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Prices of certain drugs continue to spiral out of control as alternatives are sought. ol·i·gop·o·ly (äləˈɡäpəlē), noun: a state of limited competition, in which a market is shared by a small number of producers or sellers. I have been looking at data from the Centers for Medicare & Medicaid Services…
There are winners and losers in the recently posted proposed rule. Weighing in at 1,824 pages, the Inpatient Prospective Payment System (IPPS) proposed rule for the 2020 fiscal year had something for everyone – and, in some cases, nothing at all. To the latter point, there’s no doubt that Ronald…
A complex process is simplified in a tabular comparison. Not infrequently, in the process of utilization review (UR), we run into situations in which, as physician advisors, we get to review Medicare cases that do not match their original “label” (i.e. the initial status selection was likely not a proper…
Assigning status to likely terminal patients. I received a great question last week and thought I’d share it with you, our readers. This case management manager wanted to know how to determine status for a patient who came into the ED and was deemed unlikely to live past 24 hours.…
CMS pledging improved healthcare quality and expanded access for patients. The release of the Inpatient Prospective Payment System (IPPS) proposed rule for the 2020 fiscal year came with a bit of branding. “Rethinking Rural Health” and “Unleashing Innovations” were the two catchy slogans unveiled by the Centers for Medicare &…
Surgery has a long history. Even as long ago as in ancient Egypt, we have found remains showing evidence of trephination, the boring of a hole in the skull for brain surgery. More than a century of experimentation in repairing the intestines without causing sepsis eventually was solved with a…
The subtle distinctions of obstruction and witness tampering. The Mueller report’s discussion of obstruction of justice and witness tampering provides an excellent opportunity to consider how the instinct to say “don’t talk to the government” can prompt prosecution. (For those who enjoy reading legal analysis, the report has a lengthy…
The search for a solution might begin with CMS. We have a problem in America. We spend way too much money on healthcare, and the outcomes we do get are not great. I am pretty darn tired of hearing about the move from volume to value. Do you know what…