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Washington state suspends Medicaid emergency department limits

Washington state emergency physicians are claiming a victory with the governor’s decision to suspend a zero-tolerance Medicaid emergency department payment policy that was scheduled to kick in on April 1. The American College of Emergency Physicians praised Gov. Chris Gregoire for putting a hold on the implementation of the policy, which would have denied Medicaid payment for ED care given to patients diagnosed with one of about 500 conditions deemed by the state to be non-urgent. State legislators approved the limits as a way to cut down on paying EDs for care that patients should be receiving in physician offices or other less costly settings. ACEP and its state chapter warned that the exclusion list was too broad and would apply to many patients who legitimately believed they were dealing with emergency situations when they showed up at EDs. A prohibition on paying for the treatment of sprains in the ED, for instance, would affect Medicaid patients who needed to rule out the ...

CMS rules contribute to drug shortages, hospital pharmacists say

Federal guidance requiring strict adherence to manufacturer labels for inject-able drugs has forced hospitals to throw away perfectly good drugs that are in short supply, according to a survey of pharmacy directors and managers. The Institute for Safe Medication Practices, based in Horsham, Pa., has called on the Centers for Medicare & Medicaid Services to review its policies involving stability and beyond-use dating of medicines. The institute surveyed 715 hospital pharmacists and managers who reported that following manufacturer directions has contributed to national drug shortages. CMS requires pharmacists to be compliant with Food and Drug Administration-approved labels to avoid the use of expired drugs. But pharmacists who were surveyed said some labels are not current and that newer, evidence-based research supports a longer shelf life in certain circumstances. Those studies have shown that diluted drugs remain stable beyond their stated expiration dates, said Allen J. V ...

Sleeping pills pose added death risk for obese patients

The mortality rate for obese patients who regularly take sleeping pills is nine times higher than the death risk for similar patients who do not use the drugs, said a study presented at an American Heart Assn. scientific meeting in March. Researchers examined the medical records of more than 34,000 patients treated in the Geisinger Health System in Pennsylvania. After controlling for sex, age, smoking status, alcohol use, marital status and ethnicity, the obese patients who took hypnotic medicines regularly — at least 132 pills annually — were 9.3 times likelier to die than patients with similar health who did not. Even obese patients who took 18 pills or fewer annually had a death rate eight times higher. The added risk of sleeping pills for obese patients also applied to drugs such as zolpidem, marketed as Ambien by Sanofi-Aventis, which is thought to be less problematic than older, longer-acting sedatives. Obese patients using zolpidem regularly had an eightfold higher dea ...