Medicare roundup: Alabama pain clinic spending 'hotspot'; quality improvement program scrutinized

May 13 2014

Also, the controversy about paying for a hepatitis-C cure and reinstating physicians who lost their licenses. 

The Hill:  CMS Moves To Improve Medicare Quality Of Care
The Centers for Medicare and Medicaid Services has tapped two contractors to oversee a top program aimed at improving the quality of care for Medicare recipients. The agency said Friday it has hired Maryland-based Livanta and Ohio-based KePRO to oversee its Quality Improvement Organization (QIO) program.  The program enlists private companies to review medical care, improve services and help Medicare beneficiaries with complaints. It is intended to keep down costs, while providing a national network of providers who can improve healthcare services (Al-Faruque, 5/9).  

The Washington Post: Pain And Gain: An Alabama Clinic Stands Out Amid Data On Medicare Payments
Afflicted by pain from spinal injuries, botched surgeries or rare nerve conditions, patients from Tennessee, Georgia and Florida have flocked across state lines to see K. Dean Willis, a tanned anesthesiologist with salt-and-pepper hair who says he is among the top 30 experts on the use of pain pumps. ... Although some experts consider the implanted pain pump to be an unusual and controversial last resort of pain management, it has become a signature treatment at the Alabama Pain Center. ... For the first time, newly released Medicare data has identified the costs associated with specific doctors performing procedures or administering drugs. The data allows for the identification of "hotspots" for particular treatments (Brittain, Fallis and Keating, 5/10). 

BloombergBusinessweek: Doctors Banned From Medicare May Get an Easier Shot at a Second Chance
Medicare's chief watchdog plans to make it easier for doctors who have lost their licenses and gotten new ones to resume billing the program. Under a proposal published on Friday, authorities would have more latitude to reinstate doctors and other professionals banned from Medicare after they've been punished by states for misconduct. The planned change comes even as new Medicare data shows that the federal health program for older Americans pays millions of dollars to doctors whose licenses were revoked but who managed to keep practicing by getting licenses in other states (Tozzi, 5/9).

Kaiser Health News: Medicare Struggling With Hepatitis-C Cure Costs
Previous drug treatments didn't clear the virus from [Walter] Bianco's system. But it's almost certain that potent new drugs for hep-C could cure him. However, the private insurer that handles his medication coverage for the federal Medicare program has twice refused to pay for the drugs his doctor has prescribed (Knox, 5/12).