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Preventive Services, Including Contraceptive Coverage, Under the Health Care Law
All Women Should Have Access to Preventive Health Services, including Contraception, Without a Co-Pay, and Have It No Matter Where They Work
The health care law makes preventive care more accessible and affordable to millions of Americans by making certain preventive services, including all FDA-approved contraceptive methods, available without co-payments or other cost sharing requirements. This is especially important to women, who are more likely than men to avoid needed health care, including preventive care, because of cost. This requirement is a huge step forward for women’s health. Over the next few years, as an increasing number of health plans come under the law’s reach, more and more women will have access to a wide range of preventive services without co-payments or deductibles.
See on www.nwlc.org
Primary care doctors growing scarce
Roughly 4 million additional Californians are expected to obtain health insurance by 2014 through the federal health law, an expansion that will likely exacerbate the state’s doctor shortage and could even squeeze primary care access in the Bay area, experts say.
Even without the Affordable Care Act, a worsening doctor shortage had been forecast as the state’s and nation’s population ages and grows, and as a generation of older doctors retires. But by mandating that individuals have insurance and expanding Medicaid, the law will extend coverage to an additional 30 million Americans and place a greater strain on the physician workforce, especially for primary care.
See on www.sfgate.com
7 Big Data Solutions Try To Reshape Healthcare
Skepticism is a two-edged sword. Not enough of it, and an IT manager might find himself duped into investing in software “solutions” that go nowhere. Too much of it, and skepticism can leave an IT department behind as it waits for enough proof to show a particular platform will improve outcomes beyond a reasonable doubt.
Big data analytics is at that tipping point right now in the healthcare industry. Several vendors promise better quality of care and reduced expenditures, but evidence to support those claims is somewhat tentative. Similarly, some critics of the big data movement say healthcare providers need to squeeze all the intelligence they can from small data sets before moving on to larger projects.
In a recent post in The Health Care Blog, for instance, consultants David C. Kibbe, M.D., and Vince Kuraitis argue that instead of succumbing to the allure of big data analytics, providers should focus on using small data better. In other words, concentrate on the clinical data already available in digitized form and use only those health IT tools that are directly applicable to care management.
Big data analytics, on the other hand, attempts to parse mounds of data from many disparate sources to discover patterns that could be useful in problem solving. For example, researchers are employing the big data approach to study genetic and environmental factors in multiple sclerosis to search for personalized treatments.
Some of this research might lead to exciting payoffs down the road, but IT companies are not waiting. As Kibbe and Kuraitis point out, technology firms are touting big data analytics as a must-have for healthcare systems and physician groups that aim to become accountable care organizations or make ACO-like arrangements with payers. As these ACOs and healthcare organizations try to profit under shared-savings or financial risk contracts, these proponents claim, big data can help them crunch the data for quality improvement and cost reductions.
Some providers are already using big data in patient care. According to BusinessWeek, “many [providers] are turning to companies such as Microsoft, SAS, Dell, IBM, and Oracle for their data-mining expertise.” And healthcare analytics is a growth business. Frost & Sullivan projects that half of hospitals will be using advanced analytics software by 2016, compared to 10% today.
Are healthcare providers ready for big data analytics, or should they be content with the more limited data analytics capabilities built into their EHR systems and relational databases to point the way to new policies and procedures?
When asked to weigh in on the big data/small data debate during a recent interview withInformationWeek Healthcare, David Blumenthal, former head of the Office of the National Coordinate of health IT, said, “It’s not an either/or choice. Big data starts with small data. As we have more information on health and disease and the patterns of care … that information will provide useful insights into what works, what doesn’t. What the natural history of disease is. It will enable us to do studies faster and more efficiently … But it’s going to take a while to figure out how to use the data.”
See on www.informationweek.com
BMJ Group — “Stop the silent misdiagnosis: patients’ preferences matter”
The BMJ Group is owned by the British medical Association, and it provides research, medical information, and resources to improve outcomes for patients and the provision of healthcare worldwide.
In recent decades, rapid advances in the biosciences have delivered an explosion of treatment options. This is good news for patients, but it makes medical decision making more complicated. Most critically, an accurate medical diagnosis is no longer sufficient to identify the proper treatment. Just as important is an accurate preference diagnosis.1 Every option for treatment (a term that we use broadly here, to include procedures, tests, and even watchful waiting) has a unique profile of risks, benefits, and side effects. Doctors, generalists as well as specialists, cannot recommend the right treatment without understanding how the patient values the trade-offs. Regrettably, patients’ preferences are often misdiagnosed.
The article’s authors provide a method for making better preference diagnoses:
- Adopt a mindset of scientific detachment
- Formulate a data based provisional diagnosis
- Engage the patient in conversation and deliberation
- Team talk
- Option talk
- Decision talk
The result should be better care, not necessarily more care, but more cost effective care and better patient satisfaction.
This study was also commented on by The Dartmouth Center for Health Care Delivery Science in a press release, in which it stated that “Standard & Poor’s has warned a number of countries, including the US and UK, could see their credit ratings downgraded within the next decade if they fail to cut health care costs.”
Federal health care law is just one part of changes in medical care
Now that the election is over, healthcare experts are focusing on how to make healthcare reform work for patients and providers. It was never supposed to be easy. Obamacare presents a paradigm shift in how healthcare is being thought about in this country. Unfortunately, this process of intelligently implementing the law is three years late, but finally it’s starting.
One example of how people are beginning to think was reported in LiveWell Nebraska (Omaha World Herald):
American medical care is changing for a variety of reasons, and the results in many cases are unpredictable, University of Nebraska Medical Center experts said Thursday at a forum.
The changes are occurring because of the federal health care law, which is now secure with President Barack Obama’s re-election, federal budget constraints and a general acceptance that the American health care system is inefficient.
The experts’ comments ranged from optimism that care will improve with teamwork to concern that there will be too few doctors and nurses in an underfunded system.
Modern Healthcare Survey: Continued Anger over Obamacare
In an internet survey conducted after the presidential election, Modern Healthcare found that there remains “a deep vein of anger over the effects of the Patient Protection and Affordable Care Act.”
Of the 829 people who responded to the survey, 67% said the reform law would have a negative impact on the bottom lines of their healthcare business. Only 33% said the law would have a positive impact.
Respondents listed the following issues as important ones that need to be addressed by Congress and the President:
- Medicare sustainable growth-rate payment formula
- Improving overall clarity around the schedule for implementing the law’s various goals
- Need for more primary care physicians to manage the added population of patients
CMS Issues Outpatient Policy and Payment Changes
CMS finalized the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center rule on Thursday, November 1, 2012.
The final rule (which is over 1,200 pages and will be published in the Fed. Reg. on 11/15/12) updates the Medicare payment policies and rates for hospital outpatient and ASC services beginning January 1, 2013.
Rates and policies set in the calendar year (CY) 2013 final rule with comment period will increase payment rates for hospital outpatient departments by 1.8 percent. The increase is based on the projected hospital market basket—an inflation rate for goods and services used by hospitals—of 2.6 percent, minus 0.8 percent in statutory reductions, including a 0.7 percent adjustment for economy-wide productivity and a 0.1 percentage point adjustment required by statute.
The OPPS rule also contains a significant change from prior policy: as proposed, it bases relative payment weights on geometric mean costs rather than median costs. Basing the OPPS payments on mean costs better reflects average costs of services and aligns the metric used in rate-setting for the OPPS with the IPPS.
For CY 2013, ASC payment rates will increase by 0.6 percent—the projected rate of inflation of 1.4 percent minus a 0.8 percent productivity adjustment required by law. Medicare uses changes in the consumer price index for urban consumers (CPI-U) as the measure of inflation for ASCs.
The rule also makes changes to the quality-reporting program for hospital outpatient departments and for ASCs.
USDOJ S.D. Florida: Owner of Miami Home Health Company Sentenced to 37 Months in Prison for $60 Million Health Care Fraud Scheme
The owner of a Miami health care agency was sentenced today to 37 months in prison for his participation in a $60 million home health Medicare fraud scheme, announced U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; Michael B. Steinbach, Acting Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office.
Rodolfo Nieto Jr., 40, of Miami, was sentenced today by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida. In addition to his prison term, Nieto was sentenced to serve three years of supervised release and ordered to pay $1.1 million in restitution.
On Aug. 14, 2012, Nieto pleaded guilty in the Southern District of Florida to one count of conspiracy to defraud the United States and to receive health care kickbacks.
Nieto was the owner and operator of Ronat Home Health Care Inc. According to court documents, during the time of the conspiracy, Ronat was a Florida home health “staffing agency” that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries. Ronat subsequently became a home health agency.
According to court documents, from approximately January 2006 to approximately November 2009, Nieto accepted kickbacks in return for recruiting Medicare beneficiaries to be placed at Nany Home Health Inc., a Miami home health agency that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries. The owners and operators of Nany paid Nieto kickbacks in return for allowing Nany to bill the Medicare program on behalf of the patients Nieto had recruited through Ronat. Specifically, as part of the scheme, Nany billed Medicare for home health services purportedly provided by Ronat.
See on www.justice.gov
USDOJ: Boehringer Ingelheim Pharmaceuticals to Pay $95 Million to Resolve False Claims Act Allegations
Connecticut-based Boehringer Ingelheim Pharmaceuticals Inc. has agreed to pay $95 million to resolve allegations relating to the improper promotion of the stroke-prevention drug Aggrenox, the chronic obstructive pulmonary disease (COPD) drugs Atrovent and Combivent, and the hypertension drug Micardis, the Justice Department announced today.
The Food and Drug Administration (FDA) has approved Aggrenox to prevent secondary strokes, Combivent to treat continued symptoms of bronchospasm in patients with COPD who already are on a bronchodilator and Micardis to treat hypertension. The settlement resolves allegations that Boehringer improperly marketed each of these drugs and caused false claims to be submitted to government health care programs.
According to the government’s allegations, Boehreinger promoted each of the three drugs for uses that were not medically accepted indications and were not covered by federal health care programs. Specifically, the settlement resolves allegations that Boehreinger promoted Aggrenox for certain cardiovascular events such as myocardial infarction and peripheral vascular disease; that Combivent was marketed for use prior to another bronchodilator in treating COPD; and that Micardis was marketed for treatment of early diabetic kidney disease. The uses were not for medically accepted indications and were not covered by federal health care programs.
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.
GWU Face the Facts: Medicaid covers nearly half the 1.2 million Americans getting regular treatment for HIV – 47%
Nearly 1.2 million Americans get regular treatment for HIV, and Medicaid covers almost half of them – 47 percent. Only 1 percent of Medicaid clients have HIV; their care consumes 2 percent of the Medicaid budget ($5.3 billion). They represent 23 percent of all HIV-infected people in the U.S; not all those infected are receiving treatment.
African-Americans are at particular risk for HIV. Half of Medicaid HIV patients are African-American, and the CDC estimates new HIV infections run six times as high among African-Americans as for white men.
See on facethefactsusa.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 