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July 23, 2004
Vol. 2, Issue 29
FTC/DOJ Issue Joint Report On Competition In Healthcare Industry
The Federal Trade Commission (FTC) and the Department of Justice (DOJ) released July 23 a joint report examining competition in the healthcare sector and recommending ways to improve performance of the marketplace. The 361-page report, "Improving Health Care: A Dose of Competition," stems from twenty-seven days of hearings on healthcare and competition held from February through October 2003, an FTC-sponsored workshop in September 2002, and independent research.
In opening remarks at a July 23 press briefing, R. Hewitt Pate, DOJ Assistant Attorney General for the Antitrust Division, said the $1.6 trillion healthcare industry can benefit from rigorous competition. According to Pate, the DOJ's joint participation with the FTC reflects the agency's commitment to strong enforcement in this area. Pate highlighted two important areas of interest as payor-side matters—particularly those involving managed care organizations, merger review, and contracting policy and practices—and criminal enforcement.
FTC Chairman Timothy J. Muris said the report focuses on a number of key areas, including the importance of reliable information on prices and quality, eliminating barriers to competition, and relying on competition when possible. The report also provides six recommendations and eleven observations offering the agencies' perspective on a number of current antitrust enforcement issues in healthcare.
Among the recommendations in the report is that private payors, governments, and providers should continue experiments to improve incentives for providers to lower costs and enhance quality. Consumers should have access to more information on prices and quality and be given incentives to use that information in making their healthcare choices.
The report also suggests states that decrease barriers to market entry, including reconsidering certificate of need programs. "On balance, the FTC and DOJ believe that such programs are not successful in containing health care costs, and they pose serious anticompetitive risks that usually outweigh their purported economic benefits," according to an FTC press release.
Other recommendations include reexaming the roles of subsidies given their potential to distort competition and regulating pharmacy benefit manager transparency.
The report also addresses a host of other topics such as consumer-driven healthcare, hospitals mergers, and mandated benefits.
The Commission voted 5-0 to issue the report.
To read the report, click here.
DHHS Announces New Health Information Technology Initiative
Department of Health and Human Services (DHHS) Secretary Tommy G. Thompson July 21 released the report "Decade of Health Information Technology: Delivering Consumer-centric and Information-Rich Health Care," which outlines a ten-year plan for implementing the adoption of electronic health records for all Americans.
The new initiative is designed to transform the delivery of healthcare by building a health information infrastructure that will include electronic health records (EHRs) for all Americans and a nationwide network to link health records.
Under the new EHR system, health information would always be current and always available to physicians and other healthcare professionals.
Thompson said that he would appoint a leadership panel to assess the costs and benefits of health information and report that information to him by the fall. As part of the initiative, Medicare will create an Internet portal to allow Medicare beneficiaries to access their personal Medicare information.
Thompson also said that Medicare will move quickly to promulgate rules on e-prescribing of drugs and develop common standards.
The report cited four major goals in the initiative: (1) bringing information tools to clinical practice; (2) building a healthcare information infrastructure; (3) using health information technology to encourage people to be involved in their healthcare decisions; and (4) expanding public health monitoring, quality of care measurement, and bringing research advances more quickly into medical practice.
The report said the three phases of implementation are: (1) developing the market institutions that are needed for a market to exist in health information technology; (2) encouraging investment at the clinical level and for the development of a national network; and (3) achieving high quality and performance accountability.
"Health information technology can improve quality of care and reduce medical errors, even as it lowers administrative costs," Thompson said. "It has the potential to produce savings of 10 percent of our total annual spending on health care, even as it improves care for patients and provides new support for health care professionals." At the same time, security and privacy of electronic medical records would be improved over protections of paper-based records, Thompson said.
To read DHHS' press release and the report, go to http://www.dhhs.gov/news/press/2004pres/20040721a.html
To read DHHS' fact sheet about the report, go to http://www.dhhs.gov/news/press/2004pres/20040721.html
GAO Faults JCAHO's Accreditation Process, Lawmakers Call For Increased Federal Oversight
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) came under fire this week with the release of a new report by the Government Accountability Office (GAO) that found significant gaps in JCAHO's pre-2004 accreditation process and raised concerns about patient safety.
According to the report, "Medicare: CMS Needs Additional Authority to Adequately Oversee Patient Safety in Hospitals" (GAO-04-850), JCAHO failed to identify serious deficiencies in a number of hospitals that were later identified by state surveyors.
Responding to the report, Senate Finance Committee Chairman Charles Grassley (R-IA) and House Ways and Means Health Subcommittee ranking minority member Pete Stark (D-CA) unveiled a bipartisan bill that would give the Centers for Medicare and Medicaid Services (CMS) additional oversight authority over the national accreditation organization.
Unlike other healthcare accreditation programs, JCAHO enjoys unique statutory authority in that the hospitals it accredits generally are deemed compliant with Medicare quality and patient safety requirements. In 2002, JCAHO accredited 82% of Medicare-participating hospitals.
CMS currently lacks the ability to limit or remove JCAHO's accreditation authority when the agency identifies lapses in the organization's performance, GAO noted. Instead, CMS' only recourse is including recommendations in its annual report to Congress and asking JCAHO to voluntarily implement the agency's suggestions.
"Approval from the Joint Commission is supposed to be the gold standard, not a rubber stamp," Grassley said in announcing the bill, which is co-sponsored by Sen. Max Baucus (D-MT) in the Senate.
Under the measure, CMS could restrict or remove JCAHO's accreditation authority if the agency found the organization's performance lacking.
"While more may need to be done, the legislation we're introducing today will improve accountability," Stark said. "It establishes a clear chain of command within the hospital oversight process to improve patient safety. It will assure that taxpayer dollars are being spent in facilities that meet Medicare's standard," Stark said.
Previous studies conducted by GAO and the Department of Health and Human Services Office of Inspector General also have raised concerns about whether JCAHO could effectively identify patterns of deficient care.
To examine the effectiveness of JCAHO's accreditation process in detecting hospital deficiencies, GAO examined validation surveys conducted by various state agencies between fiscal years 2000 through 2002 in a sample of 500 JCAHO-accredited hospitals.
According to GAO, state surveyors found 31%, or 157 hospitals, in the sample had serious deficiencies. Of those 157 hospitals tagged by the state validation surveys, JCAHO failed to identify 78%, or 123 hospitals, as having serious deficiencies, GAO reported. JCAHO also did not identify 69% of the serious deficiencies found by state agencies.
Although JCAHO recently revamped its hospital accreditation process, including the use of unannounced surveys by 2006, GAO said the ability of the new process to better detect serious deficiencies remained an open question given its recent implementation and the limitations of pilot testing thus far.
GAO also found lacking CMS' current process for evaluating JCAHO's performance. "CMS does not consistently portray the extent to which serious deficiencies are missed and does not identify the limitations in reporting the estimates it makes from its survey sample," GAO said.
"For 3 consecutive years, JCAHO's hospital accreditation program, which accredits most of the hospitals participating in Medicare, exceeded CMS's threshold for unacceptable performance," GAO concluded.
GAO recommended that Congress give CMS the same oversight authority as it has over other accreditation programs. GAO also said CMS should improve its existing oversight activities of JCAHO's hospital accreditation process.
Commenting on the report, JCAHO said it did not object to GAO's suggestion that Congress give CMS the same oversight authority as it has over other accreditation programs, but urged policymakers "not to make decisions based on an incomplete portrayal of the Joint Commission's effectiveness."
JCAHO faulted the report's methods and use of statistics, calling them incomplete and erroneous.
"Essentially, what the GAO is providing to the reader is an incomplete ratio of 'non-agreement' between the Joint Commission and the State Survey Agencies," JCAHO said. JCAHO said such "non-agreement" is the product of numerous factors including the timing difference between the JCAHO and the state agency surveys.
JCAHO also argued that GAO underestimated the potential of its new survey process and failed to consider data showing how it is better able to detect patient care deficiencies.
"The Joint Commission is deeply concerned that the GAO has provided the public with a report that uses misleading metrics and omits highly relevant information about the Joint Commission's performance."
To read the report, click here.
To read Sen. Grassley's statement and the bill he announced, click here.
To read Rep. Stark's statement, go to http://www.house.gov/stark/news/108th/news_2004-07-20_GAO-JCAHO.htm
To read JCAHO's statement, go to http://www.jcaho.org/news+room/press+kits/gao/statement.htm
DOJ Closes Investigation Of UnitedHealth Group's Acquisition Of Oxford Health Plans
The Department of Justice (DOJ) recently closed its investigation of UnitedHealth Group, Inc.'s acquisition of Oxford Health Plans, Inc., the agency announced July 20. UnitedHealth Group is one of the largest private insurers in the country and Oxford is a large regional health insurer in New York, New Jersey, and Connecticut.
DOJ concluded after an intensive investigation in which nearly 100 industry participants were interviewed that the combined firm of UnitedHealth Group and Oxford would not have a significant market share in the relevant product market.
"The wide variety of health insurance products offered, the differentiation among product lines, the diversity of health insurance customers, and the different methodologies for pricing to customers, would make it difficult for health insurers to coordinate on price or other dimensions of competition," said the agency in a press release.
DOJ also investigated the possibility that the combined company could have buying-side market power over healthcare providers in two product markets—physician services and hospital services. In finding that "the merged company will not account for a substantial percentage of provider revenues," DOJ noted that, because PPO and POS plans were popular in the tri-state area, insurers were committed to providing out-of-network benefits to their members. Therefore, a hospital would not necessarily lose revenue as a result of dropping an insurer.
To read DOJ's press release, go to http://www.usdoj.gov/opa/pr/2004/July/04_at_498.htm
President Bush Signs Bill To Fight Bioterrorism
President Bush signed July 21 the BioShield Act of 2004, a bill aimed at helping America better protect itself in the event of bioterrorism. Project BioShield authorizes $5.6 billion over ten years for the government to purchase and stockpile vaccines and drugs to fight anthrax, smallpox, and other chemical agents. The Department of Health and Human Services (DHHS) has already taken steps to purchase 75 million doses of an improved anthrax vaccine for the Strategic National Stockpile, said the President in remarks at the signing of the bill.
The law also gives DHHS new authority to expedite research and development of new medicines to defend against bioterrorism. The National Institutes of Health will launch initiatives to speed the development of new treatments for victims of a biological, radiological, or nuclear attack. Grants for this type of research would have taken eighteen months to two years under the old rules, said Bush, but under Project BioShield DHHS expects the process to be completed in about six months.
"With the signing of the BioShield legislation, President Bush has improved our nation's bio-preparedness in an important way," said DHHS Secretary Tommy G. Thompson in a statement. "We will now be able to quickly purchase important medical countermeasures in the event of a threat to our country. This law also sends a clear signal that the U.S. government is prepared to be a full partner with the research community in the fight against bio-terrorism."
To read the White House press release, go to http://www.whitehouse.gov/news/releases/2004/07/20040721-2.html
To read a DHHS Fact Sheet on Project BioShield, go to http://www.hhs.gov/news/press/2004pres/20040721b.html
FDA Proposes Rule Aimed At Providing Better Information To Sponsors About Status Of New, Generic Drug Applications
The Food and Drug Administration (FDA) issued in the July 20 Federal Register (69 Fed. Reg. 43351) a proposed rule intended to bring more consistency to how the agency informs drug manufacturers about the status of their new drug applications or abbreviated new drug applications.
Under current rules, the FDA sends new and generic drug applicants "approvable letters" and "non-approval letters" after completing its review. The FDA typically issues a non-approval letter if the application has major deficiencies, such as failure to demonstrate effectiveness or a major safety concern, and an approvable letter if only minor deficiencies are present, such as a labeling issue.
But the distinction between approvable and non-approvable letters "became somewhat blurred," the FDA noted in the proposed rule. Moreover, the agency said, in some cases it ended up approving applications for which it had initially issued a non-approvable letter.
Thus, FDA is proposing to replace the approvable/non-approvable distinction with "complete response letters." According to FDA, the complete response letters are intended to "ensure a consistent approach to informing sponsors of needed changes before we can approve an application, with no implication as to the ultimate approvability of the application."
The proposed rule also would designate resubmissions of new drug applications as "Class 1" or "Class 2" depending on the nature of the changes needed to obtain market approval.
Class 1 resubmissions would encompass those applications that needed only limited changes such as draft or final printed labeling, safety or stability updates, or other minor clarifying information. Class 1 resubmissions would start a new, two-month review cycle.
Class 2 resubmissions would involve those applications that required more extensive information, including items that may need to be presented to a public advisory committee. Class 2 resubmissions would initiate a new, six-month review cycle.
The proposed rule would retain the "major" and "minor" distinction for resubmissions of generic drug applications. A resubmission in the "major" category would start a new, six-month review cycle, whereas one in the "minor" category would initiate a new cycle of thirty days to a few months.
To read the proposed rule in the Federal Register, click here.
FDA Announces Standard Format For Reporting Of Clinical Trial Data
The Food and Drug Administration (FDA) announced July 21 the Study Data Tabulation Model (SDTM), a standard format that sponsors of human drug clinical trials can use to submit data to the agency. FDA expects the standard format to result in greater efficiencies in FDA reviews of New Drug Applications.
The announcement was made as part of the Department of Health of Human Services' global plan for implementation of health information technology presented at the Secretarial Summit on Health Information in Washington, D.C. The SDTM "is consistent with the FDA's Critical Path initiative because it will help automate the largely paper-based clinical trials research process and foster easier communication and collaboration among clinical researchers," said FDA in a press release.
"The importance of a standard for the exchange of clinical trial data cannot be overstated," said Dr. Lester M. Crawford, Acting FDA Commissioner. "FDA reviewers spend far too much valuable time simply reorganizing large amounts of data submitted in varying formats. Having the data presented in a standard structure will improve FDA's ability to evaluate the data and help speed new discoveries to the public."
The SDTM standard will be available on FDA's Web site at http://www.fda.gov/cder/regulatory/ersr/ectd.htm.
To read FDA's press release, go to http://www.fda.gov/bbs/topics/news/2004/NEW01095.html
Senate Committee Hears Testimony On Inspection Of Imported Drugs
The Senate Governmental Affairs Subcommittee on Investigations heard testimony July 22 from Richard M. Stana, Director of Homeland Security and Justice Issues of the Government Accountability Office, about the government's efforts to enforce prohibitions on personal importation of prescription drugs.
Stana said that under current law the importation of prescription drugs is illegal, with few exceptions, but that Americans continue to order prescription drugs from Canada and other countries and have them shipped to the U.S.
Any drugs that are imported into the U.S. must meet certain requirements under federal law. Stana said there is growing concern that Americans that purchase drugs over the Internet from foreign countries run the risk of receiving drugs that are adulterated, misbranded, or not approved by the Food and Drug Administration (FDA).
The reason so many adulterated and unapproved drugs are entering the U.S. is that Customs and Border Patrol (CBP) and the FDA do not have the resources to check all of the packages of drugs that enter the U.S. each day, Stana explained.
Stana noted that CBP and FDA inspect some packages that contain prescription drugs, but that many are not inspected because each agencies' requirements for inspecting and processing drugs are time-consuming.
Both agencies are addressing the problems with drug package inspection, said Stana, but it is too early to tell if the agencies' efforts are adequately addressing the problem.
To read Stana's testimony, click here.
Boston Announces Pilot Program To Import Drugs From Canada; FDA Sends Warning Letter To Wisconsin Governor
Boston mayor Thomas Menino announced July 21 a pilot program to import prescription drugs from Canada. The Meds by Mail program is available to city employees and retirees enrolled in the Blue Cross Blue Shield health plan with access to medications by mail.
"Drug prices have been rising too fast," said Menino. "And it is certainly my hope that the industry will make changes in their pricing structure so that people don't have to choose between filling their prescriptions and buying groceries."
The medications available in the program will be brand name drugs used to treat chronic conditions and will exclude drugs that have severe interactions with other drugs, require significant medical management, are temperature sensitive, or are controlled substances.
Meanwhile, the Food and Drug Administration (FDA) sent a warning letter to Wisconsin Governor Jim Doyle citing safety concerns with the drugs being purchased through Wisconsin's importation program. The July 22 letter said that "it is increasingly clear" that the pharmacies participating in the program "are in violation of the standards" established by the state to ensure safety.
In its letter, FDA cited a report by the Pharmacy Society of Wisconsin that found that of the 765 prescriptions dispensed to Wisconsin citizens, 316 violated the contracts the state entered into with three Canadian pharmacies. Despite repeated warnings that the pharmacies were violating the agreements, the state has taken no corrective action, said FDA.
The agency reiterated its concern over the violations and said the program puts Wisconsin residents at risk.
For more information on the Boston program, go to http://www.cityofboston.gov/publichealth/medsbymail.asp
Ernst & Young Settles False Claims Act Case For $1.5 Million
U.S. Attorney for the Eastern District of Pennsylvania Patrick Meehan announced July 20 that accounting firm Ernst & Young has agreed to pay the United States a $1.5 million settlement to resolve allegations that it provided improper advice to hospitals that resulted in submissions of false claims to the Medicare program.
On January 5, 2004, the government filed a complaint in the Eastern District of Pennsylvania, United States v. Ernst & Young, Civil Action No. 04-0041. The complaint alleged that Ernst & Young's healthcare consulting division knowingly gave improper advice and caused nine hospitals to submit claims for payment under Medicare for certain outpatient blood tests that were performed but were not medically necessary. In addition, the government alleged that the company knowingly prepared reports that failed to disclose the improper conduct of the client hospitals.
Despite agreeing to the settlement, Ernst & Young has denied that it caused any false claims to be submitted to the Medicare program or that it concealed or failed to disclose any false claims.
"This settlement should provide a wake-up call not only to health care providers but also to the consultants on whose advice they rely," said Meehan in a press release. "It is the duty of an independent reviewer to be alert to abuse and not to remain, as the complaint alleges, 'deliberately ignorant.' Those who market themselves as experts have the responsibility to provide accurate information. The integrity of the Medicare system depends on it."
To read the settlement agreement, click here.
Gambro Announces Tentative $350 Million Settlement To Resolve Fraud Allegations
Gambro Healthcare US announced July 21 that it had reached a preliminary understanding with the Department of Justice (DOJ) to pay $350 million to resolve civil and criminal charges that it defrauded Medicare. The tentative settlement also would require Gambro Healthcare US, a subsidiary of Swedish-based medical technology company Gambro AB, to enter into a corporate integrity agreement.
Under the preliminary settlement, which is subject to further negotiation and court approval, Gambro Healthcare US, without admitting liability, would pay $310 million to resolve civil fraud allegations. The company would also set aside an additional $15 million in an escrow account for any state claims regarding their Medicaid programs.
Under the settlement, Gambro Supply Corporation, which ceased operations effective December 31, 2002, would pay $25 million and plead guilty to a felony charge that its predecessor, REN Supply Corporation, made false statements to Medicare in 1993 and 1996 regarding its status as a wholly owned subsidiary of REN USA Inc. to get around certain federal prohibitions applicable to dialysis supply companies.
Gambro Supply Corporation would be the only Gambro unit excluded from federal healthcare programs under the terms of the tentative deal, the company said.
If finalized, the settlement would end the investigation into whether Gambro Healthcare US and its affiliates submitted false claims to Medicare for their services and whether certain arrangements with pharmaceutical companies and physicians were illegal.
To read the company's press release, go to http://www.gambro.com/IRpage.asp?id=3508&p=press&afw_id=34615&lang=en&content_only=1
DHHS OIG Approves Arrangement Between Geriatric Group Practice And Consulting Physicians
A geriatric group practice's proposal to employ certain primary care physicians as consultants for the group's nursing home patients would not generate prohibited remuneration under the Anti-Kickback Statute, the Department of Health and Human Services (DHHS) Office of Inspector General (OIG) concluded in an advisory opinion posted July 22.
The OIG concluded that, because the Internal Revenue Service (IRS) had deemed the consultants bona fide employees of the geriatric group, the proposed arrangement fell within the statutory exception and regulatory safe harbor for employee compensation.
Under the proposal, the geriatric group, a professional service corporation comprised of physicians specializing in treating nursing home residents, would employ the primary care physicians who treated the residents before their admissions to the nursing home. The consulting physicians would be available to respond to questions from the group about a particular patient's medical history.
The consulting physicians would receive $50 per hour for a maximum number of hours per month based on the number of patients for which they consult. Monthly compensation would be capped at $750 for fifteen hours of service for twenty or more patients, the opinion said in describing the arrangement.
The geriatric group provided the OIG with a private letter ruling issued by the IRS indicating that the consulting physicians qualify as bona fide employees of the group.
The OIG noted that the Anti-Kickback Statute excepts from its reach bona fide employment arrangements and the OIG safe harbor regulations provide that the term "remuneration" as used in the statute does not include amounts paid by an employer to a bona fide employee.
Assuming the consulting physicians are bona fide employees under the IRS definition, the OIG concluded that the statutory exception and regulatory safe harbor would apply.
The OIG cautioned that the force of the advisory opinion hinged on the consulting physicians meeting the IRS definition of a bona fide employee. A similar arrangement with independent contractor physicians would raise additional fraud and abuse concerns, the OIG observed.
"The anti-kickback statute disfavors payment structures that tie compensation, even for services, to patients referred by the compensated party. Here, where such payments are made through an employment relationship specifically deemed bona fide by the IRS, the arrangement is protected despite the risk it otherwise presents of fraud and abuse," the OIG said.
To read Advisory Opinion No. 04-09, click here.
Update
New Report Recommends Healthcare Reforms
The National Coalition on Health Care has issued a report, "Building a Better Health Care System: Specifications for Reform," which calls on Congress to enact new legislation within the next two to three years to require healthcare coverage for all Americans.
The Coalition says that policymakers must dramatically overhaul the country's healthcare system because more Americans will lose their health insurance or be unable to pay for it in the next few years.
Escalating healthcare costs are not just a healthcare problem but also a major economic problem that reduces economic growth, job creation, and corporate profits, the Coalition said. Rising healthcare costs also affect the viability of pensions.
The report found that premiums for family healthcare coverage in 2006 will be more than double the cost of premiums in 2001. The number of Americans without healthcare coverage will rise from 41 million in 2001 to 51 million by 2006.
The report recommended that, in addition to requiring healthcare coverage for all Americans within two to three years, policymakers bring cost increases for healthcare in line with increases in other parts of the economy within five years; launch a nationwide effort to dramatically improve the quality, safety, and value of care; make the financing of healthcare more equitable; and simplify and modernize the administration of healthcare.
Senate Finance Committee Chairman Charles Grassley (R-IA) said that, "In announcing its recommendations for health care reform today, the National Coalition on Health Care made an important contribution to the current dialogue on how to make our health care system work better."
To read the Coalition's press release about the report, click here.
To read the report, click here.
Twenty States Require Insurance Coverage Of Key Colorectal Cancer Screening Tests, GAO Finds
Twenty states have laws as of May 2004 that require private insurers to cover key colorectal cancer screening tests, the Government Accountability Office (GAO) found in a report released July 19.
Colorectal cancer is the second leading cause of cancer deaths in the U.S., accounting for 57,000 deaths in 2004, said GAO in its report, "Private Health Insurance: Coverage of Key Colorectal Cancer Screening Tests Is Common but Not Universal" (GAO-04-713). Because Congress is considering legislation that would require coverage of colorectal cancer screening tests among all private health insurers, GAO undertook to examine the extent to which the tests are already being covered.
The report found that the majority of health insurance plans that were sold to small employers and individuals in states without laws requiring coverage did cover all four screening tests recommended by the American Cancer Society. The report also found that most large employer plans and most Federal Employee Health Benefit Program plans covered all four screening tests.
In commenting on the report, the American Cancer Society suggested that the report overstated the extent of coverage and did not explain sufficiently the methodological limitations of the study. Conversely, America's Health Insurance Plans (AHIP) also commented on the report but felt that it overstated the lack of coverage.
To read the report, click here.
New Jersey Appeals Court Says Insurer Had Duty To Defend Former Hospital CEO In Hospital's Counterclaim Against Him
An insurer was required to defend a counterclaim brought by a hospital against its former chief executive officer even though it insured both parties under its directors' and officers' liability policy, a New Jersey appeals court held recently.
Affirming the lower court's judgment, the appeals court rejected the insurer's contention that public policy precludes an insurer from defending one insured when sued by another insured. Here, the officer's alleged negligence occurred in the course of his employment and therefore the insurer was required to provide his defense under the terms of the policy, the appeals court found.
Mohamed Hebela sued Hospital Center at Orange (Hospital) in state trial court alleging he was improperly terminated from his position as chief executive officer. The hospital counterclaimed, alleging that Hebela negligently performed his job duties causing the hospital to suffer damages.
Hebela meanwhile sought a determination that the Health Insurance Company (Healthcare), which provided a directors' and officers' liability insurance policy to the hospital, was required to provide a defense to the counterclaim, which it had refused to do. The hospital's action was eventually dismissed on Hebela's summary judgment motion.
Subsequently, the trial court held that Healthcare owed Hebela a duty to defend him against the hospital's counterclaim. Hebela sought and was awarded $154,061.51 in counsel fees. Healthcare appealed.
The New Jersey Superior Court, Appellate Division, affirmed as to the judgment that Healthcare was obligated to provide a defense to the counterclaim but reversed as to the award of damages.
As a threshold matter, the appeals court determined that the policy's insuring clause encompassed the counterclaim at issue here. Specifically, the appeals court noted that Hebela was an officer at the time the alleged "wrongful acts" occurred and the counterclaim constituted a "claim" covered by the policy. Finding no ambiguity in the terms of the contract, the appeals court held that Healthcare was required to defend Hebela against the hospital's counterclaim.
The appeals court rejected Healthcare's contention that public policy precludes an insurer from providing coverage to one insured (Hebela) when sued by another insured (the hospital). The appeals court found that no such public policy existed in New Jersey.
In the appeals court's view, cases cited by Healthcare to support its public policy argument were inapposite because they merely established that a corporate director may not obtain coverage for a claim brought by a corporation or other directors when the director is sued for actions outside the scope of his or her job duties when so defined by the policy. Here, the hospital expressly alleged that Hebela was negligent in performing his job duties.
"The public policy which we must follow is that which instructs our courts to enforce an insurance policy 'as written,' and not seek 'to make a better contract for either of the parties' than that which they chose to make for themselves," the appeals court noted in affirming the trial court's grant of summary judgment to Hebela.
The appeals court agreed with Healthcare, however, that the trial court's award of counsel fees was unreasonable. The problem with the award was that the trial court made no attempt to distinguish between those fees associated with the counterclaim and those fees associated with prosecuting Hebela's original complaint against the hospital, the appeals court observed.
Although a precise allocation of defense costs between covered and non-covered claims is often not possible, "the lack of scientific certainty does not justify imposing all of the costs on the insurer by default." Thus, the appeals court reversed and remanded the award for further consideration of the apportionment issue.
To read the case, Hebela v. Healthcare Ins. Co., No. A-0417-02T3 (N.J. Super. Ct. App. Div. June 28, 2004), go to http://lawlibrary.rutgers.edu/decisions/appellate/a0417-02.opn.html
Study Finds Long Term Care Insurance Could Reduce Government Spending
Long term care insurance (LTCI) can reduce Medicare and Medicaid expenditures, a new study by America's Health Insurance Plans found. The study, "Long-Term Care Insurance in 2002," concluded that state and federal healthcare program spending for long term care could be reduced if more Americans had LTCI.
The LTCI market has grown an average of 18% each year between 1987 and 2002. In 2002, there was significant growth in the employer-sponsored market for LTCI, with employer-sponsored policies accounting for 30% of all policies sold in 2002.
The benefits of having LTCI include allowing disabled seniors to remain in their homes longer, which delays the use of institutional services; provides for more home services for the elderly than non-privately insured seniors; reduces an individual's chances of having to spend their own money for nursing home care; and reduces out-of-pocket expenses for seniors.
To read the study, click here.
CMS Proposes Implementation Plan For $1 Billion Program For Funding Of Emergency Services Provided To Undocumented Aliens
The Centers for Medicare and Medicaid Services (CMS) announced July 22 a new program that will provide $1 billion over four years to help hospitals recoup the cost of providing emergency room care to uninsured patients, including undocumented aliens.
"We intend to use this new program to support all aspects of emergency treatment—including hospital, physician, and ambulance services—that have been strained by providing uncompensated care for undocumented immigrants," said CMS Administrator Mark McClellan. "This funding will strengthen all of the components of emergency health care to help make sure that everyone in the community gets emergency help when they need it."
CMS also released on July 22 a policy paper requesting comments on its implementation approach for the program. The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) provides $250 million per year for fiscal years (FYs) 2005 through 2008 for payments to hospitals providing emergency care to undocumented aliens in § 1011.
In implementing § 1011, CMS proposes to calculate each state's allotment "by multiplying the total appropriation ($167 million) by the proportion generated by dividing the number of undocumented aliens who reside in each state by the total number of undocumented aliens in all states."
The remaining one-third of the total appropriation, or $83 million, will be "divided among the six states with the highest number of undocumented alien apprehensions for each fiscal year," said CMS. Using preliminary data from FY 2003, CMS determined that the six states that would receive portions of the $83 million are Arizona, California, Florida, New Mexico, New York, and Texas. The states could change, however, when data from July 1, 2003 through June 30, 2004 is analyzed.
To read CMS' press release on the program, go to http://www.cms.hhs.gov/media/press/release.asp?Counter=1123
To read the policy paper, click here.
CMS Says Medicare Benefits Will Not Interfere With Medicaid
Benefits for low-income Medicare beneficiaries will not interfere with Medicaid or other federal benefits, the Centers for Medicare and Medicaid Services (CMS) and the Office of Management and Budget jointly announced. The $600 credit that low-income Medicare beneficiaries will receive when they enroll in a Medicare-approved drug discount card program will not count against the individual when they apply for Medicaid or other federal benefits such as housing or food stamps.
"As the Medicare law intended, low-income beneficiaries don't need to worry that government help from one program will take away help from another," said Department of Health and Human Services Secretary Tommy G. Thompson. "As a result of the new law, low-income Medicare beneficiaries need not have to chose between food and medicine."
In a letter to state Medicaid directors, CMS makes clear that "a person should not be disadvantaged under other Federal programs, including Medicaid" because he or she is receiving a discount on prescription drugs. Citing § 1860D-31(g)(6) of the Social Security Act, CMS specifies that the guidance provided in the letter changes the normal Title XIX rules in the case of Medicare beneficiaries who are enrolled in the Medicare-Approved Drug Discount Card and the Transitional Assistance programs who later become eligible for Medicaid.
According to the letter, the guidance applies specifically to states in which individuals can qualify for Medicaid by spending down excess income by incurring medical expenses.
CMS also provides a Drug Card and Medicaid Spenddown Q & A, which provides further guidance on this issue. CMS states that "neither the $600 credit nor the discount prices will prevent or delay an individual's eligibility for Medicaid." According to the Q & A, Medicaid will calculate an individual's level of drug spending using the "pre-discount" price of the drugs.
The Q & A also reiterates that if an individual receives the $600 Medicare credit and then later becomes eligible for Medicaid, he or she does not lose the credit.
To read CMS' press release, go to http://www.cms.hhs.gov/media/press/release.asp?Counter=1115
To read CMS' letter to state Medicaid directors, click here.
To read the Drug Card and Medicaid Spenddown Q & A, click here.
Seniors Are Saving With Discount Drug Card, McClellan Says
At a hearing July 19 before the U.S. Senate Special Committee on Aging, Mark McClellan, Centers for Medicare and Medicaid Services (CMS) Administrator, said that seniors using Medicare-approved discount drug cards are saving 11% to 18% on brand name drugs and 35% to 65% on generic drugs. Almost four million people have already signed up for the program and about 25,000 more are signing up each business day, said McClellan.
Savings for low-income seniors are even greater, said McClellan, referencing a CMS analysis that found that low-income beneficiaries can save 32% to 86% over national average retail prices over a seven-month period, when both the discounts and $600 transitional assistance are taken into account.
McClellan also emphasized the outreach efforts his agency has made to educate beneficiaries about the benefits of the drug card and detailed upgrades that CMS has made to its Web site to help individuals choose the right card for them.
In addition, the program has strict pharmacy access standards so that beneficiaries will be able to access retail pharmacies, said McClellan. The standards ensure that the pharmacy network is broad enough that 90% of urban enrollees live within two miles of a network pharmacy; 90% of suburban enrollees live within five miles; and 70% of rural beneficiaries live within fifteen miles.
Gail Wilensky, who ran the Medicare program in the nineties, also testified before the committee. "The most important feature is that low-income individuals will receive the full $600 for 2004 even though the program only starts mid-year," Wilensky said. "Second in importance is that individuals who do not spend the full $600 may roll-over any remaining funds to 2005."
Wilensky added that the biggest help for low-income seniors will come when the full Medicare drug benefit goes into effect in January of 2006. Although that seems a long way away, Wilensky warned that CMS will have to be vigilant to make that deadline. "Many in the public have complained about the January 2006 start-date of the Part D benefit. These complaints are usually made by people who do not understand the large number of operational decisions that need to occur," Wilensky said. "It will take a Herculean effort on the part of CMS to implement the major provisions of the legislation in the time specified."
To read Mark McClellan's testimony, click here.
New Study Finds Medicare "Doughnut Hole" Could Be Eliminated By Lowering Prices To Level Of Other Industrialized Nations
The controversial "doughnut hole" in Medicare drug coverage could be eliminated if the government were willing to reduce drug prices to the same level as those of other industrialized countries, a new study found.
In the study, "Doughnut Holes and Price Controls," researchers found that drug prices in industrialized countries are 34% to 59% lower than in the United States, and if Medicare could meet the lower prices the doughnut hole could be eliminated. Alternatively, the doughnut hole could be eliminated if Medicare beneficiaries could buy their prescription drugs from Canada, the United Kingdom, or France.
The reduced drug prices would leave Medicare spending unchanged, but payments by beneficiaries would be significantly reduced. However, the researchers concluded that lowering prices could harm pharmaceutical innovation.
The study determined that under the current Medicare benefit total projected drug spending in 2006 will be $101.9 billion, based on a 20% drug discount, of which the government would pay $44.5 billion, beneficiaries $31 billion, and third-party payors $26.4 billion. If Medicare negotiated lower prices with an average 45% discount, the government would pay the same amount, but beneficiaries would only pay $19.1 billion and third-party payors $9.9 billion.
The study also found that by lowering drug prices the pharmaceutical industry would not be able to fund as much research and development of new drugs as it does now. Policymakers would have to balance the needs of Medicare beneficiaries with the potential harm to innovation and advances in medicine.
The study was conducted by the Johns Hopkins University Bloomberg School of Public Health and was funded by the Commonwealth Fund and the Robert Wood Johnson Foundation.
To read the study, go to http://www.healthaffairs.org/press/julyaugust0403.htm
CBO Stands By Its $394 Billion Medicare Cost Estimate
The Congressional Budget Office (CBO) this week issued a detailed report of how it arrived at the $394 million over ten-year cost estimate of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA), which added a prescription drug benefit to Medicare and extensively revamped the program.
The cost of the new Medicare law has been a hot-button issue ever since the Bush administration, as part of its fiscal year 2005 budget proposal, placed the price tag of the Medicare reforms at $534 billion over ten years.
Some lawmakers complained that they were never informed of the higher estimates and sought investigations into allegations by Centers for Medicare and Medicaid Services (CMS) chief actuary Richard S. Foster that former CMS Administrator Tom Scully threatened to fire him if he disclosed the agency's estimates.
But despite the controversy, CBO has stood by its estimate of the law's cost. "Anytime a complex and substantially new program is created, difficulties arise in predicting its outcome, particularly in the case of an entitlement program with a large number of potential enrollees," CBO said.
Projections could deviate on several key variables, including the number of those participating in the basic drug benefit or low-income subsidy program.
"Until such information becomes available, however, the cost estimate described here represents the agency's best judgment about the net budgetary impact of the Medicare drug benefit that was established by the MMA," said the CBO.
To read the report, "A Detailed Description of CBO's Cost Estimate for the Medicare Prescription Drug Benefit," click here.
Medicaid's "Perverse Incentives" Must Be Realigned To Ease Financial Woes, New Study Says
Medicaid costs will continue to skyrocket without improving quality of care unless policymakers address the "perverse incentives" inherent in the massive federal-state healthcare program, according to a new study released July 19 by the American Legislative Exchange Council (ALEC).
According to the study, the Medicaid program is rife with perverse incentives that encourage massive overspending with little accountability.
And one of the root causes of Medicaid's perennial financial woes, the study found, is the open-ended federal match that "encourages states to spend ever more on Medicaid and become very creative with what constitutes 'Medicaid' spending in order to maximize federal matching dollars."
Moreover, despite ever-increasing spending, Medicaid access and the quality of care provided through the program are declining, the study found.
"If spending more money by itself could deliver better healthcare, then Medicaid would have delivered by now," said James Frouge, the study's author and ALEC's healthcare analyst. "But spending without reform has failed, and more patient choice is the right cure."
The study proposed limiting the federal match that states have access to and expanding the Cash and Counseling program under which Medicaid beneficiaries receive a cash allotment to buy medical services of their choice.
To read the study, click here.
CMS Publishes Proposed Rule On Medicare Program Exclusions
The Centers for Medicare and Medicaid Services (CMS) published in the July 23 Federal Register (69 Fed. Reg. 43956) a proposed rule establishing procedures for imposing exclusions for certain violations of the Medicare program.
In 1998, CMS published a final rule in the Federal Register (63 Fed. Reg. 68687) that provides procedures for pursuing civil monetary penalties (CMPs) and assessments for noncompliance with program or regulatory requirements. CMS did not address program exclusions in the final rule.
The proposed rule addresses CMS' exclusion authority stemming from CMP violations, and delineates the general requirements and procedures for the imposition of an exclusion under Medicare, Medicaid, and other federal healthcare programs.
CMS noted that the proposed rule will not materially impact the hearing and appeals procedures that are available to anyone that is excluded from a program.
Comments on the proposed rule are due by September 21, 2004.
To read the proposed rule, click here.
CMS Issues Notice Of Extended Availability Of Certain SCHIP Funds
The Centers for Medicare and Medicaid Services (CMS) published in the July 23 Federal Register (69 Fed. Reg. 44013) a notice of the extended availability to the end of fiscal year (FY) 2004 of unexpended funds under the State Children's Health Insurance Program (SCHIP) from the appropriations for FYs 1998 and 1999.
The notice also sets forth the amount of unexpended SCHIP funds under the FY 2000 allotments that are available to the fifty states, the District of Columbia, and the Commonwealths and Territories through the end of the period of availability on September 30, 2004.
The unexpended allotments for FY 2001 are also set forth in the notice. Qualifying states may elect to receive their available SCHIP allotments as increased matching funds for certain Medicaid expenditures.
To read the notice about the SCHIP funds, click here.
Senate Clears Patient Safety Bill
The Senate approved July 22 legislation intended to improve patient safety by promoting medical error reporting.
The "Patient Safety and Quality Improvement Act" would encourage voluntary error reporting by protecting patient safety data from disclosure so that healthcare providers could report medical errors without fear of being sued.
The reports would be analyzed by patient safety organizations, which would develop new procedures and techniques to protect patients and prevent correctable errors.
The legislation was prompted by a 1999 Institute of Medicine Report that found as many as 98,000 people die each year as a result of preventable medical errors.
The Senate Committee on Health, Education, Labor and Pensions unanimously approved S. 720 last year, while the House passed a similar bill in March 2003 (H.R. 663). The House and Senate versions must now be reconciled in conference.
"More Americans die each year from medical errors than breast cancer, AIDS, or motor vehicle accidents. As a physician who has taken the Hippocratic Oath, this is unacceptable," said Senate Majority Leader Bill Frist, M.D. (R-TN).
The American Medical Association (AMA) applauded the bill's passage. According to the AMA, the strategies included in the measure would "complement AMA members' innovative efforts to make patients safer."
For more information on the patient safety bills, go to http://thomas.loc.gov/ and search on S. 720 and H.R. 663.
JCAHO Issues 2005 National Patient Safety Goals
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) released July 20 its 2005 National Patient Safety Goals for the various healthcare entities it accredits.
JCAHO first introduced six goals with associated requirements in January 2003 as a way to improve patient safety in accredited organizations. For 2004, JCAHO added a seventh goal related to healthcare-associated infections.
Goals are issued separately for each type of healthcare setting accredited by JCAHO, including ambulatory care and surgery centers, office-based surgery, assisted living facilities, behavioral healthcare, critical access hospitals, disease specific care programs, home healthcare, hospitals, nursing homes, and laboratories.
Earlier this year, the Sentinel Event Advisory Group, which develops the goals and their associated requirements, sought comments on more extensive revisions, including new goals for hospitals regarding reconciling medications and other treatments across the continuum of care and reducing the risk of patient harm resulting from falls.
The revisions also included a new requirement under the existing "improve the accuracy of patient identification" goal to develop a plan for implementing bar code technology no later than January 1, 2007. That requirement, however, was not included in the final set of goals approved by JCAHO in July.
"The 2005 National Patient Safety Goals extend our expectations of accredited organizations in providing safe, high quality care," said JCAHO President Dennis S. O'Leary, M.D. "We know that focusing on these specific areas of performance will reduce the frequency of unanticipated serious events in health care."
To read the 2005 National Patient Safety Goals, go to http://www.jcaho.org/accredited+organizations/patient+safety/npsg.htm
U.S. Court In Maine Denies Motion To Amend Preliminary Injunction Barring Enforcement Of State Unfair Prescription Drug Practices Statute
A federal court in Maine denied a motion to amend a preliminary injunction barring enforcement of a prescription drug statute on the ground the effect of any change in the law by the legislature to avoid ERISA pre-emption was unclear and ordered the parties to proceed with discovery.
Plaintiff Pharmaceutical Care Management Association sued the Maine Attorney General (defendant) in federal court seeking a preliminary injunction barring the enforcement of the Unfair Prescription Drug Practices Act (UPDPA). The court granted the preliminary injunction on the grounds plaintiff was likely to succeed on its claim that the Employee Retirement Income Security Act (ERISA) pre-empted the UPDPA and that the UPDPA was an unconstitutional taking.
Defendant then moved to amend or vacate the injunction on the grounds recent legislation had cured any defects in the UPDPA and any remaining defective provisions could be severed.
The U.S. District Court for the District of Maine denied defendant's motion. Defendant argued that because UPDPA had been amended to remove certain provisions it was no longer pre-empted by ERISA. The court said that there was still an issue about the effect of UPDPA generally to warrant the imposition of a preliminary injunction.
The UPDPA includes two subsections, ME. REV. STAT. ANN. tit. 22 § 2699(2)(D) and (G), that require pharmacy benefits managers to disclose certain information to their clients. In the preliminary injunction the court determined that of the disclosure requirements (2)(D) had to be upheld because it had a confidentiality provision, but (2)(G) was an unconstitutional taking. Defendant argued the ruling on (2)(G) should be vacated on the ground that later legislation added confidentiality language to (2)(G) and it was no longer a taking of trade secret information. The court concluded that (2)(G) specifically calls for the disclosure of trade secret information and regardless of what the legislature later did to address any perceived problems with that section, leaving the preliminary injunction in place was appropriate.
The court then turned to the issue of severability and noted that the preliminary injunction did not discuss whether unconstitutional or pre-empted provisions of the UPDPA could be severed from the remaining provisions. The UPDPA contains no severability provision, said the court, and generally there is a presumption in favor of severability. It was unclear whether the legislature would have enacted certain provisions of UPDPA if it had known ERISA would have pre-empted its application, the court observed. The court also noted that defendant had the burden of proving the issue of severability and "barely mentioned the severability issue in his legal memorandum on the preliminary injunction." The court concluded that it was unclear how UPDPA enforcement would work without interfering with ERISA pre-emption, and therefore the court would not address that issue on the motion to amend. The court denied the motion to amend the preliminary injunction and ordered the parties to proceed with discovery.
To read the case Pharmaceutical Care Management Ass'n v. Maine Attorney Gen., No. 03-153-B-H (D. Me. July 7, 2004), click here.
2004-2005 Year in Review
The last year has been no different than previous years in terms of crucial legal developments for health lawyers and their various clients. In this Year in Review, the American Health Lawyers Association (Health Lawyers) asked each of its Practice Groups to appoint a task force to select the most important legal developments in its substantive area during the last twelve months - fifteen months. The task forces have accomplished their appointed tasks by submitting summaries of cases, administrative rulings, statutes, and governmental guidance.
Antitrust
Compiled by Health Lawyers' Antitrust Practice Group.
To read the review, download yir20005_Antitrust.pdf
Fraud and Abuse, False Claims and Self Referral
Compiled by Health Lawyers' Fraud and Abuse, False Claims and Self Referral Practice Group.
To read the review, download yir2005_Fraud.pdf
Healthcare Liability and Litigation
Compiled by Health Lawyers' Healthcare Liability and Litigation Practice Group.
To read the review, download yir2004_HLL.pdf
Health Information and Technology
Compiled by Health Lawyers' Health Information and Technology Practice Group.
To read the review, download yir2004_HIT.pdf
Hospitals and Health Systems
Compiled by Health Lawyers' Hospitals and Health Systems Practice Group.
To read the review, download yir2004_HHS.pdf
HMOs and Health Plans
Compiled by Health Lawyers' HMOs and Health Plans Practice Group.
To read the review, download yir2004_HMOs.pdf
Information and upcoming deadlines for public comments on healthcare related federal regulations.
| Agency | Number | Deadline | Type of Rule | Description | Fed. Reg. |
| CMS-OIG | OIG-9-CPG | 7/23/04 | Notice | OIG Draft Supplemental Compliance Program Guidance for Hospitals | 69 Fed. Reg. 32012 |
| CMS | CMS-1265-P | 8/2/04 | Proposed Rule | Medicare: Home Health Prospective Payment System Rate Update for CY 2005 | 69 Fed. Reg. 31247 |
| CMS | CMS-1727-P | 8/24/04 | Proposed Rule | Medicare: Provider Reimbursement Determinations and Appeals | 69 Fed. Reg. 35715 |
| CMS | CMS-1492-IFC | 8/30/04 | Interim Final Rule | Medicare Ambulance MMA Temporary Rate Increases Beginning July 1, 2004 | 69 Fed. Reg. 40287 |
| FDA | 2004N-0018 | 9/8/04 | Proposed Rule | Human Subject Protection: Foreign Clinical Studies Not Conducted Under an Investigational New Drug Application | 69 Fed. Reg. 32467 |
| CMS | CMS-6146-P | 9/21/04 | Proposed Rule | Medicare: Revised Civil Monetary Penalties, Assessments, Exclusions, and Related Appeals Procedures | 69 Fed. Reg. 43956 |
FDA names Daniel G. Schultz, M.D. Director of Center for Devices and Radiological Health, http://www.fda.gov/bbs/topics/news/2004/NEW01093.html
Washington Post: Healthcare is big issue in Presidential campaign as Americans search for cheaper prescription drugs, http://www.washingtonpost.com/wp-srv/politics/issues2004/battleground_midwest.htm
Compliance
Participants agreed that any patient telephone numbers that would appear in phone records that were subpoenaed in a divorce action of two physicians would not be PHI and there was no HIPAA violation in producing the records. List participants also had a lengthy discussion about the reasons physicians should not be paid extra for being on call. Links were provided for a list participant that asked if anyone knew the total number of pages of all Medicare regulations. Participants also gave cites for summaries of states' referral and Stark laws.
CPR
List participants discussed what types of professionals, such as psychologists, can be included on a hospital's medical staff.
HIT
Posters discussed whether two employees who accessed a patient's PHI improperly should be fired. Another poster asked whether the title of security official needed to be assigned only to one individual or could be assigned to several individuals. Another discussion centered around whether a group health plan could release subrogation claims data to an insured's counsel without written authorization from the insured.
In-House
List participants discussed the negative consequences to an individual's reputation when a legal complaint is posted on the Internet but does not reflect the fact that the case was settled or the charges later proven unfounded. Another topic of discussion focused on perceived differences and potential implications of the titles "Vice President and General Counsel" and "Vice President of Legal Affairs" for the head attorney at a hospital. Posters also examined requiring certain standards of conduct for employees outside of the work environment in keeping with an organization's core values.
LTC
List participants discussed whether various states have statutes or policies that implement IDR procedures.
Stark
Posters had a lengthy discussion about reaching through a physician to charge a DHS provider with violating Stark II. In connection with that discussion, posters also discussed a Stark violation being a basis for a qui tam action under the FCA. Posters also examined a scenario involving the physician recruitment exception under Stark. Another topic focused on whether hospitals had surveyed their medical staffs to determine whether they have financial relationships with physicians' immediate family members.
FDA Publishes Final Rule On Inflation Adjustment For Civil Money Penalties
The Food and Drug Administration (FDA) published in the Federal Register (69 Fed. Reg. 43299) July 20 a final rule adjusting for inflation the maximum civil money penalty amounts that are within the FDA's jurisdiction. The Federal Civil Penalties Inflation Adjustment Act requires federal agencies to issue regulations adjusting each civil monetary penalty in their jurisdiction every four years. The adjustments to the civil monetary penalties are based on cost of living adjustments under the Consumer Price Index. The rule is effective September 20, 2004.
To read the final rule, click here.
CMS Approves Ohio Plan To Improve Care For Chronic Illnesses
The Centers for Medicare and Medicaid Services (CMS) approved July 20 an Ohio Medicaid plan that will improve quality of care for individuals with chronic diseases and is aimed at keeping them healthy and avoiding the need for expensive treatments and hospitalizations. The plan will assign case managers to nearly 25,000 Medicaid enrollees by the end of next year. The case managers will work closely with the chronically ill to educate them about their disease and encourage them to comply with medical regimens. "As a physician, I know how the importance of a focused case management program designed to help patients with complex diseases and their health care providers follow an effective plan of care," said CMS Administrator Mark McClellan. "The use of case managers for patients with potentially costly diseases can greatly enhance understanding and compliance, and that means fewer complications and better quality of life for people with these diseases."
To read CMS' press release, go to http://www.cms.hhs.gov/media/press/release.asp?Counter=1118
DHHS Announces Grants To Strengthen Nursing Workforce
The Department of Health and Human Services (DHHS) announced July 22 almost $15.5 million in grants to universities, colleges, nursing schools, medical centers, and other healthcare institutions to promote quality and diversity in the nursing workforce. The funds were awarded in reaction to the nursing shortage that currently exists and the increasing shortage projected by DHHS. The majority of the grants will be awarded under the Nurse Education, Practice and Retention Program, which is designed to increase enrollment in nursing programs; develop internship and residency programs; promote cultural competency among nurses; improve access to healthcare for medically underserved populations; and boost nurses' retention rates. "The national nursing shortage threatens the quality of America's health care," said DHHS Secretary Tommy G. Thompson. "These grants will help us meet future demand for the essential health care services that nurses provide."
To read DHHS' press release, go to http://www.hhs.gov/news/press/2004pres/20040722.html
Editorial Staff
|
Legal Editors Bianca L. Bishop, Esq. Daniel A. McBride, Esq. Lisa R. Cohen, Esq. |
Technical Editors Sharon L. Gallaher |
Submissions to HLW
We invite you to share with your colleagues the information you find pertinent to your practice. If it's important to you, we'd like to know about it. Contributions range from articles and analysis to comments on important industry developments.
The four main content elements of Health Lawyers Weekly are articles and analysis, news, features, and best practices. The following gives more detail on each of these areas and includes some ways you can contribute. If you have an area of interest that isn't covered in these areas, we would still like to hear from you.
Articles and analysis—We are looking for contributions in all areas of health law. You can help by providing content or by volunteering to provide peer review. Insightful articles written for your firm's or group's newsletters are also welcome.
News—We are constantly on the lookout for any significant or interesting news items, including new cases, federal and state legislative and regulatory developments, and general industry news. You can help by alerting us to developments in any of these areas or by providing comments on these events regarding their impact on health law. We are also looking for additional "sources." Often members in the know will give us a heads up on breaking news before it becomes public. All source information is treated as confidential.
Features—Submissions of interest to specific segments of the health law industry are welcomed. These areas can include, but are not limited to, in-house counsel, small law, long term care, food and drug, teaching hospitals, labor, litigation, and federal and state government.
Best practices—We are very interested in publishing best practices, checklists, or any useful practice or client development tools. Practical information learned from running your practice, ranging from expense saving ideas to outsourcing, is also welcomed.
Topics of special interest to us right now include:
Submissions or questions can be sent to HLWEditors@healthlawyers.org or contact Blair Dobbins at (202) 833-0755 or bdobbins@healthlawyers.org.
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