Medicine & Health articles from June 2006

Medicine & Health archives from June 2006

Industry consolidation means fewer competitors for health plans: antitrust accusations have already started to fly.(Managed Care)
June 5, 2006... Consolidation among insurers is eroding competition in the health plan marketplace, warns a new study from the American Medical Association. But fewer competitors may actually spell trouble for health plans down the road. Leading plans are...

Keep an eye on the charts requested by 'bounty hunters': providers should contact CMS if the RACs recycle appealed claims.(Audits)(Recovery Audit Contractors)(Brief article)
June 5, 2006... The Recovery Audit Contractors, which have been looking at just hospital claims, are starting to look at physician claims now. If providers are located in New York, Florida or California, RACs could soon be on their doorstep. Providers...

Deadline to obtain NPIs for new doctors is coming up: carriers won't give physicians any leeway on enrollment jam.(national provider identifiers )
June 5, 2006... If practices don't have national provider identifiers for all of their providers, practices may have trouble enrolling them in Medicare--even before an upcoming deadline. Problem #1: The Centers for Medicare & Medicaid Services announced...

Moratorium on physician ownership of specialty hospitals almost over: P4P system will keep specialty hospitals in check, CMS claims.(Specialty Hospitals)(Brief article)
June 5, 2006... Medicare could lead a new crackdown on doctors' investments in specialty hospitals--if influential Senators get their way. A moratorium on Medicare enrollment for new physician-owned specialty hospitals will end August 8. At a May 17 Senate...

Plans court new employer customers with consumer-driven benefit designs: Kaiser Permanente's wait-and-see approach to CDHC could give it an edge in the employer market.(consumer-driven health care)
June 5, 2006... Successful managed care organizations aren't necessarily the first players to bring a "big idea" to market. Some health-plan industry frontrunners excel by bringing good benefit designs to the table. But other leaders find success simply by...

Big grants could bring insurers' health IT initiatives to fruition: one state pours money into e-prescribing efforts.(Health Plans)
June 5, 2006... The Bush Administration's push to advance health information technology is stirring up grant opportunities galore. The Blue Shield of California Foundation is awarding $3.12 million in grant monies to 14 nonprofit organizations in...

Final rule won't disrupt organ procurement services: OPOs face new quality measures, competitive certification.(Industry Notes)
June 5, 2006... A new final rule will change the way organ procurement organizations obtain Medicare and Medicaid coverage. In a final rule--appearing in the May 31 Federal Register--the Centers for Medicare & Medicaid Services has established new data...

Intestine transplant facilities still must have 10 surgeries per year.(Industry Notes)
June 5, 2006... In related coverage news, CMS won't change its current rule for approving intestinal transplant facilities, the agency announced in National Coverage Decision memo 168. Medicare only allows intestinal and multivisceral transplantation in...

Medicare funding problems could pull health plans into the red.(Industry Notes)(Report)(Brief article)
June 5, 2006... CMS recently released this year's Medicare Trustees Report--and along with it, some serious program funding concerns. Per Medicare Modernization Act guidelines, the report compares Medicare's overall projected expenditures to its dedicated...

Home care chains run up revenues while profits languish.(Industry Notes)
June 5, 2006... Publicly traded home care companies are seeing bigger and bigger revenues, but that may not translate into bigger profits. Gentiva Health Services Inc. announced a big jump in revenues for the quarter ended April 2. The Melville, NY-based...

The House passed a 2007 budget resolution that didn't include any Medicare cuts, following the Senate's lead.(In Other News ...)
June 5, 2006... The House passed a 2007 budget resolution that didn't include any Medicare cuts, following the Senate's lead. But the budget also didn't include any money to rescue physicians from next year's 4.6 percent cut.

Centers for Medicare & Medicaid Services.(In Other News ...)
June 5, 2006... It took only 273 days to develop a new National Coverage Determination under the new process, which took effect in 2004, according to a report to Congress by the Centers for Medicare & Medicaid Services. Before that, it took 370 days for NCDs...

Wheelchair suppliers won't just be working with physicians under the new power wheelchair rule--therapists will continue to play a major role as well.(In Other News ...)(Brief article)
June 5, 2006... Physical and occupational therapists handling high-end power wheelchairs won a small victory in the latest power mobility device (PMD) regulation released last month. The PMD final rule officially recognizes therapists' role in the prescription...

Physicians may see more denials for high-cost procedures and high-level visits for chronic patients in the future, as policymakers search for ways to bring down spending in higher-cost locations.(In Other News ...)(Brief article)
June 5, 2006... Physicians may see more denials for high-cost procedures and high-level visits for chronic patients in the future, as policymakers search for ways to bring down spending in higher-cost locations. Medicare pays three times as much to treat...

Physician kickbacks lead to record payout.(Fraud & Abuse)(Brief article)
June 5, 2006... A recent settlement by Clearwater, FL-based Lincare reinforces the notion that Stark self-referral and anti-kickback claims are serious business. Lincare agreed to repay $12 million, including $10 million to the HHS Office of Inspector...

Also: doctor prescribed Oxycontin to random patients, gets 150 months.(Fraud & Abuse)
June 5, 2006... * West Palm Beach pain management doctor Andrew Weiss will serve a whopping 150 months in prison after he pied guilty to four counts of prescribing Oxycontin to patients who didn't need it, or who weren't even his patients, the U.S. Attorney...

Hyannis, MA cardiologist Philip Chiotellis will repay 51.9 million to settle claims he submitted fraudulent bills to the Medicare program.(Fraud & Abuse)(Brief article)
June 5, 2006... * Hyannis, MA cardiologist Philip Chiotellis will repay 51.9 million to settle claims he submitted fraudulent bills to the Medicare program. He allegedly billed for cardiovascular stress tests when he only performed lower-paying cardiac...

Challenge: make MA plans more affordable for sicker benes: MA program not the great deal policymakers intended it to be, study charges.(medicare advantage)
June 12, 2006... Once an attractive alternative to traditional fee-for-service Medicare, Medicare Advantage is getting a scathing review from a recent study for its sky-high out-of-pocket costs for beneficiaries in poor health. "Out-of-pocket costs for MA...

LTC facilities struggle to solve Part D problems; nursing homes make advocacy, attention to care paramount to stave off disaster.(long term care)
June 12, 2006... Quick fixes aren't in the Medicare Part D forecast, but long-term care organizations are finding ways to weather the storm. "If there was a Part D honeymoon, it's over," says Charles Crecelius, MD, a multi-facility medical director in...

Insurers can get huge savings from electronic claims, study shows: turnaround time for health plans decreased dramatically.(Health IT)
June 12, 2006... Providers and insurers alike are moving--rapidly--toward electronic claims, yielding substantial reductions in claims-processing costs. Providers currently submit an impressive three-quarters of all health insurance claims electronically,...

Why stand-alone PDPs are attracting more enrollees--despite higher premiums; how risking adverse selection could actually help plans to nab more Part D market share.(PDPs)
June 12, 2006... Allegations of private health plans' lackluster roles in Medicare don't stop with the Medicare Advantage program (see related article on page 1). Health care policy analysts are spreading the word that stand-alone prescription drug plans are...

CMS doesn't feel providers' part D pain, physicians claim; nurse practitioners may soon be able to bill for their own services in hospitals.(Centers for Medicare and Medicaid Services)(Practicing Physicians Advisory Council meeting)(Conference notes)
June 12, 2006... The Centers for Medicare & Medicaid Services brushed off physicians' concerns about the Part D drug program at the May 22 meeting of the Practicing Physicians Advisory Council. PPAC had recommended that CMS keep track of how much time...

Doctors with abundant resources at their fingertips are less happy than others; survey proves once and for all that money can't buy happiness.(Brief article)
June 12, 2006... Doctors in areas with more medical resources are less satisfied with the quality of care in their areas than doctors in resource-poor areas, Dartmouth Medical School researchers found in a survey. There's a simple explanation, however. The...

The Senate won't pass a bill that aims to ease overcrowding in hospital Emergency Departments, Senate Majority Leader Bill Frist (R-TN) told the American College of Emergency Physicians, according to CQ Daily.(In other news)
June 12, 2006... The Senate won't pass a bill that aims to ease overcrowding in hospital Emergency Departments, Senate Majority Leader Bill Frist (R-TN) told the American College of Emergency Physicians, according to CQ Daily. Senators need to learn more about...

The House Ways and Means Health Subcommittee passed a bill.(In other news)
June 12, 2006... The House Ways and Means Health Subcommittee passed a bill to establish national standards on privacy and usage of electronic health records. The bill also promises to lead to national standards on medical data storage and interoperability.

Suppliers of power mobility devices have gained ground in their battle against the PMD final rule, reports the Power Mobility Coalition.(power mobility devices)(Brief article)
June 12, 2006... Suppliers of power mobility devices have gained ground in their battle against the PMD final rule, reports the Power Mobility Coalition. The House Government Reform Subcommittee on Regulatory Affairs released a May 19 letter calling on CMS to...

A higher dose of flu vaccine increases the immune response in the elderly.(Brief article)
June 12, 2006... A higher dose of flu vaccine increases the immune response in the elderly, shows a new study sponsored by the National Institutes of Health's National Institute of Allergy and Infectious Diseases. In a clinical trial conducted by...

Medicare's error rate is improving, according to the latest Comprehensive Error Rate Testing program report.(In other news)
June 12, 2006... Medicare's error rate is improving, according to the latest Comprehensive Error Rate Testing program report. The mid-year error rate was only 5.1 percent, down from 5.2 percent in 2005 and 10.1 percent in 2004. CMS found $11.9 billion in...

The insurance industry is splitting new hairs over pill-splitting.
June 12, 2006... The insurance industry is splitting new hairs over pill-splitting. Some insurers are encouraging patients to cut their drug copayments in half by adopting this controversial technique. Drug manufacturers commonly charge the same amount for...

The disease management marketplace is evolving as rapidly as DM techniques themselves.(American Healthways Inc. acquires LifeMasters Supported SelfCare Inc.)(disease management)(Brief article)
June 12, 2006... The disease management marketplace is evolving as rapidly as DM techniques themselves. In a bid to get into the Medicaid market, DM vendor Healthways of Nashville, TN, recently announced it will acquire its competitor LifeMasters Supported...

The Medicare Advantage market hasn't seen its last acquisition--not by a long shot.(In other news)
June 12, 2006... The Medicare Advantage market hasn't seen its last acquisition--not by a long shot. HealthSpring Inc. of Nashville, TN, announced that it will acquire Florida-based HMO America's Health Choice Medical Plans, Inc. for $50 million. HealthSpring...

House budget resolution excludes Medicare cuts: HHAs still will have a tough fight this year.(Legislation)
June 12, 2006... After the Senate excluded Medicare and Medicaid cuts from its budget resolution in March, the House followed suit in its budget resolution that passed narrowly May 18. But the House resolution does call for the Ways and Means Committee to...

CMS has a lot of work to do to whip Medicare into shape: Medicare can't keep up with rapid technological advances, MedPAC says.(Medicare)
June 19, 2006... Providers must become more accountable for the quality of the care they provide--and Medicare must take the reins, the influential Medicare Payment Advisory Commission says. In MedPAC's "Report to Congress: Increasing the Value of...

New regulations may breed new opportunities as buzz builds around insurance mandates: Massachusetts has set a high bar on low-cost coverage--and insurers are optimistic about new market potential.
June 19, 2006... If Massachusetts' new health insurance mandate radically reduces the state's number of uninsured, other states are sure to experiment with similar forms of legislation. New mandates could mean tremendous new market opportunities for...

Are CDHPs a threat to consumers? NCQA demands protections: consumer advocacy groups want more insurance regulations, standards.(Consumer-directed health plans)
June 19, 2006... As new health insurance products, such as consumer-directed health plans, are entering the marketplace at a rapid pace, consumer advocacy and accrediting organizations alike are crying out for more information for enrollees. Staggering...

Efficiency key to post-cap survival for oxygen providers: and an act of congress couldn't hurt.(Oxygen)
June 19, 2006... More questions than answers remain regarding how the Deficit Reduction Act of 2005 will redefine Medicare payments for oxygen equipment. But savvy suppliers know one thing for sure: Careful planning can help soften any blow the law might...

Insurer makes small-business benefit models more appetizing by expanding the menu: plus: plans earn customers' loyalty with provider choice and flexibility.(Health Plans)
June 19, 2006... Kaiser Permanente recently announced it's rolling out a new plan for small business owners with two to 50 employees. Instead of the lean palette of coverage options that's typical of most plans' small-business benefit models, Kaiser has...

Correction.(Correction notice)
June 19, 2006... Correction: In last week's issue of Medicine&Health (Vol. 60 No. 22) on page 6, a news item appeared in our Industry Notes about a Senate bill that would ease overcrowding in emergency departments. The news item requires the following...

Feds base false claims charges on erroneous cost report: beware this punishing legal tactic.
June 19, 2006... A lawsuit to challenge a cost report disallowance backfired on Visiting Nurse Association Health Care Services Inc. in Staten Island, NY. The VNA is paying $1.6 million to settle Medicare fraud charges, according to a release from U.S....

Doctor may have violated killer's confidentiality: 1 in 5 doctors now has access to full-fledged information technology.(Brief article)
June 19, 2006... North Dakota physician Jan Marie Flattum-Riemers may have violated Jerric Ballensky's confidentiality when she told state troopers he had marijuana in his system. Flattum-Riemers examined Ballensky after an accident in which he swerved...

The North Carolina Medical Board erred in suspending Gary Lustgarten's medical license in the state after he testified as an expert witness against two other neurosurgeons, Victor Keranen and Bruce Jauffman, in a wrongful death lawsuit.(In other news)
June 19, 2006... The North Carolina Medical Board erred in suspending Gary Lustgarten's medical license in the state after he testified as an expert witness against two other neurosurgeons, Victor Keranen and Bruce Jauffman, in a wrongful death lawsuit....

Nearly 21 percent of doctors interviewed in 2004-2005 said they had access to information technology (IT) that allowed them to perform at least four out of five important clinical tasks, according to the Center for Studying Health System Change.(Brief article)
June 19, 2006... Nearly 21 percent of doctors interviewed in 2004-2005 said they had access to information technology (IT) that allowed them to perform at least four out of five important clinical tasks, according to the Center for Studying Health System...

United Regional Health Care System didn't display any malice when it refused to reinstate the privileges of Ob-Gyn physician Paul Kinnard, who retired in 2000 and then decided to reapply for privileges two years later, the 78th.(Brief article)
June 19, 2006... United Regional Health Care System didn't display any malice when it refused to reinstate the privileges of Ob-Gyn physician Paul Kinnard, who retired in 2000 and then decided to reapply for privileges two years later, the 78th. District Court...

A court must consider whether Ohio physician Josef Korinek was negligent, the Court of Appeals for Ohio's Eighth Circuit ruled in Czarney v. Porter et. al. (2006-Ohio-2471).(In other newsd)(Brief article)
June 19, 2006... A court must consider whether Ohio physician Josef Korinek was negligent, the Court of Appeals for Ohio's Eighth Circuit ruled in Czarney v. Porter et. al. (2006-Ohio-2471). When Ann Marie Czarney was admitted to Amherst Hospital with bleeding...

Young invincibles: insurers look for ways to sell them coverage: health plans are studying the demographic to develop marketing efforts.(Health Plans)
June 26, 2006... Twenty-somethings who put a lower priority on health insurance are traditionally hard sells when it comes to individual insurance policies, and if insurers are vying for a larger chunk of this market, traditional marketing methods may not work...

Argument over HHABN implementation heats up between provider, patient advocacy groups: beneficiary advocates go to court to secure quicker implementation of new notices.(Patient Notices)
June 26, 2006... The break home health providers thought they were getting on advance beneficiary notices may be short-lived. The beneficiary advocates who filed the lawsuit that sparked the ABNs, the Center for Medicare Advocacy, have filed a motion asking...

July 1 ABN deadline would set agencies scrambling: HHAs should keep a look-out for last-minute change.(Regulations)(Brief article)
June 26, 2006... Home health agencies should prepare for the fact that Connecticut federal court may order a July 1 implementation date for the home health advance beneficiary notice. Neither side is predicting where the court will fall on the Center for...

High-paying ED visits are on the rise: ED visits could see an upcoding emergency soon.(Hospitals)(Brief article)
June 26, 2006... Emergency Department physicians and hospitals may be upcoding evaluation & management visits in the ED, according to one study. The number of high-level E/M services in the ED increased sharply from 2002 to 2004, a nationwide study of...

'Substantial compliance' not enough in deferred comp reimbursement case: Medicare manual rules, court says.(Lawsuits)
June 26, 2006... If providers want to fight the rules in the Medicare Provider Reimbursement Manual, they'll have a tough battle ahead. That's the lesson learned by Puerto Rican home health agency Visiting Nurse Association Gregoria Auffant Inc. in a recent...

No action on Medicare cuts until year's end: plus: Abbreviations may shorten patients' lives.(Industry Notes)
June 26, 2006... A desire to prevent a cut to physicians' payments in January is "the biggest driver" behind Congress' desire to pass Medicare legislation this year, according to The Hill. The American Medical Association will be putting a full-court press on...

Abbreviations kill thousands of people per year, according to the Food and Drug Administration.
June 26, 2006... Abbreviations kill thousands of people per year, according to the Food and Drug Administration. The FDA is joining with the Institute for Safe Medication Practices to stamp out doctors' abbreviations on medical notes. Among the killers are...

Medical oxygen therapy would continue to be covered by Medicare as a continuous rental under a bill introduced into Congress May 25.(Brief article)
June 26, 2006... Medical oxygen therapy would continue to be covered by Medicare as a continuous rental under a bill introduced into Congress May 25. The Deficit Reduction Act of 2005 shifted medical oxygen therapy from a continuous rental benefit under...

The HHS Office of Inspector General recovered more than $1 billion from health care fraud.(In Other News)
June 26, 2006... The HHS Office of Inspector General recovered more than $1 billion from health care fraud and abuse in the first half of 2006, according to its semiannual report. One doctor repaid the OIG $881,000 to settle charges of billing both the...

The OIG is also keeping M0175 on the front burner.(In Other News)(Brief article)
June 26, 2006... The OIG is also keeping M0175 on the front burner. In its latest semiannual report to Congress, the OIG recaps its reports on the OASIS item regarding prior inpatient stays, emphasizing that home health agencies improperly coded the question on...

The OIG also profiles two home care-related fraud cases in its latest semiannual report to Congress.(In Other News)(Brief article)
June 26, 2006... The OIG also profiles two home care-related fraud cases in its latest semiannual report to Congress. Interim HealthCare of Wyoming Inc., Interim HealthCare of Southern Wyoming Inc. and the agencies' owner agreed to pay $250,000 to resolve...

Home care providers accredited by the Joint Commission on Accreditation of Healthcare Organizations.
June 26, 2006... Home care providers accredited by the Joint Commission on Accreditation of Healthcare Organizations have a few more items to add to their to-do lists. JCAHO added two requirements to its 2007 National Patient Safety Goals that will affect home...

Lincare Holdings Inc. has agreed to pay $526,000 to end a federal whistleblower lawsuit.(In Other News)
June 26, 2006... Lincare Holdings Inc. has agreed to pay $526,000 to end a federal whistleblower lawsuit. The suit claimed three of the company's Massachusetts facilities overbilled Medicare between January 1999 and March 2004, according to U.S. Attorney...

Physicians could make it harder for visiting nurses to vaccinate seniors and others against the flu.
June 26, 2006... Physicians could make it harder for visiting nurses to vaccinate seniors and others against the flu. At a June 12 meeting, the American Medical Association considered proposals to limit flu vaccine access for visiting nurse associations...

State auditors say Oregon's Seniors and People With Disabilities Division paid out more than $100,000.(In Other News)(Brief article)
June 26, 2006... State auditors say Oregon's Seniors and People With Disabilities Division paid out more than $100,000 too much for home care services. The overpayments occurred when payments continued after the patient had been transferred elsewhere and...

Type 2 diabetes accounts for 95 percent of all diabetes cases.(In Other News)
June 26, 2006... Type 2 diabetes accounts for 95 percent of all diabetes cases and almost all undiagnosed cases, according to a study in the June 2006 Diabetes Care.