Challenges of Running a Practice
Many physicians in private practice wish they could spend less time running their practice—and more time practicing medicine, an American Express survey of 663 physicians indicated. Of the physicians who respondented, 26% described the dual role of practicing medicine and running their business as “extremely challenging,” and half reported spending the equivalent of at least 1 full day each week on tasks related to business management. “Nearly one in four say they would not have opened their own medical practice if they fully understood the business challenges of running a practice when they began their careers,” medical practice management specialist J. Max Reiboldt said in response to the findings. Many respondents noted that they felt the need to develop better business skills, including financial and business management. The Medical Practice Monitor survey was based on interviews conducted in 2004 by Harris Interactive.
Payments for the Elderly
U.S. seniors spent an average of $11,089 out of pocket on health care goods and services in 1999, but nearly half that amount was reimbursed by Medicare, and another 15% was paid for by Medicaid, according to a report by the Centers for Medicare and Medicaid Services' Office of the Actuary. The amount spent out of pocket by seniors was quadruple the average of $2,793 for people under age 65 years. “What this report shows is the importance of our effects to bring down the high cost of health care for America's seniors,” CMS Administrator Mark B. McClellan, M.D., said in a statement. Although people aged 65 years and over made up only 13% of the population in 1999, they accounted for 36% of personal health care spending, according to the report. Conversely, children made up 29% of the population but accounted only for 12% of personal health care spending in that year.
Medicaid Prescription Drug Charges
The Medicaid program is being overcharged for prescription drugs, George M. Reeb testified to the House Energy and Commerce subcommittee on oversight and investigations. Mr. Reeb, who is the assistant inspector general for the Centers for Medicare and Medicaid Audits at the Department of Health and Human Services, said part of the problem is that states vary greatly in the reimbursement amounts they set for prescription drugs. For example, “based on state data, we estimated that, overall, Medicaid could have saved as much as $86.7 million in fiscal year 2001 if all 42 states had reimbursed at the same price as the lowest paying state for each of the drugs reviewed,” Mr. Reeb reported in his testimony. Among his recommendations is that states be provided with enhanced access to accurate wholesale pricing information and adopt other strategies to contain costs.
Guidance on Inpatient Status
To help physicians do a better job of admitting patients to the hospital, CMS should simplify its use of the terms “observation” and “inpatient admission,” a federal advisory panel has recommended. The Practicing Physicians Advisory Council drew up the resolution after CMS officials indicated that there was some “confusion” between hospitals and admitting physicians on patient status. Specifically, there are times when a hospital admits a patient to inpatient status when the physician intended the patient to be admitted for observation. The panel recommended that CMS provide this guidance on the “MedLearn Matters” Web site, which posts articles to Medicare providers that help them understand new or changed Medicare policy.
Historic Fraud Case in Missouri
In the largest fraud settlement reached in the Eastern District of Missouri, Gambro Healthcare will pay more than $350 million in criminal fines and civil penalties to settle allegations of health care fraud in the Medicare, Medicaid, and TRICARE programs. The settlement resolves civil liabilities stemming from alleged kickbacks paid to physicians, false statements made to procure payment for unnecessary tests and services, and payments made to Gambro Supply, a sham durable medical equipment company. “Gambro engaged in fraud to obtain millions of dollars of federal health insurance funds for unnecessary tests and services,” said U.S. Attorney James G. Martin in a statement. Gambro Healthcare, a global provider of kidney dialysis services, “cooperated fully with the government to settle this matter and put behind us issues that arose during a period of rapid and complex industry consolidation in the 1990s,” said its president, Larry Buckelew.
Malpractice: No. 3 Issue for Voters
Medical malpractice reform was one of the top three health care issues for voters who participated in a survey sponsored by the Federation of American Hospitals, ranking behind the uninsured, and before reimportation of drugs from Canada. Most of the respondents (40%) cited lawyers as being the most responsible for physicians leaving their practice due to high malpractice insurance costs, followed by insurance companies (26%), plaintiffs (17%), and physicians (5%). Insurance companies and HMOs were cited as the biggest reason for rising health care costs (37%), followed by lawsuits (30%). On other health care issues, seven out of 10 voters overwhelmingly opposed cuts to Medicare and Medicaid programs. The study represented a poll of 1,000 registered voters, plus 478 voters aged 65 and older.