Medical errors' causes traced
Thousands of medical errors per year are attributable to the mishandling of a few types of drugs, miscommunication among hospital caregivers and misidentification of patients, according to data to be released this week by U.S. Pharmacopeia, a medical-safety advocacy organization. The data validate the Joint Commission on Accreditation of Healthcare Organizations' choice of safety goals and showed where improvements still need to be made, said Diane Cousins, vice president of a research unit of U.S. Pharmacopeia. Among the findings: Nearly 5% of errors were due to misidentification of patients, communication problems among caregivers represented the third leading cause of error and nearly 1,850 errors involved IV infusion pumps. For more in-depth coverage, visit the "Don't Miss" section on the modernhealthcare.com home page
Lower hospital payment urged
The Medicare Payment Advisory Commission issued a preliminary recommendation that hospitals receive a payment increase of 0.4 percentage points below inflation in fiscal 2005. That would amount to a 2.8% increase in payment rates. If adopted, the recommendation, which MedPAC commissioners have yet to formally approve, would pay hospitals less in 2005 than they would receive under current law. Under the Medicare reform bill passed by Congress last month, hospitals that publicly report quality data would receive a full-inflation update in 2005. All hospitals would receive a full-inflation update in 2004. Some analysts said MedPAC has yet to digest the Medicare bill and incorporate its provisions into the recommendation process. MedPAC also estimated the overall Medicare margin for 2002 at 3.2%, down from 4.2% in 2001. Margins will approximate 2.8% in 2004, MedPAC predicted, but the Medicare bill could increase that figure.
IG initiatives pay off
HHS' inspector general's office said its various initiatives saved taxpayers $23 billion in the fiscal year ended Sept. 30, an increase in savings of $1 billion over fiscal 2002. The amount includes $21.6 billion from the implementation of recommendations by the inspector general's office to reduce costs or streamline operations within Medicare, Medicaid and 300 other state and federal programs the agency oversees. Some $988 million of the total was collected from provider settlements and $405 million came from identified overpayments. The office oversaw or conducted 2,643 audits, conducted 60 evaluations of department programs and opened 1,685 criminal cases. It now has more than 2,700 open investigations. During the fiscal year, inspector general investigations led to 576 criminal convictions, 243 civil settlements and the exclusion from Medicare and Medicaid of 3,275 healthcare providers, both individuals and companies.
R.I. ponders quality measure
A healthcare reform package proposed by Rhode Island Lt. Gov. Charles Fogarty would expand current efforts to measure and report hospital quality and perhaps lay the groundwork for increased regulation of health plans' reimbursement to providers. The largest elements of the proposal, however, would be a prescription drug plan for needy residents modeled after a controversial program in Maine and a state-sponsored health plan to help small businesses afford the cost of insuring workers. Like the Maine program, Rx RI would take advantage of state purchasing power to reduce drug prices. In a news release, Fogarty, a Democrat, said, "Overall, (Rhode Island) hospitals are doing extremely well (on quality) when compared to the hospitals nationwide. However, we should strive to meet the standards 100% of the time." The possibility of a "strengthened regulatory role in rate-setting and provider reimbursement for health plans" also should be considered and studied, Fogarty said.
Rehab payment regs delayed
The CMS said it would not implement a new rule governing rehabilitation hospital payments on Jan. 1, 2004, as planned because of time constraints. The agency already should have published the final regulations to fulfill statutory requirements for a January implementation but has yet to do so. A later implementation date has not been set. The CMS proposal, released in September, triggered a firestorm of protest from rehabilitation facilities and lawmakers, who contended it would put many facilities out of business (Nov. 24, p. 12). Under the proposal, a hospital would qualify for Medicare rehabilitation reimbursement if at least 65% of its patients were diagnosed with at least one of 12 medical conditions. Currently, a hospital needs 75% of its patients to have one of 10 qualifying conditions. Industry groups contend that rehabilitation hospitals would suffer under the new regulations because they don't adequately take into account new procedures. Although the Medicare reform bill passed by Congress would delay implementation of the new regulations, the CMS said its decision not to implement them was dictated by publication requirements. The agency has not decided whether to revert to the old regulations.
Mass coverage sought in Mass.
A coalition of providers, consumers and other stakeholders filed a petition to amend the Massachusetts Constitution to mandate universal healthcare coverage. The Committee for Healthcare for Massachusetts, a ballot initiative campaign committee, has collected some 71,000 signatures in support of the amendment, said the committee's co-chair, Barbara Roop. Once certified by the secretary of state, the petition would go to the state Legislature, which would be required to convene a constitutional convention by May 15, 2004. If 25% of legislators approve the petition, it would move to the next legislative session for a second round of approval. If approved there, the amendment would go on the ballot for a public vote in 2006. The proposal does not call for any specific insurance program but would require that a plan be developed to guarantee coverage for state residents. "This will be a long campaign of persuasion," Roop said.