Some economists say a big reason for skyrocketing healthcare costs is pricey, perhaps unnecessary, and potentially dangerous tests. The problem has the potential to worsen when physicians who prescribe the tests profit from them, they say. These concerns prompted Congress to pass the Stark law barring such arrangements, but physicians are finding increasingly creative ways to get around the law. Because some clinics decline to care for patients in federal programs, they are not covered by the Stark law, for example. But some physicians may be taking advantage: Data show that MRI referrals were 50% higher and CT scan referrals were 30% higher among doctors who held a financial stake in the imaging equipment or the imaging centers to which they sent patients.
Mercy Health System has admitted that it financially backed zoning challenges by two neighborhood residents to Albert Einstein Healthcare Network's hospital project in Montgomery County, PA. Mercy Suburban Hospital is about two miles away from the proposed $300 million, 192-bed facility that Einstein and Montgomery Hospital want to build. Einstein recently filed an emergency motion seeking the power to question lawyers and their clients about the role of a lobbying firm that lists several hospitals, including Mercy, as clients.
The major goal of the new Medicare law was to block a scheduled cut in fees paid to doctors, but there's also plenty in the law that directly affects Medicare patients. Participants in Medicare will have lower out-of-pocket costs for mental-health services, and some widely used anti-anxiety and sleep drugs that Medicare previously didn't pay for will be covered. The law also aims to boost preventive healthcare, including making it easier and cheaper for new Medicare participants to get a physical checkup. But there also are cutbacks.
California officials have renewed efforts to cut payments to pharmacies for prescription drugs to millions of low-income Medi-Cal patients after a federal appeals court put a 10% rate reduction on hold. A separate lawsuit is pending against 10% cuts in state Medi-Cal reimbursements to doctors and dentists, which remain in place. The Legislature authorized the 10% reductions in February for all Medi-Cal healthcare providers, effective July 1.
Democratic lawmakers say that the Bush administration is considering a new federal rule that would withhold government funding from healthcare providers and organizations that refuse to hire workers who won't perform abortions or provide emergency contraception. Federal law already prohibits discriminating against any individual or institution that refuses to perform abortions or provide a referral for one, but the problem is that the document defines abortion as including the administration of certain contraceptives, lawmakers say.
Nearly 18 million people nationwide buy their own insurance because they're self-employed, are students or have jobs that don't offer coverage. The so-called individual health insurance market works well for some, but it is fraught with complexities for many others.
Unlike group plans offered by employers, there is no guarantee in most states that individuals can get insurance. Even if they can, their policies may not cover existing medical conditions. But fixing the problems in the individual market could go a long way toward expanding health coverage in America.
Officials with Atlanta's Grady Memorial Hospital may seal a separation agreement with their embattled CEO on the same day they expect to name a new chief executive. News that Grady is close to a deal with CEO Pam Stephenson comes days after a top Grady official said negotiations had bogged down. There has been controversy over Stephenson's two-year, $600,000-a-year contract, which some officials called a secret sweetheart deal. Several state and local officials have taken exception to the prospect she could receive a severance package worth $750,000, a provision that has been a major sticking point in negotiating her departure.
A nationwide network to collect data on blood transfusion and recipient outcomes will include four metro Atlanta hospitals at its launch. Proponents of the network say that analysis of the data will help ensure patient and donor safety, as well as lower healthcare costs. A deeper data pool would also help the network find trends and recommend treatments to reduce disease and mortality rates for patients and donors, they added.
Inflation is racing through the economy at a pace not seen in years, and medical manufacturers, distributors, and hospitals all are coping with rising prices. From the thousands of gloves used each day to plastic bed pans, blood bags, syringes, and tubing used for delivering medications to patients, prices for many everyday medical products are rising because they rely on petroleum. Now healthcare companies are making crucial decisions about whether to raise customer prices or hang tough and eat the higher costs to protect relationships or fend off competitors.
A state task force is examining why the use of hospital emergency rooms in Maine is significantly higher than the national average. Unnecessary use of emergency room services drives up healthcare spending in the state, and a number of hospitals are seeking approval to expand their emergency departments, said Maine officials.
