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Geisinger Demonstrates Improved Quality, Shares In Medicare Cost Savings

Geisinger has been recognized again for improving the quality of care while decreasing healthcare costs in the third year of a five-year Center for Medicare & Medicaid Services (CMS) demonstration project. Medicare beneficiaries who receive most of their care in the Geisinger Health System, which includes 40 community practice sites in central and northeast Pennsylvania, experienced improved quality of care at a lower cost to the federal Medicare program as compared to Medicare beneficiaries receiving their care in the same geographic region from other providers. CMS, part of the U.S. Department of Health and Human Services, launched the Physician Group Practice (PGP) Demonstration to allow physician groups to prove that providing proactive, coordinated care can also save money.

NY Inspector General Cracks Down On Medicaid Abuse

New York State Medicaid Inspector General wants increased penalties for doctors, pharmacists, nursing homes and others that bill the state for services to people who have died. Crain's New York Business reports: "In a sweeping plan to further crack down on Medicaid fraud and billing improprieties, New York state Medicaid Inspector General James Sheehan announced a plan this week to increase the penalties for billing Medicaid for services for patients who have died. In addition to fining the parties responsible and making them pay back the money, Mr. Sheehan said, he will begin posting culprits' names on his office's Web site. Earlier this month, OMIG found that a Miller Place, Long Island pharmacy had billed Medicaid $28, 000 for prescriptions for 17 deceased customers.

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AMCP Urges Academy Members To Contact Members Of Congress Regarding Proposal To Change Medicare Part D

The House Energy and Commerce Committee's version of H.R. 3200 "America's Affordable Health Choices Act" includes a provision that would require the federal government, rather than Medicare Part D plan sponsors, to negotiate prescription drug prices in the Part D program. If adopted, the provision would remove the responsibility that Part D plan sponsors currently have to negotiate drug prices and fundamentally undermine one of the plans' principal tools that allows them to design a meaningful and affordable drug benefit for seniors. The Academy is urging all members to immediately contact their lawmakers and ask them to oppose the inclusion of this provision in the final health care reform legislative package.

State Round-Up: Colorado's Medicaid Woes, Utah's Health Exchange, And More

Thursday's state news includes concerns over Medicaid reimbursement cuts in Colorado, the opening of the Utah Health Exchange amidst skyrocketing premiums and the high number of uninsured in Texas. Denver Business Journal : "Concerns are arising over whether cuts to the Medicaid reimbursement rate in Colorado will drive some medical providers to stop accepting low-income patients. Gov. Bill Ritter announced Tuesday that he will reduce such rates by 1.5 percent for medical providers and 2.5 percent for providers of behavioral-health and developmental-disability services to help close a $318 million budget shortfall" (Sealover, 8/19). The Denver Post adds that "Advocates for the homeless, indigent and uninsured say that while deep budget cuts will affect all Coloradans, the poorest will feel the sharpest pain.

Delay In Appointing Medicare Chief Baffles Lawmakers

To the puzzlement of Congress and health care experts around the country, Mr. Obama has not named anyone to lead the Centers for Medicare and Medicaid Services, " The New York Times reports. CMS provides "health insurance to 98 million people, pays 1.2 billion claims a year and has an annual budget of more than $700 billion. It has a pervasive influence on medical care, regulating hospitals, doctors, health plans, laboratories and almost every other type of health care provider. When Medicare decides to cover a new treatment or adopts a new payment policy, private insurers often follow its lead." The agency has been without "a regular Senate-confirmed administrator since October 2006, when Dr.

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Endocrine Society Calls For Medicare Coverage Of DXA Bone Density Testing To Be Extended To Men With Testosterone Deficiency

Hypogonadism, also known as testosterone deficiency, affects 4-5 million men in the United States placing them at risk for developing osteoporosis. Despite the clear association of testosterone deficiency with low bone density and osteoporosis, Medicare does not provide coverage for bone density testing for these individuals. To address this concern, today The Endocrine Society issued a Position Statement, endorsed by the National Osteoporosis Foundation, calling for Medicare coverage of bone density testing to be extended to this at-risk population. Bone mineral density, measured by dual energy x-ray absorptiometry (DXA), is an excellent predictor of the risk of fractures in both men and women.

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