How a Secretive Panel of Doctors Helps Set Health Care Costs

A Washington Post story by investigative reporters Peter Whoriskey and Dan Keating has drawn plenty of attention to a little-known committee of doctors that establishes values for each medical procedure, which in turn affects how much Medicare and private insurers pay for them. The American Medical Association committee meets once a year behind closed doors to determine the time and intensity of most of the procedures and services a doctor performs – like colonoscopies (75 minutes of a doctor’s time, …

Medicare Drug Premiums Will Rise Just $1 a Month

The average monthly premium for a basic prescription drug plan under Medicare Part D will be just $1 higher next year, the government projects. What’s more, Medicare beneficiaries get some of the credit for keeping the average low by shopping around, the Associated Press reports. For this year, seven of the top 10 Medicare drug plans raised premiums by 10 percent or more. But the average stayed low because many seniors chose plans with lower premiums. “Consumer advocates say beneficiaries should …

The Costs of Not Expanding Medicaid

I generally don’t like to tell people that I majored in economics in college, because – the painful truth be told – there’s not a lot that I actually remember about “the dismal science.” One of the few things I do remember, however, is the concept of “opportunity cost.” That’s the name economists give to the cost of not doing something. Which brings us, in today’s lesson, to Medicaid, the government-sponsored health insurance program for certain groups of low-income Americans. …

Is Your Doctor a 10? Medicare Site Takes Next Step Toward Ranking Providers

By Jordan Rau, Kaiser Health News Medicare Thursday added new features to its Physician Compare website as it prepares to start including quality data on thousands of doctors. The federal health care law requires the Centers for Medicare & Medicaid Services to publish performance data on doctors, including how patients rate them, how well the physicians’ medical interventions succeed and how well they follow clinical guidelines for basic care. The site has been up since 2010, but contained only basic …

Those Left Out of Medicaid Expansion Won’t Be Penalized … Or Insured

By Alvin Tran, Kaiser Health News Low-income Americans who live in states that have decided not to expand Medicaid eligibility will not face penalties if they fail to buy insurance next year. Discussion: 78 million consumers saved $3.4 billion on ACA-provisioned health insurance That’s according to a final rule on exemptions to the health law’s individual mandate – the law’s controversial requirement that most Americans have health coverage or pay a penalty in 2014. That rule was published Wednesday. The health …

Doctors’ Extreme Prescribing – Footprints of Medicare Fraud?

Diagnosis: possible Medicare fraud. That’s the gist of a report from the Inspector General of the U.S. Department of Health and Human Services that found hundreds of doctors with “very extreme” prescribing practices – practices that could be harming Medicare patients and costing the government untold millions. Government investigators zeroed in on doctors writing hundreds of prescriptions per patient and large numbers of prescriptions for painkillers and other addictive drugs, among other practices. Related: 6 Common Medicare Scams After sifting through …