Medicine & Health articles from July 2005

Medicine & Health archives from July 2005

'MVP' bill would bring P4P incentives to Medicare; new bill would facilitate the spread of quality incentives.(Pay-For-Performance)
July 5, 2005... Two new bills could have a huge impact on the quality of health care provided under Medicare. Sens. Chuck Grassley (R-IA) and Max Baucus (D-MT) introduced June 30 the Medicare Value Purchasing Act, which would institute quality incentives...

Seniors want Medicare savings accounts, early enrollment; many elderly and disabled are uninsured just prior to Medicare enrollment, study finds.(Retiree Health)
July 5, 2005... As increasing numbers of employers drop medical benefits from their employees' retirement packages, the baby boom generation soon will look to Medicare to provide for its health care needs. A recent study shows that Medicare beneficiaries are...

Medicare faces major challenge in LIS enrollment; enrolling millions in low-income subsidy may take a nationwide effort.(Medicare Part D)(low-income subsidy)
July 5, 2005... Approximately 7.2 million Medicare beneficiaries could miss out oil the new prescription drug benefit's low-income subsidy because of a paperwork snag. Available in January 2006, the LIS will cover between 85 percent and 100 percent of...

CMS is shortchanging hospitals, AHA says; expanded post-acute care transfer policy could cost hospitals $894 million in FY 2006.(Hospitals)(inpatient prospective payment system)
July 5, 2005... Some hospital organizations fear that the Centers for Medicare & Medicaid Services" efforts to slash Medicare costs will ultimately threaten patients" quality of care and hospitals" fair reimbursement. The American Hospital Association is...

Medicaid drug system, AWP policies are 'broken'; generic drugs are keeping Medicaid costs artificially high.(Pharmaceuticals)
July 5, 2005... Judging by the tone of a recent hearing, U.S. representatives are set to take a hard look at how the government decides on Medicaid drug payments. During "Medicaid Prescription Drugs: Examining Options for Payment Reform," held last week...

Report offers 'Third Way' on mental health reform; is the mental health field ready for quality reporting and incentives?(Mental Health)
July 5, 2005... In an effort to break the stalemate between advocates for and critics of mental health parity mandates, a think tank is calling for a new solution that attempts to bridge the political divide. Titled "Parity-Plus: A Third-Way Approach to...

AMA: P4P programs must be voluntary; physicians not happy with some incentive programs, legislation.(Physicians)(American Medical Association)
July 5, 2005... Pay-for-performance anxiety dominated the American Medical Association's House of Delegates meeting June 18-22 in Chicago. The Delegates voted for a resolution stating that the AMA won't support any P4P program that doesn't meet the AMA's...

Medicare could reap millions in savings if it only followed the HHS Office of Inspector's recommendations to the letter, the OIG claims in its new semiannual fraud report.(In Other News ...)(Brief Article)
July 5, 2005... Medicare could reap millions in savings if it only followed the HHS Office of Inspector's recommendations to the letter, the OIG claims in its new semiannual fraud report. In particular, CMS could save $1.1 billion by removing some codes from...

Nearly 94 percent of Medicare chiropractic services in 2001 were missing important supporting documentation.(In Other News ...)(Brief Article)
July 5, 2005... Nearly 94 percent of Medicare chiropractic services in 2001 were missing important supporting documentation, the HHS Office of Inspector General said in a new report, "Chiropractic Services in the Medicare Program: Payment Vulnerability...

Malpractice claims payments decreased, yet premiums soared: new study accuses malpractice insurers of grand charade.(Medical Malpractice)
July 18, 2005... A study released July 7 reports that the 15 largest AM-Best rated medical malpractice insurers in America more than doubled their premiums from 2000 to 2004, while their claims payouts essentially flatlined and their estimated future claims...

Medicare drug benefit may do more harm than good: 'clawback' payments could give states incentives to drop dual eligibles.(Dual Eligibles)
July 18, 2005... Many low-income individuals who are eligible for both Medicaid and Medicare could find themselves without prescription drug coverage on Jan. 1, 2006. Because the Medicare Modernization Act demands that states pay the federal government for...

Primary cause of high U.S. costs? High U.S. prices: study argues against malpractice lawsuits as driver of costs.(Costs)
July 18, 2005... Blame skyrocketing medical prices--not lawsuits--for the fact that Americans spend more on health care than citizens of other industrialized nations. So concludes a new study conducted by researchers with Johns Hopkins University's...

P4P may lead to a transfer from certain medical specialties: some specialty groups may lend themselves more to quality guidelines.(Pay-For-Performance)
July 18, 2005... Pay for performance seems inevitable in 2007 and 2008--but will it save Medicare any money? It's hard to predict, experts say. It doesn't help that people can't agree on a definition of quality, let alone whether quality leads to lower...

More women avoid doctors due to cost concerns: rising cost of care has become 'a central women's health issue.'.(Women's Health)
July 18, 2005... A growing number of U.S. women delay or go without essential health care--simply because the price is too high. That's the finding of a new national survey of women conducted by the Kaiser Family Foundation with help from Princeton Survey...

Frist, like most docs, getting tired of drug commercials: Senate Majority Leader calls for moratorium on direct-to-consumer ads for new meds.(Drug Ads)
July 18, 2005... Senate Majority Leader--and potential presidential candidate in '08--Bill Frist (R-TN) called for pharmaceutical companies to hold off on direct-to-consumer ads during a new drug's first two years on the market. The July 1 announcement comes...

Providers fight over lucrative knee-replacement patients: CMS' new return to old rule puts rehab and home care providers in high-stakes battle.(Rehab)
July 18, 2005... The Centers for Medicare & Medicaid Services is moving full steam ahead with the so-called 75-percent rule in the wake of a flurry of reports on its impact on the rehabilitation industry. CMS suspended the rule's enforcement in January,...

Obesity-related costs fuel spending growth: cost of caring for obese patients skyrocketing even when compared to overall rising costs.(Obesity)(Brief Article)
July 18, 2005... Any efforts to curb escalating health care costs should focus on obesity. Adding to the growing scientific evidence about obesity's impact on the health system, a new report posted on the Web site of the journal Health Affairs quantifies...

How long until we all have the same health plan?(In Other News ...)(Brief Article)
July 18, 2005... How Long Until We All Have The Same Health Plan? The consolidation of the health insurance industry is accelerating, as UnitedHealth Group will acquire PacifiCare Health Systems for $8.14 billion in cash and stocks. The acquisition will...

Should employees lose coverage tax benefits?(In Other News ...)(Brief Article)
July 18, 2005... Should Employees Lose Coverage Tax Benefits? A growing number of conservative think tanks and economists are getting behind a radical idea: Eliminating the tax breaks that allow employees to pay for health coverage with pre-tax dollars. A...

HHS speeds up medicare claims appeals.(In Other News ...)
July 18, 2005... HHS Speeds Up Medicare Claims Appeals. The Department of Health and Human Services wants to use video teleconferencing technology (VTC) to ensure that fee-for-service Medicare claims appeals are resolved within 90 days. HHS hopes the new claims...

Rural health care isn't lacking, researchers say: quality of care ranks higher than among urban patients.(Access To Care)
July 25, 2005... Any problems patients living in America's rural communities might face when seeking health care may have nothing to do with a lack of local health care providers--but could have a lot to do with lower incomes. Researchers recently found that...

Plans, providers struggle to offer patients payment info: consumers can't purchase intelligently if they don't know what services cost.(Consumerism)(American Medical Association)
July 25, 2005... As more consumers demand information about the cost of medical treatments and hospital procedures, whose responsibility is it to provide this information: health plans or providers? The American Medical Association wants insurance...

Leavitt announces who will shape Medicaid's future: advisory commission members don't represent all viewpoints, Baucus says.(Medicaid)(Michael Leavitt )
July 25, 2005... The Medicaid program's financial health during the next five years and beyond could depend on just 13 people--the voting members of the new Medicaid advisory commission. But some Democrats are already displeased with the appointed commission...

NIH's internal ethics review shows severe problems: 44 scientists violated at least one of NIH's rules.(Medical Research)(National Institutes of Health)
July 25, 2005... The National Institutes of Health director Elias Zerhouni revealed the first hard facts uncovered during the extensive internal review of 81 scientists suspected of unethical relations with nongovernmental organizations. Committee on Energy and...

States put under microscope for use of Medicaid consultants: senator wants states to provide information on contingency-fee payouts.(Medicaid)
July 25, 2005... Sen. Charles Grassley (R-IA) continues to ask tough questions about Medicaid spending overages, fraud and waste: This time, the senator is examining the state practice of hiring contingency-fee consultants. Armed with the findings of a...

Domino drops on nominee after Plan B date set: FDA to decide controversial pill's fate by September.(FDA)(over the counter sales of birth control)
July 25, 2005... After years of stops and starts, it appears the endgame in the approval process of Barr Laboratories' application to sell its "Plan B" pill is nigh. In a July 13 letter to Sen. Michael Enzi (R-WY), who chairs the Committee on Health,...

Outlook on physician pay isn't good: CMS should act to save physician payments, legislators say.(Physicians)
July 25, 2005... Avoiding an estimated 31-percent pay cut for physicians from 2006 to 2012 would be "prohibitively expensive," two influential legislators warn. Unless the Centers for Medicare and Medicaid Services acts to fix the Sustainable Growth Rate...

Sickest Medicare patients still go to physicians with poor technology.(In Other News ...)(Brief Article)
July 25, 2005... Most Medicare patient visits in 2001 went to physicians with a low level of technology in their offices, according to a new report from the Center for Studying Health System Change. Some 57 percent of Medicare patient visits were to physicians...

Health plans flocking back to Medicare.(In Other News ...)(Brief Article)
July 25, 2005... With favorable funding rates and a marketable drug benefit about to kick in, more health plans are deciding that Medicare is a profitable market. The Centers for Medicare & Medicaid Services announced June 30 that they have approved 143...

CMS chooses 6 organizations to manage high-risk patients.(In Other News ...)(Brief Article)
July 25, 2005... The Centers for Medicare & Medicaid Services (CMS) has chosen six organizations to participate in the three-year demonstration Care Management for High Cost Beneficiaries (CMHCB). CMS chose ACCENT, Care Level Management, Massachusetts General...