A California bill reforming the way Medi-Cal, the state's Medicaid program, funds nursing homes appeared to be headed for passage as the state's legislative session came to a close late last week. The bill, which passed the state Senate easily and awaited Assembly action, would base payments on staffing costs and care provided instead of giving the facilities a flat fee per resident. It also calls for nursing homes to pay a tax, which would likely give the state access to up to $250 million in federal matching funds. The matching funds provision needs CMS approval. Under the bill's current language, continuing-care and multilevel retirement communities would be exempt from the tax because they have the fewest number of Medi-Cal enrollees compared with other long-term-care facilities. The CMS has approved exemptions for continuing-care retirement communities in North Carolina and Oregon but hasn't exempted multilevel retirement communities, said Jack Christy, policy director of California Association of Homes and Services for the Aging, which fought for the exemptions in the bill.
Pennsylvanians prefer specialty
Nearly one-fifth-19%-of Pennsylvania patients are choosing free-standing surgery and diagnostic centers over hospitals, according to a new study by the Pennsylvania Health Care Cost Containment Council, an independent state agency. From July 2003 to May 2004, 48 new ambulatory surgery centers opened in Pennsylvania, bringing the total to 161. From fiscal 2001 to 2003, patient visits to surgery centers increased 80% to 501,781 from 279,335. The surgery centers are profitable, too, with the average operating margin increasing to 16% in fiscal 2003 from 12% in fiscal 2002, according to the report.
Doctors' behavior disruptive
Almost one-third of physician executives say serious problems with disruptive behavior by doctors erupt in their organization on either a monthly or a weekly basis, a pattern that underscores a growing concern within the profession, according to a new national survey. "The stress of our jobs is increasing due to the decrease in reimbursement for professional activities, increasing regulatory requirements and severe financial constraints placed upon hospitals," said one of 1,627 physician executives who responded to the survey, conducted by the American College of Physician Executives. The study's authors said executives must take firm disciplinary measures against disruptive or abusive doctors, coach physicians on appropriate behavior and mediate problems between doctors, nurses and other staff.
Anthem to work on Dirigo Health
Maine Gov. John Baldacci announced that Indianapolis-based Anthem Blue Cross and Blue Shield will be the state's partner in carrying out Dirigo Health, a public-private partnership designed to cover some 130,000 state residents by 2009. Under DirigoChoice-the plan Anthem will administer after being the only company to submit a bid-individuals and families with incomes below certain levels qualify for discounts, reduced deductibles and maximum out-of-pocket costs.