As Congress appears poised, as many on Capitol Hill have been saying lately, "on the verge of a historic moment" with healthcare care reform, it is also preparing to take on the insurance industry over costs and profits—no matter what happens with reform.
Just yesterday, House Speaker Nancy Pelosi (D-CA) in her weekly media briefing, called the announcement that insurer Cigna's profits during the third quarter jumped 92% this year to $329 million "stunning." "That's why we have to hold insurance companies accountable," she said.
She added that several provisions in the House bill (HR 3962) would attempt to address higher insurer profits. They include the amendment to overturn the decades-old McCarran-Ferguson Act addressing antitrust exemptions for the insurance industry and provisions to limit high charges by insurers. For instance, if an insurer's rates pass a designated point, that company would no longer have access to the states' health insurance exchanges.
Similarly, Sen. Thomas Harkin (D-IA), as chairman of the Health, Education, Labor, and Pensions (HELP) Committee, took on insurers on Wednesday concerning their price increases to small businesses. He said a recent survey of state insurance regulators by the National Association of Insurance Commissioners found that average insurance policies will increase between 11% to 16%—and as high as 25% to 30%—annually in most states.
At the hearing, he said, "I would have liked to question health insurance companies about these trends and practices. But not surprisingly, insurance companies are not interested in discussing them.
"Health insurance companies should open their books and explain to the American people why they support a health insurance market for small businesses that is so dysfunctional, and so lacking in transparency," he added.
In response to the insurers' reluctance to appear before the panel, Harkin announced "his own investigation into the pricing practices of health insurance companies that sell policies to small businesses."
He sent letters, with a response deadline of Nov. 17, to the heads of Humana, UnitedHealth Group, WellPoint, and Aetna asking them about how they determined insurance rates for businesses with 50 employees or fewer and medical loss ratios, which are the percentages of consumers' premium dollars that insurance companies spend on medical care.
In other Senate action this week, Sen. Jay Rockefeller (D-WV) challenged the CEO of Cigna to answer the "serious" questions about the way "his company spends consumers' healthcare premium dollars." The questions were based on recent data gathered about medical loss ratio.
In the letter to Cigna, Rockefeller, who is chairman of the Senate Committee on Commerce, Science, and Transportation, said that CIGNA had "failed to accurately account for up to $5 billion worth of health insurance it sold in the commercial group insurance market in 2008."
Rockefeller was especially concerned about individual and small business plans. Rockefeller said "the insurance industry has told Congress and the public that it spends 87 cents out of every premium dollar on healthcare," the actual medical loss ratio in the health insurance industry has appeared to be "significantly lower."
Ensuring the physicians at your hospital hold specialty certifications can be a great marketing tool. It shows patients that your physicians meet national competency standards. The problem is that not all medical specialties offer certification; although new certifications are offered each year.
Child abuse pediatricians are the latest group of practitioners to gain their own certification. The American Board of Medical Specialties (ABMS) approved the new child abuse pediatrics specialty in 2006 and the American Board of Pediatrics (ABP) issued the first certification exams this month. Medical staffs can begin verifying practitioner certification status on the ABP Web site in February 2010.
"Board certification is really necessary in a field like this, not just for the legal reasons, not just so you can go to court and be an expert [witness], because a lot of us were already doing that," says Ann S. Botash, MD, professor of pediatrics at the State University of New York (SUNY) Upstate Medical University and director of the University Hospital's Child Abuse Referral and Evaluation (CARE) program in Syracuse, NY.
Rather, Botash says it's helpful in the medical setting when she's working with other pediatricians who are good practitioners, but don't have the same experience in child abuse treatment that she has. The certification may be a deciding factor in a disagreement between two practitioners, one a specialist and the other a generalist, about a diagnosis of child abuse. It's also a helpful indicator for parents who are looking for a specialist in child abuse treatment.
"If you had a child with a heart murmur, do you want the child to see me, a general pediatrician, or do you want the child with the heart murmur to go see the specialist?" Botash says.
As president of the Helfer Society, an honorary society of physicians specializing in child abuse treatment, Botash has been working toward developing a certification in child abuse pediatrics for years. Although the new certification will not change her privileges because the certification is not procedurally based, the new specialty might someday affect finances.
"It may change how we're able to bill, because I'll be able to bill as an expert," she says. "But that takes longer because the insurance companies have to recognize it. That's the next step."
On the heels of the ABMS certification, the Accreditation Council for Graduate Medical Education (ACGME) is in the final stages of reviewing standards for residency fellowship programs in child abuse pediatrics. ACGME plans to vote on the standards in early 2010.
Emily Berry is an associate editor for Briefings on Credentialing and Credentialing Resource Center Connection, and manages CredentialingResourceCenter.com. You can reach her at eberry@hcpro.com.
A Centers for Disease Control and Prevention official says there's no national evidence so far to suggest that a rare type of methicillin-resistant Staphylococcus aureus, USA600, is more lethal than other MRSA bacteria.
"USA600 strains are an uncommon cause of human infection in the U.S., and we have no evidence to suggest USA600 is any more or less virulent, nor any more or less resistant to antibiotics, than any of the other strains of the bacteria that we encounter," says Brandi Limbago, of the CDC's division of quality promotion.
Limbago was asked to comment on a report last week from Henry Ford Hospital in Detroit in which researchers discovered MRSA bacteria in 80 patients over the last three years. Of the 80, 16 were infected with USA600, one of 12 groupings of MRSA numbered from 100 to 1200. The MRSA type of bacteria is rarely found in hospitals, and was never believed to be much of a threat for patient safety.
But of the 16 patients found to be infected with USA600, 50% died within 30 days. Of the 64 infected with other strains of MRSA, the fatality rate within 30 days was only 11%.
Carol Moore, the researcher who led the study, presented her finding at the Infectious Disease Society's annual meeting in Philadelphia. It caught MRSA experts off guard because previously the bacteria had not been remarkable.
She acknowledges that the study is premature and based on a very small number of patients. But she adds that she wanted to share the finding so the bacteria can be more carefully studied and so health providers can be forewarned.
Paul G. Auwaerter, clinical director of the Division of Infectious Diseases at Johns Hopkins University School of Medicine in Baltimore, and who was on the panel when Moore presented her report, agrees.
"It's too early to tell" if USA600 represents a new threat to patient safety, he says, because the number—16—is too small. "Who knows?" he says. "This may be a signal.
"Detroit tends to be a place where they have an intensive drug using population—and although it wasn't clear whether these patients had been intravenous drug users," he says. "we remembered that in the 1970s, some of the first signs of bad staph aureus came from Detroit.
"This is interesting to point out and it definitely bears more investigation," he says.
The shootings at Fort Hood in Texas severely taxed local hospitals as they struggled to cope with the flood of victims, and left them scrambling for blood donations as the casualties came into their emergency rooms. Victims were sent as far away as Scott & White Memorial Hospital in Temple, about 30 miles away, since it has the only Level 1 trauma center in central Texas, so designated because it is capable of handling the most serious injuries. The hospital reported receiving 10 shooting victims from Fort Hood, and called for blood donations to keep up with the demands of treating all the wounded. The hospital closed to the public in the wake of the shootings "as we focus our attention upon the victims and their families and to insure the safety of our patients and staff," a hospital statement said.
An Army psychiatrist facing deployment to one of America's war zones killed 13 people and wounded 30 others on Thursday in a shooting rampage with two handguns at the sprawling Fort Hood Army post in central Texas, military officials said. It was one of the worst mass shootings ever at a military base in the United States. The gunman, who was still alive after being shot four times, was identified by law enforcement authorities as Maj. Nidal Malik Hasan, 39, who had been in the service since 1995. Major Hasan was about to be deployed to Iraq or Afghanistan, said Senator Kay Bailey Hutchison, Republican of Texas. The victims, nearly all military personnel but including two civilians, were cut down in clusters, the officials said. Witnesses told military investigators that medics working at the center tore open the clothing of the dead and wounded to get at the wounds and administer first aid.
Kaiser Permanente unveiled plans for a $10-million medical office building that will offer primary care, some specialty care and other services to 80,000 South Los Angeles residents who are members of Kaiser's healthcare plan. Kaiser's 15,000-square-foot South Los Angeles medical offices are expected to open in 2011. A vacant building on the site will be torn down to make way for the new facility and construction is scheduled to begin soon. In recent years, a series of public and private hospitals across South Los Angeles have closed or been scaled back, compounding what civic leaders call South L.A.'s inadequate access to healthcare. About 80,000 of the 3.3 million Kaiser members in Southern California live in South L.A.
Police and health officials say a refrigerated truck carrying H1N1 vaccine has been recovered after being stolen from outside a swine flu clinic in Milwaukee. Health operators officer Raquel Filmanowicz of the city's health department said the truck was taken from the Sarah Scott Middle School after a clinic there closed Thursday. Filmanowicz said she doesn't know how much vaccine was in the truck, but that it was "compromised" in the theft and can no longer be administered. She doesn't know if the thieves were aware the truck contained H1N1 vaccine.
The AARP, the nation's largest and most influential association of older Americans, endorsed the House healthcare bill Thursday morning and vowed to lobby House members in advance of Saturday's historic vote. AARP Vice President Nancy A. LeaMond said the House package, which would spend more than $1 trillion over the next decade to expand insurance coverage to millions of Americans who lack it, meets the group's chief goals for reform, including strengthening Medicare. LeaMond praised House leaders for including a plan to close the coverage gap in Medicare prescription drug coverage known as the donut hole.
House Democratic leaders were struggling Thursday to contain uprisings on the hot-button issues of abortion and immigration that have left them little margin for error as they attempt to push through a massive healthcare reform bill this weekend. Although confident of victory, House Speaker Nancy Pelosi and other Democratic leaders were working to limit defections to the roughly 25 Democrats viewed as "hard no" votes. For party leaders, setting a weekend deadline for passage represented a calculated risk, one that could backfire if the vote—now expected late Saturday or Sunday—fails or must be delayed. But they feared that if members were given more time to consider the legislation, new issues could arise, particularly as lawmakers digest the results from Tuesday's elections.
Democratic Sen. Mary Landrieu says she generally backs President Barack Obama's healthcare overhaul efforts. But she'd like to see a few items in the bill before voting for it. As Democratic leaders enter the intensive phase of their drive to pass health legislation, they must satisfy 60 Mary Landrieus in the Senate—every Democrat and the two Democratic-friendly independents, each with individual priorities—as they try to hold together a fragile coalition with no room for error. And that has only become more complicated as Democrats from conservative states puzzle over what to make of Republican victories Tuesday in governor's races in Virginia and New Jersey.
