Medicare to fine hospitals for readmissions
Penalties per facility average about $125,000
By Ricardo Alonso-Zaldivar
| ASSOCIATED PRESS
OCTOBER 01, 2012
WASHINGTON — Medicare patients who have been hospitalized recently may have noticed extra attention when the time came to be discharged, but there’s more to it than good customer service.
As of Monday, Medicare will start fining hospitals that have too many patients readmitted within 30 days of discharge due to complications.
The penalties are part of a broader push under President Obama’s health care law to improve quality while also trying to save taxpayers money.
About two-thirds of the hospitals serving Medicare patients, or some 2,200 facilities, will be hit with penalties averaging about $125,000 per facility this coming year, according to government estimates.
Data to assess the penalties have been collected and crunched, and Medicare has shared the results with individual hospitals.
Partners HealthCare will give centers $90m
Aims to upgrade community care
Partners HealthCare plans to award community health centers $90 million over the next 15 years under a new grant program, part of a broad push to strengthen Massachusetts primary care providers.
The state’s largest hospital and physician organization is launching the initiative with its newly acquired insurer, Neighborhood Health Plan, and is scheduled to announce it Monday.
In the first round of grants, it will give $4.25 million to 49 community health centers across the state to help them adopt immediate improvements, such as upgrading technology that tracks patients’ health and redesigning office procedures so caregivers can spend more time with patients.
The grant program comes at a crossroads for community health centers. The state’s new health care cost-control law and the federal health care law raise expectations for health centers as crucial and relatively inexpensive providers of basic medical and mental health care, particularly for low-income residents.
Knee replacements gain as aging population seeks fitness
By Nicole Ostrow, Bloomberg News
Posted Sept. 26, 2012, at 7:40 p.m.
NEW YORK — Knee replacement surgeries have more than doubled over the past two decades in the United States as older Americans strive to stay active later in life, a study has found.
Total knee replacement procedures rose 162 percent from 1991 to 2010 while the number of procedures to repair a previously implanted artificial knee joint, called revision, jumped 106 percent, according to research released in the Journal of the American Medical Association.
About 600,000 total knee replacement procedures, done to relieve symptoms of severe knee arthritis, are performed each year in the U.S. costing about $9 billion annually, according to the research. About 60 percent of those procedures are paid for by Medicare, the federal government health program for the elderly and disabled, said Peter Cram, the lead study author. The study suggests the success of the surgery may need to be weighed against the increasing costs, he said.
“The growth in knee replacements encapsulates the challenges of controlling spending in the Medicare program,” Cram, associate professor of general internal medicine at the University of Iowa Carver College of Medicine in Iowa City, said in a Sept. 24 phone interview. “It is an effective surgery.”
The public health issue, Cram said, is that “a procedure that is great in small numbers is financially devastating to the Medicare program and the federal government in the long term. As a patient you want that knee replacement, but from a budgetary standpoint this starts to add up to real dollars.”
Researchers in the study published Tuesday looked at 3.27 million Medicare patients who underwent total knee replacement procedures and 318,563 who had revision surgery from 1991, the first year data were available, to 2010. The number of annual knee replacements rose to 243,802 in 2010, or 62.1 procedures per 10,000 Medicare enrollees, from 93,230 in 1991, or 31.2 procedures per 10,000 Medicare enrollees.
More people may be seeking the surgery because it is effective at relieving pain and older Americans are staying more active later in life, Cram said.
When Doctors Stop Taking Insurance
By RONI CARYN RABIN
Private health insurance used to be the ticket to a doctor's appointment. But that's no longer the case in some affluent metropolitan enclaves, where many physicians no longer accept insurance and require upfront payment from patients - cash, checks and credit cards accepted.
On Manhattan's Upper East Side, it's not unusual for a pregnant woman to pay $13,000 out of pocket in advance for childbirth and prenatal care to a physician who does not participate in any health plan. Some gynecologists are charging $650 for an annual checkup. And for pediatricians who shun insurance, parents on the Upper East Side are shelling out $150 to $250 whenever a child falls or runs a high fever.
Efforts by insurers to rein in health care costs by holding down physician fees - especially for primary care doctors, who play a critical role in health care though they are among the lowest paid doctors - appear to be accelerating the trend, and some patients say it's getting harder to find an in-network physician.
Orlene Paxson, 33, a stay-at-home mom on Manhattan's Upper East Side, was unable to find an obstetrician she liked who would accept her insurance. Many were not accepting new patients, and one highly recommended doctor did not return her call for five days and did not want to see her until 12 weeks into the pregnancy. It was Mrs. Paxson's first pregnancy and she did not want to wait, so even though her policy does not cover any out-of-network services, she and her husband chose a doctor who doesn't take insurance and paid the entire $13,000 fee themselves.
Once their daughter was born 20 months ago, Mrs. Paxson needed a pediatrician but could not find one who was in her plan, accepting new patients and within walking distance. So she again chose an out-of-network doctor.
"We stayed with her for a year and a half because we loved her," Mrs. Paxson said. At her first scheduled visit after the baby was born, the doctor "talked to me for almost three hours. She knew it was our first baby."
Hoping to inspire better nutrition, insurance giant sending out money-saving coupons
By David Lazarus, Los Angeles Times
Posted Oct. 01, 2012, at 1:10 p.m.
LOS ANGELES — Anthem Blue Cross wants people to eat better. And to help its members make more healthful food choices, the insurance giant is sending out money-saving coupons.
For ice cream.
And processed sandwich meat.
And mayonnaise. And canned vegetables.
And, strangely, deodorant.
The coupon campaign is being tested among thousands of Anthem members in California. If it proves popular, the coupons will probably be offered nationwide.
“We want you to know that we’re much more than just your health plan,” the insurer declares in its letter accompanying the coupons. “We’re your partner in helping you get and stay as healthy as possible.”
Eating well is important for lowering your risk of high blood pressure, heart disease, diabetes and strokes, the company says.
“With smart buys on delicious, wholesome foods … we’re putting the power of good health in the very best of hands — yours,” it says. “Now go and savor the journey ahead.”
Fruits and vegetables I could understand. Or organic foods. Or vitamins. Or medicine.
But it’s a bit of a surprise that Anthem’s idea of healthful living includes a coupon for $1.50 off boxes of Weight Watchers Giant Chocolate Fudge ice cream bars or Giant Vanilla ice cream sandwiches.
The Giant Chocolate Fudge ice cream bar has 110 calories, 70 milligrams of sodium and 25 grams of carbohydrates. The Giant Vanilla ice cream sandwich has 140 calories, 140 mg of sodium and 32 grams of carbs.
Those are better numbers than you’d encounter, say, with a box of Dove bars, except for the sugar. A chocolate-covered vanilla Dove bar has 320 calories, 40 mg of sodium and 32 grams of carbs.
Still, those Weight Watchers treats represent hefty chunks of the 2,000 calories, 2,300 mg of sodium and 250 grams of carbs that food experts say people should limit themselves to daily if they want to eat well.
And that’s just one healthful-eating suggestion from Anthem. There’s also a $1-off coupon for any Hormel Natural Choice sandwich meat
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