Medicine & Health articles from February 2006

Medicine & Health archives from February 2006

President Bush backs controversial health care initiatives for 2006: HSAs, medical liability reform get strong White House support.(Special Report)
February 6, 2006... In spite of ongoing glitches with the new Medicare drug plan, rising health care costs and millions of uninsured Americans, President Bush assures the nation that the federal government is meeting its responsibility to provide health care for...

Nursing homes receive poor marks for quality and safety: weak oversight, recurring understatements and poor compliance continue to plague nursing homes.
February 6, 2006... Nursing home oversight standards have increased, but not enough to resolve many important quality and safety issues. A recent report from the Government Accountability Office outlines several critical flaws in nursing home standards and...

Specialty hospitals move in on community hospitals' ability to prosper, study says: hospitals raise their defenses, fearing that specialty outfits may soon take over the neighborhood.(Hospitals)
February 6, 2006... Cardiac, orthopedic and surgical specialty hospitals are threatening to erode competing community hospitals' profitability--even in the absence of significant price competition. Competition for high-profit cases is leading community...

Plan formularies fail to provide dual eligibles with access to critical meds: enrollees must jump through contingency hoops to obtain non-formulary drugs.
February 6, 2006... Prescription drugs that dual eligibles could once access easily through Medicaid are now hard to find together on the same Medicare drug plan. Only 18 percent of enrollees' Part D plans cover all of the drugs the dual eligible population...

HSA enrollment jumps to more than 3 million: consumer-driven health care movement may be picking up speed.(Coverage)(health savings accounts)
February 6, 2006... Health savings accounts, which are gaining momentum as mandatory add-ons to high-deductible health insurance plans, have tripled their enrollees over the past 10 months--much to the surprise of some industry analysts. "This is a very...

In other news...
February 6, 2006... Qualified non-physician practitioners working in both skilled nursing and standard nursing facilities can now obtain reimbursement for patient evaluation and management visits. The new policy covers nurse practitioners, physician assistants,...

CDHPs lead cost-conscious consumers to skimp on preventive care: high-deductible plans have lower medical costs but may encourage penny-pinching to a fault, studies suggest.(consumer-driven health care)
February 13, 2006... The divide that separates consumer-driven health care's proponents from traditional plans' staunch defenders grows wider by the day. Three recent studies have shed new light on consumer-driven health plans' cost benefits. First-time CDHP...

President cuts billions from short-term Medicare, Medicaid funding: budget reconciliation bill becomes law, sets the tone for further budgetary growth restrictions in 2007.(Budget)
February 13, 2006... The 2006 budget reconciliation bill's threats to Medicare and Medicaid funding are now quite real--and they may only get worse. President Bush signed the 2006 budget reconciliation bill (S 1932) Feb. 8--just one week after he outlined his...

HHS acknowledges problems, lays out action plan in Part D progress report: 'we make no excuses,' says HHS.(Department of Health and Human Services )
February 13, 2006... The ashes are still falling in the aftermath of Medicare's drug plan rollout. Fortunately, the Department of Health and Human Services is not remiss about its role in cleaning up the mess. HHS Secretary Mike Leavitt issued a Feb. 1 progress...

Correction.(Correction Notice)
February 13, 2006... In the Jan. 30, 2006 Edition of Medicine & Health (Vol. 60 No. 6), the article Prescription Drug Package Inserts Get A User-Friendly Makeover" contained an error. The quotation, "We are pleased that the FDA is moving toward development of a...

Drug plan may ring in below cost estimates: early projections hint at plan's success but rankle skeptics.
February 13, 2006... Good news about the Medicare drug plan has been hard to come by--and harder yet to believe. Due to "stronger than expected" competition in the prescription drug market, increasing use of generics and lower overall drug costs, Part D...

Americans are eager for progressive health care reform, study shows: current system has potential to provide affordable health care, but not without radical revision.(Health Care Reform)
February 13, 2006... If Americans aren't completely sold on the idea of consumer-driven health plans, that doesn't mean they're not ready for drastic changes to the current health care system. Americans on both sides of the political fence think the nation's...

Benes with greater needs could reap greater Medicare savings: Medicare offers substantial savings for benes with chronic conditions.(Brief Article)
February 13, 2006... Part D plans could already be reducing drug costs for beneficiaries suffering from chronic conditions by as much as 40 percent, one health care think-tank says. Average potential savings range from $1,000 per year for arthritis medications...

CMS shells out millions in improper ambulance transport payments: plus: new rule changes supplier reimbursement for respiratory assist devices.
February 13, 2006... The HHS Office of Inspector General has worried for years that the Medicare ambulance transport benefit is "highly vulnerable to abuse"--and a recent analysis of 720 claims has validated those worries. One in four ambulance transport...

Medicare reclassifies timed-backup respiratory assist devices for rental caps.(Brief Article)
February 13, 2006... Beginning April 1, 2006, Medicare will change the classification system for certain respiratory assist devices that help benes to breathe when their own spontaneous breathing efforts are insufficient. Although the move promises to reduce benes'...

Rx hotlines must meet more rigorous standards in 2007.(Brief Article)
February 13, 2006... Pharmacists and providers can expect better access to Medicare prescription drug plans for their benefit and claim inquiries during the 2007 plan year. New communication standards could require Part D plans to maintain toll-free call centers...

High-priced coverage could buy plans a one-way ticket out of their own market: ever-growing premiums and deductibles drive millions of benes to weigh the risks of foregoing coverage.
February 20, 2006... As costs go up and reimbursement rates head south, plans face a difficult decision: How much is too much to ask participants to contribute? Two new studies reveal that plans' attempts to recoup costs through enrollees could ultimately cost them...

Top 10 payment changes in the new deficit reduction act: Medicare providers get to start the 2006 claims year all over again.(Reimbursement)
February 20, 2006... The intense Congressional volley that prolonged the budget reconciliation bill's enactment is over, and the new Deficit Reduction Act's rollout has begun. But providers awaiting their claims adjustment checks could still have a long wait ahead....

Agencies combine forces to combat cancer: a new HHS alliance puts biomarkers to the test.
February 20, 2006... A first-time collaboration between different Department of Health and Human Services agencies may soon send cancer therapy development into warp speed. The Centers for Medicare & Medicaid Services joined the Food and Drug Administration,...

Home health PPS reins in Medicare spending--to a potential fault: financial incentives could lead providers to compromise quality of care.(HHAs)
February 20, 2006... Steady hospital readmission rates and emergency department visits indicate that the home health prospective payment system has had no significant effects on the quality of care for Medicare beneficiaries. But that's not a good enough reason to...

Plans struggle to justify premium costs to even the deepest pockets: employers' best efforts aren't enough to make health care affordable for non-retiree workers.
February 20, 2006... Plans have long relied on employers to help bridge the cost gap between employees and their health care premiums. Those days could soon be over. As employers are able to contribute less and less toward workers' premiums, more and more...

Medicare cracks down on secondary payer billing and reimbursement: plus: controversial health care mandates get a big thumbs-down.(Brief Article)
February 20, 2006... Physicians, suppliers and providers requesting reimbursement from Medicare secondary payers have two new changes to prepare for. The Centers for Medicare & Medicaid Services announced changes to the Administrative Simplification Compliance Act...

'Wal-Mart bill' sets bad example, COC warns.(Chamber of Commerce )(Brief Article)
February 20, 2006... The U.S. Chamber of Commerce cautioned states Feb. 7 not to follow Maryland's lead regarding health care mandates. Despite Gov. Robert Ehrlich's (R-MD) veto, Maryland passed controversial legislation in January that requires large employers...

Privatization: Medicare's next evolutionary step? Managed care may have another chance at success.
February 27, 2006... Part D may have turned traditional Medicare coverage upside-down--but its implications reach far beyond prescription drug coverage. Part D may be just one more step the Medicare Modernization Act is taking toward transforming fee-for-service...

Outpatient therapy caps' short-term relief may not resolve larger issue: CMS rolls out two-pronged exceptions process.
February 27, 2006... Financial limitations on outpatient therapy services have been putting the reimbursement screws to providers and beneficiaries since Jan. 1--but finalizing an exceptions procedure that will help lighten the load has taken the Centers for...

Providers bear the burden of proof for outpatient therapy exceptions: a new modifier provides the key that unlocks automatic exceptions.
February 27, 2006... There are nearly 100 diagnoses and clinical conditions that can buy providers an exception to the new $1,740 annual spending caps on outpatient therapy services. But to receive automatic reimbursement when a qualifying service exceeds the caps,...

HSAs may foul up comprehensive plans' risk pools: consumers may have 'more skin in the game,' but plans have just as much to lose.
February 27, 2006... The White House has been extolling health savings accounts since President Bush's State of the Union Address, calling them "an important step in restraining health care inflation." In contrast, opponents who dispute HSAs' benefits denounce them...

Final enforcement rule nails violators with costly penalties: privacy, security and EHR compliance are still problems, survey reveals.
February 27, 2006... A final rule, plus revealing survey results, reflects that the Health Insurance Portability & Accountability Act is on the move. The Department of Health and Human Services issued a final rule Feb. 10 that extends key enforcement provisions...

National health care spending surpasses $2 trillion, even as growth slows: slowdown will continue due to a drop in personal health care spending.(Brief article)
February 27, 2006... The aging population and medical technology changes are the main contributing factors to expectations that national health care expenditures will double during the next 10 years, with an average 7.2 percent growth rate per year, a recent report...

Experienced surgeons make the difference for bariatric surgery coverage: plus: why medical care visits in the United States have skyrocketed.(Brief article)
February 27, 2006... Medicare will no longer restrict its bariatric surgery coverage to gastric bypass procedures. But coverage may depend on surgical centers' success rates. A new Centers for Medicare & Medicaid Services decision expands bariatric surgery...

Managed care may be to blame for decreases in visits to specialists.(Brief article)
February 27, 2006... The annual number of medical care visits reached 1.1 billion in 2001 and 2002--a 10-percent jump from the visit rate in 1999 and 2000, a recent report reveals. "Fueling the increase was a 17-percent jump in visits to primary care...