Copyright

(c) 2010-2024 Jon L Gelman, All Rights Reserved.
Showing posts with label Hospital. Show all posts
Showing posts with label Hospital. Show all posts

Monday, January 6, 2014

CMS Takes a New Direction in the Proposed MSP Appeal Process

The Centers for Medicare and Medicaid services (CMS) has proposed rules for the Medicare Secondary Payer (MSP) appeals process that will target the “applicable plan” as the primary responsible party for recovery. 

Medicare, in pursuing recovery directly from the applicable plan, removes the beneficiary, as well as the provider or supplier, as the responsible party to initial a re-determination and all subsequent levels of the administrative process that could culminate in judicial review.

Docket ID:CMS-2013-0270
Topic(s):Administrative Practices and Procedures, Health Facilities, Health Professions, Kidney Diseases, Medical Devices, Medicare, Reporting and Recordkeeping Requirements, Rural Areas, X-Rays
Document Type:Proposed Rule
Received Date:Dec 27, 2013
Start-End Page:78802 - 78807
Comment Start Date:Dec 27, 2013
Comment Due Date:Feb 25, 2014


Thursday, December 26, 2013

Does Knowing Medical Prices Save Money? CalPERS Experiment Says Yes

Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org

The fact that the cost of a hip replacement can ring up as $15,000 or $100,000 — depending on the hospital — makes a lot of people uncomfortable. But that’s only if they know about the wide price tag variations.


In an effort to raise awareness and rein in what can seem like the Wild West of health care, the California Public Employees’ Retirement System (CalPERS), the second largest benefits program in the country, and Anthem Blue Cross started a “reference pricing” initiative in 2011. The initiative involved a system to guide their enrollees to choose facilities where routine hip and knee replacement procedures cost less than $30,000.


Here’s how it works: The CalPERS program designated certain hospitals that met this cost threshold, and enrollees who chose among these facilities pay only the plan’s typical deductible and coinsurance up to the out-of-pocket maximum. Patients who opted for other in-network hospitals were responsible for regular cost sharing and “all allowed amounts exceeding the $30,000 threshold, which are not subject to an out-of-pocket maximum,” noted the report.

The results tallied savings of $2.8 million for CalPERS, and $300,000 in patients’ cost sharing, according to research released Thursday by the Center for Studying Health System Change for the non-profit group National Institute for Health Care Reform.
Researchers found that patients who received “intensive...
[Click here to see the rest of this post]

Saturday, December 14, 2013

New York Data Show Hospital Charges All Over The Map

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

New York State has pulled back the curtain on hospital charges with a new database showing what each hospital charges for 1,400 different procedures.

The differences can be dramatic: At Bellevue Hospital, the median charge for an uncomplicated birth  is $6,330, and at NYU Langone Medical Center next door, the median charge is $12,222.

Lutheran Medical Center in Sunset Park, Brooklyn, typically charges $5,686 and Maimonides Medical Center, a dozen miles away, $14,763.
Patterns can be difficult to discern, and can vary from procedure to procedure. Overall, academic medical centers are more costly because of the additional staff needed for medical training, the greater use of technology, and the severity and complexity of patients.

But those factors do not account for why at Westchester Medical Center, the median charge for a vaginal delivery is $22,143, and at New York Presbyterian Weill Cornell Medical Center, it is $11,900.

The Greater New Hospital Association said the information is “complex and can be confusing,” because “hospital charges do not reflect the far lower payments hospitals actually receive for the services they provide.” Medicare and Medicaid reimburse much less than what hospitals charge, and insurers and managed care companies also negotiate rates that have little to do with what hospitals ask to be paid.

People without insurance, however, are subject to these sticker prices. In practice, hospitals typically...
[Click here to see the rest of this post]

Tuesday, December 10, 2013

Rehospitalization Rates Fell In First Year Of Medicare Penalties

Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org

During the first eight months of this year, fewer than 18 percent of Medicare patients ended up back in the hospital within a month of discharge, the lowest rate in years, the government reported Friday. This drop occurred during the first year that Medicare financially penalized hospitals for their readmission rates, and the government seized on the decrease as evidence the incentives are having an effect.

revolving door300
The government is targeting rehospitalizations as a significant indicator of gaps in medical quality in the nation’s hospitals. While some elderly patients inevitably return to the hospital, the government and some researchers believe many of those returns are avoidable if hospitals monitor patients after their release to ensure they get appropriate medications and follow-up visits with doctors.
In the first year of the program, which began in August 2012, Medicare fined 2,213 hospitals—about two-thirds of those it evaluated— for higher than anticipated readmission rates. Last August, Medicare issued a second year of penalties against 2,225 hospitals. The maximum penalties created by the health law have risen from 1 percent of regular Medicare payments to 2 percent, and they will increase for a third and final time next August to 3 percent.
The new data reported by Medicare show that readmission rates for the first eight months of 2013 dropped below 18 percent, half a percentage point below 2012’s rate of 18.5 percent. From 2007 to...
[Click here to see the rest of this post]

Tuesday, December 3, 2013

Medicare Seeks To Curb Spending On Post-Hospital Care

Long term care is a huge part of medical care benefits. What Medicare ultimately does will control workers' compensation costs. Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

After years of trying to clamp down on hospital spending, the federal government wants to get control over what Medicare spends on nursing homes, home health services and other medical care typically provided to patients after they have left the hospital.
Researchers have discovered huge discrepancies in how much is spent on these services in different areas around the country. In Connecticut, Medicare beneficiaries are more than twice as likely to end up in a nursing home as they are in Arizona. Medicare spends $8,800 on each Louisiana patient getting home health care, $5,000 more than it spends on the average New Jersey senior. In Chicago, one out of four Medicare beneficiaries receives additional services after leaving the hospital—three times the rate in Phoenix.
Medicare per capita spending on these services, collectively known as post-acute or post-hospital care, has grown at 5 percent a year or faster in 34 of the nation’s 50 most populous hospital markets in recent years, according to an analysis health care economist Chapin White conducted for Kaiser Health News.
Last year $62 billion — one out of every six dollars Medicare spent in the traditional fee-for-service program — went to nursing and therapy for patients in rehabilitation facilities, nursing homes, long-term care hospitals and in their own homes, according to a congressional advisory panel.  
Most of them got those services after coming out of the hospital. Some of these...
[Click here to see the rest of this post]

Monday, November 25, 2013

A Reference Guide for Controlling Health Hazards to Hospital Workers

The bad news is that hospital workers have extremely high injury rates compared to other occupations.

The good news is that there are many practical and proven ways to avoid these injuries. A supplemental issue of New Solutions: A Journal of Environmental and Occupational Health Policy offers a new free report that describes over 30 health hazards to hospital workers and over 150 ways to avoid them.

In Controlling Health Hazards to Hospital Workers: A Reference Guide, specialists in occupational medicine from the United States and India describe ways to control everything from anesthetic gases to X-rays.

Hazards addressed include lifting and other ergonomic hazards, communicable diseases, hazardous drugs, chemicals, radiation, violence, stress and shift work. The researchers have summarized the literature on controlling these hazards by engineering means such as ventilation, shielding, automation, and administrative changes in procedures.

Each section describes the hazard, the literature on controls and internet resources where the reader can find more information. There are also general tips about identifying hazards and setting priorities.

The Mount Sinai School of Medicine and the New York State Nurses Association have made this supplemental issue of New Solutions (Baywood Publishing) available for free in order to reach healthcare professionals and hospital workers around the world. “It will be great for hospitals to have all this information in one resource guide,” said Professor Somashekhar Nimbalkar, one of the authors. “We will be sure to send it around to every hospital in India.”

The report, Controlling Health Hazards to Hospital Workers: A Reference Guide, New Solutions, Vol. 23, Supplement, 2013 can be freely downloaded at: http://baywood.metapress.com/link.asp?id=j676v4ul5026

The report will also be posted on the web site of the New York State Nurses Association at www.nysna.org/HealthHazards.pdf
 ….
Jon L. Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). For over 4 decades the Law Offices of Jon L Gelman  1.973.696.7900  jon@gelmans.com  have been representing injured workers and their families who have suffered occupational accidents and illnesses.

Sunday, November 24, 2013

A Remedy for Fragmented Hospital Care

Today's post was shared by NEJM and comes from blogs.hbr.org

Fragmented hospital care has been associated with higher hospital mortality and length of stay, and failures of communication and teamwork are the most commonly identified sources of “sentinel events” in hospitals — unexpected occurrences that result in actual deaths or the risk of deaths, or physical or psychological injuries.
Organizational Context
To address this problem, Emory Healthcare (EHC), the clinical delivery arm of the Robert W. Woodruff Health Sciences Center of Emory University and the largest and most comprehensive health system in Georgia, launched its Care Transformation initiative in 2009.
Through the strength of this initiative, in 2012, EHC became the first and only health system in the nation to have two hospitals — Emory University Hospital and Emory University Hospital Midtown — simultaneously in the top 10 in the University HealthSystem Consortium (UHC) Quality and Accountability ranking of U.S. academic medical centers. In 2013, these two hospitals were ranked in the top five.
The Care Transformation initiative at EHC has influenced the organization in many ways, one of which was the creation of an environment where the redesign of care models was encouraged.
This piece focuses on the development of a collaborative care model called the Accountable Care Unit (ACU), which became a re-imagining of hospital care inspired by core principles of EHC’s Care Transformation initiative: patient-and-family...
[Click here to see the rest of this post]

Sunday, November 3, 2013

A Vital Measure: Your Surgeon’s Skill

Today's post is shared from the nytimes.com
To those of us in training, the hospital was cursed. At least when it came to a certain operation.
We dreaded being asked to scrub in at these operations because we knew we would be forced to hold patient parts until our fingers went numb and arms quivered. The surgeons hunted, stabbed and slashed their way through the procedure; and whenever their knife would go a little too far, or their knot would slip, or their stitch pull, we braced ourselves for their fury…and for the inevitable extra time it would take for them to correct their errors.
The patients, many of whom had come in to the hospital walking and talking, ended up lingering for weeks afterward with infections, open wounds and other complications.
But everything changed when a new surgeon came on board. Built like a rugby player, he shocked us first with his speed, and then his results. The once unbearable day-long slog became a morning’s work; and instead of spending weeks in the hospital, his patients went home after eight days.
In the operating room, his bear paw hands turned delicate, teasing out tissues, caressing vessels and nimbly knotting thread as fine as human hair. There was not a single wasted movement; and each step blended seamlessly with the next, giving those of us who had the fortune to observe the sense that we were watching not surgery, but a well-choreographed ballet.
“It’s like you’re just standing there holding the needle or...
[Click here to see the rest of this post]

Friday, November 1, 2013

Two Kinds of Hospital Patients: Admitted, and Not

Today's post was shared by The New Old Age and comes from newoldage.blogs.nytimes.com


Judith Stein got a call from her mother recently, reporting that a friend was in the hospital. “Be sure she’s admitted,” Ms. Stein said.
As executive director of the Center for Medicare Advocacy, she has gotten all too savvy about this stuff.
“Of course she’s admitted,” her mother said. “Didn’t I just tell you she was in the hospital?”
But like a sharply growing number of Medicare beneficiaries, her mother’s friend would soon learn that she could spend a day or three in a hospital bed, could be monitored and treated by doctors and nurses — and never be formally admitted to the hospital. She was on observation status and therefore an outpatient. As I wrote last year, the distinction can have serious consequences.
The federal Centers for Medicare and Medicaid Services tried to clarify this confusing situation in the spring with a policy popularly known as the “two-midnight rule.” When a physician expects a patient’s stay to include at least two midnights, that person is an inpatient whose care is covered under Medicare Part A, which pays for hospitals. If it doesn’t last two midnights, Medicare expects the person to be an outpatient, and Part B, which pays for doctors, takes over.
It’s rare to have hospital and nursing home administrators, physicians and patient advocates all agreeing about a Medicare policy, but in this case “there’s unanimity of dislike,” said ...
[Click here to see the rest of this post]

Tuesday, October 29, 2013

Spinal fusions serve as case study for debate over when certain surgeries are necessary

The necessity of medical treatment is coming under increased questioning as payers want to rein in costs. This article is shared from the washingtonpost.com.

By some measures, Federico C. Vinas was a star surgeon. He performed three or four surgeries on a typical weekday at the Daytona Beach, Fla., hospital that employed him, and a review showed him to be nearly five times as busy as other neurosurgeons. The hospital paid him hundreds of thousands in incentive pay. In all, he earned as much as $1.9 million a year.

Yet given his productivity, some hospital auditors wondered: Was all of the surgery really necessary?

To answer that question, the hospital in early 2010 paid for an independent review of cases in which Vinas and two other neurosurgeons had performed a common procedure known as a spinal fusion. The review was conducted by board-certified neurosurgeons working for AllMed, a company accredited to audit health-care businesses.

Of 10 spinal fusions by Vinas that were selected, nine were deemed not medically necessary, according to a summary of the report.

Vinas is still working at Halifax Health, and a hospital spokesman said that, after the AllMed report, the hospital conducted an internal review that validated his surgeries. Another review conducted this year in response to litigation also validated them, the spokesman said. The hospital would not answer further questions or release details of those reviews.

Vinas “has never and will never perform an unnecessary surgical procedure on any patient,” his attorney, Robert H. Pritchard, said in a statement.

More than 465,000...
[Click here to see the rest of this post]

Thursday, October 24, 2013

US Inspector General Wants More Disclosure By Back Surgeons Who Implant their Own Devices

Back surgery is a big business and the selling of implanted medical devices are costly transactions. The US Office of Inspector General has issued a report today that their should be more disclosure to patients when back surgeons implant their own devices.

"PODs have a substantial presence in the spinal device market. PODs
provided devices used in nearly a fifth of the spinal surgeries billed to
Medicare in FY 2011, and over a third of the hospitals in our sample
purchased spinal devices from PODs. Many of these hospitals began
purchasing from PODs after 2009. Also, few hospitals in our sample
required physicians to disclose their ownership in device companies,
such as PODs, to their patients.

"In FY 2012, hospitals that purchased from PODs performed more spinal
surgeries and had slightly more complex spinal surgery caseloads than
hospitals that did not purchase from PODs. After they began purchasing
from PODs, hospitals experienced increased rates of growth in the
number of spinal surgeries performed as compared to the growth rate for
hospitals overall. Determining the cause for the increased rate of spinal
procedures was beyond the scope of our review.

"In addition, our findings raise questions about PODs’ claims that their
devices cost less than other suppliers. Within the device categories we
examined, PODs’ devices either cost the same as or more than devices
from companies not owned by physicians. This, combined with the
volume of spinal surgeries we found at hospitals that purchase from
PODs, may increase the cost of spinal surgery to the Medicare program
and beneficiaries over time. Further, hospitals inconsistently required
physicians to disclose ownership interests in PODs to either the hospitals
or their patients. Thus the ability of hospitals and patients to identify
potential conflicts of interest among these providers is reduced.

"The Sunshine Act may improve the ability of hospitals and patients to
identify physicians’ investment in device companies. The Act will
require most PODs to report to CMS all physician ownership and
investment interests.18 CMS plans to list these companies and their
payments on a publicly available Web site.

Click here to read the complete report.

Thursday, October 10, 2013

Robot Surgery Damaging Patients Rises With Misleading Marketing

Many injured workers' require surgical intervention. Safety in these procedures is questioned. Today's post was shared by votersinjuredatwork and comes from www.claimsjournal.com

Porter Adventist Hospital in Denver announced last year that Warren Kortz, a general surgeon on the medical staff, was the first in the Rocky Mountain region to use a technique known as robotic surgery to remove gall bladders through one incision in the belly button.

The operation, performed while the doctor sits at a video- game-like console, was “taking advantage of another breakthrough in robotic surgery” and is “easier on the patient,” the hospital said in a press release.

“It’s Star Wars stuff,” Kortz was quoted as saying in another article put out by the hospital touting another operation, robot-assisted parathyroid surgery, in 2010. “My prediction is it will eventually replace everything else.”

What the hospital and Kortz didn’t reveal was the risk. Even as Kortz promoted robotic surgery, 10 patients he treated suffered injuries or complications between 2008 and 2011, according to an April complaint by the Colorado Medical Board. Five had arteries punctured or torn. Objects were temporarily left inside two, and others had nerve damage. One died and another needed cardiopulmonary resuscitation. The complaint charges Kortz with 14 counts of unprofessional conduct, including sometimes not advising patients on alternatives to the robot.

Robotic surgeries are on the rise, fueled by aggressive marketing by doctors, hospitals and Intuitive Surgical Inc., which manufactures the $1.5 million robot. Advertising on...
[Click here to see the rest of this post]

Monday, September 23, 2013

State Politics and the Fate of the Safety Net

Lacking workers' compensation coverage, injured workers rely upon a safety net of Federally provided medical benefits. Under the Affordable Care Act that safety net is shrinking. Today's post was shared by WCBlog and comes from www.nejm.org


Only 2% of acute care hospitals nationwide are safety-net facilities, but they provide 20% of uncompensated care to the uninsured. Because most are in low-income communities, they typically generate scant revenue from privately insured patients. The Medicaid Disproportionate Share Hospital (DSH) program was established to help defray their costs for uncompensated care.

Currently, Medicaid DSH disburses $11.5 billion annually to the states, which have considerable latitude in allocating these funds. Some states carefully target their DSH payments to hospitals providing large volumes of uncompensated care, but others, such as Ohio and Georgia, spread their payments broadly, transforming the program into a de facto subsidy of their hospital industry.

Because the Affordable Care Act (ACA) was expected to dramatically expand insurance coverage, safety-net hospitals were expected to need less DSH money. Therefore, to reduce the cost of expanding Medicaid, the ACA reduced Medicaid DSH funding by $18.1 billion between fiscal years 2014 and 2020. To allow time for coverage expansion to take effect, the cuts are back-loaded — starting at $500 million (4% of current national DSH spending) in 2014 but reaching $5.6 billion (49% of current spending) in 2019.

The DSH cuts are so deep in part because Congress assumed that all...
[Click here to see the rest of this post]