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More details emerge on insurance tax credits and other reform standards
Washington -- The Dept. of Health and Human Services in August released three proposed rules addressing the enrollment of an estimated 30 million Americans in Medicaid and private health insurance through health insurance exchanges beginning in 2014. The three rules -- co-written by the Depts. of Treasury and Labor -- seek to implement a one-stop process to determine eligibility and enrollment for Medicaid and the Children's Health Insurance Program, and for tax credits to help purchase health insurance. "We are working with states to build a system where the responses will be immediate," said HHS Secretary Kathleen Sebelius. The enrollment systems will rely on electronic databases, including access to the most recent tax returns available to determine whether applicants will be eligible for government assistance. Applicants will provide a single set of information to determine eligibility for Medicaid, CHIP and the tax credits. The health system reform law provides for insura [Read more]
Training helps surgical residents improve some communication skills
With some training, surgical residents can improve the quality of information they communicate to patients about a specific condition, such as prostate cancer. But the training doesn't improve more general communication skills, such as empathy, says a study in the August Archives of Surgery. The study focused on 44 University of Connecticut School of Medicine general surgery residents who participated in a three-part interactive program. The program featured learning principles of patient communication, role-playing, and hearing a surgeon's experience as a physician, patient and patient's spouse. Before the training, residents scored a median 65% on a checklist of items they needed to cover with patients, including explaining what type of cancer the patient has, asking about the patient's emotions and discussing treatment. After training, the median score for what the study called case-specific communication skills jumped to 84%. But improvement was not seen in general communi [Read more]
Informal peer review records shielded from medical liability plaintiffs
An Idaho Supreme Court ruling affirmed that peer review-related records deserve broad protections from discovery in medical liability claims. That privilege applies not only to documents created within the formal peer review process, but also those generated informally for the purpose of sparking such a review and improving patient care, the high court said in a July 11 opinion in Nightengale v. Timmel. The decision is significant in that it confirms the peer review statute's reach beyond the four walls of a hospital, said Ron Hodge, associate director and legal counsel of the Idaho Medical Assn. The association was not involved in the case. The law was intended to encourage physicians to speak freely about shortfalls in patient care to improve quality and therefore "is extremely broad in what it sweeps into the material in the peer review process," Hodge said. "Without that immunity and confidentiality, physicians would be reticent to participate in the process and share crit [Read more]
CBO report links debt reduction to Medicare pay cuts
Washington -- The nation's debt as a share of the economy could be reduced several percentage points by 2021, but only if Congress allows a number of current-law policies to take effect, including a 29.5% Medicare physician pay cut in 2012. The U.S. will run a fiscal year 2011 deficit of nearly $1.3 trillion -- the third-largest shortfall of the last 65 years. Only the 2009 and 2010 deficits were larger, according to an update of the Congressional Budget Office's budget and economic outlook published on Aug. 24. The federal fiscal year ends on Sept. 30. During the next decade, CBO expects annual federal deficits to shrink beginning in 2013, thanks in part to the recently enacted Budget Control Act. The law increased the nation's statutory debt ceiling by at least $2.1 trillion but offset the increase with an equal amount in spending cuts, including at least $1.2 trillion that must be identified by Nov. 23 by the new Joint Select Committee on Deficit Reduction. Under these and oth [Read more]
ADHD rises 32% among children and teens
The number of U.S. children ages 5 to 17 diagnosed with attention-deficit/hyperactivity disorder climbed about 32% during the past decade, a Centers for Disease Control and Prevention report shows. Nearly 1 in 10 children (about 4.7 million) had the disorder in 2007-09, according to the report issued Aug. 18 by the National Center for Health Statistics. The figure went from 7% in 1998-2000 to 9% in 2007-09. The rise probably is due to the public's increased awareness of the disorder and greater familiarity among physicians about how to diagnose it, said pediatrician and lead study author Lara J. Akinbami, MD. "It doesn't really matter why the prevalence is increasing," she said. "The fact is there is a greater demand being placed on education and health care resources" because of the rise in ADHD rates. Patients with the neurobehavioral disorder often need more monitoring by primary care physicians than individuals without ADHD, due to the medication taken to reduce symptom [Read more]
Elected coroners report fewer suicides than appointed counterparts
More than 1,500 counties in America elect their coroners, and that voting may play a role in their decisions on whether to classify deaths as suicides. Elected coroners report about 13% fewer suicides than appointed medical examiners, even after controlling for other factors that affect suicide rates, according to a study presented in August at the American Sociological Assn.'s annual meeting. Because people who commit suicide usually do not leave notes or other explanations for their actions, it is often left to coroners to determine based on the evidence available whether a death is due to suicide, accident or some other cause. A lot rides on the decision, as many families and survivors fear the stigma associated with suicide or may lose out on insurance benefits if the death is ruled a suicide. "Elected coroners would feel pressure because they are elected by the public at large and would be worried about antagonizing local community stakeholders who might badmouth them," s [Read more]
Texas certificate-of-merit law ruled constitutional
Texas' certificate-of-merit law withstood another constitutional test after an appeals court validated the requirement for plaintiffs to file an expert report confirming the merits of a medical liability case. The 5th District Court of Appeals rejected arguments that the legislation amounted to an unconstitutional special law that treated medical liability lawsuits differently from other cases. Nor does a provision subjecting plaintiffs who file a deficient report to financial penalties violate the constitutional separation powers, the court said. Judges still have discretion to determine the amount of monetary sanctions and whether plaintiffs made a good-faith effort to pursue a case. The expert report requirement "rationally relates to the interest of the state to prevent medical practitioners from defending frivolous claims at a high cost to the health care system," states the Aug. 12 opinion, which reinforced past decisions on the statute. The ruling is a victory for ph [Read more]
$1 billion spent to fight Medicare fraud in 2010
Washington -- The Medicare program spent $1 billion fighting fraud and ensuring the accuracy of payments for health care services in 2010, according to a new government study. The Centers for Medicare & Medicaid Services has expanded its anti-fraud efforts after receiving increased funding from Congress and reallocating money saved from Medicare contractor consolidations since 2006, according to a Government Accountability Office report released Aug. 29. Operations include more oversight of Medicare private insurers and drug plans, and benefit integrity activities. The health system reform law also provided CMS with an additional $350 million for fraud and abuse control efforts, the GAO said. "Curbing waste and fraud, including the tens of billions of dollars in Medicare improper payments, is a big job, and we need the right tools in place to make progress," Sen. Tom Carper (D, Del.) said in a statement on the GAO report. "Moreover, government must embrace a culture of thrift [Read more]
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