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Healthcare Business News

Regional News/Northeast: Children's care often result of doc preference, capacity, study shows and other news

By Andis Robeznieks and Paul Demko
Posted: December 14, 2013 - 12:01 am ET

Variations in physician services, hospitalizations, surgeries, imaging and prescriptions in three New England states suggest that the medical care children receive is often the result of the preferences and capacity of hospitals and physicians rather than patient need, according to an analysis by the Dartmouth Atlas Project.

Researchers examined claims data generated in Maine, New Hampshire and Vermont between 2007 and 2010 from an all-payer data set for patients younger than 18 years old.

Children in Dover, N.H., had close to twice as many emergency department visits as those in Burlington, Vt.; more than twice as many children in Lebanon, N.H., had their tonsils taken out as those in Bangor, Maine; and similar variances were found in the rates for computerized tomography, or CT, scans across the region.

“The authors of the study raise challenging questions and there is a lot of detail in the study that deserves further attention,” said Dr. John Bancroft, chief of pediatrics at Maine Medical Center in Portland.

Follow Andis Robeznieks on Twitter: @MHARobeznieks

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UnitedHealthcare stopped from ending contracts with Conn. docs

Connecticut is becoming ground zero in the national backlash against health insurers that are winnowing the provider networks for their Medicare Advantage plans.

A federal judge this month issued a preliminary injunction prohibiting UnitedHealthcare—the biggest issuer of Advantage plans in the U.S.—from terminating roughly 2,000 contracts with Connecticut physicians.

“United's argument that it has a unilateral right to terminate participating physicians from participation in the Medicare Advantage plans by 'amendment' of that plan is not supported by the language of the contract or the parties' experience under it,” U.S. District Court Judge Stefan Underhill wrote in his decision.

The ruling could have national implications as UnitedHealthcare and other insurers move to tighten their Advantage networks. The changes come in response to cuts to Medicare Advantage plans—$117 billion over the course of a decade, according to the Congressional Budget Office—that were part of the Patient Protection and Affordable Care Act. Those reductions were designed to bring the costs of the private Medicare program into parity with traditional Medicare.

Connecticut Attorney General George Jepsen has pressed the CMS to scrutinize UnitedHealthcare's actions in his state, and he expressed frustration last week when the agency responded that it has “not found any issues with network adequacy.”

Follow Paul Demko on Twitter: @MHPDemko

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