Medicine & Health articles from December 2006

Medicine & Health archives from December 2006

Affordability a bigger problem among uninsured than industry leaders originally thought: new study debunks old assumptions about uninsured Americans.(Uninsured)
December 4, 2006... A startling 56 percent of the 44.6 million uninsured Americans cannot afford health insurance and are also ineligible for public assistance programs, according to new research findings, which are quite different from other statistics and data...

Why Medicare advantage is costing billions of dollars more than traditional FFS: mandated extra MA payments may be dragging down the entire program.(Medicare)(Fee for Service)(Medicare Advantage)
December 4, 2006... The federal government shelled out more than $5.2 billion in extra payments to Medicare Advantage plans over what it paid for traditional Medicare fee-for-service plans, a new report reveals. This staggering amount of extra costs for Medicare...

CMS slaps a fresh coat of paint on 'outdated and unduly burdensome' hospital regs: Medicare changes guidelines for history and physical examination, among others.(Hospitals)(Centers for Medicare and Medicaid Services)
December 4, 2006... The Centers for Medicare & Medicaid Services has finally updated its Medicare conditions of participation for hospitals to hopefully alleviate unnecessary regulatory burdens and give hospitals the flexibility they need to meet patients' needs....

Employers do feel an obligation to pay for health insurance, study shows: bonus: report charges Medicare with great oversight again in 2007 regarding Part D.(Research & Studies)(Commonwealth Fund report on employee health insurance)(choosing Medicare part D plan)(Larry C. Glasscock views on health care)
December 4, 2006... A plethora of reports, studies, surveys and other data have surfaced recently on topics ranging from Medicare Part D to transforming the health care system in the United States. Here's a look at the reports and studies of interest. *...

Providers shouldn't leave their NPI applications until the last minute: physicians especially need to get all their ducks in a row when they apply.(NPIs)(National Provider Identifier)(Brief article)
December 4, 2006... Providers must have a national provider identifier by May 2007, and it may take some time to figure out how to make the NPI work with providers' systems. Providers can get an NPI by going to https://nppes. cms.hhs.gov or calling...

OIG has a bee in its bonnet about doctors investing in medical devices: watchdog agency scrutinizes physicians' joint ventures with medical device makers.(Compliance)
December 4, 2006... Like the tycoon in the old Remington shave commercials, a doctor may like a medical gadget so much that he buys the company that makes it. But in that case, the doctor could be buying into a whole world of legal woe, experts warn. The HHS...

Medicare, Medicaid pay out nearly $10 billion each year for injuries: plus: AMA has developed 151 quality measures for physicians.(Industry Notes)
December 4, 2006... Injuries cost U.S. hospitals approximately $20 billion every year, according to new statistics from HHS' Agency for Healthcare Research and Quality. Medicare and Medicaid paid for nearly half of all injuries that require inpatient care,...

AMA calls on congress to avert 5-percent cut before it's too late.(Industry Notes)(American Medical Association)(Brief article)
December 4, 2006... The American Medical Association kept up its end of the bargain--and now it's time for Congress to hold up its end, the AMA says. The AMA promised Congress it would develop 140 physician quality measures this year, working with its...

Federal law does not preempt state law failure-to-warn claims.(Industry Notes)
December 4, 2006... When a drug company does not need the Food and Drug Administration's approval to add a warning to a drug's label, plaintiffs can defeat the company's preemption argument--even in the wake of the agency's preemption statement issued in June. ...

Centers for Medicare & Medicaid Services.(In Other News)(Recovery Audit Contractors recover $303.5 million)(Brief article)
December 4, 2006... The Recovery Audit Contractors that the Centers for Medicare & Medicaid Services is testing in New York, California and Florida recovered $303.5 million in improper payments in their first year--including $17.9 million from physicians,...

Medicare may grant a physicians an extended repayment schedule (ERS) for overpayments if she qualifies as suffering from "hardship," meaning the overpayments account for 10 percent or more of the physician's total Medicare payments.(In Other News)(Brief article)
December 4, 2006... Medicare may grant a physicians an extended repayment schedule (ERS) for overpayments if she qualifies as suffering from "hardship," meaning the overpayments account for 10 percent or more of the physician's total Medicare payments. Also, if a...

Physicians have escaped Medicare payment cuts--for the moment: Senate version of bill looks better for doctors than House version.(Physicians)
December 18, 2006... Congress moved at the very last minute to avert a 5.1-percent cut to physician reimbursement under Medicare that was supposed to take effect in January. At press time, House and Senate negotiators had agreed to a deal to cancel the...

Insurers employ pattern-recognition programs to stop fraud in its tracks: how 'prompt-pay' legislation may be helping to increase the number of improper payments.(Fraud Prevention)
December 18, 2006... Many health plan administrators have felt the pain of discovering claims fraud through after-the-fact audits. By that time, the perpetrator has the check, and the health plan is stuck trying to convince them to pay the money back. That's why...

'Hospital Compare' performance measures don't reflect changes in mortality rates: CMS may need to go back to the drawing board for hospital quality measures, study says.(Hospitals)
December 18, 2006... The Centers for Medicare & Medicaid Services began reporting hospitals' performance measures on its Hospital Compare Web site in an effort to improve quality of care in hospitals. But the quality-of-care measures that hospitals have reported on...

Top 7 managed care trends for 2007: mini-clinics on the rise, but HSAs face make-or-break year, study indicates.(Industry Trends)(Health savings accounts)
December 18, 2006... In the all-important "what the future holds" category, a comprehensive new PricewaterhouseCoopers study has outlined its top seven trends to watch for in the health industries for 2007. Some issues are fairly predictable--an overall emphasis on...

OIG report reveals providers going to prison for underdosing, falsifying records--even murder: lots of improper billing and fraud with physical therapy services, OIG finds.(Fraud & Abuse)(Office of Inspector General)
December 18, 2006... Physical therapy billings could be a major hot button in the new year, judging from the HHS Office of Inspector General's semi-annual report on fraud and abuse. A Texas physician received an 11-year, three-month sentence for taking part in...

Health IT gets a new look in patient health records: providers won't need a computer to access records from this credit-card-sized product.(Health IT)
December 18, 2006... Medical emergencies engender chaos, which means key patient information often remains unavailable to health care providers. As a result, doctors, hospitals and emergency medical workers can unwittingly pursue courses that are disastrously wrong...

HDHP, CDHP enrollment is virtually unchanged from 2005.(Industry Notes)(high-deductible health plans)(consumer-driven health plans)
December 18, 2006... A new study co-sponsored by the Commonwealth Fund and the Employee Benefit Research Institute has found that beneficiaries enrolled in high-deductible health plans are indeed more aware of the cost of the health care they purchase--the...

Physicians can make cost-sharing deals with hospitals--but they must step carefully.(Industry Notes)(Brief article)
December 18, 2006... The HHS Office of Inspector General came out with another advisory opinion (06-22) in which it blessed an arrangement in which a hospital paid a group of cardiac surgeons a percentage of the cost savings they achieve by following certain...

ASCs could soon have a new payment system.(Industry Notes)(ambulatory surgery centers)(Brief article)
December 18, 2006... Congress asked the Government Accountability Office to study the differences between payments in the hospital outpatient department and the ASC setting. The GAO found that the outpatient payments accurately reflected the costs of the same...

New price reporting could change providers' charges--and benes' expenses.(Industry Notes)(Brief article)
December 18, 2006... As insurers plan to roll out new products that will improve transparency in providers' pricing structures, many industry insiders are speculating that big changes are nearing for the current health care system. And some, especially among...

At the last minute, the Senate passed the Consumer Assurance of Radiologic Excellence Act (RadCARE), which would set standards for imaging and radiology, in consultation with "recognized experts.".(In Other News ...)(Brief article)
December 18, 2006... * At the last minute, the Senate passed the Consumer Assurance of Radiologic Excellence Act (RadCARE), which would set standards for imaging and radiology, in consultation with "recognized experts." It also would require the Department of...