Medicine & Health articles from November 2006

Medicine & Health archives from November 2006

Why American primary care physicians lag so far behind those in other countries: U.S. primary care doctors don't have the tools to provide the best possible care, study says.(Primary Care)
November 6, 2006... Primary care physicians in the United States aren't keeping up with doctors in other countries like the United Kingdom, the Netherlands, New Zealand and Australia. In some areas, such as health information technology adoption, U.S. PCPs are...

Hospitals will get a payment increase in 2007, but medicare will demand more quality reporting: CMS is concerned about the 12-percent jump in hospital outpatient expenditures.(Hospitals)(Centers for Medicare and Medicaid Services)
November 6, 2006... Although hospital administrators may get excited about the overall average 3-percent increase in Medicare payments for outpatient services in calendar year 2007, they may not like some of the hoops that the Centers for Medicare & Medicaid...

For physicians and patients, talk isn't cheap anymore: but CMS will reduce physician payments by 5 percent overall.(Physicians)(Centers for Medicare and Medicaid Services)
November 6, 2006... There's good news and bad news for physicians in the final rule that solidifies the 2007 Medicare Physician Fee Schedule. The bad news: Physicians will indeed see a much-debated 5-percent payment reduction next year. But the good news is...

Home health reimbursement could hang in the balance on election night: elections may determine fate of home care.(Legislation)
November 6, 2006... Home health agencies shouldn't count on the 2007 increase to their reimbursement from Medicare just yet. Rates are slated to jump 3.3 percent starting Jan. 1, 2007, the Centers for Medicare & Medicaid Services announced Nov. 1 (see related...

Industry groups argue over Part D doughnut hole: PDPs' gap coverage isn't 'meaningful' for seniors, consumer group claims.(Medicare Part D)(Prescription Drug Plans)
November 6, 2006... After the Department of Health and Human Services and the Centers for Medicare & Medicaid Services released data on what the private Medicare Part D drug plans will offer to enrollees in 2007, one consumer group is crying foul. HHS...

CMS may be wrong about increasing claims for PMDs.(Industry Notes)(Centers for Medicare & Medicaid Services)(Power Mobility Devices)(Brief article)
November 6, 2006... The Centers for Medicare & Medicaid Services is mistaken in its assertion that claims for power mobility devices are on the rise--and government data can prove the agency is in the wrong. That's the latest volley in a battle between the...

Medicare pays HHAs more next year.(Industry Notes)(Home Health Agencies)(Brief article)
November 6, 2006... Home health agencies will receive a 3.3-percent increase to Medicare payment rates starting Jan. 1, 2007, CMS announced Nov. 1. That's up slightly from the 3.1-percent increase CMS suggested in its Aug. 3 proposed rule on next year's...

Survey says: HMOs actually using P4P with physicians, hospitals.(Industry Notes)(Health Maintenance Organizations)(Pay for Performance)(Brief article)
November 6, 2006... In 2005, 52 percent of health maintenance organizations used pay-for-performance incentives in their provider contracts, according to a new survey. "Nearly two-thirds of HMOs that require the majority of enrollees to designate a primary...

CMS is picking and choosing which seniors to auto-enroll into Part D plans next year.(In Other News ...)(Centers for Medicare and Medicaid Services)(Brief article)
November 6, 2006... CMS is picking and choosing which seniors to autoenroll into Part D plans next year. Last year, the federal government supported its new prescription drug benefit by automatically enrolling dual eligible beneficiaries in private Medicare...

A new study looks at home health and hospice use by older adults with cancer.(In Other News ...)
November 6, 2006... A new study looks at home health and hospice use by older adults with cancer. Twenty-nine percent of cancer patients used home health services, and 10.7 percent used hospice services. Those rates compared with 7.8 percent of non-cancer...

Another home health agency will head to federal court to obtain its rightful reimbursement for physical therapist compensation.(In Other News ...)(remuneration of Physical Therapists)(Brief article)
November 6, 2006... Another home health agency will head to federal court to obtain its rightful reimbursement for physical therapist compensation. Intermediary Cahaba GBA imposed salary limits for outside therapist contractors to the compensation of directly...

National Institutes of Health.(In Other News ...)
November 6, 2006... The National Institutes of Health has put new falls information on its Web site geared toward older adults at http://nihseniorhealth.gov/falls/toc.html.

SCHIP, Part D to get extra attention from democratic majority in Congress: many industry groups think the new Democratic Congress is a boon for health care.(Mid-Term Elections)(State Children's Health Insurance Program)
November 13, 2006... The new House Speaker, Rep. Nancy Pelosi (D-CA), will have a busy first 100 hours when the January 2007 session begins. And many industry groups believe that her work during those 100 hours will make health care providers and consumers happy....

$12.2 billion in proposed medicaid-funding cuts will hit states hard: certain facilities could suffer greatly from cuts, AHCA says.(Medicaid)(American Health Care Association)
November 13, 2006... Individuals with developmental disabilities could get hurt the most from the Bush Administration's plan to slash $12.2 billion in funding for Medicaid over five years, says the American Health Care Association. The drastic funding cuts...

Physician payment reforms could happen late in new congressional session: democratic landslide means Congress may let physicians' payments slide.(Physicians)
November 13, 2006... It could be March, or even April, before Congress is able to revoke the 5 percent physician payment cut that's scheduled to hit the conversion factor in January. The Democrats took control of the House of Representatives and the Senate,...

Rehab therapists could lose big money in 2007--unless Congress steps in: new fee schedule and therapy caps spell bad news for reimbursement.(Legislation)
November 13, 2006... Not only will therapists be facing a $1,780-cap on physical therapy/speech-language pathology and the same cap on occupational therapy in 2007, but the final physician fee schedule aims to squeeze extra dollars from therapists' facilities as...

Some specialties reap massive pay increases, others suffer: women could suffer from new practice expense payments.(Reimbursement)
November 13, 2006... Some services will see drastic reductions in their practice-expense relative value units according to the final regulation from the Centers for Medicare & Medicaid Services. Many critics charged that CMS undervalued several essential...

Physicians can obtain a DME billing number to bill for oral medications: doctors may be throwing away money for anti-emetic, immunosuppressive drugs.(Medicare Part B)(Durable Medical Equipment)
November 13, 2006... Physicians are confused about whether they can bill Medicare Part B for oral medications. Medicare will actually cover a handful of oral medications, but there aren't many, says Suzan Hvizdash, physician educator for the University of...

Medicare managed care likely to become lawmakers' new financing pincushion: democratic election victory good for home care.(Home Health Care)
November 13, 2006... Home care providers may be out of the legislative hot seat for a while following the Nov. 7 elections. Control of the House is what is likely to make a big difference for home care providers, Capitol Hill insiders tell Eli. The Senate has...

Nurses' salaries grow in 2006.(Industry Notes)(Brief article)
November 13, 2006... Nurses' salaries continue to rise. The national median hourly rate for registered nurses in home health increased 4.5 percent to $25.00 in 2006, according to the HOMECARE Salary & Benefits Report published by Hospital & Healthcare Compensation...

HHS can use a higher reimbursement standard for suppliers.(Industry Notes)(Department of Health and Human Services)(Gulfcoast Medical Supply Inc.)(Brief article)
November 13, 2006... Suppliers of durable medical equipment, prosthetics, orthotics and supplies may have to submit additional evidence beyond a certificate of medical necessity to show the equipment is medically reasonable and necessary, according to a new...

Providers must look out for dual radiology billing.(Industry Notes)(Brief article)
November 13, 2006... The Part B carriers are putting in place edits designed to make sure doctors don't bill the technical component of an inpatient radiology service that a hospital is already billing for separately, according to Transmittal 1098 from the Centers...

Substance Abuse and Mental Health Services Administration.(In Other News ...)
November 13, 2006... Dextromethorphan, an ingredient commonly found in over-the-counter cough and cold remedies, contributed to an estimated 12,584 emergency room visits in 2004. Nearly half those, 5,581 visits, resulted from "nonmedical use" of the substance,...

Physicians have until Dec. 31 to decide whether to re-enroll as Medicare participating providers.(In Other News ...)
November 13, 2006... Physicians have until Dec. 31 to decide whether to re-enroll as Medicare participating providers. The enrollment period begins Nov. 15, according to CMS Transmittal 1074, dated Oct. 6 but released to the public in early November.

United Government Services.(In Other News ...)(processing for prospective payment system)(Brief article)
November 13, 2006... Regional home health intermediaries are already hard at work processing home health providers' M0175 overpayments and underpayments from the first year of the prospective payment system. RHHIs will recoup or refund related overpayments in...

Part D open enrollment begins--but doughnut hole, high drug prices still plague seniors: one organization offers tips on how enrollees can save on drugs.(Medicare Part D)
November 27, 2006... Approximately 48 percent of all Medicare Part D beneficiaries will be left without drug coverage this year when they reach the infamous "doughnut hole" in their prescription drug plans, according to a new study. Only 4 percent of the 22.5...

Self-care guides raise the bar for insurers on encouraging consumerism: plans can use these tools to emphasize patients' decision-making.(Health Plans)
November 27, 2006... As more and more health insurers are pushing beneficiaries to take on a "consumer" mindset, many health plans have had trouble finding a way to do this because benes are so far still reluctant to embrace that consumerist ideal. But there are...

On-call status could save a physician in a medical malpractice suit: how one sticky med mal case defined 'duty of care.'.(Physician-Patient Relationship)(Seeber v. Ebeling, 141 P. 3d 1180 (Kan. App. Sept. 1, 2006).)
November 27, 2006... When an on-call physician refuses to evaluate, treat or offer advice regarding a patient's medical condition, no physician-patient relationship exists and the doctor owes the patient no duty of care. In a medical malpractice case, this means...

Doctor who is allegedly anti-birth control to head up HHS' family planning programs: appointment raises questions about the future of these programs.(Department of Health and Human Services)(Brief article)
November 27, 2006... President Bush and the Department of Health and Human Services have made an interesting choice for HHS' new deputy assistant secretary for population affairs, a position that oversees federally funded family planning programs. ...

Thanks to inflation, damages cap is unconstitutional: bonus: Florida attorneys exploit a loophole in contingency fee caps.(Medical Malpractice)
November 27, 2006... In 1975, the Louisiana legislature enacted a $500,000-cap on the damages plaintiffs can receive in medical malpractice actions, and the cap includes compensatory and punitive damages combined. In 2006 dollars, that $500,000 is now worth about...

Reducing medical errors in hospitals--made easy.(Industry Notes)(Brief article)
November 27, 2006... Ensuring patient safety and decreasing errors are no doubt top priorities for U.S. hospitals. But finding simple solutions to these often complex problems and implementing new processes in institutions are the real challenges. HHS' Agency...

Will the Medicare managed-care market be fierce in 2007? More evidence says 'yes'.(Industry Notes)(Brief article)
November 27, 2006... Prior to the implementation of Medicare Part D, industry watchers predicted that Year 2 would see the market narrow as consolidation and competition would weed out more marginal offerings. Instead, the number of Medicare managed-care plans has...

Medication costs to blame for skyrocketing diabetes-treatment expenditures, statistics show.(Industry Notes)(Brief article)
November 27, 2006... Health care costs for diabetic adults increased sharply from $9.9 million in 1996 to $13.7 million in 2003, according to new data from AHRQ. The data showed researchers that these rising health care costs for treating diabetes in the...

Seraphin Manfredonia.(In Other News ...)(physician on vacation leaves pre-signed prescriptions with office assistants)(Brief article)
November 27, 2006... A vacationing pain doctor came up with an interesting new definition of "locum tenens." North Palm Beach, FL pain physician Seraphin Manfredonia pied guilty to distributing and dispensing controlled substances, prosecutors say....

Providers are allowed to submit National Provider Identifiers by themselves, but they should keep submitting old provider numbers along with them anyway, CMS says in Transmittal 249, dated Nov. 13.(In Other News ...)
November 27, 2006... Providers are allowed to submit National Provider Identifiers by themselves, but they should keep submitting old provider numbers along with them anyway, CMS says in Transmittal 249, dated Nov. 13. While the carriers are still testing...