Medicine & Health articles from October 2006

Medicine & Health archives from October 2006

Massachusetts reform plan: a miracle or a mess? Industry experts are divided: why the Mass. universal-coverage plan may not work for other states, the nation.(Universal Coverage)(Massachusetts Health Care Reform Plan)
October 2, 2006... As Massachusetts lawmakers embark on the many reforms stemming from the state's new plan for universal health coverage, industry experts and researchers are all chiming in with their opinions on whether the reform plan will swim or sink. But...

Competitive bidding coming soon--but providers question whether rule is good for patients: DME bidding could have patients limping home.(DME)(Durable Medical Equipment)(Durable Medical Equipment, Prosthetics, Orthotics & Supplies)
October 2, 2006... The next time a patient leaves her physician's office wearing a cast on her leg, her physician may be unable to provide her with a pair of crutches, thanks to a new Medicare program. The Centers for Medicare & Medicaid Services is close to...

Patient groups lobby for better access to drugs under Part D: they also want more funding for NIH, improved drug safety through FDA.(Prescription Drugs)
October 2, 2006... National patient-group leaders gathered on Capitol Hill on Sept. 26 to ask lawmakers for nearly $30 billion in funding for the National Institutes of Health in fiscal year 2007. The increased NIH funding--a 5-percent increase over funding...

AMA rejects quality-improvement, P4P programs: time is running out for fix to 5.1-percent cut.(Reimbursement)(American Medical Association)(Pay for Performance)(Brief article)
October 2, 2006... The American Medical Association's $1.5-million advertising campaign to stop Medicare pay cuts for doctors may have backfired, the Chicago Tribune reports. The AMA has angered influential Republicans by running advertisements targeting...

Health care system shouldn't monitor drugs' adverse events solely by accident; bonus: seniors suffer higher drug error rates than younger patients.(Research & Studies)(Brief article)
October 2, 2006... The United States needs to create a system to track prescriptions linked to adverse events. That was the conclusion a panel of leading international brain and behavior research experts reached on Sept. 13 at a meeting the American College of...

Family physicians rally at Capitol; United States will be clamoring for primary care physicians in 2020, researchers say.(Physicians)
October 2, 2006... More than 2,000 family practice physicians and others joined in the Vote for America's Health Rally on Capitol Hill. At the Sept. 27 rally, physicians demanded that Congress become the "Health Care Congress," according to the American Academy...

Drug maker loses in court over inadequate labeling; a drug's label is misleading if it doesn't state the risk level for developing side effects.(Pharmaceuticals)(McNeil v. Wyeth, 2006 U.S. App. Lexis 21499 (5th Cir. Aug. 22, 2006).)(Brief article)
October 2, 2006... Consider this scenario: A drug company knows that patients are using a drug it makes for longer periods of time than the Food and Drug Administration approved. The company also knows that using the drug for long periods of time can cause severe...

You've got no mail, doctors tell patients.(Industry Notes)
October 2, 2006... Only one in four doctors (24 percent) use e-mail to communicate with patients about their health issues and medication, up from one in five doctors in 2000-2001, according to a new report from the Center for Studying Health System Change. ...

HHS to patients: 'own your future'.(Industry Notes)(Department of Health and Human Services)(Brief article)
October 2, 2006... In a partnership with six states, the U.S. Department of Health and Human Services is executing an education and outreach program that encourages Americans to shoulder some of the burden for their long-term care needs, HHS announced on Sept....

Respiratory mask makers shouldn't hold their breaths waiting for liability protection.(Industry Notes)
October 2, 2006... The Fiscal Year 2006 Defense Appropriations Bill included liability protections for vaccine makers, and now companies that manufacture respiratory masks want the same protection. The companies are concerned about the liability they might...

Centers for Medicare & Medicaid Services.(In Other News ...)(Brief article)
October 2, 2006... Leslie V. Norwalk has been named the acting chief of the Centers for Medicare & Medicaid Services, federal officials announced Sept. 25. Norwalk, 40, a lawyer who has served in both Bush administrations, is now the deputy administrator at...

Medicare's plan to cap the technical component for imaging procedures at the hospital outpatient payment level will lead to payments below physicians' costs of providing the scans in the office for 126 out of 145 procedures, according to a new survey by the Moran Company.(In Other News ...)(Brief article)
October 2, 2006... Medicare's plan to cap the technical component for imaging procedures at the hospital outpatient payment level will lead to payments below physicians' costs of providing the scans in the office for 126 out of 145 procedures, according to a new...

Marsha Lynn Hoffman-Vaile.(In Other News ...)
October 2, 2006... Polk County, FL dermatologist Marsha Lynn Hoffman-Vaile faces up to 10 years in prison. She was found guilty of 44 counts of fraud, 44 counts of false claims and one obstruction-of-justice charge. She allegedly billed for higher paying...

Transmittal 158, dated Sept. 15, updates the reason a carrier can disenroll a provider from Medicare or deactivate a provider's billing number.(In Other News ...)
October 2, 2006... Transmittal 158, dated Sept. 15, updates the reason a carrier can disenroll a provider from Medicare or deactivate a provider's billing number. Reasons include no billing activity for 12 months or failure to report a change in billing...

National Association for Home Care and Hospice.(In Other News ...)(Brief article)
October 2, 2006... * CMS should use more recent cost report data in calculating the home health market basket index, says the National Association for Home Care and Hospice. NAHC made the request in its official comments to CMS on the Aug. 3 proposed rule...

CMS uploaded the October pricing file for Part B drugs.(In Other News ...)
October 2, 2006... CMS uploaded the October pricing file for Part B drugs, according to Transmittal 1059, dated Sept. 15.

HHS Office of Inspector General.(In Other News ...)(human and health services)(Brief article)
October 2, 2006... The 2007 Work Plan from the HHS Office of Inspector General adds accuracy of data on the Home Health Compare site to its list of priorities. Home health outliers, cyclical noncompliance, and the appropriateness of enhanced payments for...

Gap widens between health-spending and GDP growth rates: health care spending growth maintains high-altitude holding pattern.(Spending)(gross domestic product)
October 9, 2006... In 2005, costs per privately insured American grew by 7.4 percent, outpacing the United States' overall economic growth, according to a new study. The only silver lining, analysts say, is the slowdown in employer-sponsored health insurance...

Hospitals falling short on quality measures lose big bucks: CMS hits hospitals in their pocketbooks for not participating in quality reporting.(Hospitals)
October 9, 2006... Many hospitals that reported data on the quality of care they deliver will enjoy a 2-percent annual payment boost as a reward. But for those unlucky 171 hospitals that either didn't participate or failed the submission requirements, the Centers...

HSAs: researchers warn consumers they d better shop around: researchers find wide disparities in HSA fees.(Health Plans)(health savings accounts)(Brief article)
October 9, 2006... When it comes to fee structures, health savings accounts are all over the map--and although the higher fees seem to correlate with higher service levels, they don't necessarily mean better HSA returns, a new study has found. Health care...

The sooner the feds jump on P4P programs the better, study says: new report calls for quick P4P phase-in for home health providers.(Reimbursement)
October 9, 2006... Pay-for-performance programs in hospitals are already saving Medicare money while improving care--and the same could be true in home health agencies, according to a new report from the influential Institute of Medicine, a non-governmental...

CMS clarifies PMD coverage determination: implementation on codes, LCD delayed until Nov. 15.(PMDs)(Centers for Medicare and Medicaid Services)(power mobility device)(local coverage determination)
October 9, 2006... Medicare will still pay for a Group 2 power mobility device when appropriate, say the feds in a recent "clarification" from the Centers for Medicare & Medicaid Services. A Fact Sheet issued by CMS on Sept. 20 clarifies the point, saying...

Senate interest in 13-month cap proposal dwindles: oxygen stakeholders celebrate cap victory.(Oxygen)
October 9, 2006... Sen. Charles Grassley's (R-IA) recent pledge to drop consideration of a 13-month rental cap for oxygen equipment has oxygen suppliers and manufacturers cheering. The 13-month cap proposal, included in President Bush's budget for fiscal...

CMS boosts competition with a call for 3 new MACs.(Industry Notes)(Centers for Medicare & Medicaid Services)(Medicare Administrative Contractors)(CIGNA Government Services)(Palmetto GBA)(Brief article)
October 9, 2006... The Centers for Medicare & Medicaid Services is forging ahead with its plans to get the new Medicare Administrative Contractors up and running. On Sept. 29, the agency issued a Request for Proposal for three of 15 separate contracts that...

Doctors not e-mailing patients due to legal fears.(Industry Notes)(Survey)(Brief article)
October 9, 2006... Not only are providers shying away from electronic medical records and e-prescribing, but they are also not using cheaper, widely accessible information technology in their practices, such as e-mail, a new report reveals. Fewer than 4...

There's now a companion to the Hobson-Tanner bill in the Senate, thanks to Senators Orrin Hatch (R-UT) and Kent Conrad (D-ND).(In Other News ...)(Medicare Durable Medical Equipment Access Act (S. 3920))(Brief article)
October 9, 2006... There's now a companion to the Hobson-Tanner bill in the Senate, thanks to Senators Orrin Hatch (R-UT) and Kent Conrad (D-ND). The bill, the Medicare Durable Medical Equipment Access Act (S. 3920), aims to ease the effects of Medicare DME...

CMS has issued a "special edition" MLN Matters article to help providers bill for influenza vaccines.(In Other News ...)(Centers for Medicare and Medicaid Services)(Medicare Learning Network)(Brief article)
October 9, 2006... CMS has issued a "special edition" MLN Matters article to help providers bill for influenza vaccines. The article, SE0667, lists a variety of educational resources to ensure that Medicare FFS health care professionals have the information...

The 2007 Work Plan from the HHS Office of Inspector General adds accuracy of data on the Home Health Compare site to its list of priorities.(In Other News ...)
October 9, 2006... The 2007 Work Plan from the HHS Office of Inspector General adds accuracy of data on the Home Health Compare site to its list of priorities. Home health outliers, cyclical noncompliance, and the appropriateness of enhanced payments for home...

In related news, there's no word yet on when CMS might begin recoupment efforts related to OASIS item M0175, a CMS spokesperson tells Eli.(In Other News ...)(Centers for Medicare and Medicaid Services)(Outcome and Asessment Information Set)(Brief article)
October 9, 2006... In related news, there's no word yet on when CMS might begin recoupment efforts related to OASIS item M0175, a CMS spokesperson tells Eli. CMS called for the paybacks following a finding by the OIG that home health agencies received more...

Using an online survey could help during an influenza pandemic, according to a column by Dr. Benjamin Brewer in the Wall Street Journal.(In Other News ...)(Survey)(Brief article)(Column)
October 9, 2006... Using an online survey could help during an influenza pandemic, according to a column by Dr. Benjamin Brewer in the Wall Street Journal. Clinicians could use the online survey for surveillance purposes, and using clinical guidelines,...

Researchers struggle to measure EHR adoption among providers: e-prescribing adoption slow from what researchers can see.(electronic health record)
October 16, 2006... Physicians are catching on to electronic health records, but fewer are using EHRs with electronic prescribing and other specific functionalities, a new report says. In fact, one-quarter of physicians are using EHRs as of 2005, but fewer than 10...

Some Republicans skeptical of forcing physicians to jump through quality hoops: Congress plays 'kick the can' with physicians' reimbursements.(Physicians)
October 16, 2006... Physicians could face a 12-percent Medicare cut in 2009 and a 13-percent cut in 2010, if one proposal goes through. The House of Representatives and the Senate have come up with competing proposals for avoiding January's looming 5.1-percent...

Court order drives 2007 inpatient-hospital payment rates: new occupational-mix adjustment doesn't yield big changes to wage index.(Hospitals)
October 16, 2006... Good news for hospitals: Medicare will allow hospitals to reclassify geographic assignments so they can receive payments using another area's wage index under the fiscal year 2007 inpatient prospective payment system. The Centers for...

Daily billing, early appeals helped cushion the blow from payment freeze: physician offices still defrosting from 9-day Medicare freeze.(Reimbursement)
October 16, 2006... The worst nine days of the year are over, and providers survived. Medicare put a hold on physician payments for the last nine days of September, until the beginning of the new fiscal year on Oct. 1. Even though providers had advance notice...

New Medicare enrollment form has danger zones for providers: doctors must read the fine print before signing the new 8551.(Medicare Enrollment)
October 16, 2006... If a physician practice's compliance plan isn't up to scratch, the doctor could be signing up for a Medicare witch hunt. The new CMS 855I enrollment for physicians includes some new statements that could get providers into trouble down the...

Landmark decision reclassifies many nurses as supervisors.(Industry Notes)(Brief article)
October 16, 2006... A recent labor decision could put the breaks on nurse supervisors' union membership. The National Labor Relations Board ruled Oct. 3 that nurses with full-time responsibility for assigning fellow hospital workers to particular tasks are...

OIG squelches manufacturer partnerships.(Industry Notes)(Office of Inspector General)(Brief article)
October 16, 2006... Durable medical equipment manufacturers must be wary of partnering too closely with suppliers, says the HHS Office of Inspector General in a new advisory opinion. A DME manufacturer whose identity was not disclosed planned to underwrite...

GAO calls for MIP distribution reforms.(Industry Notes)(Government Accountability Office)(Medicare Integrity Program)(Brief article)
October 16, 2006... The Centers for Medicare and Medicaid Services should develop a new approach for allocating funds to the Medicare Integrity Program to ensure the money goes toward the most effective activities, the Government Accountability Office said in an...

Cardiac-related conditions account for hospitalized elderly.(Industry Notes)(Brief article)
October 16, 2006... Congestive heart failure, heart attack, arteriosclerosis (hardening of the arteries) and heart beat irregularities accounted for nearly 2.4 million hospital stays in 2004, according to new statistics from the Agency for Healthcare Research and...

It's not only fly-by-night doctors who face fraud charges.(In Other News ...)(Brief article)
October 16, 2006... It's not only fly-by-night doctors who face fraud charges. The government has charged Turan Itil, a former chairman of the World Health Organization who has written hundreds of scientific articles about Alzheimer's disease, with Medicare...

Southern California physician Aziz Awad will have company in prison.(In Other news ...)(Brief article)
October 16, 2006... Southern California physician Aziz Awad will have company in prison. A court found both Awad and his biller, Herman Thomas, guilty of defrauding Medicare and Medicaid. They allegedly billed Medicare $7 million for respiratory therapy...

Frederic Feit.(In Other news ...)
October 16, 2006... Prosecutors indicted Freehold Township, NJ pain management doctor Frederic Feit for defrauding insurers and health programs for $589,000. Feit allegedly billed for nerve block injections when he only provided patients with less-invasive shots...

The House and Senate adjourned without agreeing on legislation to encourage physician offices.(In Other news ...)
October 16, 2006... The House and Senate adjourned without agreeing on legislation to encourage physician offices to implement health information technology.

A federal district court dismissed a complaint filed by a home health agency seeking relief from the collection of Medicare overpayment totaling $4 million.(In Other news ...)(Brief article)
October 16, 2006... A federal district court dismissed a complaint filed by a home health agency seeking relief from the collection of Medicare overpayment totaling $4 million. The court's conclusion: The HHA failed to exhaust administrative remedies. ...

Michael Rosin.(In Other news ...)(Brief article)
October 16, 2006... A Florida doctor who scarred and, in some cases, disfigured his patients received a 22-year sentence. Michael Rosin falsely diagnosed dozens of people with cancer and performed Moh's microsurgery on them. The more layers of tissue he removed...

Health plans search for ways to spread the word about their CDHPs--other than the Web: overcoming bene tentativeness could help prospective enrollees accept consumer-driven models.(CDHPs)(consumer-driven health plans)
October 23, 2006... Consumer-driven health plans still aren't taking the nation by storm, according to recent studies. Part of the issue could be beneficiaries' reluctance--after years of having their HMOs or PPOs confine them to a narrow range of options--to make...

Americans see health care cost, access to care and uninsurance as biggest problems, for government: public ranked health care as a second-tier issue.'.(Health Policy)
October 23, 2006... Researchers and academics may be missing the mark when it comes to what Americans really care about regarding health care, a new report says. While academics have been discussing quality-of-care as the biggest issue in health care and the...

Health-benefit choice trumps cost for enrollees, surprisingly enough: although expense remains a driving factor, workers reveal that they want more coverage options.(Special Report)
October 23, 2006... Designing plans for employers is becoming something of a tightrope act for health insurers. Companies are looking to provide their workers with the health benefits they need to remain productive and satisfied in their jobs, while at the same...

CMS charges forward with P4P programs: bonus: proposed reg would release Part D claims data to federal agencies and researchers.(CMS)
October 23, 2006... Encouraged by early results showing improvement in care quality from the Premier Hospital Quality Incentive Demonstration, the Centers for Medicare & Medicaid Services is launching a new pay-for-performance demonstration for...

Current payment system doesn't account for drug discounts physicians never see, MedPAC says: physicians could receive pay boosts of up to 3-percent per year.(Physicians)(Brief article)
October 23, 2006... If you took away all the mistakes that the Centers for Medicare & Medicaid Services had made over the years in calculating the annual updates to physician payment rates, physicians would still be in for a cut of around 2.4-percent to 4-percent...

OIG zeroes in on incident- to billing: federal watchdog agency's work plan will keep it busy next year.(Compliance)(Office of Inspector General)
October 23, 2006... The HHS Office of Inspector General plans to issue a report on whether providers are following all the requirements for incident-to billing, including direct physician supervision. The OIG wants to know whether these services met the Medicare...

Independence Blue Cross brings out new PBM.(Industry Notes)(pharmacy benefits management-FutureScripts.)(Brief article)
October 23, 2006... Another insurer has decided to test the waters by starting its own pharmacy benefits management company. Independence Blue Cross has announced that it has completed its initiative to create and roll out its PBM, called FutureScripts. As a...

Insurer partners with doctor-authors in promotional drive.(Industry Notes)(Brief article)
October 23, 2006... Managed care organizations continue to explore new avenues to reach consumers, as Humana has announced a new partnership with best-selling authors Dr. Michael Roizen and Dr. Mehmet Oz. The partnership affords Humana the opportunity to connect...

Nearly two-thirds of non-U.S.-citizen Hispanics are uninsured, AHRQ finds.(Industry Notes)(Brief article)
October 23, 2006... Approximately one-quarter of Hispanics who are U.S. citizens are uninsured, compared to a whopping two-thirds of those who aren't U.S. citizens, according to data that HHS' Agency for Healthcare Research and Quality released on Oct. 17. ...

Researchers reconsider genomic tests for ovarian cancer.(Industry Notes)(Brief article)
October 23, 2006... Genomic tests aren't working to improve the quality of life for women with ovarian cancer, AHRQ finds. Nor are genomic tests (which physicians use to diagnose and guide treatment for ovarian cancer) helping to reduce the number of women who...

Health plans can put patient information at physicians' fingertips with HSA debit cards: this wave of the future makes patient data available instantly.(HSAs)
October 30, 2006... United Health Care plans to include health care and financial information on health savings account cards as early as the first quarter of 2007, according to the company's recent press release. But will the benefits outweigh the costs? Making...

Reimbursement reductions may compromise beneficiary access to oxygen, PMDs: DME suppliers battle looming pay cuts.(Reimbursement)
October 30, 2006... Two groups of stakeholders in the world of durable medical equipment are fighting separate battles over proposed Medicare cuts. Power mobility device suppliers--faced with Medicare payment rates that will drop as much as 43 percent Nov....

Consumer-directed health plans could reduce costs and utilization, experts claim: but the jury is still out on whether CDHPs discourage benes from seeking needed care.(CDHC)
October 30, 2006... If all privately insured, non-elderly Americans switched to consumer-directed health plans, the United States would see a 4-percent to 15-percent drop in care utilization, researchers find. But health savings accounts and health reimbursement...

Health industry's heavy-hitters gather to reduce cultural disparities in health care: series of reports focus on cultural competence among health care providers.(Research & Studies)
October 30, 2006... "Cultural competency" plays a significant role in improving care quality and outcomes for patients, industry leaders say. Health care organizations met at the recent fifth National Conference on Quality Health Care for Culturally Diverse...

New e-tool can help primary care clinicians with decision-making.(Industry Notes)(Brief article)
October 30, 2006... At the recent National Prevention Summit, HHS' Agency for Healthcare Research and Quality unveiled a new online tool that it designed to help primary care clinicians make decisions about recommending preventive care services to their patients....

HSAs may help workers save for retirement, NCPA says.(Industry Notes)(health saving account)(Brief article)
October 30, 2006... As many older workers struggle with the dilemma of choosing between saving for retirement or paying for health care, an industry expert with the National Center for Policy Analysis claims to have found a solution to both problems. "A...

Americans' opinions of U.S. health care system worsen.(Industry Notes)(Brief article)
October 30, 2006... The percentage of Americans who rate the health care system as "poor" has doubled since 1998, according to a survey by the Employee Benefit Research Institute and the Commonwealth Fund. And rising health care costs is the reason behind...

Stolen laptop causes privacy headache for another HHA.(Industry Notes)(Brief article)
October 30, 2006... A stolen laptop is once again creating privacy headaches for a home care provider. A thief took from a nurse's car a laptop computer containing patient information, including home addresses and social security numbers, for 14,000 patients of...

For HIV treatment, less could be more.(In Other News ...)(Brief article)
October 30, 2006... For HIV treatment, less could be more. HIV patients with treatment regimens based on a non-nucleoside reverse transcriptase inhibitor experience the same effectiveness as those receiving treatment with a protease inhibitor, even though the...

A registered nurse who at one time owned the two largest home health agencies in California has pleaded guilty to defrauding Medicare of $40 million and filing false tax returns, U.S. Attorney Debra Wong Yang says in a release.(In Other News ...)
October 30, 2006... A registered nurse who at one time owned the two largest home health agencies in California has pleaded guilty to defrauding Medicare of $40 million and filing false tax returns, U.S. Attorney Debra Wong Yang says in a release. Lourdes...

Physical therapists and others are wondering what will happen at the year's end when therapy cap exceptions are due to expire, but they may be in luck.(In Other News ...)(Brief article)
October 30, 2006... Physical therapists and others are wondering what will happen at the year's end when therapy cap exceptions are due to expire, but they may be in luck. The Securing Effective and Necessary Individual Outpatient Rehabilitation Services...