New Medicare rules designed to reduce waste and fraud in medical-equipment reimbursements are driving some home-oxygen suppliers out of business and leaving patients scrambling to find new providers. The new payment rules, effective Jan. 1, affect the more than one million people who rely on Medicare to pay for oxygen services, which relieve the symptoms of conditions, such as emphysema and chronic obstructive pulmonary disease. Under the new rules, Medicare pays suppliers at the prevailing rate—an average of $200 a month, paid 80% by Medicare, 20% by patients—for the first three years after a patient begins coverage. Suppliers are then required to continue providing oxygen services to patients for an additional two years, but at a sharply reduced payment rate. After that, patients are entitled to receive new equipment, and Medicare will resume paying suppliers at the higher rate.
A jury awarded $28 million in punitive damages in Pennsylvania state court to a plaintiff who claimed her use of Pfizer Inc.'s hormone-therapy drugs caused breast cancer. The jury had awarded $6.3 million in compensatory damages to the plaintiff, Donna Kendall, of Decatur, IL. The jury found that Pfizer units had engaged in a pattern of willful and reckless conduct. Wyeth was the primary seller of hormone-therapy drugs, and Pfizer recently acquired the company. A separate Pfizer unit, Upjohn, was a defendant in the case.
A new Novartis AG vaccine plant in North Carolina is supposed to boost the U.S.' ability to fight pandemics like the current swine-flu virus. But despite a ribbon-cutting Tuesday, it won't be pumping out flu shots for at least another two years. Nor will the plant's cutting-edge technology do much to solve one of the biggest problems vaccine makers have faced in churning out this year's swine-flu vaccine: a slow-growing virus. High-speed techniques that bypass the lengthy and onerous process of incubating viruses to make vaccine are years away. After more than five years and about $2 billion in government spending, the U.S. is still struggling to modernize and speed up production of vaccinations against deadly pandemics like swine flu. The system is undermined by a lack of manufacturing plants and by decades-old technology that takes six to nine months to make flu vaccine.
In a news conference on Tuesday aimed at pressuring swing-vote senators, leaders of the National Farmers Union, which represents about 250,000 farm and ranch families, stressed the importance of major healthcare legislation to agricultural workers in Arkansas, Maine, and Nebraska. Those states, of course, were carefully chosen. Senator Blanche Lincoln, Democrat of Arkansas and chairwoman of the Agriculture Committee, voted on Saturday to move forward with debate on the healthcare bill. But she has threatened to oppose it if big changes are not made. Lincoln has voiced particular concern over a proposed government-run health insurance plan, or public option, that would compete with private insurers.
Despite pleas from the White House, some Democratic activists are gearing up for a renewed onslaught against ... Democrats. Democracy for America, the liberal grassroots political action committee founded by Howard Dean, the former chairman of the Democratic National Committee and governor of Vermont, is appealing for money to continue its campaign against what it calls "Insurance Industry Democrats." They include Senators Blanche Lincoln of Arkansas and Ben Nelson of Nebraska. The two joined a party-line vote Saturday to allow the Senate to begin debating healthcare legislation. But they have vowed to oppose one of its key elements—the creation of a government-run insurance plan, known as a public option, to compete with private insurers.
If the Senate were going to write a new rule for Medicare payments meant to slow the growth of medical costs, you might think that the rule would apply to hospitals and doctors. A fair amount of medical care is, after all, provided by hospitals and doctors. But the Senate's health reform bill exempts hospitals from just such a rule until 2019. Doctors, meanwhile, are likely to be effectively exempt, the Congressional Budget Office says. And come 2019, a separate part of the rule will change, making the entire thing mostly moot. This odd situation is just one of the opportunities that awaits those senators who don't yet seem to have a firm position on health reform.
In the campaign to broaden support for the overhaul of American healthcare, few arguments have packed as much rhetorical punch as the there-but-for-the-grace-of-God notion that average families, through no fault of their own, are going bankrupt because of medical debt. The health reform legislation moving through Congress would attack the problem in numerous ways.
Canadian doctors have been advised not to use a batch of 170,000 doses of swine flu vaccine while authorities investigate reports of allergic reactions among recipients, drug maker GlaxoSmithKline PLC said Tuesday. Authorities routinely monitor vaccines for any signals of problems, such as the allergic reactions that do occur, rarely, every year. Company spokeswoman Gwenan White said that GlaxoSmithKline advised medical staff in Canada last week to refrain from using one batch of the vaccine while they look into reports that that it might have caused more allergic reactions than normal. GlaxoSmithKline, the world's second largest drug maker by revenue, is only investigating the one batch of its swine flu vaccine in Canada. White said no other doses of its swine flu vaccine around the world are affected.
Many facilities across the nation are investing in state-of-the art technology that allows students and staff members to gain real life experience without the fear of killing a patient.
The high-tech mannequin, Sim Man 3G, costs roughly $27,000, but can cost up to $60,000 with additional accessories and programs available for download onto the mannequin. Even though many facilities have been forced to cut back on their programs and spending, the price of Sim Man 3G has not deterred facilities from purchasing the state-of-the-art technology.
Many facilities who have purchased the technology have received grants from organizations, such as the U.S. Department of Education, the RGK Foundation, and the Robert Wood Johnson Foundation, to help fund the simulation training.
The University of Phoenix recently introduced its new, state-of-the-art SIM Man 3G "patient" mannequins as part of its new immersive learning-nursing center. The new learning center is part of the LPN and BSN degree programs, and the university plans to integrate it into other nursing degree programs as well.
A recent renovation to the 4,100-square-foot center has combined critical thinking, immersive learning, and the use of simulation training to provide students with the opportunity to learn and develop skills they will need for a future in nursing.
With the help of a grant from the U.S. Department of Education, the Grambling School of Nursing recently purchased the Sim Man 3G. Grambling also purchased a simulation mannequin mother in labor, a young boy, and a newborn baby to go along with the Sim Man 3G mannequin.
In Texas, Central Texas Medical Center in San Marcos is the first of four hospitals in Central Texas to introduce the Sim Man 3G to healthcare employees. They received a grant from the RGK Foundation to establish a mobile simulation education program in conjunction with the F. Marie Hall SimLife Center.
The Sim Man G3 is usually operated by a lab technician or medical professional in a high-tech control room. A fully equipped, simulated-reality hospital room with four beds and patient monitors, a video monitoring system, and an observation and debriefing room for playing back recorded video allow students to gain hands-on experience through simulation training.
The simulation laboratory offers students real-life patient care scenarios and an opportunity to review their work after the simulation has ended. Depending on the facility, there can be a class of nursing students or staff members all working with the mannequin at a time, or a select group of students, with the rest of the class reviewing and watching.
Once the simulation is complete, the students or staff members go into a debriefing room, where they are able to watch a video and listen to recording of the session to see what was done wrong or right.
Cuts in Medicare reimbursements that are likely to be part of any healthcare reform legislation could adversely impact credit ratings for hospitals and health systems across the country, particularly in urban areas, according to new analysis by Moody's Investor Service.
The study noted the conflicting goals of healthcare reform—expanding access to care while simultaneously reducing costs—could have significant negative implications for many high-cost urban hospitals, even if the number of insured patients increases.
"Attempts to minimize variation in healthcare costs among regions are almost certainly going to involve cuts in Medicare reimbursements to high-cost providers, which could result in rating downgrades similar to actions taken a decade ago, following the Balanced Budget Act of 1997," according to Moody's report.
Citing data from the Dartmouth Atlas of Healthcare, which monitors medical practices and costs in 306 Hospital Referral Regions (HHR) across the nation, Moody's noted huge variations in hospital pricing from region to region, ranging from $5,300 per Medicare enrollee to more than $16,000 in 2006.
Moody's rates more than 50 hospitals or health systems, and noted that all but one of the 17 highest HHRs are in urban markets. "There are many reasons why healthcare in urban areas can be more costly: high cost of living; elevated poverty and unemployment; diverse populations with diverse healthcare needs; presence of high cost academic research hospitals," the report noted.
Moody's wrote hospitals that are best positioned to withstand large Medicare cuts in high-cost regions will be part of multi-state systems that can rely on broader economies of scale and import cost-efficiencies from beyond their region, and those hospital systems that can gain the most new paying patients that are newly covered by health insurance.
Conversely, the most vulnerable hospitals will be those stand-alone hospitals that are dependent upon high-cost referral practices and that don't gain many new paying patients.
"The sharp regional cost differences across the U.S. highlight the local nature of healthcare markets. Unlike many industries, including higher education, which have a national customer base, hospitals typically draw more than 90% of their patients from within 50 miles of the hospital. When referrals, practices, and/or reimbursement patterns emerge within a community, they tend to stay entrenched locally because little competition exists from providers outside the region," the report noted.
