Beyond privacy concerns: Interactive gadgets can pose threat to children’s psychology

Children, who are learning what’s appropriate social interaction, can be affected more than adults by the human-computer relationship that’s becoming more commonplace in homes. In other public health news: early menopause, the shingles vaccine, fatty liver disease, racism, and gun safety.

NPR: Parenting in the age of Alexa, are artificial intelligence devices safe for kids?
Earlier this month, the toy-giant Mattel announced it had pulled the plug on plans to sell an interactive gadget for children. The device, called Aristotle, looked similar to a baby monitor with a camera. Critics called it creepy. Powered by artificial intelligence, Aristotle could get to know your child — at least that was how the device was being pitched. (Doucleff and Aubrey, 10/30)

The New York Times: Underweight women at risk of early menopause
Underweight women are at increased risk for early menopause, a new study has found. This study, in Human Reproduction, followed 78,759 premenopausal women ages 25 to 42 beginning in 1989. Over the following 22 years, 2,804 of them reported natural menopause before age 45. (Bakalar, 10/26)

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Amazon is poised to enter Pharma landscape — so what will that look like?

Stat: Who wins and who loses if Amazon enters the prescription drug business

Will pharma be the next business Amazon disrupts?In industry after industry, the company has turned practices and expectations inside out — and the pharmaceutical world is the latest poised for change as speculation mounts that Amazon will soon start selling prescription medicines. Anticipation has been building for months, in fact, but it heightened last week on the news that Amazon (AMZN) obtained wholesale pharmacy licenses in at least a dozen states. (Silverman, 10/30)

Bloomberg: Amazon’s ambitious October spooks stocks standing in its path
The looming threat of Inc. siphoned billions in market cap from Under Armour Inc. to FedEx Corp. to Walgreens Boots Alliance Inc. — more than $30 billion combined — in October. Companies are gearing up to face Bezos’s behemoth heading into the holiday season, with some appearing ready to get creative as the state of their industries is shaken. (Smith, 10/31)

The New York Times: The more lavish the gifts to doctors, the costlier the drugs they prescribe
When drug companies give gifts to doctors, the doctors prescribe more — and more expensive — drugs. The more lavish the gifts, the greater the effect. Researchers used data from the Center for Medicaid and Medicare Services on the prescriptions written by doctors in Washington, and information from the D.C. Department of Health on gifts from pharmaceutical and medical device companies given to providers in 2013. (Bakalar, 10/25)

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Automation spells relief for medicare advantage organizations

Daron Domino, Vice President, Messagepoint

Written by: Daron Domino

It’s a familiar, tiring drill every year for those who work for Medicare Advantage Organizations (MAOs). There is a frantic rush from the time your organization makes its bid submission on the first Monday in June through the middle of August when plan materials need to go to print. Material preparation teams are tasked with preparing benefit materials such as the Annual Notice of Change, Evidence of Coverage, and Summary of Benefit that are compliant with CMS marketing guidelines, ensuring that all regulatory language, benefits and operational information is 100 percent accurate. Sitting between Product and Compliance, material preparation teams are challenged during the annual enrollment period (AEP) preparation as they process a sea of ad-hoc change requests.

Because of CMS timelines and the Sept. 30 in-home date, the annual update process typically starts ahead of benefits and plan approval being complete. So, there is risk of doing work to prepare materials for a plan, or plans, that may not receive CMS approval.

For most MAOs, the annual materials preparation process has been largely manual, resulting in increased efforts and risk of error. Many have attempted to automate the process only to find significant lead-times, costs, complexity, and ultimately a different set of challenges.

With a traditional document automation approach, data and rules drive the process. Those taking this approach spend most of their time managing a long list of business rules. One company we interviewed ended up with thousands of rules to drive benefits and content across their Individual market and Group plans. Automation was intended to simplify the annual process, reduce time and effort, and ultimately eliminate human error. Their attempt resulted in a process that requires an IT skill-set to set up and manage complex rules and a complex QA process to assess the impact of rule changes across plans, both of which have effectively eliminated any cost benefit. As a result, the team supporting materials preparation continues to work endless hours each summer.

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Re-evaluating the Role of RCM for MACRA Success

It’s hard to believe we’re already well into the latter half of the first Medicare Access and CHIP Reauthorization Act (MACRA) reporting year. With the clock ticking, pressure continues to mount for physician organizations to close the inaugural year with strong momentum before 2018. Although CMS recently proposed several changes that may make Year 2 of the MACRA Quality Payment Program (QPP) less challenging for some providers, it could be more demanding for other organizations.

For Year 1, healthcare leaders identified “revising data management/reporting mechanisms to meet new reporting requirements” as the top QPP challenge within the fifth annual Healthcare IT Industry Outlook Survey. That difficulty is unlikely to change for 2018. Because the QPP ties provider reimbursement incentives to care quality, improvement activities, costs and electronic health record (EHR) utilization, alignment has been critical this year, but will be especially crucial moving into 2018. Given that, what opportunities can the revenue cycle management (RCM) team take advantage of to improve their MACRA performance for the remainder of this year into next?

Assembling the Right Team

Traditionally, provider organizations have focused reporting needs on claims and reimbursement data, working within separate data silos, disconnected from associated facilities. In the transition to value-based care, they’re finding it more imperative to work cohesively across three key resource groups to access and obtain the right data for MACRA needed to attain positive or even neutral adjustments to reimbursement.

Providers need to form a strategic cross-disciplinary team including representation from financial, clinical and operational IT departments to maximize access to the right data across the patient-care continuum. Considering the two reporting paths, either Advanced Alternative Payment Models (APMs) or Merit-based Incentive Payment System (MIPS), the revenue cycle representatives on the committee can offer key insights into program measure selection.

In fact, RCM representation is so critical that one might argue that successful MACRA strategy cannot move forward without it. This financial team offers specific insight into which MACRA measures to select, by tapping into their knowledge of values and performance from past physician incentive reporting programs. For example, historical data from the Physician Quality Reporting Program (PQRS) and the Value Based Payment Modifier (VBPM) can point to which measures offer the highest potential for positive reimbursement adjustments. The QPP provides options of measures to report within each category, and the right scoring criteria can make a big difference in reporting success.

Making the Most of MACRA
With RCM representation as a critical decision maker, consider utilizing theses best practices to excel with MACRA QPP reporting.

  • Get the basics. Get a solid understanding of the QPP and the two path options. Consider the best reporting measures from the full set of options for your organization. Utilize industry resources like the Centers for Medicare & Medicaid Services (CMS) QPP measure guide for your pick-your-pace reporting to avoid penalty before the first year ends.
  • Use your physician group’s medical specialties mix to your advantage. Many program measures are focused on specific population health concerns, which may relate to some medical specialties more heavily than others. If your providers already have specific-focus care programs for one of the chronic disease groups, attaining key measures for those may be easier.
  • Check out helpful resources. CMS released several resources for MIPS-eligible clinicians through the QPP. The MIPS participation factsheet covers program exemptions, participant expectations and guidelines. CMS-approved MIPS qualified registries serve as a data submission option on behalf of both individual and groups of eligible clinicians.
  • Look ahead into expanded exemptions. QPP year 2’s leniencies relieve small and rural practices by expanding exemption threshold to cover clinicians or groups who have billed less than $90,000 in Medicare Part B or treat fewer than 200 Part B patients. Your RCM staff should be able to determine quickly if your practice is below this threshold.
  • Set the foundation. MACRA reporting is lost without accurate data. Data analytics tools can work with optimized EHR systems to effectively collect, maintain, document and analyze meaningful patient data, moving beyond the abyss of unstructured information and capturing the entire picture of patient care. Likewise, while providers can continue using 2014 certified EHR technology (CEHRT) for MIPS Year 2, those who use 2015 CEHRT are eligible for a 10 percentage point bonus under the ACI category.
  • Know where you stand. If you submitted quality data in the last calendar year, consider your Quality and Resource Use Report (QRUR) from CMS, which analyzes performance at the Tax Identification Number (TIN) level. Reviewing this will help you assess performance in terms of cost and quality to consider areas to improve. Aspects of this report, like PQRS and Value-Based Payment Modifier, are rolled into MACRA. In addition the QRUR will highlight your physicians ranking among their peers to give you added insight into how forecasting will impact reimbursement as the reporting year unfolds.
  • Ensure accurate coding. Make sure billers and coders fully assess the coding system to find inaccuracies, looking for risks like downcoding or missing modifiers that can impact the overall picture of care and revenue opportunity. The importance of this type of post-care analysis cannot be overstated as these steps can dramatically alter a physician’s composite score.
  • Use 2017 to solidify footing. Reporting requirements will only accelerate after 2017. Although the pick-your-pace guideline applies this year, 2018 requires a full year of data for both the quality and cost categories (though cost has no weight on the final score). An organization should use this initial reporting year to reassess performance improvement measures while cementing its MACRA governance committee for long-term success. Under MIPS, adjustments to reimbursement and/or penalty opportunity increases to 9 percent by 2022, so use this first year as a jumping point.
  • Consider future path options. While most organizations may report under MIPS within this first year, they don’t necessarily have to follow suit in future reporting periods. With the insight from financials, decide whether MIPS or APMs reporting best fits long-term stability and growth.
  • Explore virtual groups. An addition to the QPP for Year 2 is virtual-group participation in MIPS. Virtual groups consist of solo practitioners and groups comprised of 10 or fewer MIPS-eligible clinicians coming together virtually for 2018 performance participation with at least one other solo practitioner or group. Your RCM staff is integral in deciding if a virtual group will be financially advantageous for the practice in Year 2 and afterwards.
  • Evaluate future composition of physician groups. Change is constant within the overall composition of physician groups, both from the perspective of new additions or that of attrition. Managers need to consider this financial perspective for impact on MACRA reporting since there is a two-year gap between financial reporting and reimbursement adjustments. QPP final scores will impact providers beyond reimbursement as physician scores will be published online and shared on third-party sites.

So whether you are beginning your MACRA reporting path, moving through strategic planning or in the midst of data collection, consider the significance of RCM on QPP reporting alignment and success, including governance leadership and insight into operational effectiveness. Without financial entities at the MACRA decision-making table, the full picture of reporting measure selection and outcomes cannot be seen.


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healthcare payments,VPay

Four steps to optimizing and streamlining healthcare payments

Jeffrey W. Brown, President, VPay

Written by: Jeffrey W. Brown

The stress level in physician practices is high – and not just for patients worried about their health. Office staff must balance patient scheduling and visits with office tasks and work flow, plus keep up with billing and collections. On top of that, it can seem like every task you undertake is governed by regulations, mandates, procedures and laws.

Too often physician practice employees may feel like their choices are limited, with finite options that don’t necessarily deliver the optimum, or desired, result. This can feel particularly true of payments—which are essential to a practice’s existence, but can be difficult and cumbersome to process.

There’s good news for practices spending too much time and effort on managing payments. You have options that can streamline payment and reconciliation, minimize risk and reduce costs. Perhaps surprisingly, practices should know that the best payment process may consist of several methods; you can adjust how you receive payments based on your unique practice requirements.

Optimizing payments, reducing costs
The following are four steps you can take to optimize your practice payments process and reduce costs.

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Revation Systems

IT connection nightmares and how to prevent them

Perry Price, President CEO and Founder, Revation Systems

Written by: Perry Price

It’s just another day. You get home, make dinner, then flip on the news and grab your laptop, hoping to catch up on email after a hectic day at the office. As you begin to sift through your inbox, your computer suddenly freezes. A message appears notifying you that your email and laptop have been hacked. Unfortunately, scenarios like these are becoming all too common and many businesses are being impacted by these frequent IT security breaches. Luckily, there are steps you can take to prevent being a part of the most common IT connection nightmares.

Nightmare #1: Network Ransomware Attacks

With recent cybersecurity attacks such as WannaCry permeating the news in 2017, businesses across the globe are experiencing the nightmare of network ransomware breaches. Ransomware is a type of malicious software designed to block access to a computer system until a sum of money is paid, and is quickly becoming one of the most popular forms of online attacks today. Beginning as early as 1989 with the AIDS Trojan attack, ransomware is evolving on a massive scale and predicted to cost over $6 trillion annually by 2021, according to Cybersecurity Ventures.

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Revation Systems

4 ways millennials are transforming healthcare technology

Perry Price, President CEO and Founder, Revation Systems

Written by: Perry Price

Older generations have often viewed the younger population as a tangible representation of change in our world. Whether it be the loud “rock ‘n’ roll” music associated with baby boomers or the individualistic attitudes of the “latch-key kids,” younger generations have always led the way toward significant social transformations within our nation. Today millennials are leading our society through another transformation — technology. As the largest generation, numbering 83.1 million per the United States Census Bureau 2015 Report, millennials are changing the technology landscape and spurring digital transformation.

Millennials were the first generation to grow up entirely exposed to major technological breakthroughs like the internet and smartphones, and they’re paving the way for innovations in technology, subsequently impacting almost every industry imaginable. Healthcare in particular is facing a large transformation, thanks to this booming generation. Here are four examples of how millennials are transforming healthcare technology.

  • Expanding Convenience
    Commonly referred to as the “drive-through” generation, millennials wish convenience and instant access. In fact, 60 percent of millennials boast the convenience of having a smartphone or tablet to research or buy a product or service while on-the-go. This demand for expediency continues to drive industries, namely healthcare, to provide instant, on-demand access to services. Telehealth continues to gain the interest of millennials for convenient care on-the-go. In fact, in a study conducted by Salesforce, 60 percent of millennials expressed interest in using telehealth options such as video chat with a provider to avoid going into the doctor’s office for an appointment. As this interest grows, hospitals and clinics will continue to expand telehealth technology to increase accessibility and transform the traditional methods of healthcare.
  • Shifting the World of Wearables
    Millennials have been the first users to adopt new technology and have contributed heavily to setting significant trends in the healthcare industry. In a study conducted by Barkley, millennials were found to be 2.5 times more likely to be early adopters of technology than older generations, with 56 percent reporting that they are usually the first to try new technology. Because of their willingness to adopt innovative technology, millennials have contributed heavily to the increasing popularity of wearable devices, so much so that the number of wearable devices worldwide is expected to reach an estimated 830 million in 2020. Along with an increasing number of users, 63 percent of millennials also state that they would be interested in proactively sharing their health data pulled from wearable devices with their doctor/provider to monitor their well-being.
  • Advancing Mobile Healthcare                                                                  The average millennial owns 7.7 connected devices, including smartphones, tablets and other on-the-go devices to keep the world at their fingertips. With such vast mobile access, millennials are pushing healthcare to go mobile at a rapid pace. Nearly half of all smartphone owners claim they use their devices to get health information, and one-fifth have health apps on their devices. Millennials in particular feel strongly about this advancing healthcare technology. In fact, 73 percent of millennials are interested in having their doctors use mobile devices during appointments to share information, and 71 percent would like a doctor to give them a mobile app to actively manage their well-being for preventive care, review health records and schedule appointments.
  • Accepting a World with Artificial Intelligence                                      Just a few decades ago, artificial intelligence (AI) merely held a place in our imagination, existing only within science-fiction. However, as fantastical as the concept may seem, AI has become our reality and is transforming the delivery of healthcare. In fact, according to the predictions of experts in the field 80 percent of doctors will be replaced by AI in the future. Millennials have characteristically obtained an open mindset to AI technology, and many say they trust computers as much as they trust their own providers.

The healthcare industry is on track toward a major transformation in the coming years. With technology-savvy millennials currently making up nearly a quarter of the United States population, the technology sector of the industry will likely be most impacted by such significant change. With a strong preference for convenient, on-the-go care, the millennial generation will continue to transform healthcare and drive the industry to a spectacular technological future.

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Informatica,next-generation analytics

Healthcare organizations embrace next-generation analytics

Richard Cramer, Chief Strategist Healthcare Sales, Informatica

Written by: Richard Cramer

There is no industry with a greater potential to benefit from the disruptive power of data than healthcare. Massive investments in electronic health record applications are providing enormous amounts of deep clinical and outcomes data. The emergence of social media allows insights into the perceptions and behaviors of individuals unthinkable even a few years ago. The growth in innovation in connected medical devices at home and traditional care settings enables new models of data collection and intervention. And the rapid move to value-based reimbursement models is serving as a catalyst for healthcare organizations to use data and analytics to improve efficiency and quality while reducing costs.

The pressing need for healthcare organizations to become data-driven — and to effectively use data and analytics to become more efficient and agile — is driving healthcare organizations to behave much more like early adopters of technology when it comes to analytics. This is a refreshing change from the long-standing generalization that healthcare organizations tend to adopt information technologies a decade or more after other industries. There are many examples of where this is true, including healthcare providers’ historical reliance on paper medical records that have only recently been replaced with an electronic medical record, or payers with antiquated claims processing systems and call center applications.

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Electronic bandage may heal chronic wounds

attending to a deep wound
A new smart bandage may change our wound caring practices.
Researchers have designed a “smart” bandage that is much more effective and faster-acting than regular healing patches. The same device can also be loaded with drugs, depending on the type and stage of the wound it is applied to.

The idea for the new device was born out of the need to find more efficient, expedient, and cost-effective treatments for chronic wounds.

Chronic wounds – including venous ulcers, diabetic ulcers, and pressure ulcers – are particularly challenging to treat due to the complex biological mechanism that characterizes them.

They do not heal after the standard 4 weeks of care, largely because the body does not release the compounds that are essential to healing in a timely fashion.

But the new device may change this. Being able to administer different drugs at different stages in the progression of the wound is known to help with chronic wounds, and the smart bandage allows medical professionals to do just that using one single device.

The smart healing patch was engineered by researchers from the University of Nebraska-Lincoln (UNL) in collaboration with scientists from Harvard Medical School in Boston, MA, and the Massachusetts Institute of Technology in Cambridge, MA.

In the new study – which is published in the journal Advanced Functional Materials – the team details a series of experiments that they ran in order to test the benefits of their innovation.

One of the corresponding authors of the study is Ali Tamayol, an assistant professor of mechanical and materials engineering at UNL. “The medical cost associated with [chronic] wounds is tremendous,” he says. “So there is a big need to find solutions for [them].”


How the smart bandage works

The smart healing patch is the size of a postage stamp, made up of electrically conductive fibers, and can be controlled remotely with a smartphone or another wireless or bluetooth device.

The fibers are coated with a water-based gel that can be loaded with various drugs, depending on the needs of the wound.

Antibiotics, so-called growth factors that help the tissue to regenerate, and painkillers could all be alternatively administered using the same “e-bandage,” all the while controlling remotely not only the substance, but also the dosage.

In one of the experiments detailed in the study, the researchers applied the e-bandage loaded with a tissue-growth factor to wounded mice, and a normal “dry” bandage to a control group of mice.

The experiment showed that the smart bandage helped the mice to regrow three times as much tissue than the control group did. Tissue regeneration is a key step in the healing process.


In another experiment, the team loaded the bandage with an antibiotic. The smart healing patch successfully fought off the infection.

This is the first bandage that is capable of dose-dependent drug release […] You can release multiple drugs with different release profiles. That’s a big advantage in comparison with other systems.”

Prof. Ali Tamayol

“What we did here,” he continues, “was come up with a strategy for building a bandage from the bottom up […] This is a platform that can be applied to many different areas of biomedical engineering and medicine.”

“Imagine that you have a variable patch that has antidotes or drugs targeted toward specific hazards in the environment,” Tamayol adds.

The researchers also hope that the first application of their device will be to heal the chronic ulcers that result from diabetes.

The majority of the bandage’s components have already been approved by the Food and Drug Administration (FDA), the researchers say. But before bringing the device to market, the bandage will still have to be tested in animals and then in human trials.

Until then, the team is hard at work trying to make the bandage capable of administering the appropriate treatments autonomously.

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Heart device failure: Medicare spent $1.5B over 10 years to replace defective implants

Medicare paid at least $1.5 billion over a decade to replace seven types of defective heart devices, a government watchdog says. The devices apparently failed for thousands of senior patients.

The Health and Human Services Office of Inspector General, in a report released Monday, said officials need to do a better job tracking these costly product failures to protect patients from harm. More detailed reporting could lead to earlier recognition of serious problems with medical devices and faster recalls of all types of “poorly performing” ones, the IG’s office said.

The report marks the first effort by anyone in government to assess the losses to taxpayers and patients 65 and older from medical gear that proves faulty.

Officials said the $1.5 billion lost from the seven devices from 2005 through 2014 was a “conservative estimate.” Patients also paid $140 million in out-of-pocket costs for this care, the report noted.

The report found that nearly 73,000 people on Medicare had one of the seven devices replaced because of recalls, premature failures, medically necessary upgrades or infections. It didn’t outline specific injuries patients suffered as a result.

The inspector general did not identify the manufacturers of the seven devices, but officials said they included implanted cardio defibrillators and a pacemaker that either had been recalled because of flaws or had “prematurely failed.” Pacemakers and implantable defibrillators are small devices placed under the skin to help treat irregular heartbeats.

How best to identify these defects and cut Medicare spending associated with fixing them has been under consideration at various times since 2007, according to the report. But it remains a contentious issue.

The inspector general recommended that hospitals and doctors be required to submit detailed information identifying failed devices, such as serial and batch numbers, during the billing process.

“This could help reduce Medicare costs by identifying poorly performing devices more quickly which could also protect beneficiaries from unnecessary costs and improve their chances of receiving appropriate follow-up care more quickly,” the report states.

David Lamir, an official in the inspector general’s Boston office, said the $1.5 billion figure represented a “drop in the bucket” of the true costs to Medicare from medical products that malfunction. He said device failures not only waste money, but also can expose patients to a “high risk of illness,” including needless surgeries.

The report said medical device recalls nearly doubled from 2003 through 2012 and noted they have likely cost Medicare billions of dollars. In the past five to six years, more than 200 cardiac devices have been recalled, according to the OIG. In most cases, manufacturers withdraw their products voluntarily after reports surface of injuries or malfunctions. Device makers are required to report problems they learn of, often from doctors and hospitals, to a database run by the Food and Drug Administration.

Diana Zuckerman, president of the National Center for Health Research who has testified before Congress on device safety, said her organization supports making hospitals report malfunctioning devices when they seek Medicare payments to cover an implant surgery. She said the change would help officials pinpoint faulty devices before issuing a recall for tens of thousands of products buried in patients’ bodies.

“It would be much more obvious much more quickly which implanted devices were causing problems,” she said.

Zuckerman noted that the IG report didn’t touch on many high-profile device failures, like metal-on-metal hip implants or vaginal mesh.

Medical device companies and some doctors have opposed tighter reporting saying it would be costly and difficult to integrate with existing payment claim forms and might not yield useful information.

“It is abundantly clear that data collected in electronic health records (EHR) is a far superior and more cost-effective method for monitoring the performance of medical devices,” said Mark Leahey, who heads the Medical Device Manufacturers Association. The trade group represents nearly 300 device companies.

Leahey said that the electronic health record “captures the full clinical history of the patient, their changing health status and detailed information on their medical treatments,” including any surgically implanted devices.

A Centers for Medicare & Medicaid Services spokesman said the agency had not seen the report and would have no comment.

But in written remarks included in the report, CMS Administrator Seema Verma said the tighter reporting requirement is “under consideration” and that the agency will “carefully evaluate the potential that this policy would impose a burden on physicians unnecessarily.”

CMS appears to have switched positions on whether to compel hospitals to report more details about these incidents during the Obama administration.

In a February 2015 letter to Sen. Elizabeth Warren, D-Mass., then-CMS administrator Marilyn Tavenner argued that more reporting would “entail significant technological challenges, costs and risks to normal claims processing for Medicare.”

Yet CMS and FDA supported doing so in a July 13, 2016, letter to the committee that sets standards for electronic claim forms used for medical billing.

Andy Slavitt, who succeeded Tavenner in the top CMS post and signed the July 2016 letter, called the inspector general’s report “important work” that “appears to make yet another strong case” for more complete reporting of device failures.

These policies “are important for our safety and they are clearly prudent things to do. While it requires effort from many in health care to get there, this effort is in our public interest,” Slavitt wrote in an email to Kaiser Health News.

Rita Redberg, a UC-San Francisco professor and cardiologist who advises Medicare, said unique identifiers on devices could be scanned into a patient’s medical record. Earlier recognition of trouble-prone devices also might help Medicare recoup some money wasted as a result.

“Medicare is spending a lot of money on something that doesn’t seem to be their problem,” Redberg said, adding, “Most places, if something is defective, the manufacturer is responsible for replacing it, not the store where you bought it.”

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Cost and Quality, Health Industry, Medicare

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