Cancer Therapy Advisor: The Unexpected Costs of Cancer Treatment: Out-of-Network Billing

By | In the News

“Beyond oncology, cancer patients often interact with specialists that have high rates of out-of-network billing, such as anesthesiologists, pathologists, radiologists, and assistant surgeons. “All of these specialties are generally specialties that the patients don’t choose,” said Nathan Shekita, an MBA/MPH candidate at Yale University in New Haven, Connecticut, in an interview with Cancer Therapy Advisor. These specialists often work at facilities that are otherwise in network, so patients have no reason to suspect they’ll be treated by an out-of-network provider. In a recent Health Affairs study, Shekita and coauthors reported that at hospitals in 1 insurer’s network, claims from the aforementioned 4 specialties…

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Modern Healthcare: Joint Replacement Bundled Payments Losing Their Appeal In BPCI Advanced

By | In the News

“Analyses of CMS data on Medicare’s largest bundled-payment demonstration suggest providers may have reached the limit of their ability to streamline joint replacement procedures. While the joint replacement bundle for hips and knees has been one of the most popular of Medicare’s Bundled Payment for Care Improvement Advanced program, providers are shifting to bundles for medical and chronic conditions like sepsis and chronic obstructive pulmonary disease. On total joints, participants already may have done all they could to make care more cost-effective by reducing use of post-acute skilled nursing care, said Dr. Amol Navathe, assistant professor of health policy at University of…

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Philly Inquirer: Why The Emergency Room Is Always Crowded And What We Can Do About It | Opinion

By | In the News

“For decades ever more patients have been arriving at emergency departments (EDs). As concern has mounted, and emergency department crowding – most evident in wait times – has increased, fingers have been pointed. Health systems, politicians and researchers have blamed the decline of primary care, “inappropriate” use of the ED, a fragmented health system, and more recently, social determinants of health. The solutions offered follow from these diagnoses. Improve primary care access, encourage patients and their doctors to use more primary care, penalize patients who are deemed retrospectively by simple algorithms to have used the ED inappropriately, improve care coordination,…

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Modern Healthcare: Bundles Cut Spending On Joint Replacements, But Not For Other Conditions

By | In the News

“Medicare’s voluntary bundled-payment program for hip and knee replacements reduced spending by 1.6% from 2013 to 2016 — less than previously estimated — with no overall change in quality, according to a new study in Health Affairs. Another new Health Affairs study reported that lower extremity joint replacement is the only type of clinical episode in Medicare bundled-payment programs that has produced savings so far. The meta-analysis found no evidence of reduced spending or quality improvement for other clinical episodes. The two studies highlight the challenges facing federal policymakers, hospitals and physicians in using bundled payments to achieve cost savings and…

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