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Guidance

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Aetna’s Deal for Humana May Push Up Costs for Seniors

Diane Bartz  |  

WASHINGTON (Reuters)—Aetna Inc.’s plan to buy smaller insurer Humana Inc. for $31 billion will mean seniors will pay higher Medicare Advantage premiums, according to a new report by the think tank Center for American Progress (CAP). Aetna’s proposed deal for Humana would combine Aetna’s 7% of the Medicare Advantage market with Humana’s 19%, and make…

U.S. Government Suspends Enrollment in Cigna Medicare Advantage, Drug Plans

Caroline Humer  |  

(Reuters)—The U.S. government has suspended new enrollment in Cigna Corp’s Medicare Advantage health plans for seniors and standalone Medicare prescription drug plans, citing noncompliance in its appeals and grievances procedures. The government said Cigna had deficiencies in its appeals and grievances processes in both Medicare Advantage and the Medicare prescription drug program, according to a…

How to Avoid Legal Pitfalls

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In busy rheumatology practices, mountains of paperwork for insurance companies and federal healthcare programs make it hard to keep track of what’s legal. Missing documentation is the most common way to spark an investigation. Here are a few considerations to help you avoid legal pitfalls…

U.S. Top Court Rejects New Challenge to Obamacare

Lawrence Hurley  |  

WASHINGTON (Reuters)—The U.S. Supreme Court, which delivered major rulings in 2012 and 2015 preserving President Barack Obama’s signature healthcare law, on Tuesday declined to take up a new, long-shot challenge to Obamacare brought by an Iowa artist. The court turned away an appeal by Matt Sissel, who had asserted that the 2010 Affordable Care Act…

Patients Are Essential to Grassroots Advocacy

Kelly Weselman, MD  |  

In 2015, ACR members were powerful advocates on important issues affecting public health and rheumatology. But we should not forget about an important resource—patients, each of whom can bring unique perspectives to legislators in Washington, D.C. Working together, our voices are stronger. Here’s how your patients can work with the ACR to advocate for their health and rheumatology…

High-Deductible Health Plan Enrollees Aren’t Shopping Around

Kathryn Doyle  |  

hgh(Reuters Health)—High-deductible health insurance plans have been tied to lower healthcare spending, but a new study suggests the reason is not that enrollees in those plans are savvier. High-deductible plans have lower premiums, but when enrollees need medical care, it costs them more out-of-pocket. Researchers had expected that these patients are spending less because they’re…

Ethics Forum: Physicians Face Ethical Quandary Discussing Poor Prognosis with Patients

Rashmi Shah, MD, Jennifer Barton, MD, & Robert H. Shmerling, MD  |  

Over the course of a month, you diagnose systemic sclerosis in two newly evaluated patients. Their responses to the news could not be more different. Patient 1 is a previously healthy 55-year-old man who is an avid bicyclist and skier. He presents with a several-month history of rapidly progressive skin tightening extending to the proximal…

Rheumatology Researchers Explore Role of Neutrophils in Autoimmunity

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SAN FRANCISCO—To unravel the mysteries of how autoimmunity begins in the body and, one day, to interrupt that process, rheumatology researchers are exploring the role of neutrophils, especially when they form and release neutrophil extracellular traps (NETs). At a panel discussion on Nov. 6, 2015, held at the American College of Rheumatology’s Basic Research Conference,…

Pattern Recognition Key to Fibrosing Lung Disease Diagnosis

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SAN FRANCISCO—“Interstitial lung disease is the last bastion of great medicine,” according to Paul Noble, MD, chair, Department of Medicine, director, Women’s Guild Lung Institute, Vera and Paul Guerin Distinguished Chair in Pulmonary Medicine, Cedars-Sinai Medical Center, Los Angeles. Making it great medicine, he said, are the many things still unknown about this disease. In…

Search for Infectious Triggers of Rheumatic Disease Could Yield Options to Block Process

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SAN FRANCISCO—Two hundred years ago, physicians knew nothing about what caused various forms of arthritis. Today, we have more clues about what may trigger rheumatic diseases, but still can’t pinpoint the culprits that set scores of inflammatory conditions in motion. Researchers discussed some of the background and recent findings that point to what immunologists call…