Sunday Update



Where you can understand it all—in less than five minutes!


Medicare Advantage Market Healthy and Robust

It certainly is—for now.

A nice summary of the current state of affairs.



Hospitals call for overhauls of prior auth rules.

Great insight into the PR campaign pushing back against tighter PA rules.

Medicare Advantage was initially created to give CMS an agent at the point of care with skin in the game—the clinician

Medicare Advantage Organizations (aka “the insurers’) have largely perverted it into a “code and cash grab” scheme—using the same disinterested clinicians to deliver care.

So these insurers have returned to the same cost-control tactics which have failed for fifty years—prior auths, step edits, etc….

As Medicare Advantage becomes a bigger piece of the pie, it’s no wonder that providers are pushing back.



Popular Medicare Advantage plans come under fire

Included to show how concerns about fraud are percolating down to the local level.




The Chronic Care Act represents a tranformation of the Medicare and Medicare Advantage programs to one which pays for healthcare to one which tries to reduce health care spending by funding services that impact health.

It’s an underappreciated sea change.

Will it work? Will spending money on home care decrease medical expenses

I’ll go out an a limb here and say, no.

It will provide many industries with access to the flow of federal dollars though.

An excellent, if industry biased summary of the Chronic Care Act here.




The art of medicine lies in getting the patient what they need when they need it, not what they want when they want it.