Beyond x-rays: a pricey picture
Patients and their doctors are so hooked on new ultrafast machines that see inside the body and produce photo-sharp pictures of everything from tiny clogged arteries to athletes’ torn tendons that radiological tests are threatening to overtake pharmaceuticals as the fastest-growing component of health-care costs.
[Boston Globe 2001-01-12]
Back to health care for Sen. Clinton
Hillary Rodham Clinton will continue to have her say on health care: She landed a seat Thursday on the Senate’s Health, Education, Labor and Pensions Committee. The first lady-turned-senator also was named to the Budget and the Environment and Public Works committees.
Groups Vow To Fight New Medical Privacy Regulation
Various trade groups dissatisfied with the final rules governing the privacy of a patient’s medical records plan to prod the new Bush administration to modify the regulation before it goes into effect two years from now and to ask the new Congress for legislation pre-empting all state laws on the issue.
[Medical Industry Today 2001-01-12]
NCQA launches new certification programs
The National Committee for Quality Assurance (NCQA) launched new certification programs for utilization management and credentialing today, and announced that Private Healthcare Systems, Beech Street Corporation and the Detroit Medical Center have committed to undergoing reviews.
[NCQA press release 2001-01-10]
eHealthInsurance.com gets injection
Believe it or not, there’s still a faint heartbeat emerging from the e-commerce sector, and it is coming in part from a company called eHealthInsurance.com.
[The Deal 2001-01-11]
Groundbreaking downstream risk rules close to implementation in New York
The first ever New York rules regarding transfer of financial risk between insurers and providers are close to implementation, although they must go through a public comment period prior to being finalized. The rules, which apply to provider entities taking more than $250,000 in annual prepaid capitation payments, are expected for the first time to require IPAs, hospitals and other provider risk-taking entities to post a security deposit of at least 12.5% of the annual capitation revenues.
[Harkey Report/Healthleaders 2001-01-11]
Health insurance review ‘working’
Independent arbitrators in Colorado have overturned half the denials issued by health plans for medical care or services since the state began reviewing cases last summer.
[Denver Rocky Mountain News 2001-01-12]
Drug Price Dilemma Far From Resolution, Panel Says
The ongoing debate over the cost and value of prescription drugs in the U.S. is not likely to be resolved in the near future, according to a panel of healthcare executives and government officials.
[Reuters via WebMD 2001-01-10]
California Research Bureau Issues Report Showing HMO Arbitration Is Unfair
The California Research Bureau, the state equivalent of the U.S. General Accounting Office, has issued a report today that shows more than three-fourths of Californians who are enrolled in managed care companies are forced into binding arbitration as a condition of enrollment and that the arbitration process itself is unfair.
[Foundation for Taxpayer and Consumer Rights news release 2001-01-12]
Off-topic but fascinating
God, Stephen Wolfram, and Everything Else
Profile of Stephen Wolfram, who is perhaps our leading living scientist, his work, and his forthcoming book.
Doors closing for Medicare patients
Colorado’s elderly could find it increasingly difficult to switch doctors or find a new physician if they get their health care benefits through the federal Medicare program, a new report says.
[Denver Post 2001-01-12]
Thursday, January 11, 2001
As America Grays, How Will We Pay?
. . . “For the health industry, our nation’s longevity is a gold mine,” a senior Republican congressional aide tells WebMD. “For the government, it’s bankruptcy.”
Most Americans Happy with Their Health Plans
Even though the American public’s perception of the managed care industry ranks among the lowest of all industries, a new Harris Poll released Wednesday shows that 69% of insured American adults give their own health plans an A or B rating.
[Reuters via Yahoo 2001-01-10]
New Internet MD Rating System Debuts
(Portland, Ore.) — Doctors here have become the guinea pigs in a new attempt to rate the quality of medical care. Portland was chosen by a Nebraska-based company as a pilot for a new rating system for 437 local family practitioners, internists, pediatricians, and ob-gyn doctors on the Internet.
[AP via WebMD 2001-01-10]
Medicare Expands Coverage for Self-Managing Diabetes
Healthcare providers, including non-physicians, already participating in Medicare can provide self-management training to diabetics as long as they meet quality standards for the benefit, the Health Care Financing Administration (HCFA) said in a final rule recently.
[Medical Industry Today 2001-01-11]
Doctors have plan for free basic care
Family doctors will release a proposal today they say may be a prescription for America’s health care woes — including free basic medical care for all.
[USA Today 2001-01-11]
A shortage slows down surgeries
A critical shortage of anesthesiologists in Massachusetts is forcing many operating rooms to shut down, delaying surgeries, and ending several pain treatment programs.
[Boston Globe 2001-01-11]
Providers file petition to force doctors’ group into Chapter 7
Two large doctors’ groups, an HMO and three individual doctors have filed an involuntary Chapter 7 bankruptcy petition against Heritage Southwest Medical Group P.A., saying they are owed almost $4 million in back payments.
[Dallas Morning News 2001-01-11]
Wednesday, January 10, 2001
Odds improving for patient protection bill
The makeup of the new Congress bolsters the legislation’s chances, but success on another issue — the uninsured — may take more work.
[AM News 2001-01-15]
Why Didn’t ‘MD Merger Mania’ Succeed?
So today, the merger and acquisition mania of a few years ago has all but disappeared. The PPMC industry fairly quickly showed its true colors — as largely a roll-up vehicle that lined certain investors’ pockets, for a while — and all too soon went bust when the fact became painfully obvious, at least to doctors, that remote practice management is a flawed business model.
Effect of Improved Glycemic Control on Health Care Costs and Utilization
. . . Conclusion: Our data suggest that a sustained reduction in HbA1c level among adult diabetic patients is associated with significant cost savings within 1 to 2 years of improvement.
[JAMA (abstract only) 2001-01-10]
Pharmacists’ Group Sues to Stop Discount Rx Program
(Olympia, Wash.) — A group representing Washington pharmacists has sued to try to stop a state program that would give senior citizens discounts on prescription drugs.
[AP via WebMD 2001-01-09]
Patients blamed for medical errors
The American Medical Association believes it may have discovered a root cause of many medical errors: patients themselves.
[Modern Healthcare 2001-01-08]
400 eye specialists drop PacifiCare
More than 400 optometrists and ophthalmologists have dropped out of PacifiCare of Colorado’s eyecare network since Jan. 1, leaving 427,000 Front Range members scrambling to find new doctors and reschedule procedures.
[Denver Post 2001-01-10]
HMO to lay off 25
As part of its financial turnaround plan, the struggling health insurer Harvard Pilgrim Health Care will lay off 25 employees in the next few days, executives said.
[Boston Globe 2001-01-10]
Industry Says Privacy Regs Still Need Improvements
There are as many questions as concerns about the new privacy regulation from the ranks of the healthcare industry, and one major problem is the issue of obtaining patient consent for routine use and disclosure of health records.
[Medical Industry Today 2001-01-10]
Blue Cross to Cover Some Sutter Facilities
In response to the contract impasse between Blue Cross and Sutter Health, the HMO insurer outlined a plan yesterday to extend coverage to some members in the most-trying circumstances, especially in rural areas. Blue Cross identified six Sutter hospitals the company has agreed to reimburse for services because there is no non-Sutter facility within a reasonable driving distance.
[San Francisco Chronicle 2001-01-09]
New Jersey HMOs Face New, Tougher Prescription Rules
. . . The new rules, posted this week on the state Department of Banking and Insurance Web site, permit the use of formularies. But the state is now dictating that health plans can’t limit full coverage to one drug for a given condition, if alternatives are available. If there are three drugs, for example, that can treat a disease, the formulary must include at least two….The rules also limit the price break HMOs can give patients for using formulary drugs to 30 percent.
[Newark Star Ledger 2001-01-09]
Intergroup chief Mary Gilligan, dies suddenly
Mary Gilligan, a former nurse who took over as president and CEO of Intergroup of Arizona last January, died unexpectedly yesterday morning.
[Arizona Daily Star 2001-01-10]
From Aviation To Motivation
Motivating people to sell HMO plans isn’t like pushing sports cars, and Paul Philpott knew he’d have to add the sizzle to pump up his sales staff as it gathered inside the Newport Marriott.
[Hartford Courant 2001-01-10]
Tuesday, January 09, 2001
FROM MANAGED CARE MAGAZINE
Penalizing HMOs for Medical Group Failures
State legislatures that tackle medical group insolvencies have come up with strategies that sometimes shift accountability to HMOs.
Persistence Pays Health Claims
. . . Late payments and nonpayments by insurers are plaguing not only doctors and other providers but also individuals, as the insurers are increasingly asking their customers to pay doctor bills themselves and then file claims for reimbursement.
[Washington Post 2001-01-07]
. . . In the first wave of a technology innovation that many doctors predict will save lives and money, thousands of physicians are getting professional assistance from hand-held computers popularized by Palm and other makers.
[New York Times 2001-01-08]
Diabetes linked to mental decline
People with diabetes and high blood pressure risk not only dying early, but tend to start losing mental abilities in middle age, researchers said Monday.
Weiss Reports Insurance Company Failures Up 30% In 2000; HMO Failures Down 22%
In the face of a slowing economy and stiff competition, 35 insurance companies failed in 2000, a 30% increase over the 27 failures recorded in 1999, according to Weiss Ratings, Inc., the only independent provider of ratings and analyses on the insurance industry.
[BW Healthwire 2001-01-08]
Physicians fight to keep names off premature HMO provider lists
Doctors say they lose leverage when plans put their names on provider lists before negotiations are done.
[American Medical News 2001-01-15]
HMO Sale Would Fund Foundation
A proposed sale of the HMO ConnectiCare announced Monday will provide more than $130 million to its current owner, the Connecticut Health Foundation, making it the largest health care foundation in the state.
[Hartford Courant 2001-01-09]
Monday, January 08, 2001
FROM MANAGED CARE MAGAZINE
Prescription Drug Reimportation: Panacea or Problem?
Health plans concerned about the cost of pharmacy benefits might want to look at potential effects of prescription drug reimportation — formulary issues and legal questions, to name two — even if full implementation is a while off.
(This article was prepared before HHS Secretary Donna Shalala’s December 26 decision to suspend implementation of the reimportation law.)
Medicare to Increase Payments to HMOs in 2001
The federal government Thursday issued new payment increases for health maintenance organizations (HMOs) participating in the Medicare program, and hoped the move would entice some health plans that left the program January 1 to sign up again.
[Reuters via Yahoo 2001-01-05]
Best Medicare Hmos Selected by Research Firm
The Medicare HMOs that offer older Americans the best value for the money were announced on Friday by HealthMetrix Research Inc., an independent managed care research firm.
[Reuters via Yahoo 2001-01-05]
Report Studies Disparities in State Medicaid Spending
How much money a state plows into its Medicaid program depends not only on its wealth but its desire to release the purse strings, a new analysis shows.
[Reuters Health 2001-01-05]
When the Hospital Staff Isn’t Enough
. . . Even in the best hospitals, patients and their families are turning to private nursing help to supplement care from staffs that are often short-handed and over-worked. As hospital nurses focus their efforts on patients in crisis, private “sitters” are there to tend to the more personal needs of patients, and provide some of the TLC services of yesteryear.
[Washington Post 2001-01-06]
Cancer Cases to Increase Slightly, Experts Say
The number of new cancer cases and deaths in the US will likely increase slightly this year, researchers predicted Thursday.
[Reuters Health 2001-01-05]
Money & Medicine: Learning to Manage Managed Care
When is a disease rare enough to require a medical specialist outside an insurance network? The answer is less obvious than one might believe.
[New York Times 2001-01-07]
Blood Sugar Can Gauge Risk of Death From Heart Disease
Measuring levels of sugar in the blood can help doctors predict if a patient is at risk of developing heart disease, study findings show.
[Reuters Health 2001-01-05]
Cardiovascular medicines: A missed opportunity
. . . People who need cardiovascular medicines are not getting them. Only 20-30 percent of Americans who could benefit from the drugs are taking them, according to Dr. Lynn Smaha, a Towanda, Bradford County, cardiologist and immediate past-president of the American Heart Association.
[Allentown (Pa.) Morning Call 2001-01-07]
Sutter Health Leaves Blue Cross Network
In a powerful sign that tensions between Blue Cross of California and the state’s doctors and hospitals remain unabated, the huge Sutter Health hospital and medical group chain in Northern California has dropped out of the health plan’s network.
[LA Times 2001-01-04]
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Paul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweisen, liefert er unseren Lesern nicht nur Mehrwert, sondern auch Hilfestellung bei ihren Problemen.