Chest X-rays do not save lives when used to screen for lung cancer, according to a 20-year study reported in the Journal of the National Cancer Institute. Mayo Clinic/NCI researchers found that imaging led to no reduction in mortality, but revealed many "clinically insignificant" tumors, inviting potentially unnecessary treatment.... "California, open your Golden Gate?" Only so we can leave, say physicians. State and county medical societies report a physician exodus, thanks to comparatively low capitation rates and the state's high cost of living. The Census Bureau confirms California dropped from 8th to 12th in the '90s in ratio of doctors to population.... Congress will consider restoring $21 billion in Balanced Budget Act cuts to Medicare providers over five years. Enough? Hospitals seek $25 billion, nursing homes want $17 billion, and health plans say they need $15 billion.... The Health Care Financing Administration will pay Medicare physicians about five percent more in the aggregate next year, thanks to higher reliance on RBRVUs. The upshot: Higher pay for primary care, less for specialties.... Direct-to-consumer pharmaceutical advertising will top $2 billion this year, for the first time, says Scott-Levin, the consulting firm.... Try it: An analysis in the Journal of Health Promotion suggests daily practice of transcendental meditation could prevent illness to the tune of $5 billion a year.
Managed Care’s Top Ten Articles of 2016
There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.
They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?
A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.
More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.