Many Docs Headed For Rate Cuts

HMS Healthcare Management SolutionsAbsent a significant change in the trajectory of Medicare’s physician quality reporting system, a large majority of doctors will set themselves up for future rate cuts by failing to report enough quality measures to the federal government in 2013.

A recent trends report from the Centers for Medicare & Medicaid Services (CMS) shows that fewer than 200,000 physicians, out of the more than 600,000 who were eligible for the incentive program, reported PQRS measures in 2010.

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Proportion Of Dual Eligibles Varies Across States

HMS Healthcare Management SolutionsA recent article in the Remington Report highlighted a new report by the Kaiser Commission which concluded the proportion of state Medicaid beneficiaries who are also enrolled in Medicare varies from a low of 10% in Arizona and Utah to 26% in Maine.

The report notes the variations reflect a state’s demographic profile as well as state policy choices in Medicaid eligibility and coverage. “In general, states in the East – which tend to have older overall populations – have a higher share of Medicaid enrollees who are dual eligibles than those in the Midwest and West. However, states with a relatively low share of Medicaid enrollees who are duals (such as California and Illinois) may have a much higher number of dual eligibles enrolled in Medicaid than states with a higher share, since these states have larger overall populations.”

According to the report, 26 states are developing proposals for a federal demonstration to integrate Medicare and Medicaid services and financing for dual eligibles.


MA Hospital Settles Data Breach

South Shore Hospital in Weymouth, Mass., has agreed to a $750,000 settlement over charges tied to a 2010 data breach that leaked the personal health information of more than 800,000 patients, according to a Boston Globe report.

In February 2010, South Shore Hospital contracted with Archive Data Solutions to erase and resell 473 tapes that contained patients’ Personal Health Information (PHI). The data was not encrypted, however, and the hospital did not inform Archive the tapes contained PHI. When three boxes of tapes were shipped to a Texas subcontractor, the hospital learned that only one box arrived. The lost tapes have never been found, although there is no evidence that any of the PHI was ever misused.

New ACO Links Doctors, Hospitals,Health Plan

Bloomfield health insurer Cigna and New Hampshire’s Granite Healthcare Network (GHN),  a partnership among five independent charitable health care organizations in New Hampshire, are launching a new collaborative program that will expand patient access to health care and improve care coordination in an effort to increase patient satisfaction

Cigna’s patient-centered collaboration with GHN is believed to be the largest accountable care organization in New Hampshire that links doctors, hospitals and a single health plan.

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ER Use For Non-Urgent Care

According to a recent poll from the American College of Emergency Physicians (ACEP), 85% percent of Americans who have been to the emergency department said they couldn’t wait to see their regular medical provider.

Despite efforts to curb non-urgent and unnecessary use, one in five patients went to the ER because their primary care provider sent them.

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