Citing quality-of-care issues, the CMS terminated its Medicare Advantage contract with Americas Health Choice, Vero Beach, Fla. The 12,000 enrollees in the plan, all living in Florida, were moved to United HealthCares SecureHorizons Medicare Advantage plan by the CMS, according to the agency. Americas Health Choice failed to make services available to the extent that it posed an imminent and serious threat to the health of AHC enrollees, the CMS said in a news release. This is the first time that the agency has pulled a Medicare Advantage contract for quality issues. Delayed patient referrals, poor standards of care and shortages of specialty-care providers were among the specific reasons for the contracts termination, according to a letter the CMS sent Americas Health CEO Doug Werner on July 19. A spokesman for Americas Health said that the company is focused on assisting members transition to SecureHorizons and just trying to make sure they receive continuity of care.
A CMS survey revealed that most Medicare providers are satisfied with services provided by Medicare fee-for-service contractors. For the second consecutive year, 85% of respondents rated their contractors between four and six on a six-point scale. The survey was sent to more than 36,000 randomly selected providers that serve Medicare beneficiaries across the country, and got a 65% response rate. The 2007 results, coupled with the initial 2006 results, enable CMS to begin establishing provider satisfaction performance standards for its contractors, who process more than $280 billion in Medicare claims each year, said CMS acting deputy administrator Herb Kuhn in a news release. The CMS uses the survey to measure provider satisfaction levels, as required in the Medicare Modernization Act of 2003.
Bostons 503-bed Beth Israel Deaconess Medical Center unveiled plans for expanding its Longwood Medical Area campus and building a suburban outpatient-care center at a yet-to-be-determined site. The estimated $1 billion project would take place over 10 to 15 years and would involve adding an estimated 700,000 square feet of patient-care space to the Longwood campus, according to a hospital news release. Some specific plans include building a 100,000- to 150,000-square-foot suburban outpatient-care center by 2011.
Reinforcing the notion that care for wounded war veterans falls apart after the acute-care phase, a nine-member presidential commission recommended sweeping changes to serve, support and simplify the needs of injured service members and their families. What effect the recommendations might have on the nations more than 150 Veterans Affairs medical centers and 875 outpatient clinics is unclear. What is needed, according to the commission, is vast improvement in the continuity and integration of medical and rehabilitation across the two departments. Some of the proposals in the draft report would require legislation, but most could be implemented by the White House, Defense and Veterans Affairs departments.
The Joint Commission would lose its deeming authority under House legislation that would reauthorize the State Childrens Health Insurance Program. If the measure were approved, a hospital accredited by the commission would no longer automatically meet conditions of participation under Medicare. The Joint Commission will be working with Capitol Hill lawmakers on the SCHIP legislation, a Joint Commission spokeswoman said. Sources on Capitol Hill said they expect that SCHIP reauthorization bills in the House and Senate would go up for a vote this week.
Providence, R.I.-based not-for-profit health systems Lifespan and Care New England said their boards had approved a merger, and would stick with the Lifespan name. The merger is pending regulatory approval. In 1998, the two systems voted to merge, but they abandoned the plans two years later when the state attorney general refused to sign off on the deal without an agreement to give him broader regulatory oversight.
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