Saturday, December 21, 2013

Family Medicine: Odds and Ends December 2013

Various items from various readings and comments on medical sites by various physicians:
1.  Comment on Medscape Cardiology in response to the megavitamin study--Isn't it about time that we also gave up on the ridiculous practice of prescribing statins for elevated cholesterol?  Staitins (sic) have not been determined to prevent heart disease, heart attacks or strokes.  You can read that same sentence in every ad for any statin drug.  Yet, these "wonder-drugs" sell billions of dollars each year and do absolutely nothing to affect mortality or morbidity.  Once again, why we are 5% of the world's population, yet we take close to 70% of the world's prescription meds.  We are #1 in healthcare spending and #24 in overall health.

Please, quit acting like US Medicine has a corner on the market of science.  If it weren't for the placebo effect most drugs would not reach the threshold for clinically significant findings.  What about the CHADS II study - Relative Risk reduction of 43% - great!!!  Absolute Risk Reduction of .02% - abysmal!!  (Keep taking those incredibly effective blood thinners that can't stand up to a double-blinded, randomized, controlled trial).

2.  The OAFP received the following status update on retroactive payment of enhanced Medicaid primary care physician rates. The information from Medicaid was received on December 19, 2013.

All enhanced payments from January 1, 2013, through the end of June 2013 were withheld due to a need for verification of attestation to ensure proper enrollment by physicians. Over the course of the summer, the Ohio Department of Medicaid and contractors took several steps to allow as many appropriate physicians and other providers as possible to receive the enhanced payment. By August, Medicaid had added several vaccine administration codes to the formula for calculating the 60% claims threshold; this allowed even more physicians to be eligible for the enhanced rates. August 16, 2013, was the final date for physicians to qualify for retroactive payments back to January 1, 2013. Any physicians who were approved for self-attestation after that will have the date of their self-attestation as an effective date for their enhanced payments. Through all of this, Medicaid has worked diligently to maintain a current list of approved providers, a complete list of which will be posted by the end of the calendar year (2013).

Payment of these enhanced rates will be distributed differently depending on whether the payment is from a managed care company or directly from Medicaid for fee-for-service. All payments were delayed due to the attestation issues and the retrospective payment methodology. Depending on the venue, payment is intended to occur as follows:

Managed Care Payments
The managed care plans—Americgroup, Buckeye, CareSource, Molina, Paramount, UnitedHealthcare, and WellCare, have received the primary care rate increase (PCRI) payment from Medicaid for the first and second quarters of 2013. Buckeye, CareSource, Molina, Paramount and UnitedHealthcare have also received their PCRI payment for the third quarter of 2013. Amerigroup and WellCare are no longer Ohio providers of Medicaid managed care as of June 30, 2013, and therefore will not receive any additional PCRI payments.

Eligible primary care physicians should expect to receive payments for at least services rendered in the first and second quarters of 2013 by the end of January 2014, depending on the plan. Medicaid will pay the plans for the first quarter (January-March) of calendar year 2014 in January 2014. For the remaining three quarters of 2014, the department will pay the plans the first month of the quarter. These are prospective payments for calendar year 2014. Plans must pay physicians, at minimum, quarterly.

The fee-for-service payments will start going out to eligible primary care physicians after January 1, 2014. Thereafter, payments should occur timely and in synch with regular reimbursements.

SO, the incentive to help primary care physicians survive has been delayed a year so far due to bureaucratic inability to figure our how to do it (it's the law, by the way).  Not a surprise, though.

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