BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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It is a healthcare investor conference where investors meet with digital health companies, not-for-profit hospital systems, insurance carriers, biotech and med device companies.
The J.P. Morgan Healthcare Conference is invite-only. There is no large exhibition hall. The agenda is not published.
Most of the ‘action’ happens outside the conference with private meetings across the city.
Most people who attend are not invited and they just go for the private meeting opportunities.
Hear a summary of the 2023 J.P. Morgan Healthcare Conference from This Week Health‘s Bill Russell and his guest Rob, DeMichiei–the former CFO of UPMC.
Hospital systems actually have a plan to cut costs for the first time in AGES.
Insurance carriers are going to become healthcare providers themselves.
Will insurance carriers eat hospitals’ lunch? etc.
These Laws Were Put Into Place So That Doctors Would Not Put Shareholders Before Patients and So That Corporations Would Not Interfere with Doctor Judgement.
Corporate Practice of Medicine Laws are at the State Level, NOT the Federal Level.
Each State Has Its Own Exceptions Such as 1) Doctors Can Work for Companies That Are Owned by Other Doctors and 2) Doctors Can Work for Hospitals.
Accordingly, Private Equity Firms Have Been on a Physician Practice Buying Binge.
Two of the Largest Purchases Were KKR’s Purchase of Envision’s 25,000 Doctors for Almost $10 Billion and Blackstone’s Purchase of Team Health’s 20,000 Doctors for $6 Billion.
If Corporate Practice of Medicine Laws Say that Doctors Cannot Work for a Corporation, How are Private Equity Purchases of Physician Practices Legal?
RAND and Harvard University Researchers Recently Published a Study in the Journal of the American Medical Association Examining How Doctors are Paid by Hospital System-Owned Practices. The Study Found that only 9% of Primary Care Physician Compensation was Based on Value (Quality and Cost-Effectiveness) and only 5.3% of Specialist Compensation was Based on Value.
The Study Concluded: “The results of this cross-sectional study suggest that PCPs and specialists despite receiving value-based reimbursement incentives from payers, the compensation of health system PCPs and specialists was dominated by volume-based incentives designed to maximize health systems revenue.”
CMS pays Medicare Advantage Plans per member based on a risk score. The more chronic conditions the person has, the larger the payments CMS makes to the Medicare Advantage Plan.
Medicare Advantage Plans may be overexaggerating how sick their members are in order to increase their payments from CMS.
The Department of Justice is currently suing Cigna and Elevance (Anthem) for such over exaggerations.
However there is a deeper problem… CMS itself had performed its own audits, but has not done so in 10 years. CMS identified $650M in overpayments and did nothing about them.
When the Kaiser Family Foundation (KFF) requested information on the audits, CMS refused. KFF had to sue CMS to obtain the audit information and it took 3 years for KFF to win the case.
Perhaps it is incompetence on the part of CMS or perhaps CMS does not want to reveal the audits or do anything about them due to political pressure.