MedWorm: Medicaid

Government health spending seen hitting $1.8 trillion

Reuters: Health — Tue, 07 Feb 2012 13:32:25 +0100

WASHINGTON (Reuters) - Government spending for Medicare, Medicaid and other healthcare programs will more than double over the next decade to $1.8 trillion, or 7.3 percent of the country's total economic output, congressional researchers said on Tuesday. (Source: Reuters: Health)

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National Quality Forum endorses 2 American College of Surgeons NSQIP measures

EurekAlert! - Social and Behavioral Science — Tue, 07 Feb 2012 05:00:00 +0100

(Weber Shandwick Worldwide) Two outcomes-based measures from the American College of Surgeons National Surgical Quality Improvement Program were recently endorsed by the National Quality Forum. The two measures, surgical site infection and urinary tract infection, were developed by ACS in partnership with the Centers for Medicare and Medicaid Services, as possible national outcomes measures that could be adopted by the governmental body as early as 2015. (Source: EurekAlert! - Social and Behavioral Science)

Comparative Effectiveness of Oxaliplatin vs Non-Oxaliplatin-containing Adjuvant Chemotherapy for Stage III Colon Cancer

JNCI — Tue, 07 Feb 2012 05:00:00 +0100

Conclusion The addition of oxaliplatin to 5-FU appears to be associated with better survival among patients receiving adjuvant colon cancer treatment in the community. (Source: JNCI)

'Heart Team' Key for Medicare TAVI Coverage

MedPage Today Public Health — Mon, 06 Feb 2012 18:37:10 +0100

(MedPage Today) -- Highly skilled "heart teams" from high-volume centers are part of the requirements for Medicare reimbursement for transcatheter aortic valve implantation (TAVI) proposed by the Centers for Medicare & Medicaid Services. (Source: MedPage Today Public Health)

Mental Health Weekly — Mon, 06 Feb 2012 05:00:00 +0100

AbstractColorado Promoting Efficient BH Care Delivery Through Telehealth ProgramTechnology, Work of Change Teams Enhance Access at Kentucky CenterEmployment Program Positive for Veterans With PTSDHouse Votes to Repeal Long‐Term Care Insurance ProgramGroups Prepare to File Brief to Support ACA Medicaid ExpansionBriefly NotedState NewsBusinessComing up (Source: Mental Health Weekly)

Kansas Medicaid reform plan wins points with state's medical society

American Medical News - GOVERNMENT — Fri, 03 Feb 2012 13:07:47 +0100

The proposal won't cut physician pay but will set quality goals and establish medical homes. (Source: American Medical News - GOVERNMENT)

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Corporate Whistle Blower Center Urges ER Physicians Or Hospital...

PRWeb: Medical Pharmaceuticals — Fri, 03 Feb 2012 06:24:02 +0100

The Corporate Whistle Blower Center is urging Emergency Room Physicians, nursing managers, or hospital accounting, or coding staff to turn in their hospital for Medicare, or Medicaid fraud, if the...(PRWeb February 01, 2012)Read the full story at http://www.prweb.com/releases/2012/2/prweb9156050.htm (Source: PRWeb: Medical Pharmaceuticals)

Variation in State Unintended Pregnancy Rates In the United States

Perspectives on Sexual and Reproductive Health — Fri, 03 Feb 2012 05:00:00 +0100

CONCLUSIONS: State programs and policies should pay particular attention to increasing support for family planning services for minority groups. Findings also suggest that insurance coverage and receipt of Medicaid among women of reproductive age deserve further exploration as potentially important mechanisms for reducing state unintended pregnancy rates. (Source: Perspectives on Sexual and Reproductive Health)

CMS Releases Details Of Proposed National Coverage For TAVR

Forbes.com Healthcare News — Fri, 03 Feb 2012 02:46:39 +0100

On Thursday the Centers for Medicare & Medicaid Services (CMS) released a memo containing details of its proposed Medicare coverage for TAVR (transcatheter aortic valve replacement). The memo is a response to a formal request for national coverage determination (NCD) from the Society of Thoracic Surgeons (STS) and the American College of Cardiology (ACC). The memo will be open for public comment until March 3, after which a final determination will be made. (Source: Forbes.com Healthcare News)

New cost-cutting Medicaid rule could save US billions

Pharmaceutical Technology — Fri, 03 Feb 2012 00:00:00 +0100

A newly proposed cost-cutting rule implemented into the US Medicaid programme could save the country up to $17.7bn over five years, say US health officials. (Source: Pharmaceutical Technology)

Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA): Applicability to Hospital Inpatients and Hospitals With Specialized Capabilities

Federal Register updates via the Rural Assistance Center — Thu, 02 Feb 2012 15:22:44 +0100

This request for comments from the Centers for Medicare & Medicaid Services addresses the applicability of the Emergency Medical Treatment and Labor Act (EMTALA) to hospital inpatients. (Source: Federal Register updates via the Rural Assistance Center)

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Pharmacists say marketing of Medicare drug plans is misleading

American Medical News — Thu, 02 Feb 2012 12:59:50 +0100

A community pharmacy association has asked the Centers for Medicare & Medicaid Services to allow disgruntled patients to switch Part D plans midyear. (Source: American Medical News)

Medicaid Program; Covered Outpatient Drugs

Federal Register updates via the Rural Assistance Center — Thu, 02 Feb 2012 06:00:00 +0100

This proposed rule from the Centers for Medicare & Medicaid Services would revise requirements pertaining to Medicaid reimbursement for covered outpatient drugs to implement provisions of the Patient Protection and Affordable Care Act of 2010. This proposed rule would also revise other requirements related to covered outpatient drugs, including key aspects of Medicaid coverage, payment, and the drug rebate program. (Source: Federal Register updates via the Rural Assistance Center)

AMCP objects to proposed reporting requirements for Part D

Drug Topics - Top News — Thu, 02 Feb 2012 05:00:00 +0100

The Academy of Managed Care Pharmacy is not pleased with changes to the Medicare Part D reporting requirements proposed by the Centers for Medicare and Medicaid Services. (Source: Drug Topics - Top News)

CMS's Final Regulations on Accountable Care Organizations

The Heritage Foundation Papers: Health Care — Wed, 01 Feb 2012 21:59:00 +0100

The Centers for Medicare and Medicaid Services (CMS) has issued final regulations for Accountable Care Organizations (ACOs). The outcome is disappointing (Source: The Heritage Foundation Papers: Health Care)

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Saving Medicaid: A Path to Comprehensive Medicaid Reform

The Heritage Foundation Papers: Health Care — Wed, 01 Feb 2012 21:47:00 +0100

The joint federal–state health program for the poor is fueling the federal entitlement crisis, bankrupting state budgets, and delivering substandard care to enrollees while crowding out private health insurance options for many (Source: The Heritage Foundation Papers: Health Care)

Safety Net EDs Meet Goals for Length of Stay (CME/CE)

MedPage Today Public Health — Wed, 01 Feb 2012 14:21:10 +0100

(MedPage Today) -- Emergency department visits as hospitals that care for large numbers of Medicaid and uninsured patients are about the same length as those at hospitals serving more economically stable populations, researchers found. (Source: MedPage Today Public Health)

National Study Shows Majority Of Self-Harming Adolescents Don't Receive A Mental Health Assessment During Emergency Room Visit

Health News from Medical News Today — Wed, 01 Feb 2012 09:00:00 +0100

A national study of Medicaid data shows most young people who present to emergency departments with deliberate self-harm are discharged to the community, without receiving an emergency mental health assessment. Even more, a roughly comparable proportion of these patients receive no outpatient mental health care in the following month. These are the findings from a study conducted by researchers at Nationwide Children's Hospital that appears in the Journal of the American Academy of Child & Adolescent Psychiatry... (Source: Health News from Medical News Today)

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates; Corrections

Federal Register updates via the Rural Assistance Center — Wed, 01 Feb 2012 06:00:00 +0100

This document from the Centers for Medicare & Medicaid Services corrects technical errors that occurred in the Addendum of the final rule entitled Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates which appeared in the August 18, 2011 Federal Register. (Source: Federal Register updates via the Rural Assistance Center)

A Comparison of Two Approaches to Increasing Access to Care: Expanding Coverage versus Increasing Physician Fees

Health Services Research — Wed, 01 Feb 2012 05:00:00 +0100

ConclusionsThe findings suggest that (1) coverage expansions, even if they substantially reduce patient cost sharing, do not necessarily increase physician utilization, and (2) increasing the generosity of provider payments in public programs can improve access among low‐SES children, and, through spillover effects, increase higher‐SES children as well. (Source: Health Services Research)

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Patient and hospital characteristics associated with traditional measures of inpatient quality of care for patients with heart failure

American Heart Journal — Wed, 01 Feb 2012 05:00:00 +0100

Background: The purpose of this study was to determine patient and hospital characteristics associated with 4 measures of quality of inpatient heart failure care used by both the primary payer of heart failure care in the United States (Center for Medicare and Medicaid Services) and the main hospital accrediting organization (The Joint Commission).Methods: We used data from Get With The Guidelines Program for patients hospitalized with heart failure. Eligibility for receiving care based on the Center for Medicare and Medicaid Services performance measures was determined for assessment of left ventricular ejection fraction (LVEF; n = 60,601), use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) if LVEF (Source: American Heart Journal)

Paper Clips For Root Canals Lands Dentist In Jail

Health News from Medical News Today — Tue, 31 Jan 2012 22:00:00 +0100

When dentists do a root canal they are supposed to use steel posts, and definitely not paper clips. A dentist from Massachusetts has just received a 1-year prison sentence at the Bristol County House of Correction, for using paper clips for just such procedures - he had faced charges of assault and battery, as well as defrauding Medicaid to the tune of $130,000, and intimidating a witness. Dr. Michael Clair, according to prosecutors, in an effort to reduce costs, would use parts of paper clips for root canals. A number of patients developed a range of problems, including infections... (Source: Health News from Medical News Today)

Wide Use of Doc ID Numbers Makes Fraud Easy

MedPage Today Public Health — Tue, 31 Jan 2012 21:23:30 +0100

(MedPage Today) -- Widespread distribution of physician identifiers makes it easy to fraudulently bill insurers in the doctor's name, two MDs who work at the Centers for Medicare and Medicaid Services charged. (Source: MedPage Today Public Health)

Government health spending seen hitting $1.8 trillion

Reuters: Health — Tue, 31 Jan 2012 20:56:22 +0100

WASHINGTON (Reuters) - Gvernment spending for Medicare, Medicaid and other healthcare programs will more than double over the next decade to $1.8 trillion, or 7.3 percent of the country's total economic output, congressional researchers said on Tuesday. (Source: Reuters: Health)

Transportation Service for Medicaid Enrollees Surpasses 857,000 Rides in First Six Months

Wisconsin DHFS Press Releases — Tue, 31 Jan 2012 20:30:00 +0100

The state's non-emergency medical transportation manager, LogistiCare, has received more than 380,000 calls from Medicaid enrollees and coordinated more than 857,000 trips to physician and dental visits, mental health outpatient therapy appointments, physical, occupational or speech therapy, and hospital stays, according to Department of Health Services (DHS) officials. (Source: Wisconsin DHFS Press Releases)

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Judge Blocks 10% Medicaid Cut for Physicians in CaliforniaJudge Blocks 10% Medicaid Cut for Physicians in California

Medscape Today Headlines — Tue, 31 Jan 2012 19:32:15 +0100

In her preliminary injunction, US District Judge Christina Snyder said the rate reduction could cause too many providers to close their doors to Medicaid recipients. Medscape Medical News (Source: Medscape Today Headlines)

How to fix Medicare, Redux

Forbes.com Healthcare News — Tue, 31 Jan 2012 15:39:24 +0100

The Republican Presidential primary’s shift down south to Florida has brought discussions of healthcare, particularly Medicare, back to the forefront of the national discourse. With its struggling economy and sizeable elderly population, social welfare programs like Medicare, Medicaid and Social Security are top of mind to Florida voters. (Source: Forbes.com Healthcare News)

Bill Seeks Surcharge for Utah Smokers on Medicaid

RWJF News Digest - Public Health — Tue, 31 Jan 2012 05:00:00 +0100

If private health insurers can add a surcharge for smokers, why not Medicaid? That's the argument behind a bill Utah Republican Rep. Paul Ray has proposed that could become a first-in-the-nation state law imposing a higher co-payment for tobacco-using residents enrolled in Medicaid. (Source: RWJF News Digest - Public Health)

The impact of insurance status on outcomes after surgery for spinal metastases

Cancer — Tue, 31 Jan 2012 05:00:00 +0100

CONCLUSIONS:This nationwide study suggests that disparities based on insurance status for patients undergoing surgery for spinal metastases may be attributable to a higher acuity of presentation. Cancer 2012. © 2012 American Cancer Society (Source: Cancer)

Comparison of adverse events during 5‐fluorouracil versus 5‐fluorouracil/oxaliplatin adjuvant chemotherapy for stage III colon cancer

Cancer — Tue, 31 Jan 2012 05:00:00 +0100

CONCLUSIONS:The incremental harms of adjuvant chemotherapy with 5FU/oxaliplatin versus 5FU alone were modest in patients with stage III colon cancer who were insured by Medicare and Medicaid. The additional harms in patients aged ≥75 years largely were restricted to outpatient events and did not extend to an increased rate of hospitalization or early death. Cancer 2012. © 2012 American Cancer Society (Source: Cancer)

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Retail groups object to proposed federal limits on generic reimbursement

Drug Topics - Top News — Tue, 31 Jan 2012 05:00:00 +0100

Two key retail pharmacy groups, the National Association of Chain Drug Stores and the National Community Pharmacists Association, have renewed their opposition to proposed federal upper limits for generic drug reimbursement under Medicaid. (Source: Drug Topics - Top News)

Association of Emergency Department Length of Stay With Safety-Net Status [Original Contribution]

JAMA — Tue, 31 Jan 2012 05:00:00 +0100

Conclusion Compliance with proposed ED length-of-stay measures for admissions, discharges, transfers, and observations did not differ significantly between safety-net and non–safety-net hospitals. (Source: JAMA)

Retail groups object to proposed federal limits on generic reimbursement

Modern Medicine — Tue, 31 Jan 2012 05:00:00 +0100

Effectiveness of a High End Users Program for Persons with Psychiatric Disorders.

Community Mental Health Journal — Tue, 31 Jan 2012 05:00:00 +0100

Authors: Rothbard AB, Chhatre S, Zubritsky C, Fortuna K, Dettwyler S, Henry RJ, Smith M Abstract To evaluate the effectiveness of an intensive system of case management for high end users of inpatient care in reducing psychiatric inpatient utilization. A pre-post study design with a contemporaneous comparison group was employed to determine the effects of a State designed intervention to reduce inpatient care for adults with a mental health disorder who had high utilization of inpatient psychiatric care between 2004 and 2007. Logit and negative binomial regression models were used to determine the likelihood, frequency and total days of inpatient utilization in the post period as a function of the intervention. Data from administrative reporting forms and Medicaid claims were used ...

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Bill seeks surcharge for Utah smokers on Medicaid

USATODAY.com Health — Tue, 31 Jan 2012 01:04:18 +0100

A Utah representative says smokers on Medicaid cost the state $104 million annually. (Source: USATODAY.com Health)

Dentist ordered to jail for fraud over paper clip root

Reuters: Health — Mon, 30 Jan 2012 22:23:22 +0100

BOSTON (Reuters) - A former Boston-area dentist accused of substituting paper clips for stainless steel posts in patient root canals was sentenced to two and a half years in jail for Medicaid fraud, authorities said on Monday. (Source: Reuters: Health)

How Safe Are Our Hospitals?

RWJF News Digest - Quality/Equality — Mon, 30 Jan 2012 18:29:42 +0100

Centers for Medicare and Medicaid Services’ website, Hospital Compare, began reporting patient safety ratings for thousands of the nation’s hospitals, including those in the Washington area, in October 2011. (Source: RWJF News Digest - Quality/Equality)

How Often Do Catastrophic Injury Victims Become Medicaid Recipients? - Zaloshnja E, Miller TR, Coben J, Steiner C.

SafetyLit: All (Unduplicated) — Mon, 30 Jan 2012 15:32:08 +0100

BACKGROUND:: People without adequate insurance may separate financially from their families and move onto Medicaid after a catastrophic injury. Medicaid then covers all of their medical care costs. No estimates for Medicaid conversions due to injury exist ... (Source: SafetyLit: All (Unduplicated))

Frequently Asked Questions Section 6411(a) of the Affordable Care Act

Rural web sites and other tools via the Rural Assistance Center — Mon, 30 Jan 2012 14:43:55 +0100

Collection of common questions covering general information on the Medicaid RAC (Recovery Audit Contractor) and operational guidance to States. -- Centers for Medicare and Medicaid Services (Source: Rural web sites and other tools via the Rural Assistance Center)

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State Medicaid RACs At-A-Glance

Rural web sites and other tools via the Rural Assistance Center — Mon, 30 Jan 2012 14:39:03 +0100

Map summarizes the status of each state and territory RAC program, based on the information submitted in its Medicaid State Plan Amendment (SPA.) During the implementation phase of these RAC programs, this website will be updated on an ongoing basis. -- Centers for Medicare and Medicaid Services (Source: Rural web sites and other tools via the Rural Assistance Center)

States ask Supreme Court to stop Medicaid expansion

American Medical News - GOVERNMENT — Mon, 30 Jan 2012 12:00:00 +0100

The national health system reform law will require states to broaden coverage to people who earn up to 133% of the federal poverty level. (Source: American Medical News - GOVERNMENT)

Affordable Care Act Will Save States and Taxpayers $17.7 Billion on Prescription Drugs

News stories via the Rural Assistance Center — Mon, 30 Jan 2012 06:00:00 +0100

Provisions in the health care reform law, the Affordable Care Act, will save taxpayers and States an estimated $17.7 billion over five years on prescription drugs bought through Medicaid, according to estimates in a proposed rule issued today by the Centers for Medicare & Medicaid Services (CMS). (Source: News stories via the Rural Assistance Center)

Majority of self-harming adolescents don't receive a mental health assessment in ERs

EurekAlert! - Social and Behavioral Science — Mon, 30 Jan 2012 05:00:00 +0100

(Nationwide Children's Hospital) A national study of Medicaid data shows most young people who present to emergency departments with deliberate self-harm are discharged to the community, without receiving an emergency mental health assessment. Even more, a roughly comparable proportion of these patients receive no outpatient mental health care in the following month. These are the findings from a study conducted by researchers at Nationwide Children's Hospital that appears in the Journal of the American Academy of Child & Adolescent Psychiatry. (Source: EurekAlert! - Social and Behavioral Science)

Quality of Life in Late‐Life Disability: “I Don't Feel Bitter Because I Am in a Wheelchair”

Journal of the American Geriatrics Society — Mon, 30 Jan 2012 05:00:00 +0100

ConclusionFactors that influence quality of life in late‐life disability were similar across ethnic groups. As the number of elderly adults from diverse backgrounds with late life disability increases in the United States, interventions should be targeted to maximize daily sense of control and dignity. (Source: Journal of the American Geriatrics Society)

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More Data Needed on Carotid AtherosclerosisMore Data Needed on Carotid Atherosclerosis

Medscape Today Headlines — Fri, 27 Jan 2012 22:31:15 +0100

The Centers for Medicare and Medicaid Services' Medicare Evidence Development and Coverage Advisory Committee met to once again discuss the latest available evidence on different treatments of carotid atherosclerosis, and the only clear message was these questions remain a moving target. Heartwire (Source: Medscape Today Headlines)

Could the PPACA's Medicaid Expansion be Unconstitutional?

Forbes.com Healthcare News — Fri, 27 Jan 2012 20:54:03 +0100

While most of the public debate on the constitutionality of the health reform law has centered on the “individual mandate” – the requirement to obtain government-approved health insurance or pay a penalty – the Supreme Court has also agreed to consider another, far less discussed issue: whether the law's expansion of Medicaid eligibility might be an unconstitutional federal infringement on state legislative authority. (Source: Forbes.com Healthcare News)

CMS' Tavenner spotlights innovation

Healthcare IT News — Fri, 27 Jan 2012 16:17:06 +0100

Marilyn Tavenner, acting administrator for the Centers for Medicare & Medicaid Services, expressed urgency in pressing forward with the “triple aim” goals of better individual healthcare, better population health and lower costs called for in the health reform law. Speaking Jan. 26 at the Care Innovations Summit in Washington, DC, Tavenner highlighted the work of the CMS Innovation Center. read more (Source: Healthcare IT News)

Medicaid cost control has lead to less use of antipsychotics

PharmacoEconomics and Outcomes News — Fri, 27 Jan 2012 15:13:30 +0100

(Source: PharmacoEconomics and Outcomes News)

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States maintain or ease access to Medicaid and CHIP

American Medical News - GOVERNMENT — Fri, 27 Jan 2012 13:08:21 +0100

Twenty-nine states lowered cost-sharing, increased eligibility or improved enrollment systems in 2011, according to a survey. (Source: American Medical News - GOVERNMENT)

Lower Extremity Vascular Injuries: Increased Mortality for Minorities and the Uninsured?

Journal of Vascular Surgery — Fri, 27 Jan 2012 11:25:15 +0100

There are mortality disparities associated with race and insurance status in patients with penetrating lower extremity vascular injury. Outcome disparities for Medicaid patients, people of color and the uninsured may be partially attributable to differences in baseline healthcare characteristics and/or hospital performance (Osborne NH et al. J Vasc Surg 2009;50:709-13). The author's considered that in trauma patients heterogeneity of injury, difficulties in injury measurement and a lack of standardized care may contribute to potential disparities in trauma outcomes, including vascular injury. Their hypothesis was that mortality rate disparities by socioeconomic status and race could be explained by injury heterogeneity. They therefore limited analysis of vascular injury to a group with ho...

Corporate Whistle Blower Center Urges Healthcare Medical Device &...

PRWeb: Medical Pharmaceuticals — Fri, 27 Jan 2012 06:33:34 +0100

In 2010 the US GAO estimated that Medicare fraud alone was at least $60 billion dollars in the United States. This number does not reflect an estimate of what Medicaid fraud could be. The Corporate...(PRWeb January 25, 2012)Read the full story at http://www.prweb.com/releases/2012/1/prweb9136322.htm (Source: PRWeb: Medical Pharmaceuticals)

Elder Self‐Neglect and Hospitalization: Findings from the Chicago Health and Aging Project

Journal of the American Geriatrics Society — Fri, 27 Jan 2012 05:00:00 +0100

ConclusionReported elder self‐neglect was associated with higher rates of hospitalization in this community population. Greater severity of self‐neglect was associated with a greater rate of hospitalization. (Source: Journal of the American Geriatrics Society)

Perspective: The Medicaid Adult Quality Measures Program

MD Consult: News: Top Stories — Fri, 27 Jan 2012 00:00:00 +0100

Read the full story on MD Consult: Perspective: The Medicaid Adult Quality Measures Program (Source: MD Consult: News: Top Stories)

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Medicaid Medical Homes in North Carolina Save $894 Million Medicaid Medical Homes in North Carolina Save $894 Million

Medscape Today Headlines — Thu, 26 Jan 2012 21:38:53 +0100

Something as simple as same-day appointments keeps patients healthier and out of the hospital, a medical home physician says. Medscape Medical News (Source: Medscape Today Headlines)

Cardiologists Seek Ways to Improve Medicare Policy (with video)

MedPage Today Geriatrics — Thu, 26 Jan 2012 15:00:00 +0100

(MedPage Today) -- The Centers for Medicare & Medicaid Services is revising its guidance on the use of a policy called "coverage with evidence development," and the American College of Cardiology has some ideas about how to improve the policy. (Source: MedPage Today Geriatrics)

Grassley Probes High-Volume Medicaid Prescribers

MedPage Today Geriatrics — Thu, 26 Jan 2012 14:00:00 +0100

(MedPage Today) -- Sen. Charles Grassley (R-Iowa) has demanded that state Medicaid officials explain what they're doing about physicians who hand out huge numbers of painkiller and psychiatric drug prescriptions paid for by Medicaid. (Source: MedPage Today Geriatrics)

Texans Tops in Meaningful Use

Blogged_Arteries — Thu, 26 Jan 2012 06:00:00 +0100

More Texas physicians are meeting federal meaningful use criteria in adopting electronic health records (EHRs) than in any other state, according to an analysis of Centers for Medicare & Medicaid Services data by the Institute for Health Technology Transformation. (Source: Blogged_Arteries)

Quasi-experimental trial of diabetes Self-Management Automated and Real-Time Telephonic Support (SMARTSteps) in a Medicaid managed care plan: study protocol

BMC Health Services Research — Thu, 26 Jan 2012 05:00:00 +0100

DiscussionOutcomes will provide evidence regarding real-world implementation of ATSM within a Medicaid managed care plan serving safety net settings. The evaluation trial will provide insight into translating and scaling up health information technology interventions for linguistically and culturally diverse vulnerable populations with chronic disease.Trial Registration: National Clinical Trials Registry ClinicalTrials.gov NCT00683020 (Source: BMC Health Services Research)

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Center for Medicare and Medicaid Innovation Aims to Cut Health-Care Costs

RWJF News Digest - Quality/Equality — Thu, 26 Jan 2012 05:00:00 +0100

The Obama administration touts it as a key solution to the nation’s runaway health-care spending: a new national center set up by the 2010 health-care law to test and implement groundbreaking ways to cut costs while improving patient care. (Source: RWJF News Digest - Quality/Equality)

Medicare, Medicaid, tort reform in play in Florida primary

MD Consult: News: Top Stories — Thu, 26 Jan 2012 00:00:00 +0100

Read the full story on MD Consult: Medicare, Medicaid, tort reform in play in Florida primary (Source: MD Consult: News: Top Stories)

Dentist used paper clips in root canals as part of fraudulent Medicaid scam

NaturalNews.com — Wed, 25 Jan 2012 06:00:00 +0100

A former Fall River, Massachusetts, dentist has pleaded guilty to bilking the Medicaid system out of $130,000, illegally prescribing prescription drugs, intimidating a witness, and committing assault and battery. CBS Connecticut reports that Michael Clair had been running... (Source: NaturalNews.com)

Physician fee schedule rate change delayed

Modern Medicine — Wed, 25 Jan 2012 05:00:00 +0100

The Centers for Medicare and Medicaid Services (CMS) released the final rule for its physician fee schedule November 1 and stated that providers would see an across-the-board reduction of 27.4% for services in 2012, but much is still unclear about this change. (Source: Modern Medicine)

Veracyte thyroid test gets boost with Genzyme deal

bizjournals.com Health Care:Biotechnology headlines — Tue, 24 Jan 2012 20:39:28 +0100

When biotech drug developer Genzyme Corp. said Friday that it will market a thyroid nodule analysis test, South San Francisco-based Veracyte Inc. got a big boost. Although terms of the deal were not disclosed, Genzyme’s promotion means the Afirma test from Veracyte will get higher visibility. Genzyme, which was bought last year by French drug developer Sanofi, markets Thyrogen for patients with well-differentiated thyroid cancer. The deal follows news earlier this month that Medicaid benefits contractor Palmetto GBA will pay for Afirma’s use... (Source: bizjournals.com Health Care:Biotechnology headlines)

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Medicare Panel to Consider Carotid Therapy Evidence

MedPage Today State Required CME — Tue, 24 Jan 2012 18:43:12 +0100

WASHINGTON (MedPage Today) -- The Centers for Medicare and Medicaid Services (CMS) is seeking information on which carotid atherosclerosis treatments work best to prevent stroke and death in Medicare patients. (Source: MedPage Today State Required CME)

Dentist pleaded guilty, paper clip used in root canals

USATODAY.com Health — Tue, 24 Jan 2012 14:58:59 +0100

Former dentist in Massachusetts has pleaded guilty to Medicaid fraud for using paper clips instead of stainless steel posts in root canals. (Source: USATODAY.com Health)

Hawaii Medicaid program awards contract to five vendors

bizjournals.com Health Care:Pharmaceuticals headlines — Tue, 24 Jan 2012 06:08:34 +0100

Hawaii’s Medicaid program has awarded contracts to five health-care organizations to administer the programs for low-income residents. The contracts awarded by the Department of Human Services’ Med-Quest Division went to AlohaCare, HMSA Quest, Kaiser Foundation Health Plan, Ohana Health Plan and UnitedHealthcare Community Plan, the department said in a news release. The state had delayed the annual $540 million contract to Hawaii’s managed-care provider plans while it awaited federal approval for amendments to a request for proposal it had issued in August... (Source: bizjournals.com Health Care:Pharmaceuticals headlines)

South Carolina employs IT to boost Medicaid for kids

Healthcare IT News — Mon, 23 Jan 2012 14:14:24 +0100

South Carolina has received kudos for improving improving how it expands and retains eligible children in Medicaid by using information from other safety-net programs, such as food stamps. The technology is employs to share data have also led to greater efficiency and reduced state administrative costs. read more (Source: Healthcare IT News)

Medicaid medical homes saved $1 billion in North Carolina

American Medical News - GOVERNMENT — Mon, 23 Jan 2012 11:45:21 +0100

However, sicker enrollees and those eligible for both Medicare and Medicaid have posed more challenges for the program. (Source: American Medical News - GOVERNMENT)

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Summarizing activity limitations in children with chronic illnesses living in the community: a measurement study of scales using supplemented interRAI items

BMC Health Services Research — Mon, 23 Jan 2012 05:00:00 +0100

Conclusions: Unpaid caregivers, usually parents, can provide assessors lacking either medical or nursing training with reliable and valid information on the activity limitations of children. One can summarize these data in scales that are both internally consistent and valid. Researchers and clinicians can use supplemented interRAI items to provide guidance for professionals and programs serving children, as well as older persons. This research emphasizes the importance of developing medical information systems that allow one to integrate information not only across care settings but also across an individual's life course. (Source: BMC Health Services Research)

Why the United States Center for Medicare and Medicaid Services should not extend reimbursement indications for carotid artery angioplasty/stenting.

Vascular — Mon, 23 Jan 2012 05:00:00 +0100

Authors: Abbott AL, Adelman MA, Alexandrov AV, Barnett HJ, Beard J, Bell P, Björck M, Blacker D, Buckley CJ, Cambria RP, Comerota AJ, Connolly ES, Davies AH, Eckstein HH, Faruqi R, Fraedrich G, Gloviczki P, Hankey GJ, Harbaugh RE, Heldenberg E, Kittner SJ, Kleinig TJ, Mikhailidis DP, Moore WS, Naylor R, Nicolaides A, Paraskevas KI, Pelz DM, Prichard JW, Purdie G, Ricco JB, Riles T, Rothwell P, Sandercock P, Sillesen H, Spence JD, Spinelli F, Tan A, Thapar A, Veith FJ, Zhou W PMID: 22271806 [PubMed - as supplied by publisher] (Source: Vascular)

Opinionator: What We Give Up for Health Care

NYT Health — Sat, 21 Jan 2012 22:41:04 +0100

If liberals care about middle-class salaries, public education and other state-funded services, they need to care about controlling health care costs as much as conservatives do. (Source: NYT Health)

Is U.S. Health Spending Finally Under Control?

RWJF News Digest - Quality/Equality — Sat, 21 Jan 2012 14:54:20 +0100

“Growth in U.S. health spending remains slow in 2010” was the headline of a news release on Jan. 9 by the Centers for Medicare and Medicaid Services, part of the Department of Health and Human Services. (Source: RWJF News Digest - Quality/Equality)

Former Psychiatrist Gets Judgment, Jail Time for FraudFormer Psychiatrist Gets Judgment, Jail Time for Fraud

Medscape Today Headlines — Fri, 20 Jan 2012 21:35:50 +0100

A former Idaho psychiatrist was ordered to pay nearly $95,000 in a judgment this week, adding to a prison sentence of up to 5 years for obstruction and falsifying records relating to Medicaid fraud. Medscape Medical News (Source: Medscape Today Headlines)

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Report calls for expanded Georgia Medicaid managed care

bizjournals.com Health Care:Pharmaceuticals headlines — Fri, 20 Jan 2012 21:12:55 +0100

A consultant is recommending Georgia enroll all of its Medicaid patients in managed care, including those now receiving traditional fee-for-service coverage. A report released Friday by the Georgia Department of Community Health (DCH) suggests that more than 357,000 Medicaid recipients enrolled in fee for service – primarily the aged, blind and disabled – join the 1.1 million being covered through managed care. The report, put together by Navigant Consulting Inc. of Chicago, argues that aged, blind and disabled patients covered through fee-for-service plans don’t have access to care-management programs that provide chronic-care services they need more than most patient groups... (Source: bizjournals.com Health Care:Pharmaceuticals headlines)

CWF president argues with feds over healthcare spending

Healthcare IT News — Fri, 20 Jan 2012 15:05:40 +0100

Karen Davis, president of the Commonwealth Fund and a nationally recognized economist, has a bone to pick with the federal government's recent report on U.S. healthcare spending. Growth in U.S. health spending remained slow in 2010 and the health share of the gross domestic product was unchanged from 2009, the Centers for Medicare and Medicaid Services reported. read more (Source: Healthcare IT News)

Ohio governor proposes Medicaid shared savings

American Medical News — Fri, 20 Jan 2012 13:09:24 +0100

Gov. John Kasich also wants a single care manager and benefits access point for people eligible for both Medicare and Medicaid. (Source: American Medical News)

Johnson & Johnson Settles Risperdal Claim in Texas

NYT Health — Fri, 20 Jan 2012 02:34:40 +0100

Johnson & Johnson said it would pay $158 million to end a lawsuit that accused it of inappropriately marketing its Risperdal antipsychotic drug to Texas residents on Medicaid. (Source: NYT Health)

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Lack of dental coverage sends patients to ER for pain

USATODAY.com Health — Thu, 19 Jan 2012 23:36:12 +0100

Government-managed health care programs, such as Medicaid, pay for emergency room visits, but there is limited dental coverage. (Source: USATODAY.com Health)

Johnson & Johnson subsidiary to settle Medicaid fraud charges

bizjournals.com Health Care:Physician Practices headlines — Thu, 19 Jan 2012 22:19:07 +0100

Texas Attorney General Greg Abbott on Thursday said that Janssen Pharmaceuticals has agreed to pay the state $158 million to settle allegations that the drug maker engaged in Medicaid fraud. Prosecutors for the state claimed that Johnson & Johnson (NYSE: JNJ) and its subsidiary Janssen urged physicians to prescribe Risperdal to children and the elderly for schizophrenia and dementia, despite the fact that the FDA had not yet approved the drug for those uses at the time. In settling the case, Janssen officials are denying that the company engaged in false or misleading statements regarding the antipsychotic prescription medication... (Source: bizjournals.com Health Care:Physician Practices headlines)

Arkansas DHS Chief: $114 Million to Keep Services Intact

Arkansas Business - Health Care — Thu, 19 Jan 2012 22:12:16 +0100

Arkansas Human Services Director John Selig says that the $114 million in new money requested for Medicaid in the state is needed to keep existing services and is not intended for an expansion of the program. (Source: Arkansas Business - Health Care)

J&J to pay $158 million to settle Texas Risperdal case

Reuters: Health — Thu, 19 Jan 2012 17:43:16 +0100

AUSTIN, Texas (Reuters) - Johnson & Johnson said on Thursday it will pay $158 million to settle a Texas lawsuit accusing the drugmaker of improperly marketing its Risperdal anti-psychotic drug to state residents on the Medicaid health program for the poor. (Source: Reuters: Health)

Survey: Hospitals' RAC audits usually managed by one compliance employee

Cardiovascular Business News — Thu, 19 Jan 2012 16:43:59 +0100

The Health Care Compliance Association, a nonprofit trade association for healthcare compliance professionals, determined that hospital audits conducted through the Centers for Medicare & Medicaid Services’ Recovery Audit Contractor program are usually handled by compliance departments and that they generally take a single full-time employee to manage. (Source: Cardiovascular Business News)

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States put tech to work on Medicaid enrollment

Healthcare IT News — Thu, 19 Jan 2012 14:23:44 +0100

More than half of states expanded and simplified their Medicaid and Children’s Health Insurance Programs’ eligibility, enrollment and renewal procedures in 2011, often using technology to streamline and automate processes. That efficiency helped states to continue their coverage for low-income adults and children at the same level as the previous year. Enhanced federal funding drove many states to begin major development work to modernize decades-old eligibility and enrollment systems. read more (Source: Healthcare IT News)

Arkansas Legislators to Examine Health, Human Services

Arkansas Business - Health Care — Thu, 19 Jan 2012 13:26:14 +0100

Arkansas lawmakers are expected to focus on a proposed $114 million increase in funding for Medicaid as they continue budget hearings for the legislative session. (Source: Arkansas Business - Health Care)

Medicaid Enrollment Steady in 2011, Report Finds

MedPage Today Public Health — Thu, 19 Jan 2012 13:00:00 +0100

WASHINGTON (MedPage Today) -- Enrollment in state Medicaid and Children's Health Insurance Program (CHIP) remained steady in 2011 and into 2012, and some states made it easier for low-income people to have coverage, according to a new survey from the Kaiser Family Foundation. (Source: MedPage Today Public Health)

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A Statewide Intervention to Improve Access to Hospice and Palliative Care for Seriously Ill Medicaid Enrollees (416-A)

Journal of Pain and Symptom Management — Thu, 19 Jan 2012 03:24:50 +0100

Discuss training and quality improvement components of a statewide intervention to improve access to hospice, palliative, and supportive care for seriously ill Medicaid enrollees. (Source: Journal of Pain and Symptom Management)

CareSource unveils consumer feedback program

bizjournals.com Health Care:Biotechnology headlines — Wed, 18 Jan 2012 20:25:00 +0100

CareSource has introduced a new consumer feedback program, iConnect, which will allow its members to communicate more easily with the Medicaid managed care provider. CareSource consumers who voluntarily become part of iConnect will be asked to answer questions and participate in polls via telephone, text message, email and social media outlets. Members also will have the chance to attend live events, according to the company. Dayton-based CareSource, the third largest company in the region with 900 local employees, hopes to reach consumers through iConnect that it might not have otherwise... (Source: bizjournals.com Health Care:Biotechnology headlines)

CMS to host webinar series on bundled payment initiatives

Cardiovascular Business News — Wed, 18 Jan 2012 16:32:22 +0100

The Centers for Medicaid & Medicare Services will host a series of webinars dedicated to helping healthcare organizations understand bundled payment programs as part of its accelerated development learning session series. (Source: Cardiovascular Business News)

Commentary on ‘The DOPPS Practice Monitor for US Dialysis Care: Trends Through April 2011’: No Surprises Yet

American Journal of Kidney Diseases — Wed, 18 Jan 2012 13:56:37 +0100

The initial announcement, finalization, and ultimate implementation of the end-stage renal disease prospective payment system (PPS), also called the expanded bundle, were accompanied by much angst in the nephrology community and agitation among high-profile stakeholders. Overnight, fee-for-service reimbursement by the US Centers for Medicare & Medicaid Services (CMS) to dialysis providers for many dialysis-related services, including most medications administered in the dialysis unit, was replaced by adjusted lump-sum payments for each hemodialysis treatment provided. Included in these new per-session payments were many of the most costly elements of dialysis care, including erythropoiesis-stimulating agents (ESAs), intravenous iron supplements, and intravenous vitamin D analogues, along w...

Medicaid Program; Disproportionate Share Hospital Payments - Uninsured Definition

Federal Register updates via the Rural Assistance Center — Wed, 18 Jan 2012 06:00:00 +0100

This proposed rule from the Centers for Medicare & Medicaid Services addresses the hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments under the Social Security Act. (Source: Federal Register updates via the Rural Assistance Center)

14 senators express concern about limits on Medicaid generic drug reimbursements

Drug Topics - Pharmacy News — Wed, 18 Jan 2012 05:00:00 +0100

Fourteen U.S. senators recently expressed their concerns with the Centers for Medicare and Medicaid Services’ proposed Federal Upper Limits for Medicaid generic drug reimbursements. (Source: Drug Topics - Pharmacy News)

The Effect of Dementia on Medication Use and Adherence Among Medicare Beneficiaries With Chronic Heart Failure.

The American Journal of Geriatric Pharmacotherapy — Wed, 18 Jan 2012 05:00:00 +0100

CONCLUSIONS: EBM medication adherence was high in this population, regardless of ADRD status. However, patients with ADRD had lower EBM use compared with those without ADRD. Low use of specific EBM medications such as β-blockers was found in both groups. Therefore, interventions targeting increased treatment with specific EBMs for CHF, even among patients with ADRD, may be of benefit and could help reduce CHF-related hospitalizations. PMID: 22264854 [PubMed - as supplied by publisher] (Source: The American Journal of Geriatric Pharmacotherapy)

CMS awards $2.5 billion for meaningful use in 2011

Modern Medicine — Wed, 18 Jan 2012 00:35:50 +0100

The Centers for Medicare and Medicaid Services gave $2.5 billion to doctors and hospitals in 2011 for using EHR systems. Find out what the bonus recipients have in common. (Source: Modern Medicine)

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IVANS LIME™ HIE helps hundreds of providers process health claims faster and protect revenue

Healthcare IT News Press Releases — Tue, 17 Jan 2012 16:22:10 +0100

IVANS, Inc., is helping healthcare customers get paid faster and reduce their rate of uncompensated care through its LIME Health Information Exchange (HIE) platform, which integrates a web-based portal to securely connect providers with more than 4,000 payers for checking patient eligibility, processing claims and tracking payments. Used by half a million healthcare organizations nationwide, IVANS LIME™ portal supports the entire Medicare, Medicaid and Commercial claims workflow, thereby helping providers save time, increase efficiency and uncover new revenue streams. read more (Source: Healthcare IT News Press Releases)

14 senators express concern about limits on Medicaid generic drug reimbursements

Drug Topics - Top News — Tue, 17 Jan 2012 05:00:00 +0100

Clinical outcomes, quality of life, and costs associated with implantation of vagus nerve stimulation therapy in pediatric patients with drug-resistant epilepsy.

European Journal of Paediatric Neurology — Tue, 17 Jan 2012 05:00:00 +0100

CONCLUSIONS: VNS in pediatric patients is associated with decreased resource use and epilepsy-related events, cost savings, and QALY gain. PMID: 22261080 [PubMed - as supplied by publisher] (Source: European Journal of Paediatric Neurology)

Physician innovators among those advising on health delivery reforms

American Medical News - GOVERNMENT — Mon, 16 Jan 2012 12:00:00 +0100

Those chosen as CMS innovation advisers are expected to quicken the pace of system reforms for Medicare, Medicaid and CHIP. (Source: American Medical News - GOVERNMENT)

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Payer Status and Treatment Paradigm for Acute Cholecystitis [Original Article]

Archives of Surgery — Mon, 16 Jan 2012 05:00:00 +0100

Conclusions Medicaid payer status confers inferior access to surgical treatment for AC. While this finding may be due in part to patients' health beliefs and physician preferences, the magnitude of difference suggests that health systems factors may provide a significant contribution toward clinical decision making in this entity. (Source: Archives of Surgery)

Mental Health Weekly — Mon, 16 Jan 2012 05:00:00 +0100

AbstractOklahoma Payment and Outcome System for CMHCs Prompts Improved ServicesField Troubled by States' Challenge to ACA Medicaid ProvisionOklahoma Outcome Measures Focus on Improving Care AccessVirtual Learning for M.S.W. Allows Network of Field PlacementsNew Denver Recovery Center Aims to Expand Vital Services for Mental Health ConsumersAPA: Stress Findings in Survey Suggest Public Health CrisisBriefly NotedState NewsResourcesComing up (Source: Mental Health Weekly)

Differences in Intra-Cranial Pressure Monitor Utilization and Subsequent Outcomes Between Insured and Uninsured Patients After Traumatic Brain Injury

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:13 +0100

Introduction: Disparities in outcome after Traumatic Brain Injury (TBI) have been previously demonstrated for uninsured patients. However, the cause of this discrepancy is not well defined. We hypothesized that there are differences in Intra-Cranial Pressure (ICP) monitor utilization and subsequent outcomes between insured and un-insured patients after TBI. Methods: This was a retrospective of review of the most recent National Trauma Databank research datasets from 2007-2008. All patients that met ICP insertion criteria as set forth by the most recent Brain Trauma Foundation Guidelines were included in the analysis. Relevant demographic data, injury characteristics, invasive procedures, and outcomes were abstracted from the dataset. Patients were stratified by insurance into respective Pr...

Hospital Characteristics and Participation in the National Surgical Quality Improvement Program

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:02 +0100

Conclusions: NSQIP participants do not represent the diversity of hospitals performing high-risk general and vascular surgery nationwide. to enable quality improvement efforts in small, rural, and critical access hospitals, which may have high surgical mortality rates and limited resources, other methods of outcome feedback are needed. (Source: Journal of Surgical Research)

ACA to Bring Influx of Diabetics to Medicaid (CME/CE)

MedPage Today Primary Care — Sat, 14 Jan 2012 14:00:00 +0100

(MedPage Today) -- Health reform will increase the number of uninsured adults with diabetes who will be covered by Medicaid, researchers found. (Source: MedPage Today Primary Care)

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Better, Together: Care Partners Program

DukeHealth.org: Duke Health Features — Fri, 13 Jan 2012 19:06:44 +0100

An outpatient case management intervention known as Care Partners is a collaboration between Duke University Hospital, Durham Regional Hospital, Duke HomeCare & Hospice, Durham Community Health Network, and various community-based health care agencies. The goal of the Care Partners program is to enhance the focus and care of patients with chronic diseases. The program uses a patient-centered model to help empower patients to optimize their health, gain further understanding of their chronic disease, and to have timely access to appropriate services and providers, enhancing their ability to manage their care outside of the acute or emergency department setting. In this model, patients are joined with a “care partner” who is supported by an oversight team of individuals represent...

Medicare Plans Recruit Healthy Seniors By Offering Gym Benefits

Health News from Medical News Today — Fri, 13 Jan 2012 08:00:00 +0100

Because healthy enrollees cost them less, Medicare Advantage plans would profit from selecting seniors based on their health, but Medicare strictly forbids practices such as denying coverage based on existing conditions. Another way to build a more profitable membership is to design insurance benefits that attract the healthiest patients. In a study published in the New England Journal of Medicine, Brown University researchers report that plans have managed to do just that by offering fitness club memberships as a covered benefit... (Source: Health News from Medical News Today)

Meaningful Use Deadline Coming

Blogged_Arteries — Fri, 13 Jan 2012 06:00:00 +0100

Physician have until Feb. 29 to register and attest to meeting meaningful use requirements to receive payments for 2011 through the Medicare & Medicaid EHR Incentive Program Registration and Attestation System. (Source: Blogged_Arteries)

Medicaid HMO Expansion: Are You Ready?

Blogged_Arteries — Fri, 13 Jan 2012 06:00:00 +0100

On March 1, Texas will complete statewide expansion of the Medicaid HMO model by requiring most patients living in rural and South Texas counties to obtain their health care services from physicians and providers participating in one of the Medicaid HMO networks. (Source: Blogged_Arteries)

Beebe Budget: Extra $100 Million for Medicaid, $55 Million for Schools

Arkansas Business - Health Care — Thu, 12 Jan 2012 22:02:07 +0100

Arkansas Gov. Mike Beebe said Thursday he will call for more than $100 million in additional funding for Medicaid and $55 million for public schools when he presents his balanced budget proposal next week. (Source: Arkansas Business - Health Care)

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Costs to States of Non Compliance with PPACA's Medicaid Expansion

The Heritage Foundation Papers: Health Care — Thu, 12 Jan 2012 20:31:00 +0100

In March 2012, two years after the enactment of the Patient Protection and Affordable Care Act (PPACA), the Supreme Court will hear challenges to the federal health care legislation. One issue the court will take up is whether the PPACA’s Medicaid expansion constitutes a coercive infringement on state sovereignty by the federal government. Relevant to that dispute is the economic burden to a state that—in the face of the impending PPACA-mandated Medicaid expansion—decides to end its participation in Medicaid, thus forfeiting its entire federal Medicaid funding. This Heritage Foundation analysis attempts to calculate that burden. (Source: The Heritage Foundation Papers: Health Care)

Medicare Program; Medicare Advantage and Prescription Drug Benefit Programs: Negotiated Pricing and Remaining Revisions; Prescription Drug Benefit Program: Payments to Sponsors of Retiree Prescription Drug Plans

Federal Register updates via the Rural Assistance Center — Thu, 12 Jan 2012 15:55:33 +0100

This final rule from the Centers for Medicare & Medicaid Services implements and finalizes provisions regarding the reporting of gross covered retiree plan-related prescription drug costs (gross retiree costs) and retained rebates by Retiree Drug Subsidy (RDS) sponsors; and the scope of waiver authority under the Social Security Act (the Act). (Source: Federal Register updates via the Rural Assistance Center)

All Heat, No Light — The States' Medicaid Claims before the Supreme Court

New England Journal of Medicine — Wed, 11 Jan 2012 22:00:06 +0100

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print. (Source: New England Journal of Medicine)

States File Brief Opposing ACA's Medicaid Expansion

MedPage Today Public Health — Wed, 11 Jan 2012 19:00:00 +0100

WASHINGTON (MedPage Today) -- The Affordable Care Act's Medicaid expansion is "coercive" and "transforms the basic nature" of the program, according to a brief filed with the Supreme Court by 26 states. (Source: MedPage Today Public Health)

States oppose Obama healthcare Medicaid law

Reuters: Health — Wed, 11 Jan 2012 17:28:04 +0100

WASHINGTON (Reuters) - Twenty-six states challenging President Barack Obama's sweeping healthcare overhaul filed a Supreme Court brief on Tuesday arguing the law unconstitutionally expands the Medicaid program for the poor and disabled. (Source: Reuters: Health)

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ED Eye Care In Florida - A Payment Review

Health News from Medical News Today — Wed, 11 Jan 2012 16:00:00 +0100

A major part of Florida's emergency department eye care is reimbursed through Medicaid or paid for directly by the patients. According to a study published in the Archives of Ophthalmology, one of the JAMA/Archives journals, these findings may be beneficial in strategic planning as the debate over how best to implement the nation's new health care reform law progresses... (Source: Health News from Medical News Today)

US states oppose Obama healthcare Medicaid law

Modern Medicine — Wed, 11 Jan 2012 05:00:00 +0100

WASHINGTON (Reuters) - Twenty-six states challenging President Barack Obama's sweeping healthcare overhaul filed a U.S. Supreme Court brief on Tuesday arguing the law unconstitutionally expands the Medicaid program for the poor and disabled. (Source: Modern Medicine)

Better care for 'dual eligibles' suggested

Health News - UPI.com — Wed, 11 Jan 2012 03:42:52 +0100

WASHINGTON, Jan. 10 (UPI) -- Two U.S. researchers suggest a plan to improve care for dual eligibles -- retirees eligible for both Medicare and Medicaid. (Source: Health News - UPI.com)

Smoking cessation saves Medicaid money

Health News - UPI.com — Wed, 11 Jan 2012 00:39:57 +0100

WASHINGTON, Jan. 10 (UPI) -- Including comprehensive tobacco cessation benefits in U.S. Medicaid insurance coverage can result in substantial savings for Medicaid programs, researchers say. (Source: Health News - UPI.com)

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Midland Memorial Hospital receives federal funds for meaningful use of OpenVista EHR

Healthcare IT News Press Releases — Tue, 10 Jan 2012 14:00:44 +0100

Medsphere Systems Corporation and Midland Memorial Hospital today announced that Midland Memorial has met the requirements for Stage One Meaningful Use with Medsphere’s OpenVista system, the empowering electronic health record (EHR), and has received an initial reimbursement from the federal government. According to Midland Memorial administrators, the hospital has received initial disbursements of $2.3 million from the Medicare side of the program and $1 million in Medicaid compensation. read more (Source: Healthcare IT News Press Releases)

Growth in U.S. Health Spending Remains Slow in 2010

News stories via the Rural Assistance Center — Tue, 10 Jan 2012 06:00:00 +0100

U.S. spending on health care grew 3.9% in 2010 to $2.6 trillion, slightly surpassing the record-low 3.8% growth in 2009, the Centers for Medicare & Medicaid Services reported today. (Source: News stories via the Rural Assistance Center)

Measuring Quality: 368 New Ideas For 2012

RWJF News Digest - Quality/Equality — Tue, 10 Jan 2012 05:00:00 +0100

How should Medicare and Medicaid measure doctors, hospitals, dialysis centers and other health care providers it pays? (Source: RWJF News Digest - Quality/Equality)

HHS Publishes New Medicaid Quality Measures

MedPage Today Campaign '08 — Mon, 09 Jan 2012 22:16:36 +0100

WASHINGTON (MedPage Today) -- The Department of Health and Human Services has released a set of 26 quality measures that will eventually be used to determine the quality of care that adult Medicaid patients are receiving in each state. (Source: MedPage Today Campaign '08)

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Growth in Health Spending Nears Record-Low Rate

MedPage Today Campaign '08 — Mon, 09 Jan 2012 20:00:00 +0100

WASHINGTON (MedPage Today) -- Healthcare spending grew slowly in 2010 -- at a rate of 3.9% -- in part because high unemployment and reduced household income led people to scrimp on doctors' visits and medications, new data from the Centers for Medicare and Medicaid Services show. (Source: MedPage Today Campaign '08)

Weak Economy Curbs U.S. Health Spending

RWJF News Digest - Public Health — Mon, 09 Jan 2012 05:00:00 +0100

The Centers for Medicare and Medicaid Services reports that total health spending in the U.S. increased by 3.9 percent in 2010, just a notch above the slowest rate since the government started keeping track — 3.8 percent in 2009. (Source: RWJF News Digest - Public Health)

Emergency Department Eye Care in Florida: A Study of Principal Payer Sources 2005 Through 2009 [Clinical Sciences]

Archives of Opthalmology — Mon, 09 Jan 2012 05:00:00 +0100

Conclusions A substantial proportion of ED eye care in Florida is reimbursed through Medicaid or is paid for out of pocket. How the Patient Protection and Affordable Care Act of 2010 and the national economic recovery will affect safety-net institutions such as EDs and hospital staff is speculative, but the effect could be substantial. (Source: Archives of Opthalmology)

Effective Interventions For Stemming The Growing Crisis Of Diabetes And Prediabetes: A National Payer's Perspective [Overview Of The Crisis]

Health Affairs — Mon, 09 Jan 2012 05:00:00 +0100

Between a fifth and a third of US adults will have diabetes by midcentury, up from one in ten now, according to a government estimate. We project that over the next decade, around 40 million adults could have diabetes and 100 million could be diagnosed with its clinical precursor, prediabetes. Related health care spending could reach $512 billion annually in 2021. Evidence-based interventions can curb diabetes and its clinical complications, but little has been done to implement them on a wide scale. What’s needed, among other measures, are new risk-assessment methods to identify subpopulations that will benefit most; the enrollment of consumers in new care models that support and encourage lifestyle change; partnerships with pharmacists, nurses, and health coaches; an...

The Affordable Care Act Lays The Groundwork For A National Diabetes Prevention And Treatment Strategy [Lifestyle Interventions]

Health Affairs — Mon, 09 Jan 2012 05:00:00 +0100

This article presents a three-part proposal: expand the Diabetes Prevention Program nationally; build care coordination through health teams into the traditional Medicare program; and use these teams to connect public health, prevention, and treatment. Enrollment in evidence-based lifestyle modification programs—specifically, those focused on excess weight—should be added as a covered benefit under Medicare with no cost sharing. Funding for the Medicare component could be provided through the budget of the Center for Medicare and Medicaid Innovation. The proposal in its totality has the potential for improving health outcomes and reducing costs. (Source: Health Affairs)

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Medicare Advantage Chronic Special Needs Plan Boosted Primary Care, Reduced Hospital Use Among Diabetes Patients [Medical Management & Care]

Health Affairs — Mon, 09 Jan 2012 05:00:00 +0100

The Affordable Care Act of 2010 authorized the continued availability of Medicare Advantage Chronic Condition Special Needs Plans (C-SNPs). This case study examines the model of care used by the largest such plan, Care Improvement Plus, and compares utilization rates among its diabetes patients with those of other beneficiaries enrolled in fee-for-service Medicare in the same five states. This special-needs plan emphasizes direct contacts with patients to help identify gaps in care and promote primary and preventive health care. The comparative analysis indicates that people with diabetes in the special-needs plan—particularly nonwhite beneficiaries—had lower rates of hospitalization and readmission than their peers in fee-for-service Medicare. For example, risk-adjusted hospit...

Medicaid Expansion Under Health Reform May Increase Service Use And Improve Access for Low-Income Adults With Diabetes [Implications For Medicaid]

Health Affairs — Mon, 09 Jan 2012 05:00:00 +0100

Medicaid’s key role in financing diabetes care will grow when many low-income uninsured people with diabetes gain eligibility to the program in 2014 under the Affordable Care Act. Using a national data set to describe current health care use and spending among the nonelderly, low-income adult population, we found that adult Medicaid beneficiaries with diabetes had total annual per capita health expenditures more than three times higher ($14,229 versus $4,568) than those of adult beneficiaries without diabetes. At the same time, Medicaid facilitates financial protection and care access among beneficiaries with diabetes. Low-income adults with diabetes who were uninsured used fewer services, spent more out of pocket, and reported worse access than did their peers who were covered by Me...

Diabetes Management For Low-Income Patients In Los Angeles: Two Strategies Improved Disease Control In The Short Term [Community Case Studies]

Health Affairs — Mon, 09 Jan 2012 05:00:00 +0100

We examined two programs, the first using a short-term intensive intervention by a care team including nurses and a specialist, and the second integrating case management and clinical pharmacy programs into primary care in a community clinic. We show evidence that both models improved short-term disease control, as measured by reductions in HbA1c and low-density lipoprotein (sometimes referred to as "bad" cholesterol). However, integrating case management and clinical pharmacy programs into a primary care setting was less labor-intensive and potentially less expensive than the care team intervention. The challenge is to understand the essential aspects of these interventions; refine their design so that they are more cost-effective and fiscally feasible; and identify long-term health and c...

State Medicaid Programs Did Not Make Use Of Prior Authorization To Promote Safer Prescribing After Rosiglitazone Warning [Diabetes Drug Safety]

Health Affairs — Mon, 09 Jan 2012 05:00:00 +0100

We examined the impact of the Food and Drug Administration’s May 2007 safety warning regarding rosiglitazone (Avandia), a diabetes drug found to raise the risk of heart attacks, on the drug’s availability on state Medicaid preferred drug lists and on the prescribing of diabetes medications more generally for Medicaid beneficiaries. Nearly all state Medicaid programs covered rosiglitazone as a preferred drug, requiring no prior authorization, with minimal change after the safety warning. At the same time, the safety warning was associated with a greater-than-expected decline in rosiglitazone prescribing among states providing coverage as a preferred drug. This suggests that providers reacted to the safety warning by reducing prescriptions. However, Medicaid programs that di...

A smoking cessation benefit can save money for Medicaid

ScienceDaily Headlines — Sat, 07 Jan 2012 20:14:14 +0100

New research indicates that including comprehensive tobacco cessation benefits in Medicaid insurance coverage can result in substantial savings for Medicaid programs. The study found that every dollar spent in program costs resulted in an average program savings of $3.12, which represents a $2.12 return on investment. (Source: ScienceDaily Headlines)

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Diabetes Care Suffers With Insurance Lapses (CME/CE)

MedPage Today Nephrology — Fri, 06 Jan 2012 16:13:05 +0100

(MedPage Today) -- For low-income diabetic patients, having Medicaid coverage most of the time is not as good as keeping it continuously when it comes to timely preventive care, researchers said. (Source: MedPage Today Nephrology)

Honoring their service: behavioral health services in North Carolina for military service members, veterans, and their families. - Alexander-Bratcher KM, Martin G, Purcell WR, Watson M, Silberman P.

SafetyLit: All (Unduplicated) — Fri, 06 Jan 2012 15:21:09 +0100

The North Carolina Institute of Medicine Task Force on Behavioral Health Services for the Military and Their Families examined the adequacy of Medicaid- and state-funded services for mental health conditions, developmental disabilities (including traumatic... (Source: SafetyLit: All (Unduplicated))

Prevalence and treatment of depression in children and adolescents with sickle cell disease: a retrospective cohort study. - Jerrell JM, Tripathi A, McIntyre RS.

SafetyLit: All (Unduplicated) — Fri, 06 Jan 2012 15:21:09 +0100

OBJECTIVE: To describe the prevalence and treatment of comorbid depressive disorders in children and adolescents diagnosed with sickle cell disease. METHOD: A retrospective cohort design evaluating South Carolina Medicaid medical and pharmacy claims betwee... (Source: SafetyLit: All (Unduplicated))

System-Level Health Disparities in California Emergency Departments: Minorities and Medicaid Patients Are at Higher Risk of Losing Their Emergency Departments. - Hsia RY, Srebotnjak T, Kanzaria HK, McCulloch C, Auerbach AD.

SafetyLit: All (Unduplicated) — Fri, 06 Jan 2012 15:21:09 +0100

STUDY OBJECTIVE: Emergency department (ED) closures threaten community access to emergency services, but few data exist to describe factors associated with closure. We evaluate factors associated with ED closure in California and seek to determine whether ... (Source: SafetyLit: All (Unduplicated))

Maine faces $220 million Medicaid budget deficit

American Medical News - GOVERNMENT — Fri, 06 Jan 2012 13:00:39 +0100

The governor's proposal to reduce eligibility by 75,000 people requires federal approval. (Source: American Medical News - GOVERNMENT)

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HHS Adopts HIPAA Standard for Electronic Funds Transfers/Remittance Advice (CMS-0024-IFC) Action

News stories via the Rural Assistance Center — Fri, 06 Jan 2012 06:00:00 +0100

The Centers for Medicare & Medicaid Services (CMS) today announced an interim final rule with comment period under which the Department of Health and Human Services adopts standards for the Health Care Electronic Funds Transfers and Remittance Advice transaction under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). (Source: News stories via the Rural Assistance Center)

UofL geriatrician selected for new federal Innovation Advisors Program

EurekAlert! - Social and Behavioral Science — Fri, 06 Jan 2012 05:00:00 +0100

(University of Louisville) Christian Davis Furman, M.D., M.S.P.H., vice chair for geriatric medicine in the Department of Family and Geriatric Medicine at the University of Louisville, has been selected for the Centers for Medicare and Medicaid Services' Innovation Advisors Program. She is the only Kentuckian among the 73 individuals from 27 states and the District of Columbia selected to participate. (Source: EurekAlert! - Social and Behavioral Science)

Influence of Race, Insurance, Socioeconomic Status, and Hospital Type on Receipt of Guideline-Concordant Adjuvant Systemic Therapy for Locoregional Breast Cancers [Breast Cancer]

Journal of Clinical Oncology — Fri, 06 Jan 2012 05:00:00 +0100

Conclusion Sociodemographic and hospital factors are associated with guideline-concordant use of systemic therapy for breast cancer. The identification of modifiable factors that lead to nonguideline treatment may reduce disparities in breast cancer survival. (Source: Journal of Clinical Oncology)

Tribal child welfare. Interim final rule.

Fed Regist — Fri, 06 Jan 2012 05:00:00 +0100

Authors: Abstract The Administration for Children and Families (ACF) is issuing this interim final rule to implement statutory provisions related to the Tribal title IV-E program. Effective October 1, 2009, section 479B(b) of the Social Security Act (the Act) authorizes direct Federal funding of Indian Tribes, Tribal organizations, and Tribal consortia that choose to operate a foster care, adoption assistance and, at Tribal option, a kinship guardianship assistance program under title IV-E of the Act. The Fostering Connections to Success and Increasing Adoptions Act of 2008 requires that ACF issue interim final regulations which address procedures to ensure that a transfer of responsibility for the placement and care of a child under a State title IV-E plan to a Tribal title IV-E...

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