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Boston Globe
a day ago
- Health
- Boston Globe
An attack on the medical establishment buried in an 1,800-page regulation
Medicare officials have been loath to change it because it has spared them from needing their own staff and budget to make such pricing decisions, along with the unpleasant politics of adjudicating conflicts between competing groups of physicians. But a change buried inside a 1,803-page proposed regulation published last Monday suggests the Trump administration would like to move away from this longstanding system. If finalized, it could begin overturning a process that has entrenched pay advantages for certain kinds of doctors. Get Starting Point A guide through the most important stories of the morning, delivered Monday through Friday. Enter Email Sign Up 'We're modernizing Medicare by correcting outdated assumptions in how physician services are valued,' said Chris Klomp, a deputy administrator of the Centers for Medicare and Medicaid Services, in an email. Advertisement Robert F. Kennedy Jr., the secretary of health and human services, has emphasized that medicine should focus more on primary care and prevention, and less on the treatment of advanced diseases. He has also crusaded against 'corporate medicine,' and has specifically criticized the American Medical Association. Stat News reported in November that Kennedy was considering policies to disempower the AMA committee. Advertisement Dr. Bobby Mukkamala, the AMA's president, was highly critical of the proposed change. 'The American Medical Association believes that proposals to exclude or limit the input of expert practicing physicians and health care professionals in the development of Medicare payment policy would ultimately harm patients and represents a radical departure from the time-tested CMS decision-making process,' he said in a statement. The current AMA committee, known as the RUC, uses data gathered in surveys of doctors to set formulas for every kind of medical care. The committee suggests payment rates to Medicare's regulators, who almost always adopt them. The system is effectively zero-sum — any increases for one kind of doctor represents decreases for others. While private insurers are free to develop their own formulas for paying doctors, they tend to follow Medicare's lead, making the committee very influential on what kinds of medical care get the largest (and smallest) financial rewards. The estimates are often outdated. Existing payments are reviewed on average only once every 17 years. A Washington Post investigation in 2013 reported on numerous gastroenterologists who had billed Medicare for more than 24 hours' worth of colonoscopies a day. The reason wasn't fraud. Medicare was still paying the doctors as if each test took 75 minutes to complete, when most doctors were able to complete one in 30 minutes. (The colonoscopy payment has since been adjusted.) Under the new proposal, Medicare would pay 2.5 percent less for every procedure, operation and medical test in 2026, based on data suggesting there have been improvements in 'efficiency' over the years. Payments for treatments based only on time, like a consultation with a family physician or neurologist, would not be cut. Such adjustments would be repeated every three years. Advertisement The proposal also looks to change the kind of data Medicare should consider instead of the relatively small surveys, noting that new sources of health data from hospitals and electronic billing systems could offer more accurate information. The effort to adjust what doctors are paid for their work is just one part of the large rule, which also contains provisions to broaden coverage for telemedicine, pay for more mental health care, and reduce overpayments for a new and expensive type of skin bandage. One other provision, meant to better account for the costs of running a medical practice, also affects the relative pay of different medical specialists. In some cases, those changes would reduce payments to the types of medical specialists whom the efficiency adjustments are meant to benefit. That policy would adjust payments to doctors based on whether they offer services on a hospital campus or in a private practice office, effectively lowering payments in the hospital and boosting those elsewhere. Taken together, the overall proposal would do more than just increase the salaries of primary care doctors. It would also increase the average pay of an allergist next year by 7 percent, and decrease pay for a neurosurgeon by 5 percent, according to estimates published by Medicare. It would lower pay by 6 percent for infectious disease specialists, who tend to earn low salaries and perform few procedures -- and increase average pay for vascular surgeons by 5 percent. Dr. Adam Bruggeman, a spine surgeon in San Antonio who leads the council on advocacy for the American Academy of Orthopaedic Surgeons, said he was sympathetic to arguments that the current system may be paying for some medical procedures inaccurately. But he said the proposal — which would cut payments for all procedures next year — was too crude a solution to that problem. He described the 'efficiency' changes as 'taking an ax to the whole thing.' Advertisement 'We're just fighting an arbitrary number with another arbitrary number, and that doesn't help,' he said. This article originally appeared in
New York Times
a day ago
- Health
- New York Times
An Attack on the Medical Establishment Buried in a 1,800-Page Regulation
For decades, the prices Medicare pays doctors for different medical services have been largely decided not by Medicare itself, but by a powerful industry group, the American Medical Association. An committee meets in secret to determine the difficulty and time demands of each type of medical visit, test and procedure, and then recommends to Medicare how much doctors should be paid for performing them. And for decades, critics have complained that this process unfairly rewards surgeons and other specialists, at the expense of primary care physicians and other generalists. Medicare officials have been loath to change it because it has spared them from needing their own staff and budget to make such pricing decisions, along with the unpleasant politics of adjudicating conflicts between competing groups of physicians. But a change buried inside a 1,803-page proposed regulation published last Monday suggests the Trump administration would like to move away from this longstanding system. If finalized, it could begin overturning a process that has entrenched pay advantages for certain kinds of doctors. 'We're modernizing Medicare by correcting outdated assumptions in how physician services are valued,' said Chris Klomp, a deputy administrator of the Centers for Medicare and Medicaid Services, in an email. Want all of The Times? Subscribe.
Scottish Sun
3 days ago
- Sport
- Scottish Sun
‘I got that one wrong' – Eni Aluko opens up on Ian Wright row and Match of the Day legend's refusal to accept apology
IN WRIGHTING 'I got that one wrong' – Eni Aluko opens up on Ian Wright row and Match of the Day legend's refusal to accept apology ENI ALUKO admits she was "wrong" to suggest Ian Wright has blocked opportunities for female pundits and "respects" his decision not to accept her public apology. Aluko, 38, and Wright, 61, were caught in a storm back in April when the former Lioness insinuated the Arsenal legend is getting in the way in women's football. Advertisement 2 Ani Aluko admits she was 'wrong' to suggest Ian Wright has blocked opportunities for female pundits Credit: Matthew Ashton - AMA/Getty Images 2 Aluko 'respects' Wright's decision not to accept her public apology Credit: MI News/NurPhoto/Shutterstock (15306837cf The ex-Chelsea ace spoke about the importance of making sure female pundits were not blocked by men, suggesting there is a finite amount of opportunities and men need to be aware of that. Aluko told Radio Four's Women's Hour three months ago: "I've worked with Ian a long time and, you know, I think he's a brilliant broadcaster. "But I think he's aware of just how much he's doing in the women's game. I think he should be aware of that. "We need to be conscious and we need to make sure that women are not being blocked from having a pathway into broadcasting in the women's game." Advertisement Read More on Football OUT OF THE BLUE Sterling in limbo at Chelsea as fees Blues expect for outcasts revealed Aluko has since apologised to Wright after public backlash, but the Match of the Day legend was left "very disappointed" and is unable to accept. Now the former Juventus ace has held her hands up and conceded she could have handled the whole situation in a better manner. Aluko told The Mirror: "I think I could have done better in responding to the question I was asked, and just keeping it as a general issue. "I've always been the person, to be honest, to hold my hands up and say: 'Listen, I got that one wrong. That was, that was a mistake'. If I had been on the other end, I would probably have felt the same. Advertisement CASINO SPECIAL - BEST CASINO BONUSES FROM £10 DEPOSITS "Apologies are acts of respect. Apologies are a show of humility. I did a lot to try to apologise to Ian privately. "So when you're seeing a public apology, it's actually the last resort. But it was a public forum that I spoke about him on, and I felt a public apology was important. Ian Wright says he 'cannot accept' Eni Aluko's apology as Arsenal legend responds over women's football punditry row "I respect that [Wright's refusal to accept her apology]. I respect how he feels. It's really about my apology. That's all I can do. Advertisement "Then, whenever the person's ready to have a conversation, I'm ready to have a conversation. But I respect if it's not the right time, I totally respect that." Aluko has since returned to punditry as she covers this summer's Women's European Championships.
CTV News
5 days ago
- Business
- CTV News
Unions dominated Alberta political donations in past decade
Over the last decade, Albertans, corporations and unions made 97,275 donations totalling $90.9 million to provincial political parties, candidates and third-party advertisers. (Photographer: Brent Lewin/Bloomberg) Between 2015 and 2024, Albertans, corporations and unions made 97,275 donations totalling $90.9 million to provincial political parties, candidates and third-party advertisers. Here's a breakdown of the biggest spenders and beneficiaries. Edmonton and Calgary led the province in donations, contributing 37 per cent and 30 per cent of the total dollar amount, respectively. Though corporations and unions were prohibited from making contributions directly to parties or candidates midway through 2015, they still outspent most individual donors through their funding of third-party advertisers and accounted for 18 of the top 20 largest donors of the last decade. For the top five donors, nearly all of the funds were transferred from unions and professional associations to their own registered political entities. The single largest donor of the last decade was the Health Sciences Association of Alberta (HSAA), which gave over $6 million. The majority of the HSAA's cash, 92 per cent, was gifted from the union to its registered third-party advertiser. All of the Alberta Medical Association's (AMA) $1.8 million in donations went to the AMA third-party. Top 10 political donors in Alberta overall HSAA - $6.1 million AMA - $1.8 million Alberta Teachers' Association - $1.1 million United Nurses of Alberta - $998,103 National Police Federation - $ 709,759 UFCW Local 401 - $686,237 Merit Contractors Association - $466,249 Alberta Civil Trial Lawyers Association - $381,572 Association of Academic Staff of the University of Alberta - $221,229 Stanley Milner - $207,408 Milner, a prominent figure in Alberta's energy sector, died in 2021 , but still holds the top spot for individual donors in the last decade, giving more than twice that of the second highest contributor, Tourmaline Oil Corp. CEO Mike Rose . The top 10 individual donors were split evenly between Edmonton and Calgary. Edmonton Stanley Milner - $207,408 AAFund - $63,808; Alberta Advantage Fund - $75,000; Progressive Conservative Association of Alberta - $34,000; Shaping Alberta's Future - $25,000; United Conservative Party - $8,600; Edmonton-Calder PC Association - $1,000. Mary Katherine Williams - $41,442 Alberta NDP Lorne Dach - $40,679 Alberta NDP Christina Gray - $38,662 Alberta NDP David Eggen - $38,390 Alberta NDP Calgary Mike Rose - $100,000 AAFund - $50,000; Alberta Advantage Fund - $50,000 Patricia Cartwright - $52,186 Alberta Liberal Party Ian Cartwright - $48,485 Alberta Liberal Party Gordon Arnell - $47,050 Wildrose Party - $45,200; Pro-Life Alberta Political Association - $850; UCP - $1,000 Brad Shaw - $42,243 Alberta Advantage Fund - $30,000; UCP - $12,243 Brett McKay, Local Journalism Initiative Reporter, Investigative Journalism Foundation
Indian Express
5 days ago
- Business
- Indian Express
Coca-Cola refutes Trump's sugar claim, backs corn syrup as ‘safe'
The Coca-Cola Company has defended its continued use of high-fructose corn syrup (HFCS) in its US beverages, responding to Donald Trump's claim that he had persuaded the brand to switch to using real cane sugar instead. 'I have been speaking to Coca-Cola about using REAL Cane Sugar in Coke in the United States, and they have agreed to do so,' Trump said in a Truth Social post late Tuesday. 'I'd like to thank all of those in authority at Coca-Cola. This will be a very good move by them — You'll see. It's just better!' Coca-Cola initially issued a polite statement thanking 'President Trump's enthusiasm' for the brand, saying it looked forward to 'new innovative offerings within our Coca-Cola product range.' But by Thursday, the beverage giant issued a more detailed defence of HFCS, a sweetener that has long been controversial and blamed by some for contributing to rising obesity rates in the US. 'The name sounds complex, but high fructose corn syrup (HFCS) – which we use to sweeten some of our beverages – is actually just a sweetener made from corn,' the company said in a statement, The Guardian reported. 'It's safe; it has about the same number of calories per serving as table sugar and is metabolized in a similar way by your body.' The company cited the American Medical Association (AMA), saying it 'has confirmed that HFCS is no more likely to contribute to obesity than table sugar or other full-calorie sweeteners,' and added, 'Please be assured that Coca-Cola brand soft drinks do not contain any harmful substances.' In 2023, the AMA had stated that 'insufficient evidence exists to specifically restrict use of high fructose corn syrup (HFCS) or other fructose-containing sweeteners in the food supply or to require the use of warning labels on products containing HFCS.' As per report by The Guardian, Trump's fondness for Diet Coke is well known — including the installation of a red button in the Oval Office that summoned a butler with a can of the beverage. Diet Coke, however, does not use corn syrup or cane sugar; it's sweetened with aspartame, a low-calorie artificial sweetener.
