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Prices soar in North Carolina as hospitals purchase oncology practices and dominate cancer market
Large nonprofit hospitals in North Carolina are dramatically inflating prices on chemotherapy drugs at a time when they are cornering more of the market on cancer care, an investigation by the Observer and The News & Observer of Raleigh has found.
The newspapers found hospitals are routinely marking up prices on cancer drugs by two to 10 times over cost. Some markups are far higher.
It’s happening as hospitals increasingly buy the practices of independent oncologists, then charge more – sometimes much more – for the same chemotherapy in the same office.
Asked about the findings, hospital officials said they are relying on a longtime practice of charging more for some services to make up for losses on others. Hospitals have a name for this: cost-shifting. …
Unlike many independent clinics, they say, hospitals suffer losses from treating patients without insurance and patients covered by Medicaid, the government program for the poor and disabled. Some independent oncologists acknowledge that they often refer such patients to hospitals.
Hospital officials say they provide counseling and many other cancer services that insurers don’t cover.
Officials for Carolinas HealthCare and Novant, which runs four Mecklenburg County hospitals, emphasize that they provide free care to many financially needy cancer patients.
See on www.charlotteobserver.com
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Program for ‘medically fragile’ kids in Illinois hanging on despite threatened cuts
MARQUETTE HEIGHTS — The little boy jumping in the middle of the bed, screeching out his favorite song, “Play that Funky Music White Boy,” has congenital central hypoventilation syndrome, a gene mutation that causes his body to forget to breathe.
The rare disease is also the reason 5-year-old Alex has had a tube sprouting from his windpipe since he was 6 weeks old and a bedroom that doubles as a hospital room. But right now, it is not the rarity of Alex’s disease that concerns his parents. It’s Illinois’ effort to reduce wide-ranging Medicaid costs, his father says, at the expense of children like Alex who rely on medical technology and round-the-clock nursing care to live at home.
Bill and Holly Thompson are among some 500 families throughout the state who depend on what’s called the MFTD waiver, or the Medically Fragile and Technology-Dependent Waiver program.
With the waiver, their children are eligible for Medicaid regardless of parental income. Without it, parents can’t afford the round-the-clock nursing care — at an average cost of $188,000 a year — their children require to avoid institutionalization.
MFTD-waiver families have popped up as one of the most vociferous grass-roots groups fighting specific changes in the state’s Medicaid reform package. So far, families have played a role in blocking state plans to shift more of the costs to families, impose income eligibility caps and change standard-of-care definitions. They’ve cornered Julie Hamos, head of the state Department of Healthcare and Family Services, at public forums and filed a lawsuit to stop the changes.
The federal Centers for Medicare and Medicaid Services stepped in, asking state officials to request a deadline extension so federal officials would have time to review the changes. An initial Sept. 1 deadline has been extended 90 days.
Families no longer eligible for the waiver would face huge out-of-pocket expenses with no transition plan. Some say they’d have to quit their jobs, work part time or divorce to make sure their children get the proper care. Or their children might be forced to move into a nursing home, which would cost Medicaid three times as much as the waiver program.
See on www.sj-r.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Curbing hospital readmission vital, Connecticut making progress
Recent headlines about high readmission rates forcing 2,200 hospitals nationwide to forfeit Medicare funds for patients who are readmitted to hospitals raises the questions: Can hospital readmission rates be reduced? …
The individual and combined successes of Connecticut health care communities show that improved medical processes, transfer of critical information and standardized education leads to better health care outcomes, and that translates to healthier patients and families, and a health care system that is much more cost-effective.
Reducing preventable hospital readmissions should continue to be a national priority. However, the community care transitions work in Connecticut is a harbinger of hope. We can be proud and optimistic that Connecticut is taking a proactive stance to reduce avoidable hospital readmissions in all communities statewide. This is not a challenge that can be fixed overnight, but real progress has been made.
See on articles.courant.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Telemedicine to Lower Cost for 5 Health Issues
Telemedicine is the advanced technology that will allow patients to monitor their own health at home.
These devices can upload patient test outcomes to an online database, where their physicians can keep an eye out for dangerous patterns in the patient’s health. The prevalence of telemedicine is slowly increasing and becoming more advanced, leaving the impetus behind improved health with the patient.
Healthcare IT News (2012) recently announced the five areas of healthcare that telemedicine will likely improve greatly over the coming years:
(1) active heart monitoring,
(2) blood pressure,
(3) diabetes,
(4) prescription compliance, and
(5) sleep apnea.
Physicians and product developers hope that telemedicine will be able to improve patient health by increasing continual monitoring and therefore catching problems before symptoms show up.
Telemedicine is also expected to decrease healthcare costs in these areas by eliminating unnecessary doctor visits and preventing bigger health problems earlier.
See report: http://ihealthtran.com/pdf/Telemedicine_iHT2.pdf ;
See on iht2blog.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Mostashari says EHR incentives estimated to reach $20 billion by 2015 | Legal Transcription
There are no set appropriations for how much the federal government can spend on rewarding providers who adopt and use electronic health records under the Medicare and Medicaid meaningful use EHR incentive program, according to National Coordinator for Health IT Farzad Mostashari, M.D.
“Whoever qualifies, gets paid; there’s no hard cap,” said Mostashari, who gave a keynote at the Annual Policy Summit for the Health Information Management and Systems Society (HIMSS) on Wednesday.
Mostashari said the federal government estimates it will pay out around $20 billion in incentives before the program shifts to a penalty in 2015, but there is no fixed budget set in the HITECH Act that mandated the program. The government recently announced it has paid out nearly $7 billion since the program began in 2011.
See on www.lawscribes.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
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AAFP recommends greater role for primary care docs in Medicare | Healthcare Finance News
Congress must repeal the sustainable growth rate formula to stabilize Medicare physician payments, and CMS needs to adopt a series of strategies that would strengthen the Medicare program by enhancing the role of primary care physicians, said the American Academy of Family Physicians in a recent letter to CMS.
See on www.healthcarefinancenews.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Healthcare Business Models Clash with Reforms – HealthLeaders Media
Healthcare executives responding to a survey say the nation will see major changes in the way healthcare is delivered and paid for in the next five years as providers and payers struggle to do more with less.
Most of those executives, however, also believe that the fee-for-service-based business models they’re using now will be at least “somewhat sustainable” or fare even better in the face of new challenges brought on by healthcare reform.
KPMG LLP consultants surveyed more than 200 senior leaders in healthcare and found that 73% of health systems executives, 81% of health plan executives, and 79% of drug makers said their business models were somewhat sustainable or better over the next five years.
See on www.healthleadersmedia.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
HCA Probe Spotlights Cardiologists’ ’Irresistible Temptation’ – HealthLeaders Media
Physicians specializing in cardiology coined the term “oculostenotic reflex” over a decade ago. But the phrase has been popping up this month in conversations about accusations that thousands of patients underwent inappropriate heart procedures at HCA hospitals in Florida and in three other states, the subject of a federal probe.
Writing in the journal Circulation in 1995, Eric Topol, MD, and Steven Nissen, MD, described this phenomenon as “an irresistible temptation among some invasive cardiologists to perform angioplasty on any significant residual stenosis after thrombolysis”—that is, after clot-busting medications have been used.
Nissen and Topol wrote that while professional organizations don’t support this practice, “the ritual of reflex angioplasty is exercised thousands of times each year.”
See on www.healthleadersmedia.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
USDOJ: Eight Individuals and a Corporation Convicted at Trial in South Florida in $50 Million Medicare Fraud
Eight individuals and a Miami-based corporation were convicted by a federal jury for their participation in a Medicare fraud scheme involving the submission of more than $50 million in fraudulent billings to Medicare, the Department of Justice, the FBI and the Department of Health and Human Services (HHS) announced today.
Antonio Macli, the owner of Biscayne Milieu Health Center Inc., a mental health care corporation, his son Jorge Macli, Biscayne Milieu’s CEO, and Antonio Macli’s daughter Sandra Huarte, an executive at the company, were each found guilty in U.S. District Court for the Southern District of Florida of one count of conspiracy to commit health care fraud, and one or more substantive counts of health care fraud, conspiracy to commit a health care kickback scheme and conspiracy to commit money laundering and substantive counts of money laundering. Antonio Macli and Jorge Macli were also convicted of substantive kickback counts. Dr. Gary Kushner, the medical director at Biscayne Milieu, was found guilty of conspiracy to commit health care fraud and a substantive count of health care fraud. Rafael Alalu, a therapist, and Jacqueline Moran, who handled Medicare billing for Biscayne Milieu, were each found guilty of conspiracy to commit health care fraud and substantive counts of health care fraud. Anthony Roberts and Derek Alexander, two patient recruiters, were each found guilty of one count of conspiracy to commit a health care kickback scheme, and each was convicted of one health care kickback count.
The defendants were charged in a superseding indictment returned June 5, 2012. Twenty other individuals who worked at Biscayne Milieu have all previously pleaded guilty.
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Texas Tribune — Proposed Medicaid Fraud Rules Worry Providers
The state’s Health and Human Services Commission is seeking formal approval for new Medicaid fraud rules that doctors allege deny them due process and expand investigators’ power to halt their funding.
For months, HHSC’s Office of the Inspector General has been increasingly relying on a federal rule — part of President Obama’s health care plan — that allows the agency to freeze financing to any health provider accused of overbilling Medicaid. That means they can halt the flow of funding before they complete a full-fledged investigation, and often, providers say, before doctors are given any chance to defend themselves.
HSC says the new state rules — a rewrite of the existing statute — give investigators the tools to stop the bleeding before bad actors run off with the state’s money. They say fraud investigations aren’t opened without good reason, and the idea that there’s no due process is preposterous.
The agency says the new rules, which must be approved by the executive commissioner, are necessary to bring the state in line with federal health reform and measures passed in the last legislative session. It is “mostly a clean-up of the existing rules,” agency spokeswoman Stephanie Goodman said.
But attorneys for health care providers, who are still trying to parse the rewritten rules, say the language the state is preparing to codify appears to put even more power into investigators’ hands than what they’ve already received from the federal government.
See on www.texastribune.org
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Joseph Rugg's Health Law Blog 