RESUMEN
OBJECTIVE: The 2013 Physician Payments Sunshine Act mandates that all U.S. drug and device manufacturers disclose payments to physicians. All payments are made available annually in the Open Payments Database (OPD). Our aim was to determine prevalence, magnitude, and nature of these payments to physicians performing neurologic surgery in 2015 and to discuss the role that financial conflicts of interest play in neurosurgery. METHODS: All records of industry financial relationships with physicians identified by the neurological surgery taxonomy code in 2015 were accessed via the OPD. Data were analyzed in terms of type and amounts of payments, companies making payments, and comparison with previous studies. RESULTS: In 2015, 83,690 payments (totaling $99,048,607) were made to 7613 physicians by 330 companies. Of these, 0.01% were >$1 million, and 73.2% were <$100. The mean payment ($13,010) was substantially greater than the median ($114). Royalties and licensing accounted for the largest monetary value of payments (74.2%) but only 1.7% of the total number. Food and beverage payments were the most commonly reported transaction (75%) but accounted for only 2.5% of total reported monetary value. Neurologic surgery had the second highest average total payment per physician of any specialty. CONCLUSIONS: The neurological surgery specialty receives substantial annual payments from industry in the United States. The overall value is driven by a small number of payments of high monetary value. The OPD provides a unique opportunity for increased transparency in industry-physician relationships facilitating disclosure of financial conflicts of interest.
Asunto(s)
Bases de Datos Factuales/estadística & datos numéricos , Revelación/estadística & datos numéricos , Industria Farmacéutica/estadística & datos numéricos , Neurocirujanos/estadística & datos numéricos , Neurocirugia/estadística & datos numéricos , Bases de Datos Factuales/economía , Industria Farmacéutica/economía , Humanos , Medicaid/economía , Medicaid/estadística & datos numéricos , Medicare/economía , Medicare/estadística & datos numéricos , Neurocirujanos/economía , Neurocirugia/economía , Patient Protection and Affordable Care Act/economía , Patient Protection and Affordable Care Act/estadística & datos numéricos , Physician Payment Review Commission/economía , Physician Payment Review Commission/estadística & datos numéricos , Estados Unidos/epidemiologíaRESUMEN
The Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act of 2015 fundamentally changes how physicians who care for Medicare patients will be paid. Although physicians won't see changes in their payments in 2017, they need to understand that their performance in 2017 will be the basis for the payments made to them starting in 2019. This article summarizes the two paths for determining future Medicare payments established by the law: the merit-based incentive payment system and advanced alternative payment models.
Asunto(s)
Medicare Access and CHIP Reauthorization Act of 2015/legislación & jurisprudencia , Medicare/legislación & jurisprudencia , Planes de Incentivos para los Médicos/legislación & jurisprudencia , Physician Payment Review Commission/legislación & jurisprudencia , Mecanismo de Reembolso/legislación & jurisprudencia , Predicción , Medicare/economía , Medicare/tendencias , Medicare Access and CHIP Reauthorization Act of 2015/economía , Medicare Access and CHIP Reauthorization Act of 2015/tendencias , Minnesota , Planes de Incentivos para los Médicos/economía , Planes de Incentivos para los Médicos/tendencias , Physician Payment Review Commission/economía , Physician Payment Review Commission/tendencias , Mecanismo de Reembolso/economía , Mecanismo de Reembolso/tendencias , Estados UnidosAsunto(s)
Planes de Aranceles por Servicios/economía , Physician Payment Review Commission/economía , Planes de Aranceles por Servicios/tendencias , Gastos en Salud/tendencias , Humanos , Physician Payment Review Commission/tendencias , Mecanismo de Reembolso/economía , Mecanismo de Reembolso/tendencias , Estados UnidosAsunto(s)
Costos de la Atención en Salud/normas , Medicare/normas , Physician Payment Review Commission/normas , Médicos/normas , Calidad de la Atención de Salud/normas , Gastos en Salud/normas , Humanos , Medicare/economía , Physician Payment Review Commission/economía , Médicos/economía , Calidad de la Atención de Salud/economía , Estados UnidosAsunto(s)
Planes de Aranceles por Servicios/normas , Directrices para la Planificación en Salud , Paquetes de Atención al Paciente/normas , Physician Payment Review Commission/normas , Planes de Aranceles por Servicios/economía , Humanos , Paquetes de Atención al Paciente/economía , Physician Payment Review Commission/economía , Medición de Riesgo/economía , Medición de Riesgo/normas , Estados UnidosRESUMEN
It is widely held that fee-for-service (FFS) payment systems reward volume and intensity of services, contributing to overall cost inflation, while doing little to reward quality, efficiency, or care coordination. Recently, The National Commission on Physician Payment Reform (sponsored by SGIM) has recommended that payers "should largely eliminate stand-alone fee-for-service payment to medical practices because of its inherent inefficiencies and problematic financial incentives." As the current and former Chief Medical Officers of a large national insurer, we agree that payment reform is a critical component of health care modernization. But calls to transform payment simultaneously go too far, and don't go far enough. Based on our experience, we believe there are several critical ingredients that are either missing or under-emphasized in most payment reform proposals, including: health care is local so no one size fits all; upgrading performance measures; monitoring/overcoming unintended consequences; using a full toolbox to achieve transformation; and ensuring that the necessary components for successful delivery reform are in place. Thinking holistically and remembering that healthcare is a complex adaptive system are crucial to achieving better results for patients and the health system.
Asunto(s)
Planes de Aranceles por Servicios/tendencias , Política de Salud/tendencias , Physician Payment Review Commission/tendencias , Médicos/tendencias , Planes de Aranceles por Servicios/economía , Planes de Aranceles por Servicios/normas , Humanos , Physician Payment Review Commission/economía , Physician Payment Review Commission/normas , Médicos/economía , Médicos/normas , Estados UnidosAsunto(s)
Honorarios Médicos/legislación & jurisprudencia , Honorarios Médicos/tendencias , Medicare Assignment/economía , Medicare Assignment/legislación & jurisprudencia , Medicare Assignment/tendencias , Medicare/economía , Medicare/tendencias , Physician Payment Review Commission/economía , Physician Payment Review Commission/tendencias , Control de Costos/economía , Control de Costos/legislación & jurisprudencia , Humanos , Rol del Médico , Estados UnidosAsunto(s)
Medicare/legislación & jurisprudencia , Physician Payment Review Commission/legislación & jurisprudencia , Comités Consultivos/legislación & jurisprudencia , Control de Costos/legislación & jurisprudencia , Control de Costos/métodos , Humanos , Medicare/economía , Physician Payment Review Commission/economía , Política , Estados UnidosRESUMEN
BACKGROUND: Health care is a highly regulated industry and interventional pain physicians (IPPs) are right in the government's bull's eye. Over the next few years, IPPs will find themselves responding to audit requests from Medicare. An IPP's response to a Medicare record request should be tailored specifically to the type of request and the specific circumstances of the IPP. With so much at stake, IPPs should not underestimate the importance of an immediate and thoughtful response. OBJECTIVES: This article discusses 1) the various types of record requests used by Medicare, 2) the practical steps an IPP should take in response to a record request, 3) the Medicare appeals process, and, 4) the practical steps an IPP should take in connection with the appeals process. DISCUSSION: IPPs should maintain an effective compliance program and ensure that medical records are appropriately documented before any audit takes place. If a Medicare audit decision is unfavorable, IPPs should understand the available appeals process and the steps that need to be taken to win the appeal. CONCLUSION: With advance preparation and a considered response, IPPs can positively influence the outcome of a Medicare audit.
Asunto(s)
Auditoría Médica/legislación & jurisprudencia , Medicare/legislación & jurisprudencia , Neurología/legislación & jurisprudencia , Manejo del Dolor , Physician Payment Review Commission/legislación & jurisprudencia , Pautas de la Práctica en Medicina/legislación & jurisprudencia , Analgesia/economía , Analgesia/normas , Adhesión a Directriz , Humanos , Auditoría Médica/economía , Auditoría Médica/normas , Medicare/economía , Medicare/normas , Neurología/economía , Neurología/normas , Dolor/diagnóstico , Dolor/economía , Physician Payment Review Commission/economía , Physician Payment Review Commission/normas , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/normas , Estados UnidosAsunto(s)
Educación de Postgrado en Medicina/economía , Geriatría/educación , Política de Salud/economía , Medicare/legislación & jurisprudencia , Apoyo a la Formación Profesional/legislación & jurisprudencia , Educación de Postgrado en Medicina/legislación & jurisprudencia , Educación de Postgrado en Medicina/tendencias , Geriatría/legislación & jurisprudencia , Geriatría/tendencias , Política de Salud/legislación & jurisprudencia , Política de Salud/tendencias , Humanos , Medicare/tendencias , Physician Payment Review Commission/economía , Physician Payment Review Commission/legislación & jurisprudencia , Physician Payment Review Commission/tendencias , Política , Apoyo a la Formación Profesional/tendencias , Estados UnidosRESUMEN
The use of specialty differentials in the newly adopted Medicare fee schedule has been debated over the past 2 years. Arguments supporting the elimination of specialty differentials for optometrists and ophthalmologists are presented. The first recommendations by the Physician Payment Review Commission eliminating specialty differentials represent a victory for optometry in its efforts to achieve parity in the reimbursement of Medicare-covered services. Relative value units and practice costs to be used by the new Medicare fee schedule must be determined for optometry. Estimates of the model fee schedules for eye care procedures have been released by the Department of Health and Human Services.