, which it said has lowered projected costs for that program.

CMS separately is delaying a risk assessment proposal that was set to take affect under ObamaCare.

The announcement comes after insurers spent millions on a public relations blitz seeking to head off the cuts, and after dozens of Democrats joined Republicans in calling on the administration to keep MA rates flat to avoid cutting benefits for seniors.

Monday’s announcement is “significantly better for health plans” than the initial proposal in February, CMS administrator Jonathan Blum said in a conference call with reporters.

“The policies announced today will provide improved benefits in Medicare Advantage and the Prescription Drug Plans while keeping costs low for Medicare beneficiaries,” Blum said.  “We believe that plans will continue their strong participation in the Medicare Advantage program in 2015 and beneficiaries will continue to have access to a wide array of high quality and affordable Medicare health and drug plans.”

Read the full article from The Hill here  

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What American healthcare can learn from Germany

Last fall, Sam, an American woman who lives in Berlin, began to experience stomach pain while eating and drinking. She visited her general practitioner, who wrote her a prescription.

The problem hadn't gone away several days later, so the doctor referred her to a specialist for a gastroscopy. Her issue wasn’t deemed an emergency, though, so she had to wait about two weeks for an appointment.

“But man, was I impressed with the exam itself!” she later told me in an email. “Went to the hospital, filled out a few papers, was knocked out for a bit while they looked in my stomach, and was home again a few hours later. Everything was very efficient.”

The best part: Sam paid exactly nothing for the experience.

Read the full article from The Atlantic here  

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The human side of healthcare

A man whose elderly father fell and was wrongly diagnosed with an ear infection. Parents of an infant with acid reflux. A nurse who takes the time to listen to the dying sort through their relationships.

These are some of the stories featured in Patient Translations, an ongoing project created by Boston-area artists Kelly Sherman and Halsey Burgund that collects tales of the health care system and blends them into audio collage and telling snippets of text, empowering patients and their loved ones to share experiences of waiting rooms, diagnoses, and insurance companies.

The project is being publicly displayed as an installation at health care conferences but is available online for anyone to listen to or contribute a story; there are about 300 clips in the collage thus far.

Kate Desjardins’s brother was diagnosed with Hodgkins lymphona 2½ years ago when he was 24. Since then, he has had two stem cell transplants.

“It’s grueling for everybody,” says Desjardins, a middle school teacher from Bedford. “We trust the doctors, but we have to negotiate the medical system, which is not always the kindest thing.”

Burgund interviewed her for Patient Translations, and her voice is woven into the audio collage.

“There’s no other outlet anywhere for such a thing,” Desjardins says of sharing her story. “Especially for someone like me, who is just the sister.”

Read the full article from The Boston Globe

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VC firm Split Rock moves away from healthcare deals

Split Rock Partners is becoming the latest venture capital firm to move away from healthcare investing, Fortune has learned.

The firm, which has offices in Minneapolis and Silicon Valley, always has been a "generalist" shop, with its healthcare practice focusing more on medical device startups than on pharma or biotech companies. But managing director Michael Gorman says that the medical device space has become more challenging in recent years, whereas software and Internet services opportunities have become more attractive.

Going forward, that means that Split Rock will invest most of the remaining uncalled capital in its $300 million fund into tech startups, while being open to "select" healthcare opportunities. If and when Split Rock raises its next fund, however, all of its would be dedicated to tech.

Read the full article from CNN Money here  

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