Medicare Fraud and its Implications

This week, dozens of indviduals were arrested for Medicare fraud totaling $251 million.

Ending Medicare Fraud is a top priority for the government and a critical component to paying for healthcare reform. The far reaching impact of this fraud (across five states) should have Hospitals on high alert. Patient Access leaders need to continue their efforts to ensure Medicare compliance i.e., accurate screening processes for eligibility, secondary payer, and medical necessity.

To read the full article in The New York Times, click the link below.

http://www.nytimes.com/2010/07/17/us/17fraud.html

Study Highlights Primary Care Shortage

A George Washington University study shows that medical schools are continuing to produce more graduates going into research and specialty professions and not enough primary care doctors. The study also found that graduates of public medical schools were more likely to promote a "social mission," encouraging graduates to go into primary care, especially in underserved communities.

Many analysts believe that the continued shortage of graduates entering the primary care field is due to the low reimbursement rate. After graduating with massive debt, graduates are hesitant to select a field that pays an average of $124,000 a year, the lowest rate among physician specialties.

The new health reform law sets aside $1.5 billion in funding for primary care physicians who work in underserved areas. Some hospitals are also working to attract physicians into primary care, fearing that without first-line care, patients will flood their emergency rooms with minor and preventable conditions. This study and others that have been released, continue to serve as indicators that improvments to the delivery of care are needed to support an increased patient population.

The full George Washington study can be found here:http://www.annals.org/content/152/12/804.full?aimhp