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Survey of healthcare billers finds Medicare remarkably popular

medicare

The market-research firm Peer60 surveyed nearly 800 ambulatory-care leaders (36.8 percent of whom were physicians;  participants also included practice administrators and financial and nurse leaders) on which insurer they liked the  most.  Peer60 found that Medicare was surprisingly popular.

To the surprise of everyone, Medicare—allegedly “slow, inefficient, broken and inflexible,” ranked number two (with 16 percent of the vote), behind Blue Cross Blue Shield, which ranked first, at 22 percent, and way ahead of (UHC), which ranked a distant third, at 9 percent.

The study said that survey respondents  cited Medicare’s  fast reimbursement, efficient precertification, low staff time required to file claims, ease of negotiating with, low amount paperwork required,  fewest denied claims and the best customer service.

To read an article on this, please hit this link.

 


Feds keep trying to lower hospital-merger wave

 

tidalwave

The Federal Trade Commission plans to block the combination of two large Illinois hospital groups,  showing that the FTC and other agencies are  increasingly concerned about the ability of very big health systems to dramatically raise prices through their domination of their markets.

Recent studies that have shown the ability and indeed enthusiasm of big hospital systems for raising  prices much more than smaller systems or freestanding hospitals have added fuel to the regulatory fire.

The FTC said  that the  proposed merger of Advocate Health Care, Illinois’s state’s largest health system, and NorthShore University HealthSystem, could create a 16-hospital behemoth that would dominate the  affluent North Shore area of Chicago.

Deborah L. Feinstein, director of the agency’s Bureau of Competition, asserted that the proposed merger would probably significantly increase the combined system’s bargaining power with health-insurance plans, “which in turn will harm consumers by bringing about higher prices and lower quality.”
The hospital groups say they plan to fight the government’s move, citing the effects of the Affordable Care Act in encouraging  coordinating services and technology.

Besides the Illinois case, the FTC just in the past three weeks has moved halt the merger of two hospitals in West Virginia and joined with Pennsylvania authorities to try to stop an agreement between Penn State Hershey Medical Center and PinnacleHealth System.

The New York Times reported that James H. Skogsbergh, Advocate’s chief executive, defended the merger plan as “good for consumers and very pro-competitive.”  asserting that because the hospitals’ market was dominated by a major insurer, — Blue Cross Blue Shield —  the systems were “price takers, not price setters.”

 


Insurers must provide solid data for value-based model

 

As the Centers for Medicare & Medicaid Services accelerates the move  toward  a value-based payment model, its efforts depend upon receiving rigorously collected data from health insurers to improve care delivery, says CMS Acting Administrator Andy Slavitt, reports Health Data Management.

He emphasized that  payers should support providers in improving the entirety of their practices, or delivery-system reform won’t work.

Note that Blue Cross Blue Shield has launched a massive database to make information on healthcare quality and cost available to employers, members and provider partners.

Commercial health plans in the Affordable Care Act marketplace and in Medicare will be required to make data  for providers and patients available in machine-readable form.


AMA denounces insurance firms’ merger plans

 

Goya Giant I

One of Goya’s “Titan” paintings.

Two proposed mergers of U.S. health insurers  would hurt competition in the  health-insurance sector,  the American Medical Association, the  largest U.S. group representing physicians, said.

The AMA denounced Aetna’s plan to buy Humana and Anthem’s plan to buy Cigna as anti-competitive. Many physicians worry that the new, even bigger insurance companies that would be formed by these mergers would have the ability to force down U.S. physicians’ compensation — the  world’s highest compensation by far for doctors.

The insurers, for their part, assert that  that the deals would let them offer  cheaper insurance by using their increased size to negotiate better prices with physicians and hospitals.

The AMA said that the Anthem-Cigna behemoth  would increase market power in 13 states where the behemoth would sell individual insurance plans and competition would decrease in all 14 states where Anthem currently operates Blue Cross Blue Shield plans.

The Aetna-Humana combination, the AMA said, would raise anti-competitive issues in 14 states overall.

The American Hospital Association recently said that its analysis of the deals found that they would cut competition.


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