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Medscape
4 days ago
- Health
- Medscape
Medicare Physician GI Procedure Pay Fell; Facility Pay Rose
Medicare payments to physicians for common gastrointestinal procedures have declined in recent years, while reimbursement to ambulatory surgical centers and hospital outpatient departments has increased or held steady, according to a new analysis. These trends may exacerbate concerns that current federal payment policies are favoring consolidation in healthcare, while putting more financial pressure on clinicians in small and individual practices. Dipen Patel, MD In a recent American Journal of Gastroenterology paper, Dipen Patel, MD, of Northwestern Memorial Hospital, Chicago, and coauthors analyzed trends in Medicare reimbursement from 2018 to 2023 for colonoscopy and esophagogastroduodenoscopy (EGD) procedures. They compared changes in Medicare's physician compensation to changes in facility reimbursements for the same procedures. The results of their analysis are summarized below. Physician Fee Schedule (Adjusted for Inflation): Colonoscopy: Reimbursement dropped 22.6%. Nominal (unadjusted): 6.12% decline. Reimbursement dropped 22.6%. Nominal (unadjusted): 6.12% decline. EGD: Reimbursement dropped 22.7%. Nominal: 6.2% decline. Ambulatory Surgical Centers (Adjusted for Inflation): Colonoscopy: Reimbursement changed slightly (0.27% increase). Nominal (unadjusted): 21.7% increase. Reimbursement changed slightly (0.27% increase). Nominal (unadjusted): 21.7% increase. EGD: Reimbursement rose 6.23%. Nominal: 28.9% increase. Hospital Outpatient Departments (Adjusted for Inflation): Colonoscopy: Reimbursement changed slightly (0.65% decrease). Nominal (unadjusted): 20.6% increase. Reimbursement changed slightly (0.65% decrease). Nominal (unadjusted): 20.6% increase. EGD: Reimbursement changed slightly (0.82% increase). Nominal: 22.3% increase. The researchers examined 31 current procedural terminology codes for colonoscopy and 26 for EGD procedures. Patel, who graduated from the University of Texas Medical Branch School of Medicine, Galveston, Texas, in 2019, said part of the motivation behind the study was to raise awareness among younger physicians who may not track Medicare policy closely. 'For my generation of physicians who are coming out of training, we don't really know much about these trends,' Patel told Medscape Medical News . 'We don't really know what the policies are or how they are playing out.' Other recent studies have identified similar patterns — where professional fees have declined while facility reimbursement either rose or declined to a lesser degree for common orthopedic procedures such as shoulder surgeries and knee and hip arthroplasty. Policy Ripple Effects Patel and coauthors noted that Medicare has significant influence over US healthcare. It's the largest purchaser of healthcare services, with total annual spending exceeding $1 trillion. Commercial insurers also factor in Medicare's payment rates while setting their own reimbursement for services. The American Medical Association (AMA) has linked physician fee schedule cuts to a shift away from independent practice ownership. In May, the AMA released results from its biennial Physician Practice Benchmark Survey (administered with WebMD/Medscape). Among the findings: An estimated 58% of physicians worked as employees in 2024, up from 42% in 2012, the survey's first year. Push for Inflation-based Updates Members of both parties of Congress have backed proposals to create automatic updates in the base rate for the Medicare physician fee schedule to reflect rising costs. For example, more than 170 members of the House supported a 2023 bipartisan bill that would have created automatic annual updates for the base rate of the physician fee schedule to keep up with inflation. The bill sought increases that would fully reflect the Medicare Economic Index (MEI) , a measure used to estimate changes in costs for clinicians in practice. That bill stalled when the 119th session of Congress began in January. A Republican-led budget package contains a similar ─ but more limited ─ proposal. It would increase the Medicare physician fee schedule's base rate, but by less than the full expected gain in inflation. The House-passed version of this bill would create an initial annual bump equal to 75% of the expected MEI change, with subsequent annual increases would be 10% of that index. The Senate will work this month on the budget package, known as a reconciliation bill, likely making changes to the House-passed measure. In a May letter to top House officials. AMA described the House's MEI proposal as 'a foundational step toward comprehensive Medicare physician payment reform in the 119th Congress,' meaning the current session which ends in January 2027. Consolidations and Consequences Gary Young, PhD, director of the Northeastern University Center for Health Policy and Healthcare Research, told Medscape Medical News that debates about consolidation in healthcare have persisted for decades. 'As far back as the 1970s, some people advocated for uniting hospitals and physician practices, seeing this as a way to reduce fragmentation and create more efficient care,' said Young, who has studied both Medicare's variation in pay for services and the effect on patients of hospital acquisition of practices. 'There are people who say they never really understood why hospitals and physicians were separate to begin with,' Young said. 'Others really lament the idea that the independent physician sector may go away. They ask: 'Do we really want all of our physicians to be under the control of healthcare systems and corporate entities?'' Young also noted that in many cases, physicians initiate buyout discussions with healthcare systems due to financial pressures. 'Many physician practices are struggling, and they approach hospitals sort of as a white knight,' he said. The American Hospital Association (AHA) has made a similar argument, telling lawmakers that its members have offered 'a lifeline' to struggling physician practices ─ especially in rural areas. Last year, the AHA submitted ideas for aiding physicians to the health panel of the Ways and Means Committee. The Ways and Means health committee held a May hearing titled 'The Collapse of Private Practice: Examining the Challenges Facing Independent Medicine.' The AHA recommended: Increasing physician reimbursement through the Medicare fee schedule Reducing insurer-imposed administrative burdens, such as prior authorization. Examining the growing role of commercial health conglomerates, in acquiring physician practices. 'While a disproportionate amount of attention has been placed on hospitals' acquisition of physician practices, the reality is that large commercial insurers including CVS Health and UnitedHealth Group have recently spent billions of dollars to acquire physician practices,' AHA said in its statement. Patel and coauthors have disclosed no relevant financial relationships.
CBS News
03-06-2025
- General
- CBS News
Man shot in road rage incident on Lake Shore Drive in Streeterville, Chicago police say
Chicago police said a man was injured in a shooting stemming from a road rage incident on Lake Shore Drive Tuesday morning. Police said a 32-year-old man was driving south in the 700 block of North Lake Shore Drive, the inner part of the famed roadway, in the city's Streeterville neighborhood, when he got involved in a dispute with the driver of a black Jaguar SUV. The victim told police the SUV pulled alongside his car and the driver, a man, pulled out a gun and opened fire. The victim was shot in the elbow and drove to the 1500 block of South Wabash, where he called police. He was then taken to Northwestern Memorial Hospital in good condition, CPD said. No other injuries were reported. Police said the driver of the Jaguar SUV continued south on North Lake Shore Drive before fleeing in an unknown direction. No one is currently in custody. Area Three detectives are investigating.
CBS News
26-05-2025
- CBS News
Man beaten near Division Blue Line stop in Chicago's West Town community
A man was attacked and beaten in a busy area of Chicago's West Town neighborhood early Sunday morning. Police said at 5:25 a.m., the 34-year-old man was on the sidewalk in the 1200 block of North Ashland Avenue when a man he didn't know came up and battered him. The attacker fled in an unknown direction, police said. The scene of the attack was near the Division Street Blue Line subway stop at the triangle formed by Milwaukee and Ashland avenues and Division Street, historically called Polish Triangle. The victim was taken to Northwestern Memorial Hospital, where he was listed in serious condition. No one was in custody late Sunday. Grand Central Area detectives are investigating.
CBS News
12-05-2025
- Health
- CBS News
How front line doctors, health workers seeing domestic violence survivors help break the cycle of abuse
The first 24 hours after a domestic abuse incident have been found to be critical for survivors, their ability to get help and get out of the abusive situation. That front line response often falls to a team of doctors, hospital workers and community activists when law enforcement and the courts can't get them help fast enough. Those responders say they often see abuse victims on a repeat basis. "We have seen patients who've come here with one injury and the next time they come, they don't make it," said Dr. Anne Stey, a trauma surgeon at Northwestern Memorial Hospital. "And so that's a reality." RELATED: New protections for domestic violence victims in Illinois now in effect under Karina's Law Stey said she has seen domestic violence incidents grow significantly since the COVID-19 pandemic started in 2020. "Violence often becomes a language that people start being exposed to in the home, sometimes from a very young age, and then it is recreated when they create their own families," she said. "And it can even bleed out into the community, and it can ultimately be the cause of a lot of the community violence that we can see." Stey is part of the hospital's first response to domestic violence cases. Outside of the emergency room, she does research on ways to break the cycle for her patients. Studies show survivors of intimate partner violence are more than twice as likely to return to the ER within 30 days, which is why Stey says the follow-up matters just as much as the first response. She said poverty and unemployment are among the strongest predictors of domestic violence. According to Bureau of Justice statistics, women in households earning under $25,000 a year face abuse at three times the rate of those with higher incomes. Unemployment increases the risk of domestic violence by more than 30%. Daisy Vega works alongside Dr. Stey as Northwestern Hospital's violence intervention coordinator, helping survivors access resources like a safe place to stay, or victim compensation funding up to a year after their hospital stay. It's a critical time to help them escape any ongoing danger. "Unfortunately, with the work that I do, some people are like, 'I was meant to get shot at some point,'" she said. "And that's just the life that they think they are going to have." Gwen Baxter has herself lived with domestic violence, at a time, she said, when resources were scarce. Now she works with Acclivus, an Illinois state program that partners with six hospitals to help connect survivors to everything from housing to food and legal aid. The hospital-based programs can reduce the risk of reinjury by up to 60%, according to the American College of Surgeons. "And if they just know they got that type of support system, they become strong, you know," Baxter said. "They see outside of that relationship because some of them feel like they're in too deep." This team works not just to heal wounds, but to give hope. "They're afraid all the time," Stey said. "Having these opportunities, knowing they're not going to be on the street, knowing that they're going to have enough food for their family, knowing that they're going to be able to, you know, if their attacker comes after them that they're going to have legal recourse to prevent that person from hurting them or their family, is incredibly important." More than 12,000 victims of violence have turned to Acclivus for help during that "what's next" period after an incidence of abuse.
The Independent
09-05-2025
- Health
- The Independent
Cigna denies life-saving operation to man battling stage 4 cancer
A man fighting for his life as he battles stage 4 cancer is asking for donations after his health insurance denied him a life-saving lung transplant. Deron Wells, 59, is battling advanced lung cancer and his doctors have approved him for a double transplant, a procedure that his loved ones have described as his 'only path to survival.' However, Cigna Healthcare, his health insurer, has refused to authorize the transplant and the emergency medical transport needed to get him to the hospital for the operation. He needs to be transferred to Chicago's Northwestern Memorial Hospital for the operation. Wells was preparing to be moved from UCLA Santa Monica Medical Center on Friday, but Cigna denied coverage for the procedure and the transfer, ABC7 reported. "I am really sad that my life is in the hands of these decision-makers who seem to make these decisions in such a cold way," Wells told the outlet. The father and husband may not survive without immediate intervention, his family says. "The last option we have is for us to take him to Northwestern, period. I hope Cigna really understands the seriousness of the situation. We're not just a number. We are talking about his life," Janet Savarimuthu, his wife, told the outlet. The Independent has reached out to Cigna for comment. The insurer told ABC7 in a statement: "Our coverage guidelines are grounded in national clinical standards to help ensure the best possible outcomes for patients.' Cigna has a 21 percent claim denial rate, according to Value Penguin. The GoFundMe page has garnered $41,000 as of Friday afternoon. The organizer, his friend Scott Kern, is hoping to raise $1.5 million to cover the costs of the procedure, the emergency air transport, post-surgery recovery, and temporary relocation for his family. "Deron deserves this chance that we're fighting so hard to make sure that he gets," Kern told the outlet. Wells is pleading for the insurer to change course since he has much more to live for, telling the outlet: "I'm truly hoping that Cigna will change its tune and will have a positive outlook on this because I'm not done yet.'
