Medicare tightening payments for 'big ticket' cardiology and orthopedic procedures in 11 states

In an effort to rein in costs, the Centers for Medicare and Medicaid Services will in 2012 perform an audit before paying for certain cardiology and orthopedic procedures in key states, including Florida.

Bloomberg/San Francisco Chronicle: Hospitals Tumble On Medicare Order For Heart Procedure Audit Hospital and medical device stocks tumbled after a report said that Medicare won't pay for hospital stays in 11 states for heart and orthopedic procedures until the treatment is reviewed and deemed necessary. The Center for Medicare and Medicaid Services will require pre-payment audits on hospital stays for cardiac care, joint replacements and spinal fusion procedures, according to the American College of Cardiology in a letter to members. ... The program means hospitals won't receive payment for stays that involve cardiac care or orthopedic treatment until auditors have examined the patient records and confirmed that the care was appropriate, Jerold Saef, the reimbursement chair for the Florida chapter of the American College of Cardiology, wrote in a Nov. 21 letter to members (Wechsler and Fay Cortez, 12/4).

Forbes: CMS Tightening The Screws On Unnecessary Procedures In Florida And 10 Other States
After years of criticism that it has paid billions of dollars for unnecessary procedures, the Centers for Medicare & Medicaid Services (CMS) will soon ramp up efforts to rein in costs for unnecessary procedures. In 2012 CMS will perform an audit before paying for several big ticket cardiology and orthopedic procedures in certain key states. The news has provoked strong reactions from cardiologists and Wall Street. In Florida, in fact, 100 percent of stent, ICD, and pacemaker implantation procedures will undergo review before payment. Similar programs will take place in California, Michigan, Texas, New York, Louisiana, Illinois, Pennsylvania, Ohio, North Carolina, and Missouri, but the precise percentage and mix of cases that will undergo auditing has not yet been stated (Husten, 12/4).

Meanwhile, The Houston Chronicle investigates Medicare spending on home-based health care in its metro area -;

Houston Chronicle: Home Health Care Firms Breaking Rules, Raking In Medicare Dollars
The nation's Medicare program has dished out $1.25 billion for home-based health care in Houston over four years -; and yet nearly every agency that provides nurses, therapists and drugs for the elderly and disabled has violated state and federal standards, a Houston Chronicle investigation has found. Still, little stops the flow of taxpayer dollars to the nearly 470 companies based in America's fourth largest city. Dubbed "deficiencies" by the Texas Department of Aging and Disability Services, they include violations like failure to make sure drugs and treatments are administered properly and failure to report abuse of a patient (Langford, 12/3).