Insurance

SPOTLIGHT: Broader health coverage could reduce disparities, lawmakers say

Fri, 13 Jun 2008 06:59:52 -0400

SPOTLIGHT... Broader health coverage could reduce disparities, lawmakers say
While it wouldn't eliminate health disparities entirely, proposals to expand health insurance to all U.S. residents could reduce those disparities, according to a group of lawmakers and healthcare experts who spoke this week at a House Ways and Means Health Subcommittee hearing. Right now, they noted, women and racial and ethnic minorities often have less access to care, receive lower quality care, and have more negative outcomes than other groups, something that is influenced, though not entirely created, by a lack of health insurance. Article

ALSO NOTED: Number of uninsured young people rises; Study shows problems in physician EMR adoption; and much more...

Tue, 03 Jun 2008 06:59:50 -0400

> New research suggests that the number of young adults going without health insurance rose again in 2006, with 34 percent of college graduates spending some time uninsured in the year after graduation. Article

> Want to know just how hard it will be to get physician holdouts on board with electronic medical records? This study by the Texas Medical Association may offer a glimpse. FierceHealthIT

> With the heparin scare fresh on people's minds, now China is reporting that six patients have died after injections of immunoglobulins. FiercePharma

> While the admittedly scary side-effects aren't that common, scripts for anti-smoking drug Chantrix have fallen dramatically, in a trend one doctor calls "fear-driven." FiercePharma

And Finally... In death, Fredric J. Baur will spend eternity with his proudest invention. Article

OH hospitals lose $79 million award in DSH appeal

Mon, 02 Jun 2008 06:59:58 -0400

A group of 25 Ohio hospitals has lost the latest stage in their ongoing battle to recover a disputed $79 million in Medicare disproportionate-share payments. The hospitals had won a favorable ruling in June 2007, but last week the District of Columbia U.S. Court of Appeals reversed the decision.

The dispute stems from a disagreement over how hospitals should measure their burden related to caring for low-income patients. A federal statute requires hospitals to measure this burden based on the number of Medicaid-eligible patients they serve, but CMS had excluded patients treated under Ohio's Hospital Care Assurance Program, which subsidizes free care for indigent patients partly through Medicaid DSH funds.

To learn more about this case:
- read this Modern Healthcare article (reg. req.)

Related Articles:
Federal bill would increase DSH funding eligibility
Hospitals fail to get back DSH payments
TX may use Medicaid funds to subsidize insurance for poor

CT restricts use of 'silent PPOs'

Mon, 02 Jun 2008 06:59:54 -0400

Connecticut's legislature has joined a growing trend by adopting measures setting limits on insurers' practices of renting access to physician networks, taking a fee from the renting party while turning over none of the benefits to physicians. Typically, the primary insurer doing the renting offers the lowest rates that physician agreed to with any insurer.

The network rentals, known as "silent PPOs," have stirred up vigorous opposition among physician groups, who argue that such arrangements unfairly extend discounts on their services to companies who never approach or negotiate with them directly. Thanks in part to physician activism, more than a dozen states currently have laws on the books restricting or prohibiting the use of these arrangements.

The measure requires insurers to let contracting doctors know if they plan to sell or rent access to network discounts. It also requires insurers to maintain a list of all secondary parties who sign network rental agreements. In addition, the bill requires secondary silent PPO renters to pay on the same terms as the primary contract, and cancels the second party's contract if the first is canceled. What's more, it requires that remittance notices state clearly which entity is going to pay a bill.

To learn more about this law:
- read this AMNews piece

Related Article:
Ohio law makes health plans disclose contract terms

Consumers Union plans to rate hospitals

Thu, 29 May 2008 06:59:58 -0400

The venerable organization behind the popular Consumer Reports magazine has announced that it's getting into the hospital ratings act. The publisher, Consumers Union, already offers assessments of health-insurance plans, drugs and even some medical treatments, and is considering ratings of physician and elder groups. Its planned hospital ratings are the first step in a program to expand its healthcare ratings services.

Consumer Reports will rate about 3,000 facilities, and will include graphs showing ratings of care intensity and quality of care for nine serious conditions such as cancer and heart failure during the last two years of life. It also will include features reflecting average out-of-pocket costs for physician visits during the last two years of life for the nine conditions. The data will be drawn from the Dartmouth Atlas Project.

To learn more about the planned ratings:
- read this Wall Street Journal article (sub. req.)

Related Articles:
Some CA hospitals at odds with rating system
OH hospitals debate quality ratings
Study: Hospital satisfaction ratings climbing

SPOTLIGHT: Providers fight self-insured plans for payments

Thu, 29 May 2008 06:59:52 -0400

Increasingly, self-insured insurance plans offered by large employers and labor unions have become a worry for employers, who say that these plans aren't paying their claims in a reasonable amount of time. While insurance companies must contend with state regulators if they're too tardy in settling claims, self-insured plans are regulated by federal ERISA rules, which give them a great deal of leeway. And the number of workers covered by self-funded plans has risen sharply in recent times from, 44 percent in 1999 to 55 percent to 2007, making this an increasingly important concern for physicians and hospitals. Article

SEC backs universal health insurance ballot measure

Tue, 27 May 2008 06:59:55 -0400

While most of the discussion of universal healthcare coverage takes place outside of the corporate arena, some activist shareholders may have succeeded in forcing the discussion into stockholder debates. Of late, groups of public company shareholders such as religious groups and labor unions have pushed a proposal asking shareholders to vote on a statement endorsing universal health insurance coverage. The statement asks companies to offer official support for universal, continuous, affordable health insurance. Many companies have resisted vigorously, including, interestingly enough, health insurer UnitedHealth.

Their tactic may be working. Over the past several months, the Securities and Exchange Commission has told a group of large public companies--including Boeing, General Motors, United Technologies, Wendy's International and Xcel Energy--that they must include the proposal in their proxies. Generally speaking, companies don't have to let shareholders vote on proposals if they don't relate to a company's ordinary business operations. However, the SEC said that it sometimes is appropriate for shareholders to express views by voting on significant social policy issues--and that it feels healthcare has reached the level of importance necessary to meet such a standard.

To learn more about this issue:
- read this piece in The New York Times

MA physician group files suit over rankings

Thu, 22 May 2008 06:59:58 -0400

The Massachusetts Medical Society has filed suit to stop a scheme under which doctors are ranked using cost and quality metrics by health plans working with an agency overseeing health insurance plans for public employees. The MMS says that the Group Insurance Commission (GIC), which works with thousands of state and local employees, defamed doctors that it arbitrarily ranked lower, and defrauded patients who pay higher co-payments based on their doctor's ranking.

The medical society had worked with the GIC for four years to improve its methods, and concedes that the agency made some changes. However, it still ranks individual physicians "using inaccurate, unreliable, and invalid tools and data," according to Dr. Bruce Auerbach, MMS's president.

To compile its individual physician rankings, the GIC runs an analysis on a claims database drawn from six insurance companies. However, the MMS says this approach has many flaws, including that it penalizes doctors that take on complex, expensive cases. Also, the data itself may reflect, for example, full expenses for cases in which a doctor read a chart but didn't participate in care, skewing the individual's cost results dramatically.

To learn more about the dispute:
- read this article from The Boston Globe

Related Articles:
NY considers physician-ranking legislation
Restaurant ratings firm Zagat, WellPoint rate doctors
Foxes in the henhouse: The limits of health plan MD ratings
Physician ratings are here to stay

FL gov. signs bill mandating autism coverage

Wed, 21 May 2008 06:59:55 -0400

Florida Gov. Charlie Crist (R) has signed a bill that could force the state's health plans to cover a range of services related to autism treatment. The new law requires the state's health plans to negotiate deals with the state on how they will cover the diagnosis and treatment of autism-related disorders. If the plans don't enter into such an agreement, the state will require certain coverages by July of 2009, capped at $36,000 per year or $200,000 over the lifetime of the policy. The measure, however, only applies to large groups, not individual policies or small employers. Because of this limitation, it's expected that the bill will serve only one-half of the people with insurance who might have benefited from such coverage, according to the bill's sponsor, state Sen. Steve Geller.

To learn more about the bill:
- read this Associated Press article

ALSO NOTED: FDA may require side-effects hotline number in DTC ads; Many uninsured could be eligible for gov't insurance; and m

Fri, 16 May 2008 06:59:50 -0400

> An FDA panel is considering whether it should require direct-to-consumer advertisers to include a side-effects hotline in every commercial. FiercePharma

> A new study suggests that if every patient who was eligible was enrolled in government insurance programs, uninsured rolls in the U.S. would be much lower. FierceHealthFinance

> Novartis may be getting closer to a vaccine that could protect infants from meningococcal B infections. FierceVaccines

> Chinese citizens are facing long waits for medical care after surviving the catastrophic earthquake which recently took place there. Article

And Finally... Boy, this chiropractor has a tough collections policy. Article