Journal of Urgent Care Medicine

Medicaid Holdouts Continue to Confound ACA Proponents

Those who herald the Affordable Care Act (ACA, or “Obamacare”) as a success continue to be vexed by the six million or so citizens who are eligible for Medicaid but simply don’t sign up for it. Perhaps that should not be surprising, however, given that most people eligible for Medicaid are exempt from having to pay a penalty for being uninsured—one of the ACA’s prime incentives for individuals to get insured—and those eligible can sign …

Uncle Sam Picks Up Two-Thirds of the Healthcare Check

Even as private citizens continue to pay a greater percentage of their paychecks for healthcare, new data say that the government is picking up the biggest portion of healthcare spending overall—64.3% as of 2013. Of particular note, Medicare spending rose about 2.5% between 1999 and 2013. The data, which are published online in the American Journal of Public Health, reflect direct government payments for Medicare, Medicaid, and other public programs (eg, the Veterans Health Administration, …

Think Tank Says Aetna–Humana Deal Would Make Seniors Pay More

The Center for American Progress (CAP), a Washington, DC-based think tank, says senior citizens will be forced to pay higher Medicare Advantage premiums if Aetna’s proposed acquisition of Humana goes through. Aetna currently holds 7% of that market and Humana 19%. While their combined share of the entire current Medicare market would still be just 8%, Anthem has also moved to buy Cigna Corp. The combined effect of such deals could cut competition and result …

Will Medicare Change Make Urgent Care More Appealing?

The end of 2015 means the end of a 10 percent bonus paid to primary care physicians who care for Medicare patients. Depending on how they react, some practices could see more patients turn to urgent care for acute complaints. Essentially, primary care practices will have three options once their bonus disappears: eat the revenue loss, take in more patients to make up for it, or charge patients more. The bonus program was initiated in …

‘Step Therapy’ Usually Not What the Doctor Ordered

Proponents say “step therapy” will save the healthcare system big money while still allowing patients the medications they need. Opponents call it “fail first” and insist that the practice of having patients try cheaper versions of prescribed medications—with insurers paying for the more expensive variety only if the cheaper drug doesn’t do the job—is a bitter pill to swallow. Some clinicians claim the practice, which in effect has insurers overriding a prescriber’s choice of medications …

Humana Moves Could Impact Older Patients and Urgent Care

Humana’s plan to lower the number of elderly patients who seek care in the emergency room could end up costing urgent care centers. The company is testing a telehealth program that encourages Medicare Advantage enrollees to try “virtual” visits for relatively minor complaints before they head to the hospital. On-call clinicians would have access to the patient’s medical history and the authority to direct the patient’s care (which could still entail a trip to the …