The 2019 Medicare Readmission Penalty

The 2019 Medicare Readmission Penalty

In September, CMS released the financial penalties that hospitals will pay for excessively high percentages of readmissions within 30 days of discharge. This is an annual event when hospitals get to find out how much their reimbursement from Medicare will be cut the next year. CMS focuses on 6 diagnoses when calculating the readmission penalty: […]

Pre-Existing Conditions And Individual Mandates

Pre-Existing Conditions And Individual Mandates

The Affordable Care Act is the piece of legislation that Americans simultaneously both love and hate. Americans love not being excluded from health insurance if they have pre-existing conditions but hate being forced to buy health insurance if they don’t want to. And so, there has been an effort to eliminate the individual mandate to […]

The Final 2019 Medicare Physician Fee Schedule: Some Winners, No Losers

The Final 2019 Medicare Physician Fee Schedule: Some Winners, No Losers

Last week, CMS released the final rule for the 2019 Medicare Physician fee schedule. The initial proposed fee schedule was released last summer and would have radically changed the way that physicians are paid for outpatient clinical practice. There was a lot of criticism of the proposed fee schedule with most professional medical societies opposing […]

What Medicaid Expansion Tells Us About America’s Health

What Medicaid Expansion Tells Us About America’s Health

Medicaid expansion has been a rallying cry for both the politically far left and the politically far right. This post will examine some of the healthcare differences between those states that participated in Medicaid expansion and those states that did not expand Medicare. At its most simplistic, Medicaid expansion has increased federal and state government costs […]

Gaming Hospital Metrics

Gaming Hospital Metrics

Hospital and physician performance is measured by a lot of different quality metrics and everyone wants to look good. Sometimes, there are ways to make yourself look good without actually being good – by gaming the metrics. Nobody actually talks about these gaming strategies but a lot of people think about them. I’m not recommending […]

The High Cost Of Observation Status

The High Cost Of Observation Status

Medicare and commercial insurance companies love observation status. When a patient has to be hospitalized but only for “less than 2 midnights hospital stay”, then that patient is classified as being in observation status rather than admitted to the hospital. This classification means that the patient is technically an outpatient and not an inpatient and […]

Age Of Physicians By Specialty

Age Of Physicians By Specialty

At this month’s American Thoracic Society meeting, it was reported that 1/3 of practicing pediatric pulmonologists in the United States are over age 60, a scary number since that indicates we are soon facing shortages of pediatric pulmonologists. It turns out that it is not the only specialty with disproportionately older physicians and these statistics […]