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News Briefs |
Updated May 9, 2008 |
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| Four cardiologists have agreed to pay $387,000 to settle allegations that they received improper salary payments from the state's medical university in exchange for referring patients to the university's cardiac surgery unit. | The U.S. Attorney's Office announced the settlements, saying that the doctors were hired as part-time faculty members by the University of Medicine and Dentistry of New Jersey, while federal law prohibits a doctor from receiving a salary in exchange for referring patients, reported the Associated Press. The settlements eliminate the need for the government to file suit against the doctors to recover the salaries, and the U.S. Attorney's Office said settlements were signed over the last week with Dr. Trevor Atherley of Watchung for approximately $180,000; Dr. Joven Dungo of Caldwell for approximately $138,000, and Dr. Abdul Ameen of Bayonne for approximately $38,000. A settlement with Dr. Michael Benz of Nutley was signed on April 14 for approximately $30,000, the Associated Press noted. UMDNJ issued a statement saying that changes have been implemented to prevent such situations in the future, the Associated Press added. (Associated Press, May 8, 2008) | |
| The Bush administration appears to be softening a policy that states have complained hindered their efforts to expand health care coverage for poor children under the State Children's Health Insurance Program. | In a letter sent to states, the administration says it will give states more flexibility to prove that they have enrolled 95 percent of poor children from eligible families – a condition, laid out in an August directive, for using federal funds to expand coverage under SCHIP, reported the Wall Street Journal. Hardly any state meets that threshold, and since then several states have been forced to scale back their plans to expand coverage beyond children from families at twice the poverty level of $42,400 for a family of four, the Journal noted. The administration’s letter said it will qualify many of the 15 states that may not have met the criteria using data from the Current Population Survey; for example, state surveys can now be used, the Journal added. (Wall Street Journal, May 8, 2008) | |
| Wal-Mart Stores Inc. has expanded its drug offerings to include three-month supplies of prescription drugs for $10, stepping up the fight to attract U.S. consumers seeking cheaper medicines. |
Wal-Mart also will offer more than 1,000 additional over-the-counter medicines for $4 or less, and says it has saved consumers $1.16 billion since starting its $4 generic-drug program in 2006, reported Bloomberg News. Wal-Mart said its discount stores, Neighborhood Market supermarkets and Sam's Club pharmacies will fill prescriptions for as many as 350 generic medications at $10 for a 90-day supply, while also adding $9 medications to treat breast cancer, menopause and hormone deficiency, Bloomberg News added. (Bloomberg News, May 6, 2008) |
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| Gov. Jon S. Corzine has proposed charging co-payments to Medicaid recipients to raise $7.55 million for the cash-strapped state. | Corzine proposes a $6 co-payment on emergency room visits that are not a true emergency to raise $550,000, and a $2 co-payment on prescription drugs to raise $7 million, while the prescription drug co-payment would be capped at $10 per month per person, reported the Associated Press. Corzine does not think the increased costs would push lower-income people to stop taking prescription drugs and avoid medical treatment, contending most states have imposed co-payments without major problems, the Associated Press noted. This is the third time that Corzine has proposed Medicaid co-payments since becoming governor in 2006; his fellow Democrats, who control the Legislature, rejected them the first two times, the Associated Press added. (Associated Press, April 28, 2008) | |
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| The Medicare Health Support program, a three-year experiment to see whether disease management can prevent expensive hospital visits for people with chronic conditions like congestive heart failure and diabetes, may cost more than it saves. | After paying eight outside companies about $360 million since mid-2005 to deliver disease management services, using nurses who periodically place phone calls to patients to check whether they are taking their drugs and seeing the right doctors, Medicare is still trying to figure out whether the companies were able to keep people healthier, while preliminary data indicate that the government is unlikely to save money, reported the New York Times. Several of the companies, including two that specialize in disease management, Healthways and Health Dialog, are pressing Medicare to continue the project in some fashion beyond the end of this year, saying the government mishandled the experiment, the Times noted. Medicare says the experiment so far has not reduced medical bills enough to offset the fees the companies are charging the government – as much as $2,000 a year for each patient – while a final accounting of the experiment is likely to come no sooner than next year, the Times added. (New York Times, April 7, 2008) | |
| Federal health officials proposed adding dangerous blood clots in the leg and eight other conditions to the list of complications that Medicare would not pay to treat if they were acquired at the hospital. | Medicare set a new precedent last year by saying it would no longer pay hospitals for treating eight "never events" – conditions that occur as a result of hospital error, such as giving a patient the wrong blood type, reported the Associated Press. The newly-proposed rules add nine conditions, including: deep-vein thrombosis, ventilator-associated pneumonia, bloodstream infections with the staph aureus bacteria, and Legionnaire's disease. The government estimates that the proposed rule will save Medicare $50 million annually during each of the next three years, the Associated Press added. (Associated Press, April 15, 2008) | |
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| New Jersey physicians are accusing managed care companies of increasingly interfering with patient care with policies designed to cut costs. | Organized under NJ Physicians, a year-old Trenton-based organization representing about 1,100 New Jersey doctors, the physicians voiced their complaints before Steven Goldman, the state banking and insurance commissioner, at a Health Care Leadership Summit April 14 in Hamilton, reported the NJBIZ. Dr. John Ciccone, a member of NJ Physicians’ leadership council, says his group has three quarrels with insurers: requiring prior authorization for treatments in more cases than in the past, asking physicians to make "therapeutic switches" from prescribed drugs to other drugs in the same class that may not be as effective, and asking physicians more frequently to do "step-edits" – treating patients first with cheaper or generic drugs before moving in steps to more effective drugs, NJBIZ noted. Physicians at the meeting in Hamilton wanted Goldman to weigh in on the issue of who would take the ultimate responsibility for those policies if they adversely impact a patient’s health or become life-threatening, while Goldman said in general he would find it "very hard to hold a physician liable" for an insurer’s decision that affects the life, health or general well-being of a patient, NJBIZ added. (NJBIZ, April 28, 2008) | |
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| Health insurers are beginning to mine their patient data to look for drug safety red flags. | WellPoint Inc., in collaboration with the Food and Drug Administration, plans to launch one of the first real-time drug-surveillance systems: starting early next year, the insurer will systematically scan the medical information of more than half of its 35 million members to look for hidden patterns or spikes in medical problems that might be linked to certain medication or combination of drugs as they happen, reported the Wall Street Journal. Until now, the drug-safety monitoring system used by the FDA has been spotty, slow and passive, relying largely on harried doctors and drug companies to report problems they see crop up with patients, and capturing less than 10 percent of bad reactions, the Journal added. (Wall Street Journal, April 15, 2008) | |
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| Only a handful of physicians participated in a voluntary program last year that provides a small bonus payment to practices that report on quality measures, according to data released by the CMS. | Preliminary data on the Physician Quality Reporting Initiative (PQRI) shows that 99,000 physicians, nonphysician practitioners or therapists – 16 percent of the eligible professionals who could have reported quality data on 74 quality measures – submitted this data at least once in 2007, reported Modern Physician. Several specialties, including anesthesiology, ophthalmology and emergency medicine, had higher than average rates of participation in the PQRI, which offered physicians who successfully reported a designated set of quality measures on claims during this period a bonus payment, subject to a cap, of 1.5 percent of total allowed charges for covered Medicare physician fee schedule services, Modern Physician noted. The 2008 PQRI reporting period, which spans the entire calendar year, will offer the same bonus payment for reporting on 119 measures, Modern Physician added. (Modern Physician, February 26, 2008) | |
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| The physician-owned pediatric medical group formerly known as Children's Health Associates is branching out into operating primary care practices. | With 240 physicians at 45 practices sites throughout New Jersey and southeastern Pa., Advocare is among the top five physician-owned and -operated medical practices in the country, while it decided to expand beyond pediatric practices and into primary care practices after determining their model could be applied to family doctors as well, reported the Business Journal. About three dozen of the 240 doctors in the practice are family physicians, most of whom have joined over the past year. Under Advocare's business model, practices are merged into the medical group, not purchased, and doctors are given the option of being paid a salary, but most choose to become a partner in the organization, the Business Journal added. (Philadelphia Business Journal, March 24, 2008) | |
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| State mental health officials are negotiating with the University of Medicine and Dentistry of New Jersey to run the state's largest psychiatric hospital, which has been beset by a string of deaths and mistakes that led to the recent ouster of its top manager. | The Department of Human Services has been searching for a chief executive officer for Ancora Psychiatric Hospital since mid-December, and it has reassigned Ancora CEO Latanya Wood El, recommended discipline for six employees and is weighing charges against three clinicians, reported the Star-Ledger. Human Services officials have approached the state's medical university to run Ancora, and the agreement is under review by the Attorney General's Office, the Star-Ledger added. (Star-Ledger, February 22, 2008) | |
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| Physicians can now sign up to receive prescription drug safety alerts via e-mail instead of through postal mail. | The online network is being launched by a nonprofit group called the iHealth Alliance, which is operated by Medem Inc., while the alerts will be focused by specialty and will be limited almost exclusively to alerts that drug makers send out in "Dear Doctor" letters: significant drug-label changes, warnings and recalls, reported the Wall Street Journal. Until recently, drug companies felt bound by federal regulations dating back to the pre-Internet era that described how to send these types of communications through a paper-based system, while the FDA issued guidance in 2006 saying the rules were outdated and that it was acceptable for the messages to go out by e-mail, the Journal noted. Drug makers will pay to use the new system, which will be free for doctors and won't include any drug-company marketing materials, while doctors who don't sign up for it will continue to receive the notifications through the mail, the Journal added. (Wall Street Journal, March 25, 2008) | |
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| The pace of health care quality improvement appears to be slowing, according to the Agency for Healthcare Research and Quality's fifth annual report compiling federal and state data on more than 200 quality metrics. | A composite measure of health care quality improved at a 2.3 percent average annualized rate between 1994 and 2005, with the rate falling to 1.5 percent from 2000 to 2005, reported American Medical News. In a first stab at examining the cost efficiency of the American health care system, AHRQ noted that costs, as estimated by the Centers for Medicare & Medicaid Services, jumped 6.7 percent from 1994 to 2005, although AHRQ said that cost and quality cannot be reliably compared because expenditures are comprehensively measured, but quality is not, AMNews added. (American Medical News, April 28, 2008) | |
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| Drug and medical device companies should be banned from offering free food, gifts, travel and ghost-writing services to doctors, staff members and students in all 129 of the nation’s medical colleges, the Association of American Medical Colleges has concluded. |
The proposed ban is the result of a two-year effort by the
group to create a model policy governing interactions between the schools
and industry and, while schools can ignore the association’s advice, most
follow its recommendations, reported the New York Times. In addition
to the gift, food and travel bans, the report recommended that medical
schools:
(New York Times, April 28, 2008) |
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| Two teams of researchers with access to thousands of documents gathered for lawsuits over the painkiller Vioxx allege that Merck waged a campaign of deception to promote its drug, moving slowly to warn of possible hazards while at the same time dressing up in-house studies as the work of independent academic researchers. | The reports in the Journal of the American Medical Association in effect accuse one of the world's biggest pharmaceutical makers of various forms of scientific fraud. One study alleges that Merck gave the Food and Drug Administration an incomplete accounting of deaths in a clinical trial of Vioxx in people with mild dementia, while federal regulators eventually received the data, which added to growing evidence that Vioxx increased the risk of heart attacks and strokes, reported the Washington Post. Simultaneously, Merck was using what the JAMA authors call "guest authorship and ghostwriting" to make it appear that research done by its employees or contractors was the work of scientists at medical schools and universities – which presumably gave the findings more credibility when they were published, the Post added. (Washington Post, April 16, 2008) | |
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| Doctors who want to go paperless when ordering drugs for their Medicare patients now have a set of federal standards on how to do it, while those who are prescribing electronically already have a year in which to become compliant with the rules. | The Centers for Medicare & Medicaid Services on April 2 released final e-prescribing regulations for Medicare Part D under which physicians and pharmacies will not be required to use electronic prescriptions but must follow the new standards if they do, reported American Medical News. The regulations, set to take effect in April 2009, have four categories – formulary and benefits, medication history, fill status notification, and provider identifiers – while the standards, required by Medicare law, will govern how physicians, pharmacies and drug plans will communicate electronically to handle drug orders, AMNews added. (American Medical News, April 28, 2008) | |
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| Angioplasty procedures can be safely performed in well-run and skilled hospitals even when they don't have heart surgery back-up capabilities on site, according to a study of National Cardiovascular Data Registry data on more than 9,000 patients treated at hospitals with off-site heart surgery back-up, and nearly 300,000 patients at centers with heart surgery programs on site. | The study showed a similar rate of procedural success for angioplasty procedures done in hospitals with and without cardiac surgery on site, at 93 and 94 percent, respectively, while there were also similar rates of complications, emergency surgery and mortality with emergency surgery, reported Dow Jones Newswires. The results were presented at the annual meeting of the Society for Cardiovascular Angiography and Interventions, which is being held alongside the American College of Cardiology's annual conference this year, while researchers said the study results don't equal a broad endorsement for angioplasty at hospitals that use off-site, back-up surgical centers because there may be a wide variation of quality among individual hospitals, Dow Jones Newswires noted. Some factors in the study indicate that it included particularly good hospitals: the voluntary submissions signals their facility's commitment to quality, 92 percent of the 61 centers without onsite surgery studied were prepared to do angioplasty around the clock, and the hospitals without heart surgeons on hand tended to be slightly quicker when it came to getting patients' blood flow restored once they reached the facility, Dow Jones Newswires added. (Dow Jones Newswires, March 29, 2008) | |
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| For chronically ill patients in their last two years of life, Medicare spends an average of $59,379 in New Jersey – the highest amount nationwide, according to the Dartmouth Atlas of Health Care, which compiled records of 4.7 million patients who died during 2001-2005. | The national average for spending on such chronically ill patients was $46,412, while a large share of Medicare's expenses – about $1 out of every $3 spent – is generated by enrollees with chronic conditions in their final two years of life, reported the Associated Press. The number of days those patients spent in the hospital varied greatly depending upon where they lived, while researchers noted that the supply of beds – not how sick patients are – is the key driver, as patients in the low-cost regions were more likely to get their care at the doctor's office or at home because there was a smaller supply of hospital beds per patient, the Associated Press noted. For example, chronically ill patients in New Jersey spent 27.1 days in the hospital, which was the highest state rate in the nation, followed by New York at 27 days, while patients in Utah spent the fewest – 11.6 days in the hospital. Researchers said that more days in the hospital did not necessarily lead to better outcomes, as those patients were usually seen by more specialists, and they spent more time in the intensive care unit, but they did not live longer, on average, the Associated Press added. (Associated Press, April 7, 2008) | |
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New
Jerseyans should brace for more hospital closings, the Department of Health
and Senior Services told lawmakers at a hearing
before the Senate Budget and Appropriations Committee. |
Commissioner Heather Howard said that, with limited state money available to help hospitals and a glut of beds across the state, some closings would concentrate care at the most viable sites and let the government focus aid on the most needy areas, reported the Gannett State Bureau. Six hospitals have closed in the past 16 months and another two shutdowns are pending, while half of the state's 78 hospitals are running deficits, and state aid to the facilities is slated to drop by nearly 14 percent in Gov. Jon S. Corzine's proposed budget. While Howard would not put a figure on the number of closings expected, she pledged to work to preserve sites that are most critical to their communities, the Gannett State Bureau added. (Gannett State Bureau, April 10, 2008) | |
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| To save the Muhlenberg Regional Medical Center, supporters are promising to raise millions of dollars and enlist the help of residents, financiers and at least one member of the Super Bowl Champion New York Giants. | With the Plainfield hospital as a backdrop, about 200 people gathered last Sat. to lead a prayer vigil to protest the facility's planned closing, the fifth demonstration in recent weeks, while organizers launched a grassroots fundraising plan to purchase Muhlenberg from owner Solaris Health System, reported the Star-Ledger. Plainfield resident Olive Lynch, a council candidate for the Third Ward who proposed the idea to purchase the hospital, said shares of the hospital will be sold for $20 each to raise enough money to meet Muhlenberg's asking price – which Solaris said was at least $70 million, the Star-Ledger noted. Hospital supporters collected at least $20,000 in pledges to the cause, while Muhlenberg physician Brian Fertig said Giants center Shaun O'Hara, who lives in Hillsborough, has told him he would lend his name and clout to the Plainfield hospital's cause, the Star-Ledger added. (Star-Ledger, April 20, 2008) | |
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| The Bush administration violated federal law last year when it restricted states' ability to provide health insurance to children of middle-income families, and its new policy is therefore unenforceable, according to a ruling by the Government Accountability Office. | The ruling strengthens the hand of at least 22 states, including New Jersey, that already provide Children's Health Insurance Program coverage or want to do so, as the accountability office said the new policy amounts to a marked departure from a longstanding, settled interpretation of federal law, which must be submitted to Congress for review before it can take effect, the Times noted. The federal Centers for Medicare and Medicaid Services maintains that its Aug. 17 letter is still in effect, which told states what steps they needed to take to be sure the children's health program would not displace or crowd out private coverage under group health plans, while New Jersey and several other states have filed lawsuits challenging the Bush administration policy, and Congress may consider legislation to suspend the directive, the Times added. (New York Times, April 19, 2008) | |
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Assembly
lawmakers advanced three measures intended to improve hospitals' financial
health but delayed action on the most far-reaching step, which would have
allowed state officials to grab the reins at facilities heading toward
fiscal ruin. |
The proposals approved by the Assembly Health and Senior Services Committee would require all hospital boards of trustees to undergo training on their responsibilities, hold at least one annual meeting open to the public and cap at five times the federal poverty level the amounts hospitals can charge uninsured patients, reported the Gannett State Bureau. Each proposal stems from a recent report from a commission appointed by Gov. Jon S. Corzine that studied how to more efficiently fund state hospitals, given the limited amounts of taxpayer money available for the struggling industry. The votes represent the first legislative action taken based on the report and came as hospitals say they are in the midst of a financial crisis, with half of the facilities in the state losing money and the government cutting back its support, the State Bureau added. (Gannett State Bureau, May 6, 2008) | |
| A bill that would prohibit discrimination by health insurers and employers based on the information that people carry in their genes won final approval in Congress. | The legislation, which President Bush has indicated he will sign, prohibits health insurance companies from using genetic information to deny benefits or raise premiums for individual policies – it is already illegal to exclude individuals from a group plan because of their genetic profile – while employers who use genetic information to make decisions about hiring, firing or compensation could be fined as much as $300,000 for each violation, reported the New York Times. Some patients worry that they may be denied jobs or face higher insurance premiums if a genetic red flag shows up in their medical records, while many who do learn that they are at higher risk for a disease opt not to ask their insurance companies to cover the costs of the genetic test, to keep the information secret. Some try to persuade medical professionals not to enter the test results in their health records; others keep the information from even their own doctors, the Times noted. The bill may be hard to enforce, some experts say, and it does not address discrimination by long-term care insurers or life insurers, the Times added. (New York Times, May 2, 2008) | |
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| New Jersey has not monitored access to key personal information in a computer system that tracks care for the poor, leaving no way to know if Social Security numbers and other information about doctors and patients have been misused, a recent state audit found. | The audit by the Office of the State Auditor determined that the state Department of Human Services lacks appropriate security policies and procedures for the computer system it uses to process claims for more than one million New Jersey Medicaid patients, and that the lack of monitoring makes it impossible to determine whether an employee is accessing personally identifiable information for fraudulent purposes, reported the Associated Press. The audit cited no examples of improper activity but recommended the department log access to sensitive personal information, the Associated Press added. (Associated Press, May 1, 2008) | |
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