by Caroline Fife, M.D. | Jul 17, 2019 | Cassandra Chronicles: Regulatory and Coverage Policy, Fight the Good Fight, Healthcare Payment Policy
The table below is from one of my Quality and Resource Use Reports (QRUR). You can see the “ambulatory care-sensitive conditions include the conditions I mentioned on my last blog: bacterial pneumonia, urinary tract infection, dehydration, diabetes complications,...
by Caroline Fife, M.D. | Jul 15, 2019 | Cassandra Chronicles: Regulatory and Coverage Policy, Fight the Good Fight, Healthcare Payment Policy
Depiction of Total Per Capita Cost (per provider) After CMS calculates Medicare Spending Per Beneficiary (MSPG), it calculates a practitioner’s Total Per Capita Cost. This is the overall cost of care provided to each of the beneficiaries attributed to a specific...
by Caroline Fife, M.D. | Jul 11, 2019 | Cassandra Chronicles: Regulatory and Coverage Policy, Fight the Good Fight, Healthcare Payment Policy
I need to start with a disclaimer that I have no expertise when it comes to Medicare cost calculations. I am muddling through this by reading the materials on the CMS website. If you have a correction to anything I’ve posted or have better insight, I really want to...
by Caroline Fife, M.D. | Jul 10, 2019 | Cassandra Chronicles: Regulatory and Coverage Policy, Fight the Good Fight, Healthcare Payment Policy
A few people are starting to whisper about their experience with the Targeted Probe and Educate (TPE) process directed at claims for Hyperbaric Oxygen Therapy (HBOT). The Medicare Administrative Carriers (MACs) are supposed to educate the doctor, but so far, the...
by Caroline Fife, M.D. | Jul 3, 2019 | Healthcare Payment Policy
There are days I feel like I am the only person who did not get the office memo. That’s how I feel about Disposable Negative Pressure Wound Therapy (dNPWT) when the patient has a home health agency. dNPWT has made NPWT more practical and convenient for smaller...
by Caroline Fife, M.D. | Jul 1, 2019 | Fight the Good Fight, Healthcare Payment Policy
Guest Post Written by Jule Crider As has been reported widely in the press, the President issued an Executive Order (EO) last week on price transparency that has implications for all healthcare providers. I have pasted below excerpts from the American Hospital...
by Caroline Fife, M.D. | Jun 27, 2019 | Fight the Good Fight, Healthcare Payment Policy
“The wounds with no name” (WWNN) are wounds that are due to trauma (not surgical complications) that never heal, PLUS the chronic ulcers that are NOT diabetic, arterial, venous or pressure related. These two groups (accidental wounds and ulcers which are not obviously...
by Caroline Fife, M.D. | Feb 27, 2019 | Healthcare Payment Policy
Mario from New Life Brace and Limb came to the rescue again. He’s working on a device to off-load the spine of a quadriplegic who is going to put my son through graduate school with his pressure ulcer challenges. Every time we fix one problem, it causes another...
by Caroline Fife, M.D. | Feb 25, 2019 | Healthcare Payment Policy
Remember Hyperbaric Prior Authorization which CMS had in effect for 3 states? They didn’t have to extend the program because it was so successful. Here’s a graph of the impact from 2014 to 2016 in which HBOT utilization decreased by 50%, and not just in those 3...
by Caroline Fife, M.D. | Feb 21, 2019 | Healthcare Payment Policy
I’ve got a lot of patients who have had very targeted local radiation. Some of them got radiation years ago for really questionable reasons, the others for only recently. The non-healing wounds present in the irradiated field can be small but really persistent. The...
