Hospitals, already adjusting to $1.6 billion in cost-cutting changes to Illinois' Medicaid system, are fighting what they call an extreme new emergency rule. Under the new rule, if a Medicaid patient incurs an infection or other hospital-acquired condition during the course of a hospital stay, say, for appendicitis, the state will not pay for treating the infection or the appendicitis. The new rule goes far beyond federal regulations, industry standards, and legislators' intent when they passed Illinois' Medicaid reform laws in May, hospital officials say.
Four years ago, a group called the Ohio Perinatal Quality Collaborative brought together 20 hospitals across the state to try and address the issue of scheduling deliveries early when there is no medical need. All the hospitals were asked to collect information on scheduled births and to submit it to a common database, so the hospitals could compare their performance to the others. During the first four months of the study, for instance, there were 145 more unnecessary deliveries scheduled than during the last four months of the study. This translated to a steady drop in these births from about seven percent of all deliveries at the beginning of the study to about three percent at the end.
Nearly 2 million Californians will receive $73.9 million in rebates from health insurers as part of the federal healthcare law, according to state officials. Insurers notified government regulators in June of how much they owed customers in rebates or premium credits because they didn't spend at least 80% or more of 2011 premiums on medical care. The minimum threshold is 85% for employers with more than 51 workers. Figures released Tuesday mark the final tally for California; insurers must issue refunds by Wednesday. Many employers and consumers have already received letters informing them of their rebate amount. The average rebate is $65 per family, according to the state insurance department.
Spending on a disease like cancer tends to follow a particular pattern. There are high initial costs as the cancer is treated, and then, if all goes well, these costs taper off. For a patient with a fatal version of the disease, though, the cost curve is U-shaped, rising again toward the end—to an average of sixty-three thousand dollars during the last six months of life with an incurable breast cancer. Our medical system is excellent at trying to stave off death with eight-thousand-dollar-a-month chemotherapy, three-thousand-dollar-a-day intensive care, five-thousand-dollar-an-hour surgery. But, ultimately, death comes, and no one is good at knowing when to stop.
Jim Kuhn can be kept alive by a $90,000 heart pump, but his doctors and family say hospitals won't take his case because he has run out of Medicare days. For the past seven months, Kuhn, 53, has been in intensive care in a West Palm Beach hospital with a failing heart. But a combination of little-known Medicare limitations, hospital requirements and, most recently, uncertainty over Kuhn's ability to endure the surgery have amounted to a life-or-death situation for the former truck driver. As Kuhn waits in a hospital bed, his family hopes his condition will stabilize while they and senators, including Miami's Marco Rubio, search for a way to get him the help he needs.
What patients endure, it turns out, borders occasionally on deafening. A study this year from the University of Chicago found that average noise levels in a hospital room easily exceeded the 30 decibels, slightly louder than a whisper, recommended by the World Health Organization, and peak noise levels sometimes approached the level of a chain saw. Not surprisingly, patients in the loudest rooms suffered most, losing as much as an hour or more of sleep a night compared with those in the quietest rooms. And for every hour of sleep lost, the patients' blood pressure increased by as much as six points.