Medicare and Medicaid fraud cost American taxpayers some $54 billion last year. (We've long believed that Medicare fraud is the unofficial state sport of Florida.) CMS has tried many approaches to catching some of the perpetrators, notably through the Recovery Audit Contractor program, but the bad guys always seem to be one step ahead of the G-men.
The Obama administration wants to go high-tech in its pursuit of fraudsters, sending out "bounty hunter auditors" to find waste, fraud and abuse in Medicare and Medicaid, according to the Huffington Post.
"We're told the auditor's weapons will be sophisticated new computer programs to scan Medicare and Medicaid billing records nationwide to check for patterns of bogus claims," writes columnist Diane Dimond. "And like the early bounty hunters of the old West these modern day crime fighters will get to keep a percentage of what they recoup for taxpayers. It seems like a win-win idea. Pilot programs in California, New York and Texas over the last three years re-captured $900 million that would have otherwise gone into the crook's pockets."
The administration estimates such cybersleuths could recover at least $2 billion in wasteful and fraudulent spending over the next three years. If fraud continues at its current pace, that's less than 1.5 percent of the $162 billion CMS will squander in that three-year period, but hey, it's a start, right?
FierceHealthCare IT
10-22-2010
Friday, October 22, 2010
Company Used Dementia Patients In $200M Medicare Scam
In what Justice Department officials are calling the largest fraudulent billing plot ever prosecuted by by a healthcare fraud strike force, HHS and FBI agents arrested four people--Lawrence Duran, Marianella Valera, Judith Negron and Margarita Acevedo-- for their alleged role in masterminding an unprecedented plot to defraud the Medicare program of close to $200 million.
The people involved were owners and senior managers of American Therapeutic Corporation (ATC) and Medlink Professional Management Group, Inc. The business model of the two Miami-based businesses was Medicare fraud. The companies allegedly netted $83 million in illicit payments from Medicare since 2003, The Christian Science Monitor reports. The four people and two companies were charged in a 13-count indictment for billing Medicare for community-based mental health services that were unnecessary or never actually provided.
The alleged illegal conduct in the indictment is "unlike anything we've seen before in terms of the nature and size of the scheme," Assistant Attorney General, Lanny Breuer said in a statement yesterday.
Unlike so much Medicare fraud that involves medical equipment and services, this case involves Medicare's Partial Hospitalization program, which gives mental health patients much-needed services in outpatient settings.
ATC and other defendants preyed on some of the most vulnerable patients, paying kickbacks to owners and operators of assisted living facilities and halfway houses in exchange for patient referrals. At ATC branches, bogus mental health therapy sessions were organized where elderly and infirm patients were left in rooms for hours, and received no legitimate or medically necessary therapy. Some of the patients suffered from Alzheimer's disease or dementia, and did not even know where they were. Others simply came to make money through kickbacks.
Some of the defendants were also charged with having "charting parties," where senior managers met regularly to write up fake patient medical charts.
Patient recruiters would find people who needed a place to stay overnight and offer them free temporary housing, cash or other bribes in exchange for agreeing to pose as patients.
Since the inception of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) to fight Medicare fraud in 2007, Strike Force operations have led to charges against more than 825 defendants who falsely billed Medicare for more than $2 billion.
FierceHealthCare
10-22-2010
The people involved were owners and senior managers of American Therapeutic Corporation (ATC) and Medlink Professional Management Group, Inc. The business model of the two Miami-based businesses was Medicare fraud. The companies allegedly netted $83 million in illicit payments from Medicare since 2003, The Christian Science Monitor reports. The four people and two companies were charged in a 13-count indictment for billing Medicare for community-based mental health services that were unnecessary or never actually provided.
The alleged illegal conduct in the indictment is "unlike anything we've seen before in terms of the nature and size of the scheme," Assistant Attorney General, Lanny Breuer said in a statement yesterday.
Unlike so much Medicare fraud that involves medical equipment and services, this case involves Medicare's Partial Hospitalization program, which gives mental health patients much-needed services in outpatient settings.
ATC and other defendants preyed on some of the most vulnerable patients, paying kickbacks to owners and operators of assisted living facilities and halfway houses in exchange for patient referrals. At ATC branches, bogus mental health therapy sessions were organized where elderly and infirm patients were left in rooms for hours, and received no legitimate or medically necessary therapy. Some of the patients suffered from Alzheimer's disease or dementia, and did not even know where they were. Others simply came to make money through kickbacks.
Some of the defendants were also charged with having "charting parties," where senior managers met regularly to write up fake patient medical charts.
Patient recruiters would find people who needed a place to stay overnight and offer them free temporary housing, cash or other bribes in exchange for agreeing to pose as patients.
Since the inception of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) to fight Medicare fraud in 2007, Strike Force operations have led to charges against more than 825 defendants who falsely billed Medicare for more than $2 billion.
FierceHealthCare
10-22-2010
Monday, October 18, 2010
Obesity-Related Medical Costs Double Earlier Findings
Spending on obesity is worse than we thought. A National Bureau of Economic Research study found that obesity actually accounts for 17 percent of all medical costs annually, as opposed to 9 percent as previously determined last year.
The NBER research, conducted by John Cawley of Cornell University and Chad Meyerhoefer of Lehigh University, concluded medical costs in relation to obesity are closer to $170 billion per year than $150 billion due in large part to understated self-reporting and overly cautious research gathering, reports the Associated Press. The new report tries to take both factors into account and adjusts the statistics accordingly via balanced "repeated replications to estimate standard errors," the study's authors write.
"The authors tried to better establish that excess weight was a cause for medical costs," the AP reports. "Previous studies stopped short of saying obesity caused the costs because there was too great a chance other factors could be responsible."
The researchers compiled statistics from the exact same database used to come up with the $150 billion figure, which included information on 24,000 non-elderly adults gathered from 2000 to 2005. While the earlier estimate determined that obesity added $1,400 to a person's annual medical bill, the new calculations found that number to be more than $2,800.
Cawley and Meyerhoefer point out that the motivation behind their research is not to push for more funding related to the treatment of obesity, but simply to inform. "This paper does not estimate the medical care cost of obesity in order to argue that treatment of obesity should be prioritized above treatment of other conditions, but so that the medical care consequences of obesity will be more accurately known," they write.
FierceHealthCare
10-18-2010
The NBER research, conducted by John Cawley of Cornell University and Chad Meyerhoefer of Lehigh University, concluded medical costs in relation to obesity are closer to $170 billion per year than $150 billion due in large part to understated self-reporting and overly cautious research gathering, reports the Associated Press. The new report tries to take both factors into account and adjusts the statistics accordingly via balanced "repeated replications to estimate standard errors," the study's authors write.
"The authors tried to better establish that excess weight was a cause for medical costs," the AP reports. "Previous studies stopped short of saying obesity caused the costs because there was too great a chance other factors could be responsible."
The researchers compiled statistics from the exact same database used to come up with the $150 billion figure, which included information on 24,000 non-elderly adults gathered from 2000 to 2005. While the earlier estimate determined that obesity added $1,400 to a person's annual medical bill, the new calculations found that number to be more than $2,800.
Cawley and Meyerhoefer point out that the motivation behind their research is not to push for more funding related to the treatment of obesity, but simply to inform. "This paper does not estimate the medical care cost of obesity in order to argue that treatment of obesity should be prioritized above treatment of other conditions, but so that the medical care consequences of obesity will be more accurately known," they write.
FierceHealthCare
10-18-2010
Most Expensive Hospital Stays Cost About $18,000 A Day
The priciest hospital stays are also among the most futile. Among the top 0.5 percent of most expensive hospital stays, the average length of stay runs about 48 days and costs more than $500,000, yet more than eight in 10 of the patients involved face a major or extreme chance of dying, regardless.
This finding comes from data in Agency for Healthcare Research and Quality's newly released report, Most Expensive Hospitalizations, 2008, which uses data from a database of hospital inpatient stays in all short-term, non-Federal hospitals. Data are drawn from hospitals that comprise 90 percent of all discharges in the U.S. and include patients, regardless of insurance type.
The top 5 percent of hospital stays averaged about $18,000 in charges per day in U.S. hospitals in 2008, according to the AHRQ. Hospitals charges for the most expensive stays tended to be for patients who were getting treated for septicemia, or blood infection, hardening of the arteries and heart attacks.
The average cost for the most expensive patient stays was based on the top 5 percent of stays by cost, or about 2 million inpatient stays. The stays lasted just under three weeks (19 days). The hospitals charged on average $191,984 for those stays.
Compared with the less expensive visits, patients on more expensive hospital stays also:
Were much sicker. They were about 10 times more likely to experience extreme loss of function (39 percent vs. 4 percent).
Faced a greater risk of dying in the hospital (9 times more likely to be in the highest category for risk of death in the hospital (28 percent vs. 3 percent).
Were older. Their average age was 59 vs. 48.
The most commonly listed procedures among the top 5 percent were blood transfusion (28 percent), respiratory intubation and mechanical ventilation (27 percent) and diagnostic cardiac catheterization/coronary arteriography (13 percent).
The most expensive hospital stays occur at a higher rate in the Northeast and West and least in the Midwest.
FierceHealthCare
10-18-2010
This finding comes from data in Agency for Healthcare Research and Quality's newly released report, Most Expensive Hospitalizations, 2008, which uses data from a database of hospital inpatient stays in all short-term, non-Federal hospitals. Data are drawn from hospitals that comprise 90 percent of all discharges in the U.S. and include patients, regardless of insurance type.
The top 5 percent of hospital stays averaged about $18,000 in charges per day in U.S. hospitals in 2008, according to the AHRQ. Hospitals charges for the most expensive stays tended to be for patients who were getting treated for septicemia, or blood infection, hardening of the arteries and heart attacks.
The average cost for the most expensive patient stays was based on the top 5 percent of stays by cost, or about 2 million inpatient stays. The stays lasted just under three weeks (19 days). The hospitals charged on average $191,984 for those stays.
Compared with the less expensive visits, patients on more expensive hospital stays also:
Were much sicker. They were about 10 times more likely to experience extreme loss of function (39 percent vs. 4 percent).
Faced a greater risk of dying in the hospital (9 times more likely to be in the highest category for risk of death in the hospital (28 percent vs. 3 percent).
Were older. Their average age was 59 vs. 48.
The most commonly listed procedures among the top 5 percent were blood transfusion (28 percent), respiratory intubation and mechanical ventilation (27 percent) and diagnostic cardiac catheterization/coronary arteriography (13 percent).
The most expensive hospital stays occur at a higher rate in the Northeast and West and least in the Midwest.
FierceHealthCare
10-18-2010
Costs Of Veterans HealthCare Could Grow By 75%
More veterans and higher care costs in the next 10 years will result in billions of dollars more being spent on veterans' health care in the next decade, states a Congressional Budget Office estimate released Oct. 7.
Veterans Health Administration care costs will increase to between $69 billion and $85 billion by 2020, up from $48 billion in 2010. The number of veterans eligible for VA care -- now at 8 million -- is expected to grow by between 700,000 and 1.3 million veterans by 2020. The wide gap in the CBO estimates is due to different assumptions about several factors: the number of troops in Iraq and Afghanistan; the speed at which per-enrollee spending will grow; and the degree to which the VA relaxes enrollment restrictions. The lower forecast assumes that combined troop levels in both wars will decrease to 30,000 in 2013 and remain there until 2020, and that per-enrollee health care spending increases by 5% annually, about the same rate as in the rest of the U.S. health system.
The VA provides care to veterans at a level determined by veterans' military service. However, the VA also adjusts the care provided based on its annual congressional appropriations. VA spending increased by more than 9% on average each year between 2004 and 2009, reaching $44 billion, in 2009.
Amednews.com
10-18-2010
Veterans Health Administration care costs will increase to between $69 billion and $85 billion by 2020, up from $48 billion in 2010. The number of veterans eligible for VA care -- now at 8 million -- is expected to grow by between 700,000 and 1.3 million veterans by 2020. The wide gap in the CBO estimates is due to different assumptions about several factors: the number of troops in Iraq and Afghanistan; the speed at which per-enrollee spending will grow; and the degree to which the VA relaxes enrollment restrictions. The lower forecast assumes that combined troop levels in both wars will decrease to 30,000 in 2013 and remain there until 2020, and that per-enrollee health care spending increases by 5% annually, about the same rate as in the rest of the U.S. health system.
The VA provides care to veterans at a level determined by veterans' military service. However, the VA also adjusts the care provided based on its annual congressional appropriations. VA spending increased by more than 9% on average each year between 2004 and 2009, reaching $44 billion, in 2009.
Amednews.com
10-18-2010
Thursday, October 14, 2010
4,000 Social Security Numbers Possibly Exposed In VA Mismailing
Breaking news: A Veterans Benefit Administration office in Boston sent 6,299 benefit summary letters to the wrong addresses in September, more than half of them containing complete social security numbers, FierceGovernmentIT reports. Of the letters, 3,936 contained all nine digits of someone else's social security number, and 2,386 contained the VBA claim number of veterans based in the state. That's according to an update on data breaches the VA sends to Congress each month. The report blames the incident on a programming error.
FierceGovernmentIT
10-14-2010
FierceGovernmentIT
10-14-2010
When it comes to health plans, big spenders don't always deliver the best care, according to the new State of Health Care Quality report from the National Committee for Quality Assurance, a private, nonprofit organization dedicated to improving healthcare quality.
Here's one striking example: Vaccination rates for kids with private plans dropped by nearly 4 percentage points, while rates continued to rise for children on Medicaid plans in 2009. It's possible that a popular misconception that ties vaccines to autism has driven some parents away from evidence-based recommendations.
The report examined quality data from over 1,000 health plans that collectively cover 118 million Americans and compared types of plan by category.
There's been a drop in patient satisfaction with health plans and physicians, according to NCQA. For example, while 64 percent of members with Medicare plans said they usually or always manage to get needed care, only 53 percent of members with commercial plans felt the same. The latter was a drop from a high of 80 percent in 2005.
Another area where commercial plans lag behind Medicare and Medicaid plans is monitoring of drugs, such as Digoxin, diuretics, anticonvulsants and ACE inhibitors, which patients use for at least six months.
Medicare (83 percent) and Medicaid plans (77 percent) also fared better than commercial plans when one compares the share of members who received persistent beta-blocker treatment for six months after discharge with a heart attack diagnosis. But the report does note that commercial health plans have seen a dramatic rise in those rates, more than 34 percent since 1996 to 74 percent in 2009. "Ultimately," the report notes, "what gets measured gets improved."
FierceHealthCare
10-14-2010
Here's one striking example: Vaccination rates for kids with private plans dropped by nearly 4 percentage points, while rates continued to rise for children on Medicaid plans in 2009. It's possible that a popular misconception that ties vaccines to autism has driven some parents away from evidence-based recommendations.
The report examined quality data from over 1,000 health plans that collectively cover 118 million Americans and compared types of plan by category.
There's been a drop in patient satisfaction with health plans and physicians, according to NCQA. For example, while 64 percent of members with Medicare plans said they usually or always manage to get needed care, only 53 percent of members with commercial plans felt the same. The latter was a drop from a high of 80 percent in 2005.
Another area where commercial plans lag behind Medicare and Medicaid plans is monitoring of drugs, such as Digoxin, diuretics, anticonvulsants and ACE inhibitors, which patients use for at least six months.
Medicare (83 percent) and Medicaid plans (77 percent) also fared better than commercial plans when one compares the share of members who received persistent beta-blocker treatment for six months after discharge with a heart attack diagnosis. But the report does note that commercial health plans have seen a dramatic rise in those rates, more than 34 percent since 1996 to 74 percent in 2009. "Ultimately," the report notes, "what gets measured gets improved."
FierceHealthCare
10-14-2010
Hospitalizations for long-term care residents have become too routine, although they could be prevented, according to a report from the Kaiser Family Foundation.
The report, To Hospitalize or Not to Hospitalize, offers insights into factors behind high hospitalization rates and suggests solutions. It is based on interviews with physicians, nurses, social workers and family members of residents of long-term care facilities.
LTC residents account for a disproportionately large share of Medicare spending. According to KFF, 1.7 million Medicare beneficiaries in long-term care for all of 2006--or who died in care before the year's end--cost the program an average of $14,538 per person, more than twice the average expenditure for all Medicare beneficiaries. Medicare covers LTC residents' ER visits, hospitalizations and other medical treatments, but not stays in nursing homes, assisted living facilities or other long-term care programs.
Strategies the report suggests to cut avoidable hospitalizations include beefing up staff with more medical support and a philosophy shift about the appropriateness of hospitalization, instead of viewing it as the path of least resistance.
Among factors that drive hospitalization of LTC residents, interview participants said there were no disincentives to sending an LTC resident to the ER when a medical issue is suspected. Not only does hospitalizing a medically compromised resident reduce liability concerns and allow for more timely diagnostic tests, it also can be more convenient for physicians.
Staff and doctors may assume that the family prefers more aggressive treatment. And a lack of qualified staff, protocols and license restrictions, have further exacerbated the tendency to default to hospitalization. Often the perception of best care is 'Let's send Mrs. M to the emergency room and see what the ER finds,'" Dr. Cheryl Phillips, chief medical officer of the Bay Area nonprofit On Lok Lifeways, told Kaiser Health News. Some of the interviewees noted that residents often return from the hospital disoriented, on different meds and with new infections.
Dr. Donald Berwick, head of the Centers for Medicare and Medicaid Services, told Kaiser Health News that better coordination was needed, saying too many people experience "disintegrated care."
"The goal is to change through redesigning the system," he said.
FierceHealthCare
10-14-2010
The report, To Hospitalize or Not to Hospitalize, offers insights into factors behind high hospitalization rates and suggests solutions. It is based on interviews with physicians, nurses, social workers and family members of residents of long-term care facilities.
LTC residents account for a disproportionately large share of Medicare spending. According to KFF, 1.7 million Medicare beneficiaries in long-term care for all of 2006--or who died in care before the year's end--cost the program an average of $14,538 per person, more than twice the average expenditure for all Medicare beneficiaries. Medicare covers LTC residents' ER visits, hospitalizations and other medical treatments, but not stays in nursing homes, assisted living facilities or other long-term care programs.
Strategies the report suggests to cut avoidable hospitalizations include beefing up staff with more medical support and a philosophy shift about the appropriateness of hospitalization, instead of viewing it as the path of least resistance.
Among factors that drive hospitalization of LTC residents, interview participants said there were no disincentives to sending an LTC resident to the ER when a medical issue is suspected. Not only does hospitalizing a medically compromised resident reduce liability concerns and allow for more timely diagnostic tests, it also can be more convenient for physicians.
Staff and doctors may assume that the family prefers more aggressive treatment. And a lack of qualified staff, protocols and license restrictions, have further exacerbated the tendency to default to hospitalization. Often the perception of best care is 'Let's send Mrs. M to the emergency room and see what the ER finds,'" Dr. Cheryl Phillips, chief medical officer of the Bay Area nonprofit On Lok Lifeways, told Kaiser Health News. Some of the interviewees noted that residents often return from the hospital disoriented, on different meds and with new infections.
Dr. Donald Berwick, head of the Centers for Medicare and Medicaid Services, told Kaiser Health News that better coordination was needed, saying too many people experience "disintegrated care."
"The goal is to change through redesigning the system," he said.
FierceHealthCare
10-14-2010
Court OKs Nurse Anesthetists To Practice Unsupervised
In the latest shift in physicians' fight to preserve their turf from encroachment by nurses, advocates of physician supervision of certified registered nurse anesthetists lost a battle on Oct. 8. That's when the San Francisco Superior Court ruled in favor of Gov. Arnold Schwarzenegger and the California Association of Nurse Anesthetists, affirming that California state law does not require nurse anesthetists be supervised by a physician.
The court's summary judgment affirmed California's opt-out of the federal supervision requirement. California initially opted out in July 2009, when the governor informed CMS of the opt-out in a letter.
The California Society of Anesthesiologists and California Medical Association lawsuit, which was filed in February 2010, called for the court to make the governor withdraw the opt-out letter and declare that under state law, a CRNA is not authorized to administer anesthesia except under the supervision of a physician. According to the CMA/CSA, the suit alleged that Schwarzenegger acted contrary to state law, which states that nurses who give patients anesthesia must be supervised by a licensed physician.
The judge didn't agree. He concluded that no state statute specifically stipulates that physicians must supervise nurse anesthetists who administer anesthesia and that federal regulations allow the governor discretion to opt out of the Medicare supervision rule and still follow state law.
The judge noted that current state law does not refer to supervision and that judicially adding a supervision requirement to the law would create ambiguity. State lawmakers may impose a supervision requirement if they wish. CSA noted that earlier court opinions came to a different conclusion.
A CMA press release echoes some of the ideas in an AMA press release last week that responded to an IOM report calling for nurses to play bigger roles in healthcare. Both press releases note that nurses are critical to the healthcare team, but don't have the same education and training as doctors, which must be code language physicians are increasingly deploying to tell nurses to stay off their turf. CSA and CMA may appeal the ruling.
California is one of 16 states that has opted out and allows CRNAs to administer anesthesia without physician supervision. Earlier this month, Colorado became the 16th opt-out state.
FierceHealthCare
10-14-2010
The court's summary judgment affirmed California's opt-out of the federal supervision requirement. California initially opted out in July 2009, when the governor informed CMS of the opt-out in a letter.
The California Society of Anesthesiologists and California Medical Association lawsuit, which was filed in February 2010, called for the court to make the governor withdraw the opt-out letter and declare that under state law, a CRNA is not authorized to administer anesthesia except under the supervision of a physician. According to the CMA/CSA, the suit alleged that Schwarzenegger acted contrary to state law, which states that nurses who give patients anesthesia must be supervised by a licensed physician.
The judge didn't agree. He concluded that no state statute specifically stipulates that physicians must supervise nurse anesthetists who administer anesthesia and that federal regulations allow the governor discretion to opt out of the Medicare supervision rule and still follow state law.
The judge noted that current state law does not refer to supervision and that judicially adding a supervision requirement to the law would create ambiguity. State lawmakers may impose a supervision requirement if they wish. CSA noted that earlier court opinions came to a different conclusion.
A CMA press release echoes some of the ideas in an AMA press release last week that responded to an IOM report calling for nurses to play bigger roles in healthcare. Both press releases note that nurses are critical to the healthcare team, but don't have the same education and training as doctors, which must be code language physicians are increasingly deploying to tell nurses to stay off their turf. CSA and CMA may appeal the ruling.
California is one of 16 states that has opted out and allows CRNAs to administer anesthesia without physician supervision. Earlier this month, Colorado became the 16th opt-out state.
FierceHealthCare
10-14-2010
Wednesday, October 13, 2010
Medicare "Meaningful Use" Payouts And How It Works
There’s been a lot of talk (including myself) about the EHR stimulus money. It seems like meaningful use has taken the cake with most of the discussion with certified EHR taking a cozy second place. What I haven’t seen very much of is some practical analysis of the EHR stimulus money and the amount of money various practices will receive. So, I’m going to try to do my part to create some of this practical EHR stimulus money content.
Basically, the schedule shows you that you can earn UP TO $18,000 in 2011 (assuming of course that you can show “meaningful use” on a “certified EHR”). What hasn’t been discussed is how many doctors will be eligible for the full $18,000 in stimulus money and how many would only be eligible for $10k or $5k in stimulus money and how much allowable Medicare charges you’ll need to have to receive the full reimbursement.
The EHR stimulus Medicare payments will be paid based on 75% of the submitted allowable charges. For example, a doctors office which has allowable Medicare charges totally $24k or more will be eligible to receive the full $18k in EHR stimulus money. A clinic with $13.3k in allowable Medicare charges would only be eligible for $10k in EHR stimulus money. You can do the math for your own clinic.
Maybe this is a non issue for most clinics. I don’t know. I’ve never seen any published average reimbursement rates for a doctor. $24k doesn’t seem like a lot of Medicare reimbursement, but certainly there are some doctors who are under that amount. Later today I’ll post a poll so we can get a better idea of the average reimbursement rates for a doctor.
John Lynn
EMR And HIPAA.Com
10-13-2010
Basically, the schedule shows you that you can earn UP TO $18,000 in 2011 (assuming of course that you can show “meaningful use” on a “certified EHR”). What hasn’t been discussed is how many doctors will be eligible for the full $18,000 in stimulus money and how many would only be eligible for $10k or $5k in stimulus money and how much allowable Medicare charges you’ll need to have to receive the full reimbursement.
The EHR stimulus Medicare payments will be paid based on 75% of the submitted allowable charges. For example, a doctors office which has allowable Medicare charges totally $24k or more will be eligible to receive the full $18k in EHR stimulus money. A clinic with $13.3k in allowable Medicare charges would only be eligible for $10k in EHR stimulus money. You can do the math for your own clinic.
Maybe this is a non issue for most clinics. I don’t know. I’ve never seen any published average reimbursement rates for a doctor. $24k doesn’t seem like a lot of Medicare reimbursement, but certainly there are some doctors who are under that amount. Later today I’ll post a poll so we can get a better idea of the average reimbursement rates for a doctor.
John Lynn
EMR And HIPAA.Com
10-13-2010
Doctors Offer Discount Services Through Social Media
In addition to Facebook and Twitter, healthcare companies are also using online discount coupon sites like Groupon to promote their services, attracting a large number of uninsured people with their bargain prices, reports the Baltimore Sun.
In fact, nearly 15 percent of Groupon deals nationwide are for healthcare services, Julie Anne Mossler, a spokeswoman for the Chicago-based company, told the Sun. The website offered discounted eye exams, teeth-cleaning, electrolysis and chiropractic services, among others.
Katzen Eye Group promoted an exam and glasses deal for $50 via a Groupon deal-of-the-day email sent to tens of thousands of Baltimore area subscribers and millions nationwide. The offer "greatly exceeded our expectation," and attracted more than 300 patients, CEO Richard Edlow told the Sun.
But healthcare providers must bear in mind that sites like Groupon can just as easily deter clients, as companies can't control how their services or brands are conveyed on social media outlets, notes the Sun. For example, customers can post about a bad experience on Twitter or Facebook for others to see.
In addition, offering discount services can pose a financial risk. Companies could lose money if an offer becomes too popular, Chad Capellman, director of social media for Genuine Interactive, told iHealthBeat.
And as with other social media tools, healthcare companies must make sure they obey privacy laws when posting information to online discount websites, he added.
FierceHealthCare
In fact, nearly 15 percent of Groupon deals nationwide are for healthcare services, Julie Anne Mossler, a spokeswoman for the Chicago-based company, told the Sun. The website offered discounted eye exams, teeth-cleaning, electrolysis and chiropractic services, among others.
Katzen Eye Group promoted an exam and glasses deal for $50 via a Groupon deal-of-the-day email sent to tens of thousands of Baltimore area subscribers and millions nationwide. The offer "greatly exceeded our expectation," and attracted more than 300 patients, CEO Richard Edlow told the Sun.
But healthcare providers must bear in mind that sites like Groupon can just as easily deter clients, as companies can't control how their services or brands are conveyed on social media outlets, notes the Sun. For example, customers can post about a bad experience on Twitter or Facebook for others to see.
In addition, offering discount services can pose a financial risk. Companies could lose money if an offer becomes too popular, Chad Capellman, director of social media for Genuine Interactive, told iHealthBeat.
And as with other social media tools, healthcare companies must make sure they obey privacy laws when posting information to online discount websites, he added.
FierceHealthCare
Hospitals Go On A "Doctor" Shopping Spree
It may sound odd in a year that has seen massive hospital layoffs, but some hospitals are on a doctor-shopping spree, according to NPR/Kaiser Health News.
WakeMed employs 138 doctors, up from 47 in 2000. And it plans to hire another 60 over the next six months. Rex Healthcare, which is part of the University of North Carolina's healthcare system, has hired 30 physicians over the past few years and plans to hire another 55, according to Steve Burris, senior vice president in charge of physician employment at Rex.
Because Raleigh, N.C., is a superheated market, Burris will have to act quickly. Just this week, it was reported that UNC Hospitals nearly doubled the pay of a heart surgeon to $600,000 to ensure they retained him.
Besides ensuring a steady flow of patient referrals, hiring doctors makes it easier to coordinate services. And having more doctors on board is one way to prepare for the new healthcare reform law to kick in, rewarding the creation of more efficient, integrated approaches to care.
Losing the loyalty of local physicians can disrupt the flow of patient referrals and affect a hospital's bottom line, Burris told NPR/Kaiser Health News. In the Raleigh area, only around 67 practices aren't affiliated with a hospital; Burris predicts most eventually will be. "If we don't accommodate the needs they have, they're going to look to someone else," he said.
According to the Medical Group Management Association, half of new doctors were hired by hospitals last year. For doctors like Dr. Alden Parsons, a thoracic surgeon who just finished 15 years of medical training, it's a lifestyle choice. She didn't want long hours and the administrative headaches of running her own practice, reports NPR/Kaiser Health News.
The article, however, fails to point out another "push" factor. Cuts in Medicare reimbursements as high as 30 percent will take effect Dec. 1. They could help explain why doctors with their own practices might consider cutting and running.
FierceHealthCare
10-13-2010
WakeMed employs 138 doctors, up from 47 in 2000. And it plans to hire another 60 over the next six months. Rex Healthcare, which is part of the University of North Carolina's healthcare system, has hired 30 physicians over the past few years and plans to hire another 55, according to Steve Burris, senior vice president in charge of physician employment at Rex.
Because Raleigh, N.C., is a superheated market, Burris will have to act quickly. Just this week, it was reported that UNC Hospitals nearly doubled the pay of a heart surgeon to $600,000 to ensure they retained him.
Besides ensuring a steady flow of patient referrals, hiring doctors makes it easier to coordinate services. And having more doctors on board is one way to prepare for the new healthcare reform law to kick in, rewarding the creation of more efficient, integrated approaches to care.
Losing the loyalty of local physicians can disrupt the flow of patient referrals and affect a hospital's bottom line, Burris told NPR/Kaiser Health News. In the Raleigh area, only around 67 practices aren't affiliated with a hospital; Burris predicts most eventually will be. "If we don't accommodate the needs they have, they're going to look to someone else," he said.
According to the Medical Group Management Association, half of new doctors were hired by hospitals last year. For doctors like Dr. Alden Parsons, a thoracic surgeon who just finished 15 years of medical training, it's a lifestyle choice. She didn't want long hours and the administrative headaches of running her own practice, reports NPR/Kaiser Health News.
The article, however, fails to point out another "push" factor. Cuts in Medicare reimbursements as high as 30 percent will take effect Dec. 1. They could help explain why doctors with their own practices might consider cutting and running.
FierceHealthCare
10-13-2010
Friday, October 8, 2010
HHS Hands Out $727M To Upgrade Community Health Centers
The Department of Health and Human Services has awarded more than $727 million in grants from the Affordable Care Act to help upgrade 143 community health centers, according to an announcement made earlier today by Secretary Kathleen Sebelius. The funds will support construction and renovation of community health centers around the country and extend access to another 745,000 underserved patients, according to an HHS press release.
The community health centers will help Americans who have lost coverage or are between jobs still get healthcare services, according to Sebelius. "There is no question that the economic downturn has made it harder for some Americans to get healthcare and important preventive services," she said.
The move also has the potential of lightening the burden placed on stressed out emergency departments that have been serving as safety nets, often offering non-emergency care to the indigent.
The largest share of health center patients are not insured (38 percent), 37 percent are on Medicaid, 15 percent have private insurance and 7 percent are on Medicare, according to the Health Resources and Services Administration.
The funds were made available under the healthcare reform law, which is expected to provide $11 billion over the next five years to community health centers. The funds will go toward operating, expanding and building community health centers, nearly doubling the number of patients who can receive care, regardless of insurance status or ability to pay.
FierceHealthCare
10-8-2010
The community health centers will help Americans who have lost coverage or are between jobs still get healthcare services, according to Sebelius. "There is no question that the economic downturn has made it harder for some Americans to get healthcare and important preventive services," she said.
The move also has the potential of lightening the burden placed on stressed out emergency departments that have been serving as safety nets, often offering non-emergency care to the indigent.
The largest share of health center patients are not insured (38 percent), 37 percent are on Medicaid, 15 percent have private insurance and 7 percent are on Medicare, according to the Health Resources and Services Administration.
The funds were made available under the healthcare reform law, which is expected to provide $11 billion over the next five years to community health centers. The funds will go toward operating, expanding and building community health centers, nearly doubling the number of patients who can receive care, regardless of insurance status or ability to pay.
FierceHealthCare
10-8-2010
Judge Rules Health Reform To Be Constitutional
In the first ruling on the multi-state lawsuit against health reform, a U.S. District Judge in Detroit sided with the Obama administration in rejecting the claim that requiring Americans to buy health insurance is unconstitutional.
"The economic burden due to the Individual Mandate is felt by plaintiffs regardless of their specific financial behavior," Judge George Steeh said in his ruling. "The [Affordable Care] Act does not make insurance more costly, [and] in fact the contrary is expected; rather the Act requires plaintiffs to purchase insurance when they otherwise would not have done so."
Furthermore, Steeh refers to the plaintiffs in the case as "participants in the healthcare services market" and "not outside the market," explaining that the healthcare market isn't one created by Congress, but rather one that is fundamentally necessary.
Robert Muise, an attorney with Thomas More Law Center in Ann Arbor, Mich., who opposes the ruling, believes that the case ultimately will go to the U.S. Supreme Court, according to the Detroit Free Press. "I think it's important that this decision be reversed to prevent Congress from overreaching the way it did in passing the original mandate," he told the newspaper.
However, Timothy Jost, a professor at the Washington and Lee University School of Law writing on the Health Affairs Blog, couldn't be happier with the decision. In his post, he called the arguments made by those who brought the lawsuit "nonsense," echoing Steeh's decision by explaining that one of the roles of insurance is to prevent the shifting of costs to others by the insured.
"They claim that if Congress can require the purchase of health insurance, it will soon be passing laws requiring people to buy cars or eat spinach," Jost wrote. "You cannot drive a car in most states without liability insurance, or get a loan to purchase a home without homeowner's insurance....But if you don't own a home or drive a car, there is no reason to require the purchase of these auto liability or homeowner's insurance. Everyone can get sick or injured, however, and thus everyone must have health insurance to avoid cost-shifting."
FierceHealthCare
10-8-2010
"The economic burden due to the Individual Mandate is felt by plaintiffs regardless of their specific financial behavior," Judge George Steeh said in his ruling. "The [Affordable Care] Act does not make insurance more costly, [and] in fact the contrary is expected; rather the Act requires plaintiffs to purchase insurance when they otherwise would not have done so."
Furthermore, Steeh refers to the plaintiffs in the case as "participants in the healthcare services market" and "not outside the market," explaining that the healthcare market isn't one created by Congress, but rather one that is fundamentally necessary.
Robert Muise, an attorney with Thomas More Law Center in Ann Arbor, Mich., who opposes the ruling, believes that the case ultimately will go to the U.S. Supreme Court, according to the Detroit Free Press. "I think it's important that this decision be reversed to prevent Congress from overreaching the way it did in passing the original mandate," he told the newspaper.
However, Timothy Jost, a professor at the Washington and Lee University School of Law writing on the Health Affairs Blog, couldn't be happier with the decision. In his post, he called the arguments made by those who brought the lawsuit "nonsense," echoing Steeh's decision by explaining that one of the roles of insurance is to prevent the shifting of costs to others by the insured.
"They claim that if Congress can require the purchase of health insurance, it will soon be passing laws requiring people to buy cars or eat spinach," Jost wrote. "You cannot drive a car in most states without liability insurance, or get a loan to purchase a home without homeowner's insurance....But if you don't own a home or drive a car, there is no reason to require the purchase of these auto liability or homeowner's insurance. Everyone can get sick or injured, however, and thus everyone must have health insurance to avoid cost-shifting."
FierceHealthCare
10-8-2010
Wednesday, October 6, 2010
Dramatic Increase In CT, MRI Scans For ER Patients
The use of CT scans or MRIs in emergency departments nearly tripled over a 10-year period without a corresponding change in the prevalence of life-threatening conditions among ER patients, according to a study published in the Journal of the American Medical Association.
Between 1998 and 2007, the share of injury-related ER patients who received MRI or CT scans rose to 15 percent up from 6 percent, based on a nationwide sample of more than 300,000 ED visits from the Center for Disease Control and Prevention's National Hospital Ambulatory Medical Care Survey.
Dr. Frederick Korley, lead author and an assistant professor of emergency medicine at Johns Hopkins University, characterized the change as "a really significant increase," Reuters reports. "It implies there is a potential amount of overuse or use that is not directly yielding any meaningful clinical results," he said.
Although researchers did not say the use of advanced imaging was unwarranted, MedPage Today reports, they did call for more investigation into why CT or MRIs are increasingly used in EDs "to optimize the risk-benefit balance of advanced radiology use."
Besides raising healthcare costs with scans that can cost several hundred to a few thousand dollars, the possibly unnecessary radiation exposure and longer ER stays (an average of two hours longer) are issues worth considering, according to the authors.
What's behind the growing use of scans?
The pressure to get patients discharged as quickly as possible might drive the decision to order an imaging test, Dr. Levon Nazarian, a professor of radiology at Thomas Jefferson University Hospital in Philadelphia, told HealthDay News. He added that fear of lawsuits due to missed diagnosis is another factor.
Another expert told HealthDay that the authors failed to address the significance of a negative scan. The ability to rule out an intracranial hemorrhage, for example, is invaluable, said Dr. Raul Uppot, director of the Abdominal Imaging Fellowship Division at Massachusetts General Hospital.
FierceHealthCare
10-6-2010
Between 1998 and 2007, the share of injury-related ER patients who received MRI or CT scans rose to 15 percent up from 6 percent, based on a nationwide sample of more than 300,000 ED visits from the Center for Disease Control and Prevention's National Hospital Ambulatory Medical Care Survey.
Dr. Frederick Korley, lead author and an assistant professor of emergency medicine at Johns Hopkins University, characterized the change as "a really significant increase," Reuters reports. "It implies there is a potential amount of overuse or use that is not directly yielding any meaningful clinical results," he said.
Although researchers did not say the use of advanced imaging was unwarranted, MedPage Today reports, they did call for more investigation into why CT or MRIs are increasingly used in EDs "to optimize the risk-benefit balance of advanced radiology use."
Besides raising healthcare costs with scans that can cost several hundred to a few thousand dollars, the possibly unnecessary radiation exposure and longer ER stays (an average of two hours longer) are issues worth considering, according to the authors.
What's behind the growing use of scans?
The pressure to get patients discharged as quickly as possible might drive the decision to order an imaging test, Dr. Levon Nazarian, a professor of radiology at Thomas Jefferson University Hospital in Philadelphia, told HealthDay News. He added that fear of lawsuits due to missed diagnosis is another factor.
Another expert told HealthDay that the authors failed to address the significance of a negative scan. The ability to rule out an intracranial hemorrhage, for example, is invaluable, said Dr. Raul Uppot, director of the Abdominal Imaging Fellowship Division at Massachusetts General Hospital.
FierceHealthCare
10-6-2010
Surgeon Shortage Jeopardizes Patient Care
Shortages of surgeons--especially in small, rural communities--threaten patient access to safe, high-quality and affordable care, concludes the American College of Surgeons. Currently, population demand for surgical care is undersupplied by about 30 percent.
"Places with greater resources and better living situations attract practitioners with relative ease; while areas with fewer amenities and struggling economies may be challenged to retain surgeons or attract new ones," noted the ACS at the 96th Annual Clinical Congress in Washington.
To help practitioners, policy makers and patients identify areas lacking adequate access to surgeons, the ACS launched the Surgical Workforce Atlas. The interactive, web-based map shows the geographic distribution of surgeons relative to populations in 2009.
"This website allows users to quickly identify the supply of surgeons in their county and compare it to all other counties in the U.S.," said Thomas C. Ricketts, PhD, MPH, managing director of the ACS Health Policy Research Institute. "[W]e hope it will help decision makers understand the needs some communities have for access to surgical care."
According to the Atlas, patients in need of surgery should steer clear of Nevada, as it retains the least number of per-capita surgeons with only 34. Of its 16 counties, seven have no surgeons at all. But patients in the District of Columbia have access to the most surgeons per 100,000 people--118.
On a county level, Montour, Pa., is the best bet for surgical services, as it has about 454 surgeons per 100,000 people, the largest density of surgeons nationwide.
ACS said it is already developing a second version of the Atlas that will include surgical subspecialties, overlay facilities and visual displays using alternative geographic units.
FierceHealthCare
10-6-2010
"Places with greater resources and better living situations attract practitioners with relative ease; while areas with fewer amenities and struggling economies may be challenged to retain surgeons or attract new ones," noted the ACS at the 96th Annual Clinical Congress in Washington.
To help practitioners, policy makers and patients identify areas lacking adequate access to surgeons, the ACS launched the Surgical Workforce Atlas. The interactive, web-based map shows the geographic distribution of surgeons relative to populations in 2009.
"This website allows users to quickly identify the supply of surgeons in their county and compare it to all other counties in the U.S.," said Thomas C. Ricketts, PhD, MPH, managing director of the ACS Health Policy Research Institute. "[W]e hope it will help decision makers understand the needs some communities have for access to surgical care."
According to the Atlas, patients in need of surgery should steer clear of Nevada, as it retains the least number of per-capita surgeons with only 34. Of its 16 counties, seven have no surgeons at all. But patients in the District of Columbia have access to the most surgeons per 100,000 people--118.
On a county level, Montour, Pa., is the best bet for surgical services, as it has about 454 surgeons per 100,000 people, the largest density of surgeons nationwide.
ACS said it is already developing a second version of the Atlas that will include surgical subspecialties, overlay facilities and visual displays using alternative geographic units.
FierceHealthCare
10-6-2010
AMA: Nurses Are Not Our Equals
The American Medical Association was swift to respond to yesterday's Institute of Medicine report that called for nurses to take on a larger, more independent role in transforming healthcare in America. By 2 p.m., it had shot out a board member's response to media outlets. It's main message: Nurses are not equal to physicians. Besides reinforcing the importance of a physician-led team approach, the statement underlined the difference in education and training between nurses and physicians.
The statement issued by Dr. Rebecca Patchin, an AMA board member, notes, "Nurses are critical to the healthcare team, but there is no substitute for education and training." She goes on to compare physicians' seven or more years of postgraduate education and more than 10,000 hours of clinical experience with nurse practitioners' two to three years of postgraduate education and less clinical experience than that of a first-year medical resident.
It's possible the physicians fear the report's proposals could lead nurses encroaching on their turf and reimbursements. The Institute of Medicine report recommends that CMS reimburse advanced practice nurses--such as nurse practitioners and anesthetists--at the same reimbursement level as physicians, and calls on the FTC to ensure state laws do not overly restrict nurses' scope of practice.
Not surprisingly, Dr. Marla Weston, CEO of the American Nurses Association, told FierceHealthcare that her group was pleased with the report's recommendations. In response to the AMA's comments, she noted that the IOM report was evidence-based and that decades of research show that advanced practice nurses can function independently as primary-care providers.
She argued against limiting their practice to whatever could be supervised by physicians. "If an advanced practice registered nurse in a rural community is willing to provide care and a physician is 200 miles away, then we've just cut off access to primary care in that community," she said. "We're not using nurses to the full extent. They are an untapped resource."
FierceHealthCare
10-6-2010
The statement issued by Dr. Rebecca Patchin, an AMA board member, notes, "Nurses are critical to the healthcare team, but there is no substitute for education and training." She goes on to compare physicians' seven or more years of postgraduate education and more than 10,000 hours of clinical experience with nurse practitioners' two to three years of postgraduate education and less clinical experience than that of a first-year medical resident.
It's possible the physicians fear the report's proposals could lead nurses encroaching on their turf and reimbursements. The Institute of Medicine report recommends that CMS reimburse advanced practice nurses--such as nurse practitioners and anesthetists--at the same reimbursement level as physicians, and calls on the FTC to ensure state laws do not overly restrict nurses' scope of practice.
Not surprisingly, Dr. Marla Weston, CEO of the American Nurses Association, told FierceHealthcare that her group was pleased with the report's recommendations. In response to the AMA's comments, she noted that the IOM report was evidence-based and that decades of research show that advanced practice nurses can function independently as primary-care providers.
She argued against limiting their practice to whatever could be supervised by physicians. "If an advanced practice registered nurse in a rural community is willing to provide care and a physician is 200 miles away, then we've just cut off access to primary care in that community," she said. "We're not using nurses to the full extent. They are an untapped resource."
FierceHealthCare
10-6-2010
Tuesday, October 5, 2010
Should Nurses Scope Of Practice Be Expanded?
The manner in which nurses work in America needs to change in order to meet the rising demand for care, according to a report released today by the Institute of Medicine.
Perhaps the most striking recommendation to come out of the report is the IOM's call for government and healthcare organizations to remove scope of practice limits that prevent nurses from practicing "to the full extent of their education and training." The rationale is that millions more patients are expected to gain access to healthcare through the healthcare reform.
The report notes that of the roughly 3 million nurses in the U.S., more than 250,000 are advanced practice registered nurses, who have master's or doctoral degrees and have passed national certification exams. Yet what they are allowed to do at work varies, depending on state regulations, which may limit their scope of practice. Already about 28 states are considering expanding the role of nurse practitioners to fill the void created by the primary-care physician shortage.
Because the healthcare system today does not offer enough incentives for nurses to pursue higher degrees and more training, the U.S. faces a shortage of nursing professors and advanced practice nurses. The report calls on public and private organization to offer resources to help nurses with associate's degrees and diplomas to go on to get their bachelor's degrees in nursing.
With the doctor shortage projected to hit 63,000 by 2015, it's not surprising that the report calls for nurses to play a bigger role in healthcare. In a potentially controversial recommendation, it suggests that nurses become "full partners" with physicians and other healthcare professionals in redesigning healthcare in America. In the past, the American Medical Association has warned that broadening nurses' authority could pose a danger to patients.
FierceHealthCare
10-5-2010
Perhaps the most striking recommendation to come out of the report is the IOM's call for government and healthcare organizations to remove scope of practice limits that prevent nurses from practicing "to the full extent of their education and training." The rationale is that millions more patients are expected to gain access to healthcare through the healthcare reform.
The report notes that of the roughly 3 million nurses in the U.S., more than 250,000 are advanced practice registered nurses, who have master's or doctoral degrees and have passed national certification exams. Yet what they are allowed to do at work varies, depending on state regulations, which may limit their scope of practice. Already about 28 states are considering expanding the role of nurse practitioners to fill the void created by the primary-care physician shortage.
Because the healthcare system today does not offer enough incentives for nurses to pursue higher degrees and more training, the U.S. faces a shortage of nursing professors and advanced practice nurses. The report calls on public and private organization to offer resources to help nurses with associate's degrees and diplomas to go on to get their bachelor's degrees in nursing.
With the doctor shortage projected to hit 63,000 by 2015, it's not surprising that the report calls for nurses to play a bigger role in healthcare. In a potentially controversial recommendation, it suggests that nurses become "full partners" with physicians and other healthcare professionals in redesigning healthcare in America. In the past, the American Medical Association has warned that broadening nurses' authority could pose a danger to patients.
FierceHealthCare
10-5-2010
Monday, October 4, 2010
What The HealthCare Reform Bill Will Mean For You
The Patient Protection and Affordable Health Care Act went into effect this past March. This important piece of legislation has the potential to impact the lives of every American, from the way they receive health care from their doctors to the types of coverages they receive from their insurers.
The main provisions of the health care reform bill strive not only to ensure that more than 90% of Americans have meaningful health insurance coverage, but also to fix some of the biggest problems facing the US health care system. These include wasteful spending on excess tests and procedures, unacceptable rates of infection and medical errors and high rates of hospital re-admittance.
Below you will find information on some of the key provisions of the law and how they may impact the way you receive medical care.
Changing the Delivery of Care
Care teams
The health care reform bill will impact the way patients interact with their physicians and other health care professionals. For example, a team of professionals, referred to as a "care team", will handle patient care. The members of the team will vary depending on the patient's circumstances, but may include nurse practioners, physician assistants, specialists, nutritionists and others in addition to the patient's primary care physician. Many believe that a team approach can help cut down on medical errors because more than one person is responsible for overseeing the patient's care.
Electronic medical records
Requiring the use of electronic medical records is another way the health care reform bill may help reduce medical errors and improve patient care. Putting patient records in an electronic format will make it more accessible to members of the patient's care team and cut down on the time it takes to transfer records from one care facility to another, or even between physicians. Electronic records also can help eliminate the problem of ineligible handwriting and missing pages from a patient's file.
Improved treatments
As part of the Affordable Health Care Act, the federal government is funding research through the Patient-Centered Outcomes Research Institute that will help physicians pinpoint the best, most efficient types of treatments for certain medical conditions. Once this research is complete and doctors begin using it in practice, it can help cut back on the number of unnecessary tests and treatments physicians may use to diagnose and treat a patient.
Focus on keeping patients healthy
The new health care law also hopes to re-orientate the practice of medicine from only helping those who are sick to keeping patients healthy. In practice, this may mean check-in calls from family practioners to remind patients to come in for physicals and have other preventative treatments, like cancer screenings. It also may mean home visits from nurses after patients with serious illnesses and injuries have been discharged from the hospital.
New Insurance Rules
For 2010, the biggest changes under the health care reform bill will affect insurance coverages. These changes include:
-Insurers cannot deny coverage to children due to pre-existing condition
-No more lifetime caps on insurance coverage
-Coverage under employer-sponsored group policies will cover dependent children up to age 26
-Insurers will have to provide coverage for certain preventative measures, including screenings for high blood pressure, osteoporosis, diabetes and sexually transmitted diseases; colonoscopies and smoking cessation counseling
-Those with serious health conditions who have been unable to obtain private insurance can purchase a policy subsidized by the federal government at rates similar to those for healthy adults
More Changes to Come in 2014
Many of the measures under the health care reform bill are not set to go into effect until 2014. Some of these measures include:
- Pre-existing conditions: health insurers will no longer be able to deny coverage due to pre-existing conditions
- Penalties: those who have not purchased a health insurance policy will be assessed a penalty of $95 or up to 1% of their income for individuals, whichever is greater. The fine increases to $695 or 2.5% of an individual's income in 2016.
- Insurance exchange: insurance premiums subsidized by the federal government under the state-based insurance exchange will become available for those who fall within income guidelines. Currently, those with incomes above 133% of the federal poverty level and below 400% of the federal poverty level will be eligible on a sliding scale for the subsidies.
- Maternity care: insurance companies will be required to provide coverage for maternity care
- Nursing mothers: employers will be required to provide nursing mothers unpaid reasonable break times for pumping breast milk as well as a private place other than a bathroom to do it in
- Continuing coverage: those who quit or lose their jobs will not lose their health coverage. They will have the option to purchase coverage subsidized by the federal government through the insurance exchange. Those whose only source of income is unemployment benefits may be eligible for Medicaid.
- Expansion of Medicaid: the Medicaid program will be made available to any adult under 65 years of age who falls within the income guidelines, currently set at 133% of the federal poverty limit, or less than $29,327 for a family of four.
Conclusion
Once all of the provisions of the Patient Protection and Affordable Health Care Act go into effect, it will have a profound impact on the US health care system. Whether or not it will be able to tackle all of the problems facing the nation's health care system has yet to be seen. However, these reforms could go a long way towards improving patient care, including decreasing the number of medical errors currently plaguing our system.
24/7 PressRelease
10-4-2010
The main provisions of the health care reform bill strive not only to ensure that more than 90% of Americans have meaningful health insurance coverage, but also to fix some of the biggest problems facing the US health care system. These include wasteful spending on excess tests and procedures, unacceptable rates of infection and medical errors and high rates of hospital re-admittance.
Below you will find information on some of the key provisions of the law and how they may impact the way you receive medical care.
Changing the Delivery of Care
Care teams
The health care reform bill will impact the way patients interact with their physicians and other health care professionals. For example, a team of professionals, referred to as a "care team", will handle patient care. The members of the team will vary depending on the patient's circumstances, but may include nurse practioners, physician assistants, specialists, nutritionists and others in addition to the patient's primary care physician. Many believe that a team approach can help cut down on medical errors because more than one person is responsible for overseeing the patient's care.
Electronic medical records
Requiring the use of electronic medical records is another way the health care reform bill may help reduce medical errors and improve patient care. Putting patient records in an electronic format will make it more accessible to members of the patient's care team and cut down on the time it takes to transfer records from one care facility to another, or even between physicians. Electronic records also can help eliminate the problem of ineligible handwriting and missing pages from a patient's file.
Improved treatments
As part of the Affordable Health Care Act, the federal government is funding research through the Patient-Centered Outcomes Research Institute that will help physicians pinpoint the best, most efficient types of treatments for certain medical conditions. Once this research is complete and doctors begin using it in practice, it can help cut back on the number of unnecessary tests and treatments physicians may use to diagnose and treat a patient.
Focus on keeping patients healthy
The new health care law also hopes to re-orientate the practice of medicine from only helping those who are sick to keeping patients healthy. In practice, this may mean check-in calls from family practioners to remind patients to come in for physicals and have other preventative treatments, like cancer screenings. It also may mean home visits from nurses after patients with serious illnesses and injuries have been discharged from the hospital.
New Insurance Rules
For 2010, the biggest changes under the health care reform bill will affect insurance coverages. These changes include:
-Insurers cannot deny coverage to children due to pre-existing condition
-No more lifetime caps on insurance coverage
-Coverage under employer-sponsored group policies will cover dependent children up to age 26
-Insurers will have to provide coverage for certain preventative measures, including screenings for high blood pressure, osteoporosis, diabetes and sexually transmitted diseases; colonoscopies and smoking cessation counseling
-Those with serious health conditions who have been unable to obtain private insurance can purchase a policy subsidized by the federal government at rates similar to those for healthy adults
More Changes to Come in 2014
Many of the measures under the health care reform bill are not set to go into effect until 2014. Some of these measures include:
- Pre-existing conditions: health insurers will no longer be able to deny coverage due to pre-existing conditions
- Penalties: those who have not purchased a health insurance policy will be assessed a penalty of $95 or up to 1% of their income for individuals, whichever is greater. The fine increases to $695 or 2.5% of an individual's income in 2016.
- Insurance exchange: insurance premiums subsidized by the federal government under the state-based insurance exchange will become available for those who fall within income guidelines. Currently, those with incomes above 133% of the federal poverty level and below 400% of the federal poverty level will be eligible on a sliding scale for the subsidies.
- Maternity care: insurance companies will be required to provide coverage for maternity care
- Nursing mothers: employers will be required to provide nursing mothers unpaid reasonable break times for pumping breast milk as well as a private place other than a bathroom to do it in
- Continuing coverage: those who quit or lose their jobs will not lose their health coverage. They will have the option to purchase coverage subsidized by the federal government through the insurance exchange. Those whose only source of income is unemployment benefits may be eligible for Medicaid.
- Expansion of Medicaid: the Medicaid program will be made available to any adult under 65 years of age who falls within the income guidelines, currently set at 133% of the federal poverty limit, or less than $29,327 for a family of four.
Conclusion
Once all of the provisions of the Patient Protection and Affordable Health Care Act go into effect, it will have a profound impact on the US health care system. Whether or not it will be able to tackle all of the problems facing the nation's health care system has yet to be seen. However, these reforms could go a long way towards improving patient care, including decreasing the number of medical errors currently plaguing our system.
24/7 PressRelease
10-4-2010
Friday, October 1, 2010
Brief Consultations Cut Chronic Pain Patient Visits to ED
A simple 15- to 30-minute behavioral health consultation can cut chronic pain patients' visits to emergency rooms, according to a study in the September issue of the Journal of Emergency Nursing. The reduction in visits is especially pronounced for frequent pain patients who pre-intervention visited a hospital ED more than four times in six months.
Although hospital emergency rooms are not the best place to get help for less pressing health issues, patients with chronic pain continue to turn to them, regardless. Researchers hypothesize that a behavioral health intervention would better serve chronic pain patients and help hospitals provide cost-effective treatment at the appropriate level of care. They conducted their study in a small acute-care hospital with a 15-bed emergency department that sees 16,500 patients a year.
The intervention involved 15- to 30-minutes of counseling during which someone taught the patient pain management strategies and reinforced the need for a primary-care physician to manage pain medication, HealthDay News reports. Six months after the consultations were added, a low-use group used the ED an average of 1.4 times compared with 1.8 times in the six months before the intervention. The high-use group, saw its mean utilization drop to 4.0 ED visits from 6.8 visits in six months.
"This study suggests that an emergency department-based behavioral health consultation may be useful for reducing high utilization of emergency department services by some chronic pain patients, particularly those who consume the most services," the authors conclude.
FierceHealthCare
10-1-2010
Although hospital emergency rooms are not the best place to get help for less pressing health issues, patients with chronic pain continue to turn to them, regardless. Researchers hypothesize that a behavioral health intervention would better serve chronic pain patients and help hospitals provide cost-effective treatment at the appropriate level of care. They conducted their study in a small acute-care hospital with a 15-bed emergency department that sees 16,500 patients a year.
The intervention involved 15- to 30-minutes of counseling during which someone taught the patient pain management strategies and reinforced the need for a primary-care physician to manage pain medication, HealthDay News reports. Six months after the consultations were added, a low-use group used the ED an average of 1.4 times compared with 1.8 times in the six months before the intervention. The high-use group, saw its mean utilization drop to 4.0 ED visits from 6.8 visits in six months.
"This study suggests that an emergency department-based behavioral health consultation may be useful for reducing high utilization of emergency department services by some chronic pain patients, particularly those who consume the most services," the authors conclude.
FierceHealthCare
10-1-2010
Doctor Shortage Expected To Hit 63,000 By 2015
By 2015, one year after health reforms will take effect in the U.S., there will be a physician shortage of roughly 63,000 doctors, according to new estimates from the Association of American Medical Colleges. Earlier figures had pegged the doctor shortage at slightly less than 40,000.
The AAMC calls for an end to a freeze on Medicare support for residency training to stem the potential problem. A fact sheet accompanying the estimates notes that since 1997, Medicare support for doctors in training has not grown, despite an increase in the number of actual residents.
"Because of the concern with likely shortages, the number of medical schools is increasing, and there will be an additional 7,000 graduates every year over the next decade," the AAMC argues. "Medicare must continue paying for its share of training costs by supporting at least a 15 percent increase in GME positions, allowing teaching hospitals to prepare for another 4,000 physicians a year to meet the needs of 2020 and beyond."
While the U.S. can expect a 36 percent increase in the number of Americans over age 65 within the next 10 years, the number of doctors to treat those American will grow by only 7 percent, AAMC notes.
"In addition to the 15 million patients who will become eligible for Medicare, 32 million younger Americans will become newly insured as a result of healthcare reform," the AAMC adds, "and thereby intensify the demand for physicians even further."
FierceHealthCare
10-1-2010
The AAMC calls for an end to a freeze on Medicare support for residency training to stem the potential problem. A fact sheet accompanying the estimates notes that since 1997, Medicare support for doctors in training has not grown, despite an increase in the number of actual residents.
"Because of the concern with likely shortages, the number of medical schools is increasing, and there will be an additional 7,000 graduates every year over the next decade," the AAMC argues. "Medicare must continue paying for its share of training costs by supporting at least a 15 percent increase in GME positions, allowing teaching hospitals to prepare for another 4,000 physicians a year to meet the needs of 2020 and beyond."
While the U.S. can expect a 36 percent increase in the number of Americans over age 65 within the next 10 years, the number of doctors to treat those American will grow by only 7 percent, AAMC notes.
"In addition to the 15 million patients who will become eligible for Medicare, 32 million younger Americans will become newly insured as a result of healthcare reform," the AAMC adds, "and thereby intensify the demand for physicians even further."
FierceHealthCare
10-1-2010
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