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States embracing Medicaid managed care
Washington -- A nationwide survey of Medicaid managed care programs found that access to care under the plans is a perceived problem but that many states use managed care as a vehicle to coordinate care. Managed care includes Medicaid primary care case management programs and comprehensive and single-benefit Medicaid health plans, both nonprofit and for-profit. Of Medicaid's 54 million beneficiaries in 2010, half were enrolled in a managed care plan. An additonal 16% were in a primary care case management program, and the remaining 34% were in Medicaid fee-for-service, according to the survey, released Sept. 13 by the Kaiser Family Foundation and Health Management Associates, a research and consulting firm. The report is based on information valid as of October 2010. Medicaid directors said managed care is an attractive option because it enables states to improve accountability and restructure the delivery system to ensure access and measure quality better, said Vernon Smith, PhD [Read more]
Demand drives more hospitals to offer alternative therapies
The number of hospitals offering complementary and alternative medical services has tripled since 2000, driven principally by patient demand for low-risk therapies such as massage, guided imagery, meditation and the "healing touch" practice known as Reiki. Forty-two percent of the 714 hospitals surveyed said they provide unconventional therapies, and executives listed patient demand as the top criterion in choosing which therapies to offer, according to a report released in September by the American Hospital Assn.'s Health Forum and the Samueli Institute, a think tank that supports alternative medicine. In 2000, just 14% of hospitals told AHA researchers that they provided complementary therapies. "They are responding to the needs of their patients and the communities they are serving, while trying to differentiate themselves in the marketplace," said Sita Ananth, a Samueli Institute researcher who wrote the report. "These hospitals are really trying to see how they can address t [Read more]
Delaware Blues fined for denying cardiac tests
Delaware's insurance commissioner has fined the state's Blues plan $325,000 over what the commissioner deemed inappropriate denials of nuclear cardiac imaging tests. Blue Cross Blue Shield of Delaware "acknowledged deficiencies in claims handling" but denied violating state law. It agreed to pay the fine and spend an additional $300,000 over three years on a program developed by the American College of Cardiology to guide the appropriate use of advanced cardiac imaging tests. The news was welcomed by the ACC, which credited its Delaware chapter with helping to broker the agreement. "We hope Delaware will be a model for managing medical costs by focusing on patient-centered decision making and quality care," ACC Chief Executive Officer Jack Lewin, MD, said in a statement. "More importantly, we hope this proactive solution will prevent future cardiovascular patients from being denied the right care at the right time." The ACC program, called FOCUS, for Formation of Optimal Ca [Read more]
Medicare sign-up question about accepting new patients becomes optional
Washington -- The agency overseeing the Medicare program will not require physicians to report whether they are accepting new Medicare patients or providing advanced imaging care. The change comes after the American Medical Association wrote the Centers for Medicare & Medicaid Services about two new mandatory questions added to the program's enrollment applications in July. One question on paper and online versions of the application asks physicians, "Do you accept new Medicare patients?" Another question found only on the Web-based application asked, "Are you, or will you be, providing advanced diagnostic imaging services?" "Committing to make these fields optional is an important step to help alleviate some of the challenges physicians face during the enrollment process, and we will continue to monitor the forms to ensure the action is completed," AMA President Peter W. Carmel, MD, said in a statement. In an Aug. 4 letter, the AMA asked CMS to remove both questions from the [Read more]
Request by Texas to broaden Medicaid managed care on track
Federal health officials have given a tentative thumbs-up to a request by Texas to expand risk-based Medicaid managed care to 28 counties in rural parts of the state. But the Texas Medical Assn. is concerned that the state will not provide managed care plans enough resources to ensure that Medicaid enrollees have adequate access to care. Final federal approval for the waiver could arrive at any time, according to a Sept. 14 letter to Texas' Medicaid agency from Cindy Mann, director of the Center for Medicaid, CHIP and Survey & Certification at the Centers for Medicare & Medicaid Services. CMS and the state still were working on a formula to reinvest any savings from managed care into delivery system reforms, among other items. "We commit to doing whatever we can to expedite the process," Mann wrote. Texas Medicaid covers more than 3 million people, 1.9 million of whom already are in risk-based managed care. The waiver expansion would shift nearly all of the remaining 1.1 milli [Read more]
IOM spells out antibiotics strategy in an anthrax attack
To prepare for a potential wide-scale anthrax attack, state and local health officials should determine how antibiotics should best be stored in their communities. One approach may be to dispense antibiotics to first responders, physicians and other health workers, said a Sept. 30 report by the Institute of Medicine. They would store antibiotics and distribute them to patients when appropriate. This strategy may be beneficial for those who cannot travel to distribution points to receive antibiotics because of a medical condition. Such prepositioning strategies may provide antibiotics more quickly and efficiently. Prepositioning refers to the storage of medical countermeasures, such as antibiotics, close to or in the possession of people who need rapid access. This could include local stockpiles, workplace caches and home storage. "Delivering antibiotics effectively following an anthrax attack is a tremendous public health challenge," said emergency physician Robert Bass, MD, c [Read more]
Heart attacks can occur in women whose angiograms show open arteries
Physicians should not overlook myocardial infarction as a diagnosis for female patients with symptoms but who show no signs of obstructive coronary artery disease on an angiogram, a study says. The study, published online Sept. 26 in Circulation, found that a rupture or ulceration of cholesterol plaque in a coronary artery is common among these patients. The plaque disruption can lead to the blockage of an artery and cause a heart attack, the study authors said. By the time an angiogram is performed, however, the blood clot can break up, leaving the appearance of a normal or near-normal artery. These women "often are not treated for [myocardial infarction] and are often told that they did not have [a heart attack] based on the finding of open arteries in the angiogram," said lead study author Harmony R. Reynolds, MD. "Primary care physicians need to know that if a patient presents with myocardial infarction and has open arteries, that's still a myocardial infarction, and they [Read more]
Physician shortage in Massachusetts continues to squeeze primary care
Massachusetts is facing severe or critical shortages of doctors in eight specialties, including a deficiency of primary care physicians for the sixth year, a survey shows. Internal medicine, psychiatry and urology are seeing critical shortages, according to the 2011 Massachusetts Medical Society's "Physician Workforce Study," released in September. Dermatology, family medicine, general surgery, neurosurgery and orthopedics are seeing severe shortages, according to the 10th annual MMS report, which evaluated 18 specialties. Researchers surveyed practicing physicians, residents and fellows across the state. Neurosurgery is the only specialty new to the shortage list this year. However, three specialties on the list in 2010 did not make it this year: emergency medicine, neurology and vascular surgery. MMS President Lynda M. Young, MD, said a long-term goal is to have more physicians enter primary care. Doctors and others are working toward that goal in various ways. For example, [Read more]
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