Medicine & Health articles from August 2006

Medicine & Health archives from August 2006

2007 brings uncertainty for providers' reimbursement: providers try to predict what the future really holds for them.
August 14, 2006... With so many physician payment changes being talked about for next year, it's hard to know what's written in stone and what's scribbled in sand. Here's a complete list of all the changes that have actually become law or final regulations....

How health insurers can make DM work for chronic pain patients: the disease management umbrella will protect insurers from prohibitive costs.
August 14, 2006... Paying for chronic pain has become a huge financial burden for health plans and employers. Health care costs related to chronic pain and costs for lost days of work go into the hundreds of billions every year. While there is no cure for chronic...

Providers could change the future of their Medicare payments: providers shouldn't wait until these proposals become final to make their voices heard.
August 14, 2006... Now's the time for providers to sharpen their quills and write some letters. There are number of changes coming down the pike which could drastically affect providers' Medicare reimbursement starting next January. And unless providers let...

Medicare growth shrinks--but more cuts on the way: new analysis bucks conventional wisdom.(Brief article)
August 14, 2006... The growth rate in Medicare spending "slowed considerably" during the period from 1992 to 2003, as compared with the period from 1975 to 1983, according to a "working paper" by the Congressional Budget Office. CBO analyst Chapin White...

Physicians could soon get help upgrading their computer systems: CMS, OIG loosen up on donations of e-prescription, EHR systems.
August 14, 2006... Hospitals will be able to donate equipment and software to allow physician practices to write prescriptions electronically, thanks to two new final regulations from the Centers for Medicare & Medicaid Services and the HHS Office of Inspector...

Stark kick-starts universal health coverage debate: plus: House and Senate set to hash out fate of health IT.(Brief article)
August 14, 2006... It seems like the sleeping elephant in the room is waking up again, as prominent politicians introduce legis calling for universal health coverage. Rep. Pete Stark (D-CA), along with 26 colleagues, just introduced the "AmeriCare Health Care...

Senate bill couples ICD-10 with HIT interoperability.(Brief article)
August 14, 2006... Providers could be facing a tight deadline to adapt to the ICD-10 diagnosis code system, if the House of Representatives gets its way. The House passed a health information technology bill that would require providers to start using ICD-10...

Now is insurers' chance to put some teeth into their wellness programs.(Brief article)
August 14, 2006... The credo "live and let live" takes a back seat when consumers are forced to pay a larger proportion of escalating health care costs. Witness a new Wall Street Journal Online/Harris Interactive health care poll. More than half of the...

CMS tightens billing requirement for hours of care.(Centers for Medicare and Medicaid Services)(Brief article)
August 14, 2006... Hospices will have to report more information on their Medicare claims, starting Jan. 1, 2007. A transmittal from the Centers for Medicare and Medicaid Services (Change Request 5245) issued on July 28 spells out the policy changes. ...

Suppliers need NPIs for all locations.
August 14, 2006... Attention durable medical equipment providers: Don't neglect to get a national provider identifier for every location. CMS and the agency's contractors issued the reminder to suppliers on Aug. 1, noting that they would be linking Medicare...

HHS praises home care's pandemic: preparedness plans.(Brief article)
August 14, 2006... Federal officials recently praised home health leadership for taking action to respond to a pandemic or other emergency. Mike Leavitt, secretary of the Department of Health and Human Services, sent a letter to National Association for Home...

Medicare should restrict pay for performance to Medicare managed care plans and leave regular fee-for-service Medicare out of the experiment for now, advises a new white paper from the Cato Institute.(.)
August 14, 2006... Medicare should restrict pay for performance to Medicare managed care plans and leave regular fee-for-service Medicare out of the experiment for now, advises a new white paper from the Cato Institute. "Given Medicare's patient population, size...

Noridian Administrative Services.(.)(Brief article)
August 14, 2006... Meet the new boss, same as the old boss. Medicare chose the first of its Medicare Administrative Contractors, which will replace carriers and cover both Part A and Part B. The winner: Noridian Administrative Services, which will administer...

Centers for Medicare & Medicaid Services.(In Other News ...)
August 14, 2006... Medicare contractors should waive the Part B deductible for colorectal cancer screenings furnished on or after Jan. 1, the Centers for Medicare & Medicaid Services instructed in Transmittal 1004.

Barry Silverstein.(In Other News ...)
August 14, 2006... Plantation, FL chiropractor Barry Silverstein received a 34-month prison sentence, plus a $1.8-million refund and a $100,000 fine. Prosecutors say Silverstein bought car accident/victim information from third parties, and then paid those...

Centers for Medicare & Medicaid Services telling.(Brief article)
August 14, 2006... About 35 "underperforming" organ transplant centers are receiving letters from the Centers for Medicare & Medicaid Services telling them to prove their quality--or risk losing their Medicare enrollment, says the Los Angeles Times. The Times...

"America's emergency departments are underfunded, understaffed, overcrowded and overwhelmed- and we find ourselves on the brink of collapse," Frederick Blum, president of the American College of Emergency Physicians, told a July 27 hearing of the House Ways & Means Health Subcommittee.(Brief article)
August 14, 2006... "America's emergency departments are underfunded, understaffed, overcrowded and overwhelmed- and we find ourselves on the brink of collapse," Frederick Blum, president of the American College of Emergency Physicians, told a July 27 hearing of...

The AQA Alliance and the Hospital Quality Alliance have joined forces to promote quality measurement, transparency and improvement in health care.(In Other News ...)
August 14, 2006... The AQA Alliance and the Hospital Quality Alliance have joined forces to promote quality measurement, transparency and improvement in health care. The two will work closely with CMS and the Agency for Healthcare Research and Quality to expand...

Changing face of health care: consumers want centralized care coordination: even higher-income patients struggle to pay medical bills, survey finds.(Health Care Policy)(restructuring of health care industry)
August 21, 2006... A consumer perspective on the U.S. health care system has proven to be quite revealing: more than three-quarters of adults say that the health care system needs either fundamental changes or complete rebuilding. Also, many Americans report that...

Local malpractice environments cause large variations in cesarean rates: researchers dig into why cesarean rates aren't driven by patient risk profiles.(Medical Liability)(medical malpractice)
August 21, 2006... New statistics regarding cesarean rates in cities across the United States have startled researchers. Patient risk profiles don't impact cesarean rates as much as nonmedical factors, such as socioeconomic factors, differing medical-liability...

Forward-looking docs go online with benes--and want insurers to pay for it: it's early for plans to jump on the bandwagon, but they may need to move fast later.(Reimbursement)
August 21, 2006... Anyone who says that Internet consultations are the next big thing may be bankrolling the next big thing. But in an age where many of us spend more time online than offline, it pays for health plans to keep a close eye on the big players who...

Insurers have a tough game of catch-up if they want to gain Part D market share: last year's winners plan to cash in with expanded PFFS and MA plans.(Medicare Part D)
August 21, 2006... Late last month, for the first time, the Centers for Medicare and Medicaid Services released Part D enrollee data that broke down enrollees by type. For example, now insurers can find out not just Medicare Advantage enrollment but how many of...

BCBSA leverages vast claims records with new database product: it could promote quality care nationally, but it also riles privacy advocates.(Health Plans)(Blue Cross and Blue Shield Association)
August 21, 2006... The Blue Cross and Blue Shield Association has come out with a new product that leverages 79 million members' claims data. It's called Blue Health Intelligence, and the Blues Association hopes their new database will help participating plans...

CMS releases long-awaited quality standards for DME-POS suppliers: plus: California DMHC slaps Kaiser with its highest fine ever.(Industry Notes)(durable medical equipment prosthetics, orthotics and supplies)(Centers for Medicare and Medicaid Services )(Brief article)
August 21, 2006... After receiving thousands of comments from suppliers of durable medical equipment prosthetics, orthotics and supplies, the Centers for Medicare and Medicaid Services announced Aug. 15 that it has published the new quality standards. CMS...

Kaiser pays big fine for mismanaging kidney transplant patients.(Industry Notes)(mismanagement)(Brief article)
August 21, 2006... Kaiser Permanente had been in trouble for months amid news that its Northern California kidney transplant center was hampered by mismanagement and inattentiveness to patient complaints. Last Thursday, the California Department of Managed Health...

Oregon pushes Medicaid waiver for disabled children's home care.(Industry Notes)(new medicare plans)(Brief article)
August 21, 2006... Oregon's severely disabled children currently in nursing facilities could receive care at home if a Medicaid waiver plan goes through. Current state laws stipulate that "a child living in a nursing home is automatically eligible for...

Mass. health care reform panel compromises on premiums.(Industry Notes)(health care plans)(Brief article)
August 21, 2006... The panel that's shaping health care reform in Massachusetts, the Commonwealth Health Insurance Connector, is on a tight schedule to get subsidized coverage in place for the state's working poor. A subcommittee of the panel, after a tense...

Nursing home payments set to increase in 2007.(Industry Notes)(medicare payments)(Brief article)
August 21, 2006... The annual update notice of new payment rates for skilled nursing facilities will increase next year. Medicare payments to nursing homes will increase by approximately $560 million in 2007, CMS announced. This is a 3.1 percent increase that...

Infrared devices are under CMS' scrutiny.(Industry Notes)(treatment of neuropathy)(Brief article)
August 21, 2006... Providers shouldn't miss this window of opportunity to offer their opinions on the effectiveness or ineffectiveness of infrared devices in their facilities. CMS is seeking public comment on its proposed determination regarding infrared and...

Mystery solved? Benes with multiple conditions to blame for skyrocketing Medicare spending: new study pegs obesity as major culprit as well.(Medicare)
August 28, 2006... Beneficiaries with three or more conditions accounted for more than 92 percent of Medicare spending in 2002, researchers discovered. More aggressive treatment and preventive services for ailments such as obesity and metabolic syndrome have...

9-day payment freeze could turn into 12 days: providers need to prepare now for slow end of September.(Reimbursement)
August 28, 2006... Providers are already bracing for the nine days of pain in late September--but the situation may actually be worse than they expect. Medicare plans to hold all claims from Sept. 22 through Sept. 30, as required by the Medicare Modernization...

CMS learns a thing or two from the private sector: Medicare benes not taking advantage of covered preventive services, screenings.(Preventive Care)(Centers for Medicare & Medicaid Services)
August 28, 2006... The day before economists Kenneth Thorpe and David Howard released their study on Medicare spending (see story on page 1), the Centers for Medicare & Medicaid Services announced it would launch a new risk-reduction demonstration for Medicare...

End of moratorium doesn't mean a cease-fire in war on doc-owned hospitals: don't rush into opening a single-specialty hospital, experts warn providers.(Compliance)(doctor owned hospitals)
August 28, 2006... Physicians and hospitals alike may have rejoiced when a Medicare moratorium on doctor-owned specialty hospitals finally dragged to an end--but the problems may just be beginning. As tempting as it might be for physicians and hospitals to...

Practices losing money by buying equipment before they're sure of reimbursement: providers need to be wary of manufacturers trying to snow them into investing in new gadgets.(Coverage)
August 28, 2006... Many physician offices are raving about the latest equipment that treats intractable conditions--but many offices could be stuck with denials if they make a purchase without doing their homework first. Manufacturers' sales reps may make...

CMS evicts physicians from 'condo' laboratories: doctors forced to re-think their 'pod-lab' arrangements.(Physicians)
August 28, 2006... In recent years, many urology and dermatology practices have entered into "pod lab" arrangements--and deals often come with a 10-year lease. But it may be time to rethink those agreements, say experts. The Centers for Medicare & Medicaid...

Medically unlikely edits are back: 2,800 edits target 'non-controversial' topics: plus: case goes to trial because doctor didn't document recommendation.(Industry Notes)
August 28, 2006... A drastically unpopular set of edits is back for yet another go-around. The Centers for Medicare & Medicaid Services almost scrapped the controversial medically unbelievable edits but instead renamed them medically unlikely edits. ...

A Miami physician received a 65-month prison sentence, plus three years' supervised release and a $1.3 million repayment, for his part in an AIDS clinic scheme.(In Other News ...)
August 28, 2006... A Miami physician received a 65-month prison sentence, plus three years' supervised release and a $1.3 million repayment, for his part in an AIDS clinic scheme. Prosecutors said Isaac Nosovsky pre-signed medical agreements in 2004 and 2005,...

HHS' Agency for Healthcare Research and Quality.(In Other News ...)(Brief article)
August 28, 2006... Employees at large companies who were eligible for and enrolled in health insurance plans decreased from 87 percent in 1996 to 80 percent in 2004, according to new statistics from HHS' Agency for Healthcare Research and Quality. "The...

Carriers and other Medicare contractors should make sure they don't go after the same physicians as the Recovery Audit Contractors, CMS says in Transmittal 104.(In Other News ...)
August 28, 2006... Carriers and other Medicare contractors should make sure they don't go after the same physicians as the Recovery Audit Contractors, CMS says in Transmittal 104. The carriers should communicate with the Medicare "bounty hunters" to make sure...

President Bush.(In Other News ...)(Brief article)
August 28, 2006... CMS is revealing Medicare payment information for ambulatory surgery centers. This release of data, which includes payment information on 61 procedures performed in ASCs, follows CMS' June release of payment information on 41 procedures...

Medicare should pay for telehealth services in a critical access hospital at 80 percent of the Medicare physician rate.(In Other News ...)
August 28, 2006... Medicare should pay for telehealth services in a critical access hospital at 80 percent of the Medicare physician rate, CMS said in Transmittal 1026.

Starting Oct. 1, CMS will only issue electronic remittance advice notices.(In Other News ...)
August 28, 2006... Starting Oct. 1, CMS will only issue electronic remittance advice notices that comply with the Health Insurance Portability and Accountability Act.

Tyler Wilson will take the helm at the American Association for Homecare, the group announced.(In Other News ...)(appointment of Tyler Wilson at American association for homecare)(Brief article)
August 28, 2006... Tyler Wilson will take the helm at the American Association for Homecare, the group announced. His appointment as president and CEO will be effective Sept. 18. "We are pleased to bring such a veteran of the Washington association world...