Medicine & Health articles from July 2007

Medicine & Health archives from July 2007

Dangerous myths about seniors' mental health plague health-care industry: mental health treatments don't decrease in efficacy as patients get older.(Mental Health)
July 2, 2007... Health-care providers and policymakers who think depression is a normal part of the aging process are badly mistaken--and many are making this mistake. The nation's health-care system and the American public are not adequately handling the...

'Combined approach' to P4P may work best, demo results indicate: Medicaid managed-care P4P demo reveals solutions for future programs.(Pay-for-Performance)
July 2, 2007... Providers won't cooperate with pay-for-performance programs in Medicaid managed care if health plans don't offer up enough money, according to a P4P demonstration's results. Communication between providers and plans also played a crucial...

Alzheimer's therapy experts insist on national plan of action: one objective: 'smoother regulatory path' for new drugs.(Alzheimer's Disease)
July 2, 2007... The oncoming Alzheimer's epidemic--predicted to affect more than 15 million aging Baby Boomers by 2050--will require solutions from the government, academic researchers, and pharmaceutical industries working together. At a heating before...

Hospital buyout raises OIG's suspicions: if doctors want out, they can't profit from their clout.(Compliance)
July 2, 2007... If a doctor wants to bail out of owning part of an ambulatory surgery center, she could be out of luck. The HHS Office of Inspector General frowned on a group of physicians who wanted to unload their ASC ownership. Three orthopedic...

Doctors shouldn't leave their home addresses in the NPI database: at last, providers can look up other doctors' NPIs.(Physicians)
July 2, 2007... On Aug. 1, providers can download a new database from the feds that will help keep claims--and compliance efforts--on track. The new database will help home health agencies and other providers look up referring physicians' National Provider...

California children's health care varies widely by county: plus: new bill promises to improve Medicare payments to rural doctors.(Industry Notes)
July 2, 2007... Large disparities in children's health and well-being exist from county to county in California, which statewide figures may normally mask, according to striking new data. The nonprofit organization Children Now recently released the 2007...

Rural health-care facilities could see a big boost in Medicare reimbursement, among other perks.(Industry Notes)
July 2, 2007... A new bipartisan, Rural Health Caucus-supported bill, the Craig Thomas Rural Hospital and Provider Equity Act of 2007 (or the "R-HoPE Act"), proposes to improve Medicare and Medicaid payments to providers who care for seniors in rural and...

Cigarette tax may be the key to covering America's uninsured children.(Industry Notes)
July 2, 2007... Approximately 70 percent of American voters support a $0.30 increase per-pack in cigarette taxes to fund healthcare coverage for uninsured children, according to survey results that The Campaign for Tobacco-Free Kids recently released. ...

Consults, NPP billing lead to big payouts.(nurse practitioners and physician assistants services billing)(Brief article)
July 2, 2007... Three physicians agreed to repay $1 million after they allegedly billed for services that nurse practitioners and physician assistants provided. The physicians billed for the services as though they provided them personally. Also, a...

Centers for Medicare & Medicaid Services.(In Other News ...)
July 2, 2007... The Centers for Medicare & Medicaid Services will give some patients access to a Personal Health Record as part of a pilot program. The beneficiaries will be able to access their health records online through www.mymedicare. gov, including...

American Medical Association.(In Other News ...)
July 2, 2007... The American Medical Association unveiled its recommendations for reforming the Medicare program. They include combining the Part A and Part B funds into a single fund, which would be easier to administer; giving patients a single deductible...

California Association of Physician Groups.(In Other News ...)
July 2, 2007... In spite of all their critics, Medicare Advantage plans actually let physicians take better care of their patients, according to a new report from the California Association of Physician Groups. The reason? MA plans include "coordinated care"...

Illinois Attorney General Lisa Madigan sued two clinics in Champaign-Urbana for forming a consortium to boycott new Medicaid patients.(In Other News ...)
July 2, 2007... Illinois Attorney General Lisa Madigan sued two clinics in Champaign-Urbana for forming a consortium to boycott new Medicaid patients. Meanwhile, the Florida-based Federation of Physicians settled a Department of Justice lawsuit alleging the...

Industry leaders criticize president's SCHIP-reform plan, debate enrollment stats: waivers for coverage of parents are a major source of contention.(SCHIP)
July 9, 2007... With the State Children's Health Insurance Program up for renewal, debate continues as to whom the program should cover and how much funding it ought to receive. Currently, more than six million children are enrolled in SCHIP, 91 percent of...

Why health plans need real-time adjudication: some big challenges lie in implementing this time- and money-saving system.(Health Insurance)
July 9, 2007... Real-time adjudication can shave days, weeks and even months off of health insurers' claims-processing time. Here's what insurers, providers and patients alike stand to gain from this process and what could keep health plans from putting it...

Hurry up and wait for NPI database access: now's the time for providers to double-check their information in the database.(Physicians)
July 9, 2007... Just when it seemed like providers' troubles with obtaining the national provider identifiers for referring doctors were at an end, it turns out they'll be making do for a little longer. The Centers for Medicare & Medicaid Services had...

Medicare could auto-deny 100 percent of suspicious claims: make sure each NPI matches up to only one UPIN.(CMS)
July 9, 2007... Medicare's Program Safeguard Contractors will be on the lookout for "high-risk areas" soon. These are groups of claims with unusual patterns that show a potential for fraud and abuse. Warning signs could include: * a sudden change in...

How Humana gained a competitive edge with dental and vision benefits: also: premium increases are declining, PwC report predicts.(Health Plans)(Humana Health Care Plans Inc. purchases CompBenefits)(PricewaterhouseCoopers)
July 9, 2007... To broaden its dental and vision benefits offerings, Humana purchased dental and vision benefits company CompBenefits--for $360 million. Humana decided to purchase CompBenefits after Humana experienced an increase in profits and revenue...

PHRs can help keep medicare/medicaid benes healthy: plus: physician credentials gain more transparency with a new tool.(Industry Notes)
July 9, 2007... Many health insurers are partnering up with the Centers for Medicare & Medicaid Services for a pilot that would provide their beneficiaries with access to personal health records. The Internet-based tools could prove to be extremely beneficial...

How a new technology can help monitor provider credentials.(Industry Notes)(Brief article)
July 9, 2007... Medversant gives insurers a brand new tool to monitor providers' performance, with OneSource, "a single source for continuous monitoring and automated, real-time physician credentials verification." With convenience and increased...

American Medical Association.(In Other News ...)
July 9, 2007... The American Medical Association voted to support quality measures and pay-for-performance--but only as long as these initiatives don't open the door for the government and insurers to start meddling in how doctors treat patients. The AMA also...

Physicians usually try to exhaust non-surgical options before resorting to surgery for back pain.(In Other News ...)
July 9, 2007... Physicians usually try to exhaust non-surgical options before resorting to surgery for back pain. But surgery is by far the best option for degenerative spondylolisthesis with spinal stenosis, according to a new study in the May 31 issue of the...

Government Accountability Office.(In Other News ...)
July 9, 2007... Medicare should consider requiring credentials for sonographers who operate ultrasound machines, says the Government Accountability Office in a new report. The current inconsistent requirements are undermining people's faith in the accuracy of...

Congressional health-care proposals could cover all uninsured: bills may cut U.S. spending by up to $61 billion.(Uninsured)
July 16, 2007... A recent analysis of Congressional health-care proposals shows reason for optimism about health-care reform. This first-ever review of major Congressional bills, performed by the Commonwealth Fund Commission on a High Performance Health System,...

U.S. patients have less face time with primary care physicians: United States lags behind Australia and New Zealand in this important area of preventive care, study shows.(Primary Care)
July 16, 2007... Patients in the United States spend less time per year seeing primary care physicians than do patients in Australia and New Zealand, a recent Commonwealth Fund-supported study published in the British Medical Journal found. On average,...

Annual pay cuts could be a thing of the past: but specialties may face their own spending targets.(Legislation)
July 16, 2007... Every year, physicians face a nail-biting cliff-hanger, with a massive pay cut hanging over their heads through December--or even January--until Congress steps in for another year. But Congress may finally be ready to break the abusive...

Good news for anesthesiologists, bad news for everyone else: cardiologists, ER docs would suffer most from 9.9-percent cut.(Physicians)
July 16, 2007... Physicians' Medicare payments still face a cut of 9.9 percent next year, unless Congress acts. That's the worst news in the 2008 physician fee-schedule proposed rule, released by the Centers for Medicare & Medicaid Services. The...

What every PDP should know about PDE reconciliation: here's how insurers can prepare themselves for next year.(Medicare Part D Plans)
July 16, 2007... The reconciliation process for Medicare Part D plans' 2006 Prescription Drug Event, or "PDE," submissions is most likely a disaster for insurers' business. Find out what caused this debacle, how it will affect prescription drug plans and how...

Group puts a dollar value on family caregivers: new AARP study shines national spotlight on economic hardships of family caregivers.(Long-Term Care)
July 16, 2007... Family caregivers are the foundation of America's long-term care system, and it's about time we provide them with the financial support they both need and deserve. That's the main take-away from a report just released by the American...

Managed-care growth may slow due to marketing woes: plus: providers could lose money on MRI/CT scans.(Industry Notes)
July 16, 2007... Seven large health insurers have volunteered to stop marketing their Medicare Advantage plans temporarily, according to the Centers for Medicare & Medicaid Services. The seven insurance companies are United Healthcare, Humana, WellCare,...

A study last year by the Medicare Payment Advisory Commission miscalculated how frequently physicians use magnetic resonance imaging and computed tomography equipment.(In Other News ...)
July 16, 2007... A study last year by the Medicare Payment Advisory Commission miscalculated how frequently physicians use magnetic resonance imaging and computed tomography equipment, according to a new report released by industry group AdvaMed. The...

U.S. District Court Judge Fedrico Moreno sentenced Miami physician Julian Torres to 36 months' imprisonment and $1.36 million in repayment for his role in a fake-prescription scheme.(In Other News ...)
July 16, 2007... U.S. District Court Judge Fedrico Moreno sentenced Miami physician Julian Torres to 36 months' imprisonment and $1.36 million in repayment for his role in a fake-prescription scheme. Prosecutors said Tortes received $40,000 in kickbacks for...

A psychiatrist accused of Medicare fraud tried to claim that the CPT coding rules were too vague and he couldn't be expected to understand them.(In Other News ...)
July 16, 2007... A psychiatrist accused of Medicare fraud tried to claim that the CPT coding rules were too vague and he couldn't be expected to understand them. But the U.S. District Court for the Southern District of Illinois ruled that the rules were clear...

If patients miss an appointment, doctors can charge them for the inconvenience, according to MLN Matters article MM5613.(In Other News ...)
July 16, 2007... If patients miss an appointment, doctors can charge them for the inconvenience, according to MLN Matters article MM5613. But this shouldn't be the same as the charge for the actual service, and physicians can't bill Medicare for missed...

HHS Office of Inspector General.(In Other News ...)
July 16, 2007... The HHS Office of Inspector General withdrew a proposed rule that would have punished Medicare providers for submitting "excessive charges," in a June 18 Federal Register notice.

Health-care costs push millions into poverty each year: also: even a partially-effective vaccine would do much to slow the spread of HIV.(Studies & Reports)
July 23, 2007... A series of articles released in the recent issue of Health Affairs bring to light several global health issues, including the AIDS epidemic, financial catastrophe due to health-care costs and global health aid. At least 150 million people...

High-performing hospitals have lower mortality rates: and England comes out ahead in reducing wait times.(Hospitals)
July 23, 2007... High performance on Hospital Quality Alliance indicators can lead to lower mortality rates, a recent Commonwealth Fund-supported study finds. The HQA is a national public-private collaboration that helps hospitals voluntarily collect and...

Large employers may drop their insurance carriers in December: how benes are coping with health plans' proposed rate increases.(Health Insurers)
July 23, 2007... Everybody's feeling the sting of rising health-care costs, and health insurers are no different. But insurers have proposed the highest rate increase in four years, according to Hewitt Associates. How will employers handle these increases, and...

New CMS proposal could force doctors to scrap most imaging deals: the end result might be to force small physician practices out of business.(Physicians)
July 23, 2007... Medicare isn't just threatening to cut physicians' payments by 9.9 percent next year--it's also considering making many of the most common physician arrangements illegal (see article on page 7). The result could be a scramble to scrap--or...

Why cost-shifting hurts both insurers and benes: find out how value-based design could help.(Health-Care Costs)
July 23, 2007... When health-care costs rise, traditionally an employer's solution has been to shift the cost over to the employees' side. But a study by the Integrated Benefits Institute shows why that could be a grave mistake. Employers Are Battling High...

5 common financial deals that may soon be illegal: CMS could put physicians' joint ventures out of joint.(Compliance)
July 23, 2007... Physicians could be stuck rethinking their practice's financial arrangements if the Centers for Medicare & Medicaid Services' proposed Stark law changes go through. Here are some common arrangements that the CMS proposal would make impossible:...

Why provider networks should implement e-record systems: plus: better cafeteria food could be the key to better employee health.(Industry Notes)
July 23, 2007... Providers might be apprehensive about implementing an e-record system, but they might not be hesitant for long. A study by the University of Rochester found that installing an e-record system in hospitals pays for itself in less than two years,...

Providers may encounter patients having trouble disenrolling from private Medicare Advantage plans.(In Other News ...)
July 23, 2007... Providers may encounter patients having trouble disenrolling from private Medicare Advantage plans--a big problem for agencies in securing payment for home health services. Seniors have the right to withdraw from the plans if MA-plan reps...

Centers for Medicare & Medicaid Services.(In Other News ...)
July 23, 2007... A Medicare pilot project to reward physician groups for meeting quality targets has paid off so far, says the Centers for Medicare & Medicaid Services. All 10 of the practices taking part in the Physician Group Practice Demonstration have met...

A shockingly low percentage of benes use PHRs: also: health plans invest in community health and wellness programs for happier, healthier benes.(Health Insurers)
July 30, 2007... Despite the fact that an estimated 70 million people have access to Personal Health Records, two-thirds of Americans don't take advantage of this efficient system, according to Aetna and the Financial Planning Association. Aetna and the...

Come October, rates for generics may get scary: final rule for Medicaid payments not good for pharmacies.(Medicaid)
July 30, 2007... On July 6, the Centers for Medicare & Medicaid Services took its latest step toward steep cuts in what Medicaid will pay for generic drugs by issuing the final rule "Medicaid Prescription Drugs: Average Manufacturer Price." The agency called...

Model legislation targets dispensing fees: pharmacies follow the lead of these states to stave off big losses.(Prescription Drugs)
July 30, 2007... The health of pharmacies' profit margins could rest with state lawmakers if the feds move ahead with cuts to Medicaid rates for generic prescription drugs. State lawmakers are already seeking to offset the effects of a final rule released...

Virginia Tort-Claim damages cap applies after the jury's verdict: and now parties must meet and attempt to settle med mal claims in one Illinois county.(Medical Malpractice)
July 30, 2007... The $100,000 cap on claims brought against the Commonwealth of Virginia under the Virginia Tort Claims Act (the Act) may be applied only after a jury returns a verdict, the Virginia Supreme Court held. This mirrors the procedure required in...

Diabetic seniors should have hearing impairment screenings: plus: 'attention training' could help seniors block out distractions.(Research & Reports)
July 30, 2007... While the cause of hearing loss in diabetic adults is not yet known (it could be vascular or neurological), the numbers are clear: Diabetics have nearly double the risk of hearing loss as non-diabetics. A recent study analyzed data on 5,140...

Pharmacists should take stock of their ability to coordinate benefits: the effort may be worth more than they think.(Pharmacies)
July 30, 2007... The time is right for pharmacists to take on a bigger role in medication therapy management--including a role in helping physicians and their patients coordinate coverage, suggests a second major research effort. Substantial majorities of...

Medical homes key to better-quality care, report says: plus: planned parenthood blamed in woman's death.(Industry Notes)(Survey)(Brief article)
July 30, 2007... Adults who have medical homes reap many benefits in health-care quality and access to care, a new survey report claims. "Closing the Divide: How Medical Homes Promote Equity in Health Care," which the Commonwealth Fund released on July 20,...

Planned Parenthood faces Med Mal lawsuit for abortion that killed woman.(Industry Notes)
July 30, 2007... Did an abortion-preparation procedure cause the death of a 21-year-old woman? Aletheia Meloneon is suing Planned Parenthood and a nearby hospital because she thinks her daughter would be alive, but for that procedure. Meloncon's daughter,...

Study pinpoints way to cut number of uninsured children by one-third.(Industry Notes)(Website overview)
July 30, 2007... One-third of all children who were uninsured in 2006 lost their State Children's Health Insurance or Medicaid coverage in the previous year, according to a new study. Benjamin Sommers of Brigham and Women's Hospital in Boston calls this...