News in brief - Sept. 8, 2003

Medicare OKs emphysema treatment - Court rules in favor of Fla. patients' right-to-sue law - Medical centers must file electronic cost reports

Medicare OKs emphysema treatment

Medicare will cover lung volume reduction surgery for certain beneficiaries with emphysema, the Centers for Medicare & Medicaid Services said. The announcement was prompted by the results of a clinical trial, which found that patients who underwent the procedure function better two years afterward than patients who did not have the surgery, and with no increased risk of death.

The study was a collaborative effort between CMS; the National Heart, Lung, and Blood Institute; and the Agency for Healthcare Research and Quality. Coverage will be limited to patients who meet criteria outlined by the study.

Court rules in favor of Fla. patients' right-to-sue law

The Employee Retirement Income Security Act of 1974 does not preempt a Florida law that allows patients to sue their health plans for overruling treatments their physicians recommended, the 11th U.S. Circuit Court of Appeals said in a recent ruling. The decision is another example of the federal courts not allowing health plans to automatically use ERISA as a shield from lawsuits.

The court said Robbie Lee Land and Donna Land can go forward with their lawsuit against CIGNA Healthcare of Florida. The Lands sued after Robbie Lee Land's primary care physician and a CIGNA-approved hand specialist said he should be hospitalized for aggressive intravenous antibiotic treatment and monitoring of an infection caused by a bite from the family cat, according to court records.

A CIGNA nurse who reviewed the proposed treatment plan approved the intravenous antibiotic therapy but not the hospitalization. Land's infection got worse, and he ultimately had a finger amputated.

Medical centers must file electronic cost reports

The Centers for Medicare & Medicaid Services plans to expand the categories of health care facilities that must file electronic cost reports to Medicare. Beginning in 2005, hospices, organ procurement organizations, rural health centers, federally qualified health centers, community mental health centers and end-stage renal disease facilities will be required to file their annual cost reports electronically.

CMS said the requirement would increase accuracy of the reports and reduce preparation time. The requirement will be phased in to allow facilities to become familiar with electronic filing requirements, CMS said.