Medicine & Health articles from January 2007

Medicine & Health archives from January 2007

Doctors safe from pay cut--and also gear up for quality reporting: congress acted at the very last minute to prevent a steep cut to physicians' reimbursement in January.(Physicians)
January 1, 2007... Not only does the new law eliminate physicians' 5-percent pay cut for 2007, it also creates a fund to stabilize payments in 2008. Many physician organizations had been worried that Congress could get rid of the 2007 cut, only to end up with a...

Industry experts wonder whether $40 raise will be enough for therapists: CMS offers 3 key changes to the therapy cap for outpatients.(Regulations)(Centers for Medicare & Medicaid Services)
January 1, 2007... The therapy cap will increase from $1,740 to $1,780 in 2007 for both PT/SLP and OT, the Centers for Medicare & Medicaid Services says in Transmittal 1106 issued Nov. 9. But that's not where the changes stop. Here are the important highlights...

Why carriers have thousands of Medicare applications in backlog: providers must revalidate their enrollment information now, to avoid hold-ups later.(Medicare Enrollment)
January 1, 2007... A new clog in the Medicare physician enrollment process is holding up applications in Florida and Texas, but also in other areas, says consultant Leslie Witkin with Physicians First Physician Consulting in Orlando, FL. Problems started in...

Democrats may have the wrong idea about negotiating drug prices, NCPA claims: issue brief lists reasons why repealing ban might not be such a good thing.(Medicare Part D)(National Center for Policy Analysis)(Brief article)
January 1, 2007... Although many industry leaders cheered the Democrats' promise to repeal the legislation that bans Medicare from negotiating drug prices directly with pharmaceutical companies, a new brief finds that this may not actually lower drug prices for...

Payers push P4P for rehab providers: PTPN selects FOTO system to track patient progress.(Outcomes)(Pay for Performance)(Focus On Therapeutic Outcomes Inc)(Physical therapy provider network)(Brief article)
January 1, 2007... With all that's in the news regarding therapy caps, providers shouldn't overlook the fact that payers want to focus more on outcomes and pay-for-performance. Independent therapist private practice network PTPN hasn't overlooked this and...

Employers could be at risk when they collect genetic data from employees: study shows genetic info lacks privacy protections.(Health Insurance Portability and Accountability Act of 1996)
January 1, 2007... Knowing which rules to follow when it comes to keeping medical records is challenging enough for providers, with privacy officers struggling to choose between Health Insurance Portability and Accountability Act (HIPAA) requirements and state...

Congress extends therapy cap exceptions process: plus: California PTs call themselves 'Dr.'.(Industry Notes)(physical therapists)(Brief article)
January 1, 2007... Providers can breathe a sigh of relief that Congress has decided to extend the therapy cap exceptions process beyond 2006. Congress passed H.R. 6111, the Tax Relief and Health Care Act of 2006, which includes language to extend the therapy...

What's in a name? California lawmakers may have the answer.(Industry Notes)(California Physical Therapy Practice Act of 1953)(Brief article)
January 1, 2007... If a physical therapist in California received a doctorate of physical therapy (DPT) degree, she couldn't just tack a "Dr." to the front of her name--until now. The California Physical Therapy Practice Act, passed in 1953, restricts physical...

Recent LTC prosecutions include candid cameras, jail time for 'worthless services'.(Industry Notes)(long-term care)
January 1, 2007... The specter of nursing home staff being arrested for neglect or fraud can trigger a dangerous "this only happens to the other guy" denial. But nursing homes should analyze trends in criminal litigation involving long-term care providers to...

Medicare Payment Advisory Commission.(In Other News)(conferences)(Brief article)
January 1, 2007... Medicare patients still don't report any problems finding a doctor overall, but there was a "significant dip" in Medicare patients' access to specialists, staffers told the Medicare Payment Advisory Commission at its Dec. 7-8, 2006 meeting....

What New York and other states can learn from the Oregon Health Plan's failure: enacting universal coverage may be easier than sustaining it.(Coverage)
January 8, 2007... As New York State prepares a plan to launch universal health coverage and other states look to do the same, industry experts are cautioning state lawmakers to look at the Oregon Health Plan as a what-not-to-do example. Oregon enacted the...

Most Part D enrollees don't plan to switch in 2007: seniors still say Part D program is too complicated.(Prescription Drugs)(Brief article)
January 8, 2007... Even though enrollees have a lot of ideas about how to improve the Medicare Part D generally, they're relatively happy with the prescription drug plans they have and look forward to staying in them in 2007, a new report reveals. A tiny 5...

HSA enrollment not as high as industry analysts expect: employer contributions too low, report says.(Health Savings Accounts)(Brief article)
January 8, 2007... Despite the growing popularity of health savings accounts, only one in three individuals who are eligible to open an HSA has done so, a new report reveals. A significant gap exists between the number of individuals with HSAs and those with...

Insurer's arbitration disclosure 'unenforceable; court finds: judge wonders whether beneficiary waived his rights knowingly.(Litigation)(Zembsch v. The Superior Court of Alameda County)(Brief article)
January 8, 2007... A health insurance provider did not prominently display an arbitration disclosure on its enrollment form, and the arbitration agreement was therefore unenforceable, a California appeals court has held in Zembsch v. The Superior Court of Alameda...

Parties gear up for constitutional battle over damages caps: bonus: Tennessee physicians refuse to give up on tort reform legislation.(Tort Reform)(Brief article)
January 8, 2007... A lawsuit filed on Nov. 20 in Cook County, IL, challenges the constitutionality of recently enacted medical-malpractice verdict caps. State law currently caps awards against doctors at $500,000 and awards against hospitals at $1 million. ...

Nursing homes try alternative therapies to treat common ailments: why homeopathic remedies are becoming so popular in LTC facilities.(Long-Term Care)(Drug overview)
January 8, 2007... Some long-term care and skilled nursing facilities are trying out alternative or homeopathic remedies to ease their residents' discomfort. Alverno Health Care Facility offers "aromatherapy" to help residents with insomnia--a "lavender...

After-hours judgment calls can be dangerous for patients, researchers find: plus: increased generics use and disease management help insurer save big.(Industry Notes)
January 8, 2007... When doctors screen after-hours calls and ask patients if their problem is urgent or can wait until regular business hours, physicians are putting their patients at risk, a new study suggests. In fact, doctors shouldn't place this...

Decline in drug-spending growth yields slowest overall health-care spending growth in 6 years: percentage of persona/income Americans spend on health care still rising.(Spending)
January 15, 2007... Health care spending grew 6.9 percent in 2005 from the previous year, to nearly $2 trillion, according to the federal government's annual report. These figures may not seem like a cause for celebration, but they are--this was the slowest growth...

FDA wants more 'user fees' from pharma companies: drug companies may need to pay the FDA to monitor their drugs' safety after approval.(Prescription Drugs)
January 15, 2007... The U.S. Food and Drug Administration has proposed changes to the controversial Prescription Drug User Fee Act, which would ask pharmaceutical companies for a 28 percent increase in "user fees." The PDUFA, enacted in 1992, continues to...

Integrated medical practices are top dog for quality of care, research shows: solo-practice physicians don't take care of heart-attack patients as well as larger practices, report says.(Physicians)
January 15, 2007... When measuring preventive care and chronic-disease management, individual practice associations lag behind integrated medical groups, a new study says. The close collaboration and centralized decision making in integrated medical groups...

Health care providers not up to par on disease prevention, screenings: providers not counseling many obese adults about diet.(Preventive Care)
January 15, 2007... Despite all the major strides the U.S. health care industry has made to improve itself, health care providers are still lagging behind when it comes to preventive care, new statistics reveal. HHS' Agency for Healthcare Research and Quality...

Knock off $2.5 billion in annual health care costs--using one basic strategy: paying more up-front could save money in the long run for insurers.(Research & Studies)(Brief article)
January 15, 2007... As health care providers struggle to prevent repeat heart attacks, researchers may have found a simple solution: cover post-heart-attack patients' pharmacotherapies. Patients may often forgo taking their medications, including...

Providers who enrolled prior to 2002 need to prepare to re-enroll in medicare: bonus: physicians get a payment boost for telehealth.(CMS)
January 15, 2007... For providers who enrolled in Medicare before the Centers for Medicare & Medicaid Services started using the Provider Enrollment, Chain and Ownership System (PECOS), they can't simply make changes to their enrollment information. If a...

A 4-step plan to plug holes in providers' privacy compliance programs: practices must find the places where protected health information could leak.(Health Insurance Portability and Accountability Act of 1996)
January 15, 2007... Physician practices can reduce their HIPAA risks significantly if they follow a four-step plan, experts say. It's simply a matter of spotting and repairing places in the practice where patients' health information might leak. Think of your...

Physicians feel strongly about playing public roles: plus: carriers should be able to pay claims at 2007 rates right away.(Industry Notes)(Survey)(Brief article)
January 15, 2007... More than 90 percent of primary care physicians believe that doctors should play public roles, according to a new survey. Two-thirds of PCPs say they are actively involved in political work, community activities or advocacy, researchers...

Valentine's Day is doctors' deadline for medicare enrollment.(Industry Notes)(Brief article)
January 15, 2007... The Centers for Medicare & Medicaid Services expects contractors to be able to handle paying claims at the correct 2007 rates from the start of this month, with no delays or problems, the agency said in a "backgrounder" on the legislation that...

More young patients are undergoing bariatric surgery.(Industry Notes)(Brief article)
January 15, 2007... As mortality rates continue to decline for bariatric surgery, more obese individuals are seeking the surgical procedure as a weight loss solution, HHS' Agency for Healthcare Research and Quality finds. Since 1998, bariatric surgeries for...

The number of patients who visit publicly funded community health centers is likely to grow, a new Health Affairs study says.(In Other News ...)(Brief article)
January 15, 2007... The number of patients who visit publicly funded community health centers is likely to grow, a new Health Affairs study says. And although CHCs provide care that is "on par" with care quality in other care settings, "gaps in quality exist,...

Now is the chance for providers to sound off on their carrier's or Medicare Administrative Contractor's performance.(In Other News ...)
January 15, 2007... Now is the chance for providers to sound off on their carrier's or Medicare Administrative Contractor's performance. CMS is mailing out surveys for this year's Annual Medicare Contractor Provider Satisfaction Survey. More details are at...

New Part D bill won't lower drug prices, government officials claim; Congress passes legislation despite federal disapproval.(Legislation)
January 22, 2007... Amidst heated debate over the efficacy of current Part D legislation, the new House passed H.R. 4, the Bipartisan Prescription Drug Negotiating Authority Bill on Jan. 12 by a vote of 255 to 170. "[The] vote is a resounding victory for...

Funding for uninsured children at risk: the good news: 17 states expand access to Medicaid.(SCHIP)
January 22, 2007... Ten years ago, more than 23 percent of children whose families lived on less than 200 percent of the federal poverty level lived without health insurance. Today, fewer than 14 percent of children in similar circumstances live without medical...

House divided by corruption allegations in previous Part D legislation: partisan mud slinging tarnishes H.R. 4.(Part D)
January 22, 2007... With the passage of H.R. 4, House Democrats have delivered on a prominent part of their "Six for '06" campaign. Though the bill passed in a bipartisan vote and its title proclaims it to be a Bipartisan Prescription Drug Negotiating Authority...

Expanded enrollment period makes non-PDP MA plans more attractive; last-minute tax law could spell doom for PDPs.(Medicare Advantage)
January 22, 2007... For insurers offering a Medicare Advantage plan that comes with a prescription drug plan, the government had a nasty New Year's surprise last month. A last-minute addition to the new tax and health law will exempt MA plans without PDPs...

California following in Massachusetts's footsteps--and potentially making the same mistakes: California enters universal-coverage arena.(Coverage)
January 22, 2007... California has the highest number of uninsured residents: 6.5 million, at last count. So the state's attempt to install a universal-coverage plan should have some far-reaching effects. Here's what Gov. Arnold Schwarzenegger's proposal...

How auto insurance policies could tie into PT reimbursement; New Jersey's revolutionary bill could help physical therapists.(Therapists)(physical therapists remuneration)
January 22, 2007... A group of physical therapists with the help of legal counsel and lobbying introduced a bill in their state assembly that would mandate a minimum amount insurance companies could pay physical therapists for services. The New Jersey Society...

Hospital spending high for heart birth defects: heart and circulatory conditions account for one-third of birth defects, statistics show.(Industry Notes)(Brief article)
January 22, 2007... Hospitals spent $2.6 billion in 2004 on treating birth defects--one half of which went toward treating circulatory and heart congenital problems, HHS' Agency for Healthcare Research and Quality reports. In 2004, newborns with atrial septal...

President promises health care reform while Democrats deride proposals as more of the same; insurance might soon be cheaper for 80 percent of Americans.(Health Care Policy)
January 29, 2007... On Jan. 23 President Bush delivered his annual State of the Union address, promising tax breaks that would make health care more affordable for millions of Americans. Without offering a substitute plan Democrats lambasted the Bush...

Putting nursing homes out to pasture: seniors receive higher quality care in alternative facilities: Green Houses may lead to higher quality of life for the elderly.(Nursing Homes)
January 29, 2007... Despite 20 years worth of legislation that has led to better care in nursing homes, recent evaluations of William Thomas' Green House model for elder care suggest that Congress was trying to fix a system not worth saving. State inspectors...

Medicare Part B saves big--but for whom? Legislative effect on quality of care is unclear.(Physicians)
January 29, 2007... Physicians may have benefited from Part B drug payments more than Medicare's enrollees, a new report claims. The Medicare Payment Advisory Commission recently released the second of two Congressionally mandated reports on the "Impact of...

Coming soon to a hospital near you: a new Nationwide Health Information Network: new report on the health IT initiative details advances, future plans.(Health IT)
January 29, 2007... The Department of Health and Human Services issued a report on Jan. 23 promising that federal healthcare delivery systems will comply with newly adopted federal "Interoperability Specifications" by December 2007. This announcement marks a major...

Lack of savings in HSAs could jeopardize consumer-driven health programs; consumers aren't putting enough away to protect against health care costs, study finds.(Health Savings Accounts)
January 29, 2007... Many industry experts believe 2007 could be either the tipping point or the end of the road for health savings account growth. Newly loosened restrictions on HSA funding have made these accounts a much more inviting option. But most benes...

CIMT shows promise for stroke victims; plus: South Carolina PTs struggle with Supreme Court decision.(Industry Notes)(constraint-induced movement therapy)(Physical Therapists)(atypical antipsychotics not good options to treat dementia)(Clinical report)
January 29, 2007... Stroke survivors who had lost function in one arm showed dramatic clinical improvements lasting a year after a special two-week rehabilitation regimen, researchers say. Researchers funded by the National Institute of Child Health and Human...

Clark Mitchell.(In Other News ...)(guilty of health care fraud)(Brief article)
January 29, 2007... Miami Beach physician Clark Mitchell, already in prison for defrauding Medicaid, pleaded guilty to a health care fraud that cheated investors out of almost $1 billion, the Miami Herald reports. Mitchell and other doctors promised investors...

Center for Studying Health System Change.(In Other News ...)
January 29, 2007... Pay-for-performance programs now affect 20.2 percent of doctors, up from 17.6 percent in 2000-2001. But a whopping 70 percent of doctors receive financial rewards for productivity, according to an "issue brief" from the Center for Studying...

Congressional Budget Office.(In Other News ...)
January 29, 2007... The law that reversed the 5-percent cut to physicians' Medicare payments for 2007 will cost the government an extra $5 billion from 2007 to 2010, the Congressional Budget Office predicts.