CHICAGO (Reuters)—Medicare enrollees are moving in greater numbers than ever to the program’s managed care option as a way to save money. But the tradeoff is much less ability to use their preferred doctors and hospitals. Seniors can choose between traditional fee-for-service Medicare—which is accepted by most healthcare providers—or a Medicare Advantage plan. The latter…
Search results for: Primary care
Opinion: Adhering to Standards of Care Helps Manage Risk
Medicare and other third-party payers have started predicating reimbursement on adherence to standards of care. Post hoc chart reviews have resulted in substantial take-backs for failure to adhere to those values in cardiology, pulmonology and expanding to other areas. Outpatient medicine is also being subjected to such scrutiny. The question of standards and who sets…
Wise Transitions: Improving Pediatric–Adult Care
Transitions in medical care can be high-risk periods due to the loss of continuity in care and worsening of medical conditions. Approximately one-quarter of the estimated 18 million adolescents aged 18–21 years in the U.S. have chronic conditions, including rheumatic diseases. Interventions in rheumatology practice can improve transition processes. Transition-readiness assessment tools and transition-satisfaction scales are available for use in rheumatology transition processes…
How Rural Rheumatologists Are Coping with Passage of Affordable Care Act, Changes in Reimbursement, Payment Systems
Four years ago, a series of articles in The Rheumatologist talked about the practice of rheumatology in rural settings. Since then, changes have occurred, with the passage of the Affordable Care Act (ACA), differences in reimbursement and the trek toward value-based payment systems. One major concern expressed in the original article was the fact that…
Opinion: Why Rheumatologists Should Adhere to Standard of Care
It is valuable to understand the semantics of consultant comments. A journal article I once read indicated that when a consultant reports having seen a series of individuals with a given problem, it means they have seen two cases. When they report they have experience with a problem, they mean they have seen a (one)…
Pharmaceutical Care Models, Tools for Treating Patients with Rheumatoid Arthritis
Rheumatoid arthritis (RA) can be defined as a chronic autoimmune systemic inflammatory condition characterized by symmetrical polyarthritis. Typically, patients present with pain, stiffness and warmth of the affected joints. The condition can result in extra-articular features, adding to disability, and may eventually lead to premature death, especially if not treated early and appropriately.1,2 Over the…
Improve RA Care with Vitamin D
Background Autoimmune diseases, such as rheumatoid arthritis (RA) and systemic lupus erythematous, occur when the body attacks its own tissue because it cannot differentiate between self and non-self. This is mainly through deregulation of the immune system. Vitamin D has been known to play a critical role in bone mineralization and bone health. Activated vitamin…
Rheumatology Case Report: When Moyamoya Disease Mimicks Primary Central Nervous System Vasculitis
Case report: A 60-year-old Hispanic male with poorly controlled hypertension was sent from the primary care clinic for evaluation of malignant hypertension with a systolic blood pressure above 200 mmHg. His symptoms at the time of presentation included episodic confusion, worsening vision and an unsteady gait. A head computed tomography (CT) scan showed a subacute…
CareFirst Sees More Than Doubled Savings on Shared Rewards with Doctors
(Reuters)—Insurer CareFirst BlueCross BlueShield said on Thursday its cost savings on providing healthcare rose sharply last year in a program that rewards doctors for keeping patients out of the hospital. The non-profit health insurer operates an approach to delivering care that emphasizes coordination among providers, led by a patient’s primary care physician. The model is…
Some Public Hospitals Win, Others Lose with Obamacare
SAN FRANCISCO (Reuters)—A year and a half after the Affordable Care Act brought widespread reforms to the U.S. healthcare system, Chicago’s Cook County Health & Hospitals System has made its first profit in 180 years. Seven hundred miles south, the fortunes of Atlanta’s primary public hospital, Grady Health System, haven’t improved, and it remains as…
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