The CMS attempt to clarify emergency-care responsibilities of specialty and other hospitals doesnt go far enough to protect patients, said Sen. Chuck Grassley (R-Iowa), ranking member of the Senate Finance Committee. The agency, in guidance issued April 26, said almost all hospitalsincluding specialty hospitals and those without emergency departmentsmust be able to evaluate patients with emergencies, provide initial treatment and refer or transfer patients when appropriate. I appreciate that CMS did something to address a problem plaguing specialty hospitals, but I just dont think its enough, Grassley said. In light of an incident at West Texas Hospital, Abilene, when a patient died after the specialty hospital was unable to provide emergency services, the agency needs to do more than just remind hospitals of their Medicare requirements, Grassley said. The CMS is requesting comment in its fiscal 2008 inpatient prospective payment system rule on whether emergency services requirements should be strengthened.
A $128 million settlement agreement between 23 Blue Cross and Blue Shield plans, the Blue Cross and Blue Shield Association and physicians across the country will, if approved, resolve several class-action lawsuits that had been consolidated into one case pending in the U.S. District Court in Miami. The first lawsuits were filed more than three years ago and dealt with payment and appeal policies, denial and delay of payments, medical guidelines and other concerns. American Medical Association President William Plested said in an AMA news release the settlement resolves contentious business practices that have long frustrated physicians and jeopardized the delivery of quality patient care. But Michael Pope, a spokesman for the settling plans and an attorney with McDermott Will & Emery, noted that this is not an admission that anything said in the complaint is true. Settling plans will also pay court-determined legal fees up to $49 million, according to a news release.
Genetic information no longer could be used to deny someone health insurance or job opportunities under legislation passed by the House. If your grandmother had breast cancer, you shouldnt be denied a job or a promotion, said Rep. Robert Andrews (D-N.J.) before the 420-3 vote on the Genetic Information Nondiscrimination Act. The measure makes it illegal for a health plan or insurer to deny coverage or charge higher premiums to a healthy person based solely on a genetic predisposition to a disease. Similarly, an employer could not use genetic information in making hiring, firing or promotion decisions. The White House, in a written statement, expressed support for the legislation. Concern about unwarranted use of genetic information threatens the utilization of existing genetic tests as well as the ability to conduct further research, it said. Genetic discrimination bills have been approved twice by the Senate in recent years but were not taken up by the House. The bill awaits action by the full Senate.
Home health agencies would net an additional $140 million in payments in 2008 under proposed refinements to the home health prospective payment system announced last week by the CMS. These represent the first proposed changes to the system since 2000. Home health agencies are paid prospectively for 60-day episodes of care. The rule proposes ways to improve the comprehensiveness of the case-mix model and improve the accuracy of Medicares payments. The proposed rule also adds two new quality measures to the 10 that are currently reported by home health agencies: emergent care for wound infections or deteriorating wound status, and improvement in status of surgical wound. Home health agencies that report quality data would receive a marketbasket increase of 2.9% in 2008.
A report from the Government Accountability Office showed that more than 90% of seniors met applicable Medicaid financial laws that would allow them coverage to live in a nursing home facilitya finding that some Democratic lawmakers said showed that seniors were not out to game the federal-state program. But the GAO said that the timing of the study may have been too soon, and that more pointed data likely will come a few years down the road. At issue are provisions built into the Deficit Reduction Act of 2005 that were meant to adjust Medicaids asset-transfer policy. The report found that about 10% of approved applicants had transferred assets for less than market value, and that the average length of the penalty periodusually a delay in obtaining Medicaid coveragewas roughly six months.
Members of the Chicago Health Executives Forum, or CHEF, voted to retain their current leadership at a special meeting of the independent chapter of the American College of Healthcare Executives. Thirteen past presidents called for the election on April 11 to remove Deborah Hodges, CHEFs interim president until June; James Renneker, its president-elect; and JoAnn Becker, education committee chairwoman. At issue was the process CHEFs leaders used last fall to remove Ogan Gurel, who had held the position of president-elect and would have become president in January. Three investigators tallied the results, which showed 148 membersor about 33% of the membershipvoted in person or by proxy, according to a CHEF statement. Of those, 54% voted against removal of the three directors. CHEF bylaws require a minimum of two-thirds of the voting membership to vote for removal.
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