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Archive for Managed care

A federal study shows that government healthcare spending is expected to increase to $1.191 trillion this year as the recession suppresses private healthcare spending, the Wall Street Journal reports.
The country’s healthcare costs are projected to reach $2.510 trillion overall, a 5.5% increase from 2008, according to the study by economists and actuaries at CMS published this week in Health Affairs.
To read the full story, click here.
Categories : Managed care
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A recent study aimed at keeping elderly patients with chronic conditions out of the hospital failed, according to a study published in The Journal of the American Medical Association. CMS hoped that with increased care coordination, elderly patients could receive a clearer care message and be able to care for themselves better, thus reducing the number of hospitalizations required for these patients. In the 15 research programs, conducted from 2002 to 2005, nurses contacted patients regularly in hopes of increasing adherence to care plans and facilitating communication with physicians. The outcomes were measured by the number of hospitalizations and Medicare monthly expenditures. However, 13 out of 15 programs showed no differences in hospitalizations and did not save Medicare a significant amount of money. Experts say the program failed because changing seniors’ habits is very difficult. The study highlights challenges the healthcare industry faces as the aging population increases. Sources: The Journal of the American Medical Association, The Washington Times
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Patients with cancer undergo many expensive treatments and tests and often find themselves bankrupt even if they have insurance, according to a new report.

The report, released by the Kaiser Family Foundation and the American Cancer Society followed 20 typical cancer patients. Of those patients, nine had insurance through an employer, one paid for employer coverage through COBRA, seven had individual insurance, two received coverage through a state high-risk insurance pool, and one became uninsured.

The study found that many of the patients became too sick to work, but were able to remain covered by their employer’s insurance up to 18 months by paying the full premium, although they found the added expense hard to bear. Other patients experienced delays in treatment caused by funding problems, debt, and stress about costs.

Sources: San Francisco Chronicle, Kaiser Family Foundation

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A recent report by the Center for Studying Health System Change, a nonpartisan policy research organization, states that one in seven Americans under age 65 went without a prescription drug in 2007 because they could not afford it. The study shows the effect increased drug prices were having even before the economic recession went into full swing: in 2003, only one in 10 Americans said they couldn’t afford their prescriptions.

According to the study, people who were most likely to be unable to afford their prescriptions were uninsured and suffering from a chronic condition. Without their medications, their conditions were likely to worsen, causing them to seek expensive medical treatment.

However, in the recent survey, insured Americans were not immune to prescription pricing troubles. One in 10 Americans insured by their employer reported going without a prescription because of cost, also up from the last study in 2003.

Source: The New York Times

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Massachusetts Gov. Deval Patrick has asked the state’s most prominent hospital and health insurance leaders to take quick action to hold down rapidly rising healthcare costs, suggesting that if they did not take steps on their own, they might face new government regulation, according to the Boston Globe.

Patrick said he is considering holding hearings on health insurance premiums and the primary driver of premium increases—the rates hospitals charge insurers for members’ medical care. He has also said the state Division of Insurance has the power to reject rates it deems excessive.

Read the full story in the Boston Globe.

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Health insurance companies for Medicare received $1.3 billion more than projected in 2006, congressional auditors told the Associated Press.

The Government Accountability Office said in a report that if projections had been more accurate, much of that $1.3 billion could have gone to better benefits and lower premiums.

Read the Associated Press report.

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Use the following guidelines when documenting screening treatment, to ensure you are compliant with Emergency Medical Treatment and Active Labor Act (EMTALA):
  • For potential emergency conditions, include all medically indicated screenings, tests, mental status evaluations, impressions, and diagnoses (supported by a history and physician examination, laboratory, or other test results).
  • For pregnant women, the medical records should show the screening examination included ongoing evaluation of fetal heart tones, regularity and duration of uterine contractions, fetal position and station, cervical dilation, and status of the membranes, (e.g., ruptured, leaking, intact).
  • For individuals with psychiatric symptoms, the medical records should indicate an assessment of suicide or homicide attempts, or risk; disorientation; or assaultive behavior that indicates danger to self or others.

This tip was adapted from A Practical Guide to EMTALA Compliance. For more information about the book or to order your copy click here

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The governor of Illinois, Rod Blagojevich, announced Wednesday he will revise a bill to allow parents to have their children on their health plan until age 26, the Chicago Tribune reports.
Blagojevich says he’s identified more than 50 bills he can revise as part of his “Rewrite to Do Right” campaign, through which he aims to get healthcare coverage for the more than 300,000 uninsured residents between the ages of 19 and 25.
The governor announced that the revision also would allow parents to keep their children on their health plan until age 30 if those children are veterans.

To read the full story in the Chicago Tribune, click here.

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