Medicine & Health articles from October 2007

Medicine & Health archives from October 2007

Senate bill to reinstate $20 billion in Medicare spending: critics call for payment system reform.(Reimbursement)
October 1, 2007... Starting in January, Medicare reimbursements to physicians face a 10 percent reduction, but new legislation from the Senate Finance Committee seeks to prevent that cutback from occurring. To raise the nearly $20 billion needed to maintain...

New CARE tool to bring major post-acute care placement changes: home health and long-term care providers prepare for model project.(Medicare)
October 1, 2007... The Centers for Medicare and Medicaid Services has a demonstration project underway that could change assessment for Medicare patients in skilled nursing facilities, home health agencies, inpatient rehabilitation facilities and long-term care...

Medicaid crackdown on noncompliant prescriptions underway overlooking this law will guarantee denials.(Pharmacists)
October 1, 2007... Medicaid may be posed to pack another wallop to profit margins already eroded by Medicare Part D--and there's little time to prepare. Starting Oct. 1, state Medicaid directors begin enforcing a law that calls for all outpatient Medicaid...

Bill opens Medicaid door to advanced practice nurses: S.59/H.R. 2066 boon to Medicaid recipients, too.(Nurses)
October 1, 2007... Advanced practice registered nurses could start seeing more low-income patients if a bill currently in House and Senate committees gets the green light. The Medicaid Advanced Practice Nurses and Physician Assistants Access Act of 2007 (S....

Decision rules out shortcuts in drug claim appeals process: courts can't step in early, says one judge.(Part D)
October 1, 2007... Beneficiaries can expect to continue to jump through Part D's administrative appeals hoops when prescription drug plans deny coverage of needed drugs. Spotlight: A cancer patient who claims that her Medicare Advantage plan improperly...

New freedom initiative helps seniors stay at home, out of Green Homes: $8.8 million grant to pay for mobile care.(Elderly)
October 1, 2007... Recent models of alternative care for seniors such as the Green Home project begun in Mississippi, have emphasized the importance of making nursing homes into residential communities where elders feel at home. Now, a new $8.8 million grant aims...

PPOs still reign supreme, survey says: but don't count CDHPs out yet.(Studies And Research)
October 1, 2007... United Benefit Advisors conducted a survey of over 11,000 employers throughout the country. The goal? To find out the most common benefits offered out there today. As UBA points out, Preferred Provider Organizations reign supreme, despite...

Baby boom seniors will be 200,000 doctors short: study reveals how savvy seniors can outsmart the MD shortage.(Elderly)
October 1, 2007... Already, seniors in some areas are having trouble scoring doctor's appointments, especially in primary care, according to Prevention Magazine. The physician shortage will only worsen, state medical societies warn: By 2020 Americans could...

Insurance plans partner with providers to improve care--and slash costs: the key to avoiding medical harm to beneficiaries? Collaboration, experts say.(Studies And Research)
October 1, 2007... Nearly 15 million incidents of medical harm occur in the United States each year, according to the Institute for Healthcare Improvement. This means that beneficiaries' well-being is at stake, and medical costs for health insurance plans will...

House, Senate agree on children's health bill: physicians: Medicare 'bounty hunters' will soon be in your back yard.(Industry Notes)
October 1, 2007... The chances of averting a 15 percent Medicare cut (spread across 2008 and 2009) just got a lot slimmer. The House of Representatives agreed to drop Medicare provisions from its children's health bill in order to agree on a consensus bill...

Until recently, prescription drug prices contributed to the overall sharp rise in health care costs, but the "Wal-Mart effect" is taking prescription drugs out of the equation, reports The New York Times.(In other news ...)
October 1, 2007... * Until recently, prescription drug prices contributed to the overall sharp rise in health care costs, but the "WalMart effect" is taking prescription drugs out of the equation, reports The New York Times. "As recently as 2005, inflation...

Medical Group Management Association.(In other news ...)
October 1, 2007... * Doctors won't just restrict access to Medicare patients if Medicare rates go down--they'll also slim down the size of their staffs, according to a new survey from the Medical Group Management Association. Some 57 percent of physicians...

Doctors' claims data could be on the Internet soon.(In other news ...)
October 1, 2007... * Doctors' claims data could be on the Internet soon. A consumer group, Consumers' Checkbook, won a lawsuit, so Medicare must release data on your physicians' services. The data covers Illinois, Maryland, Virginia, Washington and Washington,...

The Recovery Audit Contractors, which receive a bonus every time they recoup your Medicare payments, will soon be spreading nationwide.(In other news ...)
October 1, 2007... * The Recovery Audit Contractors, which receive a bonus every time they recoup your Medicare payments, will soon be spreading nationwide. So far, there have been a few isolated problems with the RACs, says William Rogers at the Centers for...

Bush blocks passage of SCHIP extension: democrats vow to overturn veto on October 18.
October 8, 2007... As expected, President Bush wielded the power of the pen to prevent a $35 billion expansion of the State Children's Health Insurance Program. Congressional leaders from both sides of the aisle pledged that they would find the two-thirds...

New drugs block pain without paralysis: childbirth and surgical procedures may allow patients to remain mobile.
October 8, 2007... Scientists have found a new combination of drugs that that can selectively block nociceptors, or pain-sensing neurons, in rats without inhibiting mobility or the sense of touch, according to a new study in Nature. The implications of the...

How an LIS can pave the way to Part D subsidies: key: paying out-of-pocket may get easier for benes.(Medicare/Medicaid)
October 8, 2007... Good news: Millions of seniors could benefit from Medicare prescription drug coverage paired with a Low Income Subsidy (LIS)--and qualifying for the assistance is not as difficult as one would think. The LIS can be very valuable for...

Americans live longer than ever before: experts still caution to take the utmost care in preventing colorectal cancer.(Medicare/Medicaid)
October 8, 2007... Many Americans are living longer and healthier lives, thanks to more preventive measures. The facts: In 2005, the average American died at an age of 78, raising life expectancies in the United States to an all-time high, the Centers for...

Feds urge a brighter line between privacy, protection: misunderstanding of HIPAA, FERPA & state laws contributed to Virginia Tech shootings.
October 8, 2007... Mental health providers should expect the federal government to "clarify" how you should interpret HIPAA, FERPA, and a patchwork of state privacy laws when you work with educators and law enforcement. Misinterpretations of privacy laws...

Medicare Part D enrollees still fall through subsidy cracks: drugs are still difficult for many seniors to afford, researchers say.
October 8, 2007... A new study focusing on Medicare prescription drug beneficiaries suggests that although the program has extended drug coverage to those who had none before the advent of Medicare Part D, many beneficiaries are still facing more financial...

Straight from the Census Bureau: older workforce grows: what's driving them? Empty bank accounts or intellectual vigor?
October 8, 2007... Not only are Americans living longer--they're working longer, too. In 2000, the number of American workers between the ages of 64 and 74 was 19.6 percent. By 2006, the number of seniors working or looking for work had jumped to 23.2...

Northeast spends most on health care: do generous Medicaid benefits play a role?(Research & Reports)
October 8, 2007... Someone living in the Northeast spends about $1,000 more per year on health care than the national average, and about $2,000 more than folks living in some Western states, reports a Centers for Medicare and Medicaid Services study published in...

Blacklisted nurse aides slip through the cracks.(Industry News)
October 8, 2007... Nurse aides permanently blacklisted by the state for complaints such as abuse and stealing money from elderly patients continue working for the same agency that banned them, reported the Houston Chronicle, citing an article in the Fort Worth...

Many seniors miss out on preventive care deals.(Industry News)
October 8, 2007... Seniors aren't always aware of the tree or low-cost preventive care services that Medicare offers beneficiaries. Medicare launched a 120-city bus tour this summer to publicize available screenings and immunizations, reports The Wall Street...

Premium increase is on the horizon for 2008.(Industry News)
October 8, 2007... Most popular Medicare prescription-drug plans will raise their monthly premiums next year, and as many as 1.6 million low-income beneficiaries may have to find cheaper coverage, the Wall Street Journal reported on Sept. 29. Washington...

Mental health parity may become reality soon: how big will the burden be? It depends on which version of the bill becomes law.(Legislation)
October 15, 2007... Last month's unanimous Senate vote on mental health parity makes it increasingly likely that insurers will need to make mental health coverage equitable with other healthcare benefits. But business leaders and industry experts are pushing the...

Watch for these 5 Part D traps in 2008: dodging the donut hole gets trickier next year.
October 15, 2007... For Part D prescription drug plans, the race is on to win seniors' 2008 business. That means community pharmacists need to stay a step ahead to help keep seniors' benefits--and pharmacy profits--on track. The new Medicare Part D "plan...

Insurers keep big picture of 2008 benefits top of mind.
October 15, 2007... Community pharmacists and consumer advocates are watching carefully as Medicare Part D rolls toward its third benefit year. Here's how Medicare's drug benefit for 2008 stacks up to last year's version: Initial deductible: Up, from $265...

Seniors--and policymakers--push for staying at home: will an $8.8 million grant and a national trend create competition for nursing homes?
October 15, 2007... Recent models of alternative care for seniors, such as the Green Home project begun in Mississippi, have emphasized the importance of making nursing homes into residential communities where elders feel at home. But even with these nursing home...

Part D or Part B? Know who's covering chemotherapy drugs: decision rules out shortcuts in drug claim appeals process.
October 15, 2007... Beneficiaries can expect to continue to jump through Part D's administrative appeals hoops when prescription drug plans deny coverage of needed drugs. A cancer patient who claims that her Medicare Advantage plan improperly classified her...

Money for 2007 bonuses is guaranteed--but 2008 funds aren't: more feedback from Medicare may be available during next year's PQRI.
October 15, 2007... Some providers who had a perfect record on the Physician Quality Reporting Initiative (PQRI) suddenly stopped reporting the quality codes because they heard that there wouldn't be any money to pay bonuses for 2007, warned CMS officials on a...

Boost your compliance know-how: log on to audioeducator.com to sign up for these Eli-sponsored audioconferences.(Education)
October 15, 2007... Need a little extra instruction to help you steer clear of unwanted audits and other health care compliance woes? Just log on to www.audioeducator.com, click on "Healthcare," and browse the different specialties. Some of the many interesting...

Yee-Hah: docs flock to Texas: caps for malpractice awards bring physicians to rural areas.(News)
October 15, 2007... Everything's bigger in Texas--except malpractice recoveries and malpractice insurance premiums. In Sept. 2003, the Texas legislature passed Proposition 12, which barred courts from tinkering with legislative limits when calculating...

There's gold in them there knees, hips: ortho device makers pay $311 million to settle anti-kickback charges.(News)
October 15, 2007... Federal prosecutors are coming down hard on consulting arrangements between surgeons and device manufacturers. Replacement knees and hips are a booming market for device manufacturers as the hard-trotting baby boomers wear their bodies...

House bill requires full DSM-IV, out-of-network coverage.
October 15, 2007... The House mental health parity bill, co-sponsored by Sen. Kennedy's son Rep. Patrick Kennedy (D-RI) and Rep. Jim Ramstad (R-MN), differs from the Senate version in several key ways: Scope of coverage. Under the House bill, employers and...

Big employer, generous health insurance? Not anymore: GM, Kellogg, Ford offload benefits.
October 15, 2007... It's not just small companies asking employees to shoulder more of their health care costs. The big guys are throwing up their hands as well, according to The Wall Street Journal. On Sept. 26, General Motors Corp. and the United Auto...

More out-of-pocket: facts from the Kaiser Family Foundation.
October 15, 2007... Average annual premium for family in 2000: $6,000 Average annual premium for family in 2007: $12,000 Percent of employers offering health benefits ill 2000: 69% Percent of employers offering...

The terms of relocation bonuses can't change after the doctor's already relocated: AMA blitzes the airwaves to stop Medicare pay cuts.
October 19, 2007... Now that the Centers for Medicare & Medicaid Services has finished laying out the sweeping changes it wants to make to the Stark self-referral law, it's ready to start giving some advice. CMS issued an advisory opinion (CMS-AO-2007-01) on...

Massive overhaul of U.S. health insurance system ahead: but reforms stalled without government intervention, study urges.
October 19, 2007... A recently released report calls on the federal government and employers to take a stronger role in improving efficiency, quality and access to care if the U.S. health care system is to become more equitable. The two-part Commonwealth...

Nursing education funding saved in House vote: Congress acts to remove proposed FY 2008 nursing support cut.(Legislation Update)
October 19, 2007... Nurses seeking financial support for advanced nursing degrees in 2008 may see money coming their way after all. In a July 19 vote, the U.S. House of Representatives passed its FY 2008 Labor-HHS-Education bill, which includes funding for...

Value-driven health care model refunds $20 million in Minnesota: 3 different models for value-based purchasing seek to introduce 'premium holidays' across U.S.(Health Plans)
October 19, 2007... Most Americans can expect their health insurance premiums to rise each year; in fact, the average worker paying for family coverage shelled out $971 more for premiums in 2005 than in 2000, according to the Agency for Healthcare Research and...

For bidders, new game may be 'wait-and-see': access to care could suffer if suppliers are few.(Competitive Bidding)
October 19, 2007... The feds remain mum about how many home medical equipment suppliers submitted bids in phase one of Medicare's competitive bidding program--but beneficiaries may be in for the biggest surprise. Though the Centers for Medicare & Medicaid...

Local caregiver screening program a promising, but difficult, pitch: Napa County, CA faces more obstacles than expected with this proposed legislation.(Brief article)
October 19, 2007... Requiring criminal background checks for caregivers sounds like a great idea. But Napa County is finding this requirement harder to implement than it expected, according to the Oct. 03 Napa Valley Register. "The more we got into it, it was...

Shortage of school nurses shortchanges students: nurses critical to student success, research shows.(Advocacy)
October 19, 2007... Registered nurses working in the nation's schools have never been more vital to the health and well being of millions of students. So says the American Nurses Association (ANA) in a statement calling for the daily availability of school...

Medicare finds 7 ways to make seniors' lives easier: preventative services coverage tops the list.
October 19, 2007... It's not even December yet, but CMS is sharing some tips that make it feel like it's the holiday season. In late September, CMS announced that it had debuted a new preventive services brochure called "Diabetes-Related Services," which...

Certified nurse midwives get piece of CHAMP pie: bill nixes 65 percent Medicare payment limit for CNM services.(Legislation Update)
October 19, 2007... Certified nurse midwives could be one step nearer to full federal reimbursement for their services, thanks to a recent vote in the U.S. House of Representatives. The House passed the "Children's Health and Medicare Protection Act of 2007...

Senior centers could land financial elder abuse charges: find out how to keep senior centers in the clear.(Warning)
October 19, 2007... The infamous "free lunch seminars" that often swindle seniors into purchasing estate planning products they don't need are often phony. But if a senior center innocently hosts one of these seminars that turns out to be a scam, that could land...

Stay tuned to clear up claims questions: tip: count only visits for direct care.
October 19, 2007... The feds are holding their ground on the Jan. 1 start date for major changes to hospice claims--but don't abandon all hope. Stakeholders including the National Hospice and Palliative Care Organization, the Visiting Nurse Associations of...

DMEPOS accreditation date not set in stone.(News)
October 19, 2007... There's no deadline yet by which DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) suppliers nationwide must be accredited, confirmed an official of the Centers for Medicare & Medicaid Services at the agency's Oct. 10...

Stay in the loop! Attend an audioconference in your field: log on to audioeducator.com to sign up for these Eli-sponsored audioconferences.(Education)(Brief article)(Calendar)
October 19, 2007... Need a little extra instruction to help you steel clear of unwanted audits and other health care compliance woes? Just log on to www.audioeducator.com, click on "Healthcare," and browse the different specialties. Some of the many interesting...

New policies could snare billing privileges: enrollment fraud demo to start Oct. 31.(FRAUD & ABUSE)
October 26, 2007... Providers should count the reasons the feds' Form 855 has new meaning--or they could wind up with a slew of unpaid Medicare claims and little recourse. Back in April 2006, the Centers for Medicare & Medicaid Services (CMS) published a...

House gives labor act deserved attention: RESPECT: find out what it means for nurses, says trade group.(LEGISLATION UPDATE)
October 26, 2007... Nurse supervisors are one step closer to safeguarding their collective bargaining rights, thanks to a recent vote in the House on a measure that would protect them from a constrictive National Labor Relation Board ruling. The House...

Providers may see 15 percent pay cut from CMS: plus: recovery audit contractors gear up for nationwide rollout.(MEDICARE PART B)
October 26, 2007... The chances of physicians averting a 15 percent Medicare cut (spread across 2008 and 2009) just got a lot slimmer. The House of Representatives agreed to drop Centers for Medicare & Medicaid Services (CMS) provisions from its children's...

New office of national nurse unnecessary, nurse groups protest: federal efforts better spent boosting public health nursing network.(ADVOCACY)
October 26, 2007... A coalition of 14 organizations, many of them nursing trade groups, has made its voice heard in a letter opposing the creation of a federal Office of the National Nurse. In its Oct. 2 missive, the group, which includes the American...

Should insurers cover unconventional imaging procedures? Do these procedures benefit patients, or just waste their time?(IMAGING)
October 26, 2007... Although covering certain imaging procedures is important to insurers, what if providers begin using these procedures in unconventional ways? Is there any added benefit to the patient that could possibly warrant insurers expanding coverage?...

Stay in the loop! Attend an audioconference in your field: log on to audioeducator.com to sign up for these Eli-sponsored audioconferences.(EDUCATION)(Calendar)
October 26, 2007... Need a little extra instruction but can't spare the classroom time? Just log on to www.audioeducator.com and browse the different specialties. Some of the many interesting topics include: Nov. 28 Patricia A. Trites presents: What...

Schools' health efforts earn passing grades from CDC.(CHILDREN'S HEALTH)
October 26, 2007... A Centers For Disease Control (CDC) study lauds U.S. schools' efforts to improve students' physical education and decrease their intake of junk food and their use of tobacco, but the study also warns that some areas still need work. The...

Strapped docs launch prepaid primary care plans.(TRENDS)
October 26, 2007... People who live in Wheeling, West Virginia can buy unlimited access to primary and urgent care for an $83 monthly fee. And $125 a month will get their entire family office visits, lab work, X-rays and access to about 100 generic drugs. ...

Medicare spends $4.3 billion a year on drug-coated stents.(MEDICARE)
October 26, 2007... The drug-coated stent debate continues to rage. Researchers who analyzed Medicare data on a sample of patients from 2001-2004 have concluded that coated stents are saving Medicare 5.4 percent--adjusted for inflation--to reopen blocked arteries,...

Generic alzheimer's drug gets approval.(DRUGS)
October 26, 2007... Sun Pharmeceutical Industries Ltd. announced on Oct. 23 that the U.S. Food and Drug Administration has granted final marketing approval for its Rivastigmine Tartrate drug. This is a generic version of Novartis's Exelon capsules, which is used...

Senate stymied on medicare payment fixes.(LEGISLATION)
October 26, 2007... Saving Medicare payments from cuts of 15 percent over two years is an expensive proposition. The Senate may not have the political will for it, unless physicians keep up the pressure, say observers. The Senate Finance Committee met Oct. 17...