Conversation: Texas medical director
Medicare & Reimbursement Advisor Weekly, November 20, 2009
As a managed markets professional, I thought this comment from a medical director I spoke to this week might help you understand perspective on what gets attention and what could hurt product adoption. Barry Lachman, MD, medical director for Parkland Community HP, a Medicaid managed care plan in Texas, said medical directors in the Houston area are upset at MD Anderson Cancer Center for “aggressively promoting” proton beam therapy in the face of what Lachman said is still a lack of scientific evidence, although some commercial plans cover the therapy for certain cancer indications. Lachman said he bases most first-line health technology and drug decisions on Hayes, an evidence and literature source which rates therapy and technology products A through D. “If Hayes, for example, decided to rate Proton Beam a B, and Medicare didn’t exclude it, we would cover it right away.” Second-line decisions are based on Aetna, which the plan uses for prior authorizations as well.
Most Popular
- Articles
-
- Don't forget the three checks in medication administration
- What does case-mix index mean to you?
- Note similarities and differences between HCPCS, CPT® codes
- Q&A: Primary, principal, and secondary diagnoses
- Practice the six rights of medication administration
- Complications from immobility by body system
- Nursing responsibilities for managing pain
- OB services: Coding inside and outside of the package
- Prevent dehydration with nursing interventions
- Coding Clinic reiterates guidelines for provider documentation
- E-mailed
-
- Will the JCAHO consider my facility's use of side rails a restraint?
- Understand the spine to code back procedures correctly
- Strive to bill all payers the same
- Safe rooms for suicidal patients
- Coding Clinic reiterates guidelines for provider documentation
- CMS final rule clarifies that medical staff can extend beyond physicians
- Catch up on what's new with injections and infusions
- Capturing start and stop times for infusions
- Searched
-
- trauma informed care
- Delegation of decision making by board
- 13719
- can an LPN do home health aide supervision
- Changes to therapy reporting and reimbursement tha
- dnv standards compliance manual
- Bronchial brushes and so washings flexible
- Burroughs J. 402011 Dec. 2941. Your hospitals fina
- Case management boot camp
- medical environment update
