Bypassing politics, insurers pay for end of life talks

Sep 3 2014

These doctor-patient conversations had been labeled "death panels" by opponents of the Affordable Care Act. Meanwhile, in a bid to reduce backlogs, Medicare offers a deal to hospitals to pay 68 percent of short-term stay medical claims that were rejected by outside auditors.

The New York Times: End-Of-Life Talks May Finally Overcome Politics
Five years after it exploded into a political conflagration over "death panels," the issue of paying doctors to talk to patients about end-of-life care is making a comeback, and such sessions may be covered for the 50 million Americans on Medicare as early as next year. Bypassing the political process, private insurers have begun reimbursing doctors for these "advance care planning" conversations as interest in them rises along with the number of aging Americans (Belluck, 8/29).

The New York Times: Medicare Will Settle Short-Term Care Bills
Sharply criticized by Congress and others, Medicare quietly announced on Friday that it would settle hundreds of thousands of hospital appeals over bills for short-term care, by offering deals that could add up to several hundred million dollars (Abelson, 8/29).

Modern Healthcare: CMS Offers Holiday Sale On Audit Appeals
In a pre-Labor Day weekend bid to lower its backlog of contentious payment disputes, the CMS late Friday offered to pay hospitals 68 percent of all medical claims appealed by the service providers after having been rejected by outside auditors (8/30).

And some treatments continue to get scrutiny -

Kansas Health Institute: Physician Payment Data Put Costly Eye Treatments Under The Microscope
To [retina specialist Dr. Ajay] Singh, drugs like Lucentis represent the biggest breakthrough in ophthalmology since the advent of safe cataract surgery three or four decades ago. … But the therapeutic benefits of the drugs have, to a certain extent, been clouded by a long-running debate about the cost effectiveness of Lucentis in comparison with a closely related drug called Avastin. Genentech, a biotechnology company based in San Francisco, manufactures both. At stake are potential savings to Medicare (Sherry, 9/1).