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Category Archives: Health Care

Medicare Beneficiaries Paid Nearly Half of the Costs for Outpatient Services at Critical Access Hospitals

HHS IG Report (OEI-05-12-00085), October 7, 2014

“The Critical Access Hospital (CAH) certification was created to ensure that rural beneficiaries would have access to hospital services. Medicare reimburses CAHs at 101 percent of their “reasonable costs,” rather than at the predetermined rates set by the Outpatient Prospective Payment System (OPPS). The system that Medicare uses to calculate outpatient coinsurance amounts for beneficiaries who receive services at CAHs differs from that used for beneficiaries who receive services at acute care hospitals. Beneficiaries who receive services at CAHs pay coinsurance amounts based on CAH charges, whereas beneficiaries who receive services at acute care hospitals pay coinsurance amounts based on OPPS rates. CAH charges are typically higher than the reasonable costs associated with CAH services or the OPPS rates that acute-care hospitals receive. HOW WE DID THIS STUDY – We used 2009 and 2012 claims data to calculate the percentages and amounts of coinsurance that Medicare beneficiaries paid toward the costs for outpatient services at CAHs. Additionally, we calculated the percentages and amounts of coinsurance that beneficiaries would have paid at acute-care hospitals for 10 outpatient services that were frequently provided at CAHs. WHAT WE FOUND –  Because coinsurance amounts were based on charges, Medicare beneficiaries paid nearly half the costs for outpatient services at CAHs. In 2012, beneficiaries paid approximately $1.5 billion of the estimated $3.2 billion cost for CAH outpatient services. Additionally, the average percentage of costs that beneficiaries paid in coinsurance for these services increased 2 percentage points between 2009 and 2012. Finally, for 10 frequently provided outpatient services at CAHs, beneficiaries paid between 2 and 6 times the amount in coinsurance that they would have for the same services at acute-care hospitals.”

New GAO Reports – Changing Crude Oil Markets, Federal Paid Admin Leave, Food Safety

CHANGING CRUDE OIL MARKETS: Allowing Exports Could Reduce Consumer Fuel Prices, and the Size of the Strategic Reserves Should Be Reexamined, GAO-14-807: Published: Sep 30, 2014. Publicly Released: Oct 20, 2014. FEDERAL PAID ADMINISTRATIVE LEAVE: Additional Guidance Needed to Improve OPM Data, GAO-15-79: Published: Oct 17, 2014. Publicly Released: Oct 20, 2014. FOOD SAFETY: USDA Needs to Strengthen Its Approach toContinue Reading

How Initiatives to Reduce Fraud in Federal Health Care Programs Affect the Budget

“Observers often cite fraud as an important contributor to high health care spending, particularly in federal programs. This report describes how CBO estimates the budgetary effects of legislative proposals to reduce fraud in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), and how those estimates are used in the Congressional budget process. What Is Fraud? ForContinue Reading

Ebola crisis in West Africa brings hightened focus to need for vaccine

WSJ – Ebola Vaccine Push Ramps Up – After Years of Delay, Researchers Rush to Field Test a Shot to Prevent the Disease “The world had little interest in Ebola in 1997, which is why cell biologist Nancy J. Sullivan thought she might be able to make a mark. Today, if the scientific world is to haveContinue Reading

CRS – Patient Protection and Affordable Care Act

Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions, Angela Napili, Information Research Specialist, October 10, 2014. “The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) has numerous provisions affecting private health insurance and public health coverage programs. Many of these provisions take effect in 2014. This report provides resources to help congressionalContinue Reading

Billions in Losses if Ebola Not Stopped

“With the latest death toll from Ebola now at 3,439 in the three worst-affected countries of Guinea, Liberia, and Sierra Leone, a new economic impact assessment from the World Bank Group says that if the epidemic was to significantly infect people in neighboring countries, some of which have much larger economies, the two-year regional financialContinue Reading

Federal and State Quarantine and Isolation Authority

CRS – Federal and State Quarantine and Isolation Authority, Jared P. Cole, Legislative Attorney. October 9, 2014. “In the wake of increasing fears about the spread of highly contagious diseases, federal, state, and local governments have become increasingly aware of the need for a comprehensive public health response to such events. An effective response could include the quarantine of personsContinue Reading

New on LLRX – Clients and Suicide: The Lawyer’s Dilemma

Via LLRX.com – Clients and Suicide: The Lawyer’s Dilemma – Ken Strutin’s article discusses an increasingly visible issue, suicide, here in the specific context of criminal law. He reviews how the stress of prosecution or litigation, whether it means risking a prison term, unemployment, bankruptcy, eviction, broken family relations, isolation, or other serious consequences can create or exacerbateContinue Reading

Questions and Answers about Ebola and Pets

CDC – “The ongoing epidemic of Ebola in West Africa has raised several questions about how the disease affects the animal population, and in particular, the risk to household pets. While the information available suggests that the virus may be found in several kinds of animals, CDC, the US Department of Agriculture, and the AmericanContinue Reading

Motor Vehicle Crash Injuries: Costly but Preventable

CDC Vital Signs: “More than 2.5 million Americans went to the emergency department (ED)—and nearly 200,000 were then hospitalized—for crash injuries in 2012. On average, each crash-related ED visit costs about $3,300 and each hospitalization costs about $57,000 over a person’s lifetime. The best way to keep people safe and reduce medical costs is toContinue Reading

HHS releases 13th Report on Carcinogens

“Four substances have been added in the U.S. Department of Health and Human Services 13th Report on Carcinogens, a science-based document that identifies chemical, biological, and physical agents that are considered cancer hazards for people living in the United States. The new report includes 243 listings. Ortho-toluidine, used to make rubber chemicals, pesticides, and dyes, hasContinue Reading

Key U.S. Government Agency Positions and Officials in Global Health Policy

Key U.S. Government Agency Positions and Officials in Global Health Policy & Related Areas via Kaiser Family Foundation. See also Web Briefing: The U.S. Global Health Budget Tracker – Sep 11, 2014″The Kaiser Family Foundation has launched a new, interactive, online tool designed to provide the latest data on the U.S. government’s global health budget in an easy-to-access form. The U.S.Continue Reading