findings

Medicare auditor still paid millions despite reversals

Mon, 17 Sep 2007 06:59:58 -0400

Increasingly, it's looking like rehab hospitals dogged by Medicare auditor PRG-Schultz are going to get money back, thanks to new rulings by administrative law judges. The auditor, which has been accused of rejecting Medicare claims from rehab hospitals en masse, has faced tremendous criticism from the industry.

Now, after hitting a third level of reviews, hospitals are beginning to win reversals of the auditors' decision. However, despite the reversals, PRG-Schultz will still get paid the 25 to 30 cents per dollar it is typically paid in many cases. That's because the company's agreement allows it to get paid if its findings pass the first two levels of administrative review.

Lawyers for the 74 California rehab hospitals affected contend that these findings are likely to spell an end to the CMS-backed review program, which has been rejecting virtually all claims for patients admitted after knee and hip replacement surgery, as well as starting to deny rehab hospital claims for stroke services.

To learn more about the situation:
- read this McClatchy Newspapers piece

Related Articles:
Lawmakers question California Medicare audits. Report
California Hospital Association wants audit of auditor. Report

Study: Wrong-site surgeries, close calls common

Tue, 26 Jun 2007 20:01:34 -0400

Wrong-site surgeries happen or almost happen every other day in Pennsylvania healthcare organizations, says a new study. And, researchers suggest, those findings mirror what's taking place in other states.

Officials of the Pennsylvania Safety Authority, which conducted the survey, said in a 30-month time period stretching from June 2004 to December 2006, they received 427 near misses or reports of wrong-site surgeries. Of those, 253 were near misses. Of the remaining surgeries, which actually involved harm to a patient, 69 percent were wrong-side surgeries, 14 percent were wrong body part surgeries, 9 percent were wrong procedures and 8 percent were wrong patient cases.

Common risk factors included multiple procedures and/or surgeons, time pressure, incomplete pre-op assessments and problems with teamwork. When errors were prevented, meanwhile, it often was the patient's family, not the hospital staff, who sounded the alarm.

To gather more information from the study:
- read this Philadelphia Business Journal article

Related Articles:
Study: Pre-op briefing can lower surgical error rates. Report
Businesses say "no pay" for major mistakes. Report
Keep alert for potential errors. Editorial

Glaxo: Avandia critic should pay for stock drop

Wed, 06 Jun 2007 20:01:38 -0400

A researcher and early critic of Avandia told Congress yesterday that a GlaxoSmithKline executive threatened him with dire financial consequences when he raised concerns about the drug. Dr. John Buse, who testified before a House panel yesterday, told investigators that Glaxo executive Dr. Tadataka Yamada suggested that he should be responsible for the $4 billion drop in stock value Glaxo suffered after Avandia safety concerns came to light. In light of similar findings by Dr. Steven Nissen, a Cleveland Clinic cardiologist, the FDA is now asking Glaxo--as well as Actos maker Takeda--to put "black box" warnings on the popular drugs. Nissen's findings suggest that Avandia, Glaxo's drug, increases a patient's odds of suffering a heart attack.

To learn more about Buse's concerns:
- read this article from The Boston Globe

Related Articles:
Avandia critic says that FDA launched a smear campaign against him. Report
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Diabetes expert issued harsh Avandia critique in 2000. Report

Healthcare spending slowed in 2005

Mon, 08 Jan 2007 19:01:36 -0500

According to CMS, healthcare spending in 2005 grew 6.9 percent to $2 trillion--the slowest growth pace in 6 years. CMS credits less expensive generic drugs as a reason for the slower growth rate. In addition, states had a hand in lowering costs, as they worked together to negotiate lower prices for prescription drugs covered by Medicaid. Hospital spending, however, increased by 7.9 percent in 2005, which is roughly the same as other years. In addition, spending on nursing home care care received at physician offices and clinics also rose. Economists note while the slow in spending is good news, it's not likely to last, as more people demand expensive lifesaving medical care.

For more on CMS's findings:
- check out this AP report

Related Articles:
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Study: U.S healthcare costs more, gives less. Report

Study: Heart attack patients often not compliant

Mon, 25 Sep 2006 20:01:37 -0400

In the healthcare community, a lot of attention is focused on what physicians can do to improve patient outcomes. The growing pay-for-performance trend reflects the theory that if physicians follow a set of guidelines for treating certain diseases, it will better manage those diseases and cut down on costs. But what if a doctor does everything he or she is supposed to and the patient isn't cooperative? A study published in American Health Journal found that more than half of people who had suffered a heart attack weren't taking beta blockers--prescription drugs that could prevent another incident. "The study fits into a pattern of findings showing that even people with very serious illness fail to follow medical practices known to save lives and improve outcomes," notes the Washington Post. Patients tend to take their health less seriously once they feel they've recovered from a heart attack. Health officials note that it's important for providers to understand how they can help prevent patients from underestimating their need for continuing treatment.

For more on the study:
- read this Washington Post article

Study: Residents work too many hours

Tue, 05 Sep 2006 20:01:37 -0400

A study published in the Journal of the American Medical Association underscores the danger of overworking medical students. The study found that first year residents routinely work more than the maximum duty-hours recommended by the Accreditation Council for Graduate Medical Education (ACGME). The council requires that physicians-in-training work no more than 80 hours a week averaged over the course of four weeks, have one day off a week and not work more than 24 hours straight. Of the 4,000 residents surveyed, 62 percent reported violating those standards. The ACGME challenged the findings, saying that the study sampled only a small percentage of the nation's 100,000 residents. Its own national study found that only three percent of residents violated the standard. A separate study in the Journal found that interns who worked longer than the recommended hours were more prone to commit medical errors.

For more on this issue:
- check out the Modern Healthcare report

Report: Medicaid study wasted $275M

Tue, 29 Aug 2006 20:01:32 -0400

In 2005, a yearlong federal government study paid cancer doctors a combined $275 million for assessing their patient's side effects from chemotherapy. Now many other doctors and lawmakers feel that the study was a waste of money and that its findings will be of no real use to healthcare providers. Chemotherapy providers were given $130 every time they reported their patients' side effects. But HHS Inspector General Daniel Levinson noted, "we identified numerous anomalies and gaps in the data and collection methods." Doctors were reimbursed a median of $23,000, with some receiving ten times that. Medicaid officials defend the program, saying it successfully managed to get doctors to report on quality data. This data can lead to process improvement and better outcomes in the future.

For more on the controversy:
- read this report from the AP

Consumers reluctant to use outcomes, cost data

Mon, 14 Aug 2006 20:01:33 -0400

Apparently, Americans don't like having to do homework any more than they did when they were children. A study of 1,000 adults, which was commissioned by Destiny Health and conducted by Opinion Research Corporation, has found that despite our concerns about healthcare costs, most people are reluctant to research cost and quality data even if it's readily available. Health officials have made a lot of noise about increasing transparency in the healthcare system, though two recent Chicago Tribune articles argued that the transparency necessary for consumers to comparison shop simply isn't a reality.

If Opinion Research's findings are correct, consumers will need more than just easily accessible pricing information before they're ready to buy into CDHPs. "Today, with 97 percent of Americans covered by paternalistic forms of healthcare insurance, that motivation is missing," observed Barry Swartzberg, executive director of Destiny Health's sister company Discovery Health. "Members of those plans have little to gain from seeking lower prices or higher quality care that might be available outside their provider's network, so they have disengaged from the process and seem to be waiting for others to solve the healthcare cost crisis." The study's findings are in line with yesterday's Milwaukee Business Journal report: While about 20 percent of employers offer CDHPs, only about five to 10 percent of employees enroll in the programs.

- see this press release about the study

Report: Logging errors improves care quality

Mon, 26 Jun 2006 20:01:38 -0400

Researchers at Johns Hopkins released a study that concludes requiring doctors and nurses to report medication errors and log them in a database improves care quality and decreases the chances that providers will make mistakes. The research, which appears in the June issue of the journal Quality & Safety in Healthcare, looked at mistakes at the Johns Hopkins Children's Center. In the study, researchers found errors occur during every step of the medication process and that doctors, nurses and pharmacists made mistakes at about the same rates.

"One of the more interesting findings was that drug-administering errors, such as giving the patient the wrong drug or the wrong dose or at the wrong time, were quite common," said Christoph Lehmann, director of clinical IT at Children's. "We had focused in the past on ordering errors. This finding made us look for possible interventions on the administration side."

- see this release from Johns Hopkins

Surgeon pay rates vary within hospitals

Tue, 16 May 2006 20:01:38 -0400

A new study finds that surgeons operating in the same hospitals and conducting the same procedures often end up incurring very different costs. Researchers at Washington University in St. Louis looked at the expenses of surgeons working within the same hospital and conclude their findings could have "broad implications" for the healthcare system.

"If it's truly the case that one doctor generates lower costs for the same outcomes as another doctor, then it's fair to say there is room for cost reductions", argues study co-author Bart Hamilton of the Washington University School of Management.

- see this article from Claims Guides