News in brief - Nov. 20, 2006

Study finds little difference in adverse outcomes between care settings - Jury finds against Amerigroup in Illinois patient discrimination case - Utah helps pay for health insurance - Pennsylvania expands SCHIP access - N.Y. offers high-deductible plan - Contractors tracking Medicare payments doing fine, audit says

Study finds little difference in adverse outcomes between care settings

Rates of adverse patient outcomes for three typical Medicare services varied very little between ambulatory settings, despite the sometimes significant payment differences between sites of care, according to a recent report sponsored by the Medicare Payment Advisory Commission.

RAND Health found very low rates of adverse outcomes for cataract surgery, colonoscopy and magnetic resonance imaging of the head, neck or brain for procedures performed in a physician's office, hospital outpatient department or ambulatory surgery center. Patient characteristics were similar in all three settings.

"Because the study examined only three procedures, it is difficult to draw general conclusions," MedPAC stated.

"Nevertheless, this study demonstrates that claims data can be used to evaluate differences among sites of care and is thus an important step in addressing whether payment variations among settings are appropriate."

Jury finds against Amerigroup in Illinois patient discrimination case

A federal jury in Illinois ordered health insurer Amerigroup Corp. to pay what would ultimately amount to $144 million in damages for excluding pregnant women from enrollment in its Medicaid managed care plans.

The seven jurors found that between 2000 and 2003, Amerigroup illegally discriminated against third-trimester pregnant women, as well as patients with serious health issues, while receiving approximately $200 million in Medicaid reimbursements from the state.

Amerigroup officials said the company plans to appeal the decision to the 7th U.S. Circuit Court of Appeals. The health plan denies the allegations in the whistle-blower lawsuit brought by a former employee in 2003 and joined by the Dept. of Justice.

If the verdict is upheld, Amerigroup would be required to pay triple the $48 million in penalties for violating state and federal false claims statutes.

Utah helps pay for health insurance

A new Utah program will provide 1,000 individuals and families with up to $150 per adult and $100 per child to help pay for the cost of employer-sponsored health insurance.

The program, called Utah's Premium Partnership for Health Insurance, is limited to the first 1,000 residents who qualify. An adult qualifies if household income is less than $2,500 per month. A child qualifies if family household income is less than $3,334 per month.

Pennsylvania expands SCHIP access

Cover All Kids, Pennsylvania's State Children's Health Insurance Program, will allow families with incomes higher than 235% of the federal poverty level to buy insurance for children at rates based on income levels and other requirements. Gov. Ed Rendell signed legislation changing the program Nov. 2.

Previously, Cover All Kids limited eligibility to families at less than 235% of the federal poverty level.

N.Y. offers high-deductible plan

New York's Healthy NY program -- the state's insurance program for low-income workers -- will offer a high-deductible health plan beginning Jan. 1. The deductible will be $1,150 for individuals and $2,300 for families.

Contractors tracking Medicare payments doing fine, audit says

The two contractors hired by Medicare to determine the program's percentage of improper payments operate effectively, the Dept. of Health and Human Services Office of Inspector General concluded in a recent audit.

AdvanceMed and Livanta review claims documentation from physicians and other Medicare participants and follow up with doctors when they do not receive requested medical documents promptly.

The OIG determined that both companies were effective in giving the Centers for Medicare & Medicaid the information it needed to gauge the program's error rate.

The audit results follow a recent report from CMS that it had reduced its percentage of improper Medicare payments from 5.2% in 2005 to 4.4% in 2006. The reduction saved the program an estimated $1.3 billion this year.

Vote refines AMA stance on health reform
The AMA House of Delegates rejected attempts to rescind support of a U.S. House health reform bill and any new government-sponsored health insurance plan during the 2009 Interim Meeting.
Story - AMA House - Slideshow