Health and Fitness

Differences In Orthopedic Surgical Outcomes Revealed By Medicare Data

The more specialized a hospital is in orthopedic surgical care, the better the outcomes appear to be for patients undergoing hip and knee replacement surgery, University of Iowa researchers report in a new study of Medicare patients. Among more specialized hospitals, there were fewer serious post-surgical complications such as blood clots, infections and heart problems, as well as fewer deaths. The findings, which were published online Feb. 11 by the British Medical Journal, were based on data for nearly 1.3 million patients who received hip or knee replacement surgeries between 2001 and 2005 at 3, 818 hospitals in the United States. "The findings suggest that more specialized hospitals have better outcomes even after we account for the type of patients each hospital cares for and the number of hip and knee replacement surgeries that each hospital performs, " said the study's lead author Tyson Hagen, M.D., fellow in rheumatology at the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics.

Louisiana, Oklahoma, Mich., Arizona Plan Medicaid Cuts; N.C.'s Prison Health Costs

The (New Orleans) Times-Picayune : Louisiana "Gov. Bobby Jindal will present his 2010-11 budget request Friday, which is expected to call for cuts to health care, education and other areas of state government as his administration outlines plans for plugging a $1 billion shortfall. ... The general-fund growth is not nearly enough to offset a loss of about $650 million in federal health-care financing, the rising cost of state pensions, automatic pay raises for state workers and inflation in health-care programs." "Many of the health-care cuts proposed today may not be enacted, as there is a decent likelihood that Congress will approve a temporary fix for the biggest problem facing Louisiana's budget: a $400 million Medicaid cut due to a lower federal match rate and the expiration of the federal economic stimulus law" (Moller, 2/11). News OK : "Budget cuts at the agency that administers the state's Medicaid program could make it more difficult for patients to get the medical care they need, members of the state's medical association said Thursday.

Walgreens Pharmacies Remain In Washington Medicaid Program; Talks Continue With State Of Washington

Walgreens (NYSE: WAG)(NASDAQ: WAG) will continue filling Medicaid prescriptions at its Washington state pharmacies through March 15. The company, which operates 121 pharmacies in Washington, announced on Jan. 13 it would stop filling Medicaid prescriptions in 64 of its stores because of continued reduction in reimbursement under the State of Washington Medicaid program. The decision to delay the withdrawal from the program comes as constructive talks continue between the state and the company. "We're encouraged by the state's willingness to continue working with us to find a solution that will allow all of our stores to continue serving our Medicaid patients, " said Kermit Crawford, Walgreens senior vice president of pharmacy. "We recognize the budget challenges the administration and the Legislature face and we're optimistic that our continued talks will result in a solution that will provide the savings the state is looking for, while allowing pharmacies to maintain service for those patients with the most need and the fewest options.

Will Health Care Savings Be Used To Reduce The Deficit?

Kaiser Health News staff writer Mary Agnes Carey writes: "In their effort to overhaul the health system, President Barack Obama and congressional Democrats pressed hospitals, drug makers and other providers to accept billions of dollars in government payment cuts and new fees to help finance the legislation. ... But now, if the legislation fails, those savings, primarily cutbacks in Medicare and Medicaid, might end up being used for something far different: reducing the federal deficit" (Carey, 2/16). Read entire article. This information was reprinted from with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at © Henry J. Kaiser Family Foundation. All rights reserved.

State Round Up: Florida Considers Eliminating Popular Medicaid Plan; State Program For Low-Income Adults Changing In Minn.

Health News Florida : "This could be the year the state of Florida eliminates its popular MediPass program, which gives more than half a million Medicaid recipients, mostly aged and disabled Floridians, an alternative to HMOs. Hints of its demise showed up in the governor's budget and letters from a powerful lawmaker. The fight brewing in Tallahassee is over what service delivery system will take its place: commercial HMOs, hospital-run networks or a system that puts the primary care physician in charge. The Legislature is closely examining the MediPass program, which as of January had about 550, 000 enrollees statewide, in an effort to control spending in the Medicaid program. Although it's considered a managed-care option, MediPass is actually a primary care case-management program, in which doctors are given a monthly $2 fee for managing a patient's care. The services, such as immunizations and checkups, are reimbursed at Medicaid rates" (Sexton, 2/2). The Miami Herald reports on a different Medicaid program in Florida: "Former Gov.

2 Seattle Doctors Accused Of Medicare Fraud; CNN Offers Advice For Patients On Checking Out Their Doctors

Seattle Post-Intelligencer : Two Seattle-area doctors are accused of stealing millions from Medicare through fraudulent billing. "In separate grand jury indictments filed in U.S. District Court, federal authorities contend both men followed identical schemes in setting up shell companies designed to defraud the Medicare system." Authorities say one of the doctors "used stolen identities of actual Medicare recipients to file nearly 1, 300 false claims in six months. In doing so, [one of the doctors] allegedly received $1.9 million in payments through the federal system while delivering nothing in return." The other doctor set up a bogus business and "used stolen identities to fraudulently draw $753, 000 in Medicare reimbursements" (Pulkkinen, 2/11). In the meantime, CNN asks if you know if your doctor is a criminal. "Hundreds of doctors in the United States have been found guilty of criminal acts, according to the Federation of State Medical Boards. Many continue to practice, and patients have no way of knowing about their doctor's criminal past unless they do some online sleuthing.

PhRMA's Tauzin Quits Amid Talk That White House Deal Caused Tension Within Organization

Former congressman and powerful lobbyist Billy Tauzin is resigning as head of the pharmaceutical industry trade group after a deal he helped broker with the White House on health reform strained relationships inside the group. The New York Times : Tauzin's deal with the White House, "to limit the drug industry's total costs under the proposed health care overhaul to $80 billion over 10 years, " sparked internal dispute in the trade group, the Pharmaceutical Research and Manufacturers of America. "Like almost every other seasoned Washington player, Mr. Tauzin bet the health care overhaul was an unstoppable train, so he wagered it was better to get on board early - only to watch it come to a screeching halt. ... But after the reform stalled, some industry leaders felt the trade group had gone too far giving concessions and could lose on some important legislative issues without gaining the political protection it had sought." Under Tauzin, PhRMA spent "more than $100 million on ads to promote the overhaul.

Today's OpEds: Republicans And Medicare, Small Business Health Costs And Changes To FEHBP

On Health Care, Where You End Up Matters Most Politico Republican leaders are now saying they will not participate in the meeting unless the president takes his health reform plan off the table to start over. I understand their concerns with a variety of issues in the current bills, but where you start is not nearly as important as where you finish. After all, fees continue to skyrocket and millions remain uninsured, costing our country in many ways. ... There is no time like the present for Washington to show America that it is interested in governing, not just in campaigning. The cameras will be rolling, and we will be watching (Christine Todd Whitman, 2/12). Republicans and Medicare The New York Times What's truly mind-boggling is this: Even as Republicans denounce modest proposals to rein in Medicare's rising costs, they are, themselves, seeking to dismantle the whole program. And the process of dismantling would begin with spending cuts of about $650 billion over the next decade.

Medicaid And Other State Programs Face Questions About Fraud, Other Difficulties

The New Mexico Independent : The state's Medicaid Fraud Division said two state agencies, the Health Department and Human Services Department that administer the Medicaid program, "'filtered' and 'sanitized' information and documents requested by investigators, hindering numerous investigations." The federal Centers for Medicare and Medicaid Services wil investigate the allegations (Furlow, 2/10). Anchorage Daily News : "An Alaska mental health advocacy group that has spent years battling the pharmaceutical industry over medication is suing more than a dozen Alaska child psychiatrists, saying the doctors unnecessarily drugged children and committed Medicaid fraud" (Holland, 2/10). Deseret (Salt Lake City) News : "An audit of state insurance programs for children and the poor that at first glance might have looked like a $13.7 million stash of fraud that revenue-strapped lawmakers could recoup is mostly a product of incomplete eligibility checking by the state." The audit examined Medicaid and the Children's Health Insurance Program.

Possible State Cuts To Texas Seniors' Nursing Facility Medicaid Funding Imprudent In Light Of Worsening Facility Cost Squeeze

In testimony at a Health and Human Service Commission (HHSC) hearing on possible budget reduction options, the President of the Texas Health Care Association (THCA) warned that any cuts now to Texas Medicaid payment rates for nursing home care will confront the nursing home profession with dire financial consequences. The Federal Center for Medicare and Medicaid Services (CMS) has already begun to implement $725 million in federal Medicare cuts, which Texas has historically relied upon to prop up the already inadequate funding of state Medicaid rates that have not met the state's own rate-setting methodology since 1999. "Before we engage in discussions about cutting Texas seniors' key Medicaid-financed programs, we absolutely have to look first at the fact that nursing homes are already having to deal with a state and federal funding environment that squeezes facilities' abilities to recruit and retain high quality direct care staff and to deliver the level of care that our frail and elderly residents deserve and expect.

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