Medicare Star Ratings Allow Nursing Homes to Game the System – NYTimes.com

August 25, 2014

an examination of the rating system by The New York Times has found that Rosewood and many other top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes.The Medicare ratings, which have become the gold standard across the industry, are based in large part on self-reported data by the nursing homes that the government does not verify. Only one of the three criteria used to determine the star ratings — the results of annual health inspections — relies on assessments from independent reviewers. The other measures — staff levels and quality statistics — are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value.

via Medicare Star Ratings Allow Nursing Homes to Game the System – NYTimes.com.


You Think Financing U.S. Health Care Is Bizarre? Check Out 340B Drug Pricing

August 22, 2014

Indeed, it can be said that in no other country is as much oversight necessary—and performed—as it already is in the U.S. Here hospitals spend hundreds of millions, possibly billions, every year to be in compliance with government regulations, and government auditors and the Inspector General’s offices cost hundreds of millions more. Every U.S. hospital now has some executive vice president in charge of compliance, has a board subcommittee dealing with compliance and has a sizeable compliance department and confidential hotline for whistle blowers. There are a growing number of compliance consulting firms helping hospitals and clinics to remain in compliance with U.S. federal and state regulations, earning a fine living from the process—all at patients’ expense, of course. I have never encountered anything like it in other countries whose health systems I have studied.

via You Think Financing U.S. Health Care Is Bizarre? Check Out 340B Drug Pricing.


Patients’ End-of-Life Wishes Granted, Study Finds – WSJ

June 9, 2014

Patients who document their end-of-life wishes using a special medical form get the specific care they want in their final days, according to a study published online in the Journal of the American Geriatrics Society.The study by researchers at Oregon Health & Science University looked at the growing use of the voluntary form, called Physician Orders for Life-Sustaining Treatment, or Polst. The document lets patients request or refuse certain medical treatments such as CPR or intensive care. The study is the largest on the topic so far and the first to look at preferences stated in the form and where people actually die.

via Patients’ End-of-Life Wishes Granted, Study Finds – WSJ.


Getting The Product Right: How Competition Policy Can Improve Health Care Markets

May 22, 2014

As hospital, physician, and health insurance markets consolidate and change in response to health care reform, some commentators have called for vigorous enforcement of the federal antitrust laws to prevent the acquisition and exercise of market power. In health care, however, stricter antitrust enforcement will benefit consumers only if it accounts for the competitive distortions caused by the sector’s long history of government regulation. This article directs policy makers to a neglected dimension of health care competition that has been altered by regulation: the product. Competition may have failed to significantly lower costs, increase access, or improve quality in health care because we have been buying and selling the wrong things. Competition policy makers—meaning both antitrust enforcers and regulators—should force the health care industry to define and market products that can be assembled and warranted to consumers while keeping emerging sectors such as mHealth free from overregulation, wasteful subsidy, and appropriation by established insurer and provider interests.

via Getting The Product Right: How Competition Policy Can Improve Health Care Markets.


The Effects of Regulation and Litigation on a Large For-Profit Nursing Home Chain

May 19, 2014

This article examined the effects of state regulation and civil class-action litigation on corporate compliance with nurse staffing and quality standards, corporate strategies to manage staffing and quality, and corporate financial status of a large for-profit nursing home chain. A historical case study was used to examine multiple public data sources, focusing on facilities in California from 2003 to 2011 during and after regulatory actions and litigation. The results showed that the state issued numerous deficiencies for violations of the nurse staffing and quality standards with minimal impact on quality compliance with state law. A class action jury trial found the chain violated the state’s minimum staffing standard on one-third of the total days during a six-year period and awarded a $677 million verdict. A court settlement and supervised injunction resulted in compliance with minimum staffing and some improvement in quality measures, but quality levels remained below the average California facilities. The litigation also had some negative financial impact on Skilled’s California facilities and parent company. Civil litigation had more impact on the chain than the regulatory oversight.

via The Effects of Regulation and Litigation on a Large For-Profit Nursing Home Chain.


The ICD-10 emperor has no clothes

April 25, 2014

The howling about the delay of ICD-10 was loud and fierce. It seems the quality of health care in the United States depends on our ability to use 68,000 diagnosis codes. The rest of the world has switched to ICD-10, and we alone insist on using an outdated coding system. Here’s a secret. The World Health Organization’s version of ICD-10 has about 16,000 codes, equivalent to ICD-9-CM. The rest of the world is not using ICD-10-Clinical Modification set, which has 68,000 codes. Only we, in the US, are considering that. The Canadian version of ICD-10 has about 16,000 codes, but the physicians do not use those codes for billing and reimbursement. They use a more limited code set of about 600 three-digit codes. Let me repeat this: The WHO version of ICD-10 that the rest of the world uses about 16,000 codes. Our version, developed jointly by the CDC and the American Hospital Association has 68,000 codes.

via The ICD-10 emperor has no clothes.


States Fail To Make Health Care Prices Transparent To Consumers

March 25, 2014

Forty-five of 50 states – 90 percent – fail to adequately make price information available to their consumers even as the Affordable Care Act, employers and insurance companies push for greater transparency, according to a new analysis.

In their “Report Card on State Price Transparency Laws,” the nonprofit Health Care Incentives Improvement Institute and Catalyst for Payment Reform, gave 45 states a failing grade with the highest grades awarded to Maine and Massachusetts, which each received a “B.” No states received an “A.” States with high grades generally share information about inpati

via States Fail To Make Health Care Prices Transparent To Consumers.


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