Lawsuits, Or Threat Of Them, Hover Over Medicare Policy

News outlets report on the government's position on releasing doctor-specific information and on Medicare patients' access to physical therapy. And, ProPublica investigates prescribing practices.

Modern Healthcare: Doctor-Specific Medicare Claims Data Could Be Released
For decades, the CMS has kept secret its records on Medicare claims payments to individual physicians. But Justice Department statements in a recent lawsuit and the first-ever releases of other provider charge data this year suggest the federal government's position on keeping doctor-specific information secret may be changing. Proponents of releasing the data say it could help identify patterns of waste and fraud and help patients and insurance companies find doctors who deliver the most efficient and highest quality care. But medical groups have successfully fought to keep the payment information secret (Carlson, 6/24).

Kaiser Health News: FAQ: Medicare Beneficiaries May See Increased Access To Physical Therapy Or Some Other Services 
For years, seniors in Medicare have been told that if they don't improve when getting physical therapy or other skilled care, that care won't be paid for. No progress, no Medicare coverage -- unless the problem got worse, in which case the treatment could resume. ... In January, a federal judge approved a settlement in which the government agreed that this "improvement standard" is not necessary to receive coverage (Jaffe, 6/25).

In other Medicare news -- 

ProPublica/NPR: Top Medicare Prescribers Rake In Speaking Fees From Drugmakers
When the blood pressure drug Bystolic hit the market in 2008, it faced a crowded field of cheap generics. So its maker, Forest Laboratories, launched a promotional assault on the group in the best position to determine Bystolic's success: those in control of prescription pads. ... The strategy worked. In the 2012 fiscal year, sales of Bystolic reached $348 million, almost double its total from two years earlier, the company reported. Now, data obtained and analyzed by ProPublica suggest another factor in Bystolic's rapid success: Many of the drug's top prescribers have financial ties to Forest (Ornstein, Weber and Lafleur, 6/25).

MedPage Today: Many Medicare $$$ Go To Preventable Illness
Nearly 80 percent of the roughly $92 billion in acute care Medicare costs in 2010 were racked up by the 10 percent of patients who comprise the high-cost cohort, and 9.6 percent of those costs were for potentially preventable hospitalizations, researchers found. Among Medicare patients who fell short of the highest expenditures, 16.8 percent of costs were spent on preventable hospitalizations, Karen Joynt, MD, of Brigham and Women's Hospital in Boston, and colleagues wrote online in the Journal of the American Medical Association (Petrochko, 6/24).

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