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Medicaid's mental health emergency
A private psychiatric hospital in Washington says its participation in a new federal demonstration project already is helping alleviate the burden of the most acutely mentally ill on emergency departments in the nation's capital. Since July 2012, the Psychiatric Institute of Washington has stabilized and treated 150 patients with acutely chronic and serious mental health conditions under the Medicaid Emergency Psychiatric Demonstration project. Roughly two-thirds of these patients came from local emergency departments. By responding quickly to their needs, “we have been very helpful to those organizations and helping them unclog their emergency rooms,” said Howard Hoffman, MD, the institute's executive medical director. The hospital stabilizes, evaluates and treats these patients either through therapy or medication, and then provides them with aftercare programs when they're discharged. The type of care provided by the institute is not new. What is new under this demo is tha [Read more]
Mental health minimum benefits bolstered
Doctors navigating their way through the Affordable Care Act's final minimum coverage requirements for 2014 face a complex environment in which more people are obtaining access to mental health care and other services, but doing so through benefits that can vary significantly by insurer and by state. On Feb. 20, the Dept. of Health and Human Services issued a final rule mandating a core package of 10 “essential health benefits” categories that qualified plans on health insurance exchanges — and some plans outside of those marketplaces — will need to cover. Each state has been asked to choose a benchmark plan from a selection of popular existing plans to determine more precisely what benefits must be covered under the categories. Although the affected plans now have a benefits floor that will ensure more uniformity, plans will retain some flexibility, not only in benefits design but also in cost sharing and utilization management, said Sonya Schwartz, program director for [Read more]
2% Medicare pay cut set under sequestration
Deep, across-the-board federal budget cuts officially went live for Medicare and other public health programs after Congress and President Obama failed to reach an agreement on avoiding sequestration before the March 1 deadline. More than $85.4 billion will be cut from the federal budget in 2013. Reductions to Medicare will represent about 12% of the total reductions, or $9.9 billion, in part through lower payments to physicians and other health professionals for providing services. The automatic reductions were written into law in 2011 as part of a deal to raise the nation’s debt ceiling. It was designed to act as a fail-safe mechanism in case lawmakers and the White House were unable to agree on more targeted deficit reduction provisions. Those cuts won’t be evident right away. The reductions in Medicare doctor rates will begin with services provided on or after April 1 even though the sequestration order is issued on March 1, according to the Congressional Budget Office. T [Read more]
Internists call to end “assault” on doctor-patient relationship
Payment and coverage expansion reforms to the health care system won’t succeed unless physician-patient relations can improve, the American College of Physicians concluded in a new policy paper. “Physicians and patients are challenged by seemingly relentless intrusions into their relationship,” said Bob Doherty, ACP’s senior vice president of governmental affairs and public policy. “None of us want our doctors to be rushed from patient to patient, from task to task. If this is the system we have, then the system needs to change.” He spoke during a Feb. 20 conference call to assess the report’s findings. In some respects, it’s the best of times for health care in the U.S., with more people set to obtain coverage starting in 2014 under the Affordable Care Act, Doherty said. However, “resistance in many states to expanding Medicaid and setting up exchanges [is] affecting the poor,” he said. In its paper, the ACP called for a renewed commitment to implement cov [Read more]
Health system brands go national
Some of the biggest brand names in health care delivery are deciding that it’s not enough to be a prestigious place in the distance. Places like Mayo Clinic in Rochester, Minn., Cleveland Clinic and MD Anderson Cancer Center in Houston have established affiliate programs that put their names on systems far afield from their main campuses. Duke University Health System in Durham, N.C., is working with LifePoint Hospitals, a large chain of for-profit community hospitals based in Brentwood, Tenn., to set up joint ventures to buy hospitals. Generally, the prominent organizations are partnering with local institutions that are established, but are often not considered the biggest or most prestigious names in their home area. The motivation by both sides in these deals is stronger branding as a way to increase revenue, marketing experts say. For the name-brand institutions, affiliating with, or buying, a local hospital can formalize existing clinical relationships and allow them to c [Read more]
Humana reveals to investors how it pays physicians
As part of what Humana CEO Michael McCallister described as his company’s plans to push an integrated care delivery model “as far and as fast as we can take it,” the insurer said it wanted to satisfy investors by showing its progress in some way. Starting with its fourth-quarter 2012 earnings report delivered Feb. 4, Humana listed for investors the breakdown of how it pays its 180,000 contracted and employed “primary care providers,” including physicians. In its report, the Louisville, Ky.-based health insurer broke down its primary care population by the number of doctors paid by capitation, those who are paid by capitation but have no downside risk, and those paid by traditional forms of payment, such as fee for service. Regina Nethery, Humana’s vice president of investor relations, said the decision was made to share the data with investors because the company is still fairly new in its efforts to implement an integrated care delivery model that includes putting mo [Read more]
Toolkit offers new ideas for preventing hospital falls
Integrating fall-prevention protocols into scheduled rounds, grouping cognitively impaired patients into so-called safety zones and doing post-fall assessments are some new strategies to reduce the number of falls for hospital patients. The ideas are part of a recently released Agency for Healthcare Research and Quality toolkit aimed at cutting the estimated 700,000 patient falls that happen in hospitals each year. Since 2008, the Centers for Medicare & Medicaid Services has denied hospitals payment for complications due to a fall or trauma in the hospital that results in fractures, burns or other serious injuries. Despite the financial incentive, progress in preventing falls has not been easy, experts say. Setting a goal of zero falls is probably unrealistic, they added, given that hospitalized patients often need treatments that may make them unstable on their feet, and yet they need to be mobile to prevent bed-rest complications such as de-conditioning, pressure ulcers, aspiratio [Read more]
Ways EHRs can lead to unintended safety problems
In spring 2012, a surgeon tried to electronically access a patient’s radiology study in the operating room but the computer would show only a blue screen. The patient’s time under anesthesia was extended while OR staff struggled to get the display to function properly. That is just one example of 171 health information technology-related problems reported during a nine-week period to the ECRI Institute PSO, a patient safety organization in Plymouth Meeting, Pa., that works with health systems and hospital associations in Kentucky, Michigan, Ohio, Tennessee and elsewhere to analyze and prevent adverse events. Eight of the incidents reported involved patient harm, and three may have contributed to patient deaths, said the institute’s 48-page report, first made privately available to the PSO’s members and partners in December 2012. The report, shared with American Medical News in February, highlights how the health IT systems meant to make care safer and more efficient can s [Read more]
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