Physicians in the Dallas-Fort Worth-Arlington area who prescribe Medicare-covered durable medical equipment, prosthetics, orthotics and supplies to their patients will have to use certain contracted suppliers starting July 1, 2008. Physicians and patients will be responsible for determining which suppliers are Medicare-contract suppliers to make sure their medical products and services will be covered by Medicare.
The 10 product categories affected in Texas are:
-Oxygen supplies and equipment;
-Standard power wheelchairs, scooters and related accessories;
-Complex rehabilitative power wheelchairs and related accessories;
-Mail-order diabetic supplies;
-Enteral nutrients, equipment and supplies;
-Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs) and related supplies;
-Hospital beds and related accessories;
-Negative-pressure wound-therapy pumps and related supplies and accessories; and
-Walkers and related accessories.
To find out if a supplier is included in the program, use the search tool on www.medicare,gov or call 1-800-MEDICARE.
Physicians in other communities outside of the Metroplex should also take heed: the program will expand to 70 additional areas in 2009 with further expansions in the future.
Also, read the CMS-published PDF, “What You Should Know if You Need Medicare-covered Equipment or Supplies,” but skip to the second half of the second page for the most-pertinent information.
Wednesday, May 14, 2008
Thursday, May 8, 2008
Nurses Behaving Badly
TEST - WFAA reports more than 1 of 20 Texas nurses has criminal record, Naughty, naughty
Wednesday, May 7, 2008
Insurers Get the Blame for Health Costs and TAFP CEO Banning Gets Quoted in H Chron Commentary
Houston Chronicle columnist Clay Robison reported that health insurers topped the list of those to blame for the high cost of health care in a recent public opinion poll by pollster Bryan Eppstein. Coming in a close second was drug companies.
Robison went on to report that Texas ranks third in the nation when it comes to how much health insurance premiums have risen in recent years. He noted that while the Texas Department of Insurance doesn't have much power to regulate insurers, the Lege could do something about it during the department's impending sunset review.
"Expect a big fight, with doctors and insurers, former allies in the so-called 'tort reform' coalition, squaring off against each other," Robison wrote. "Small-business owners, another important part of the tort army, probably will jump in with the doctors."
To illustrate the rate increases with which employers and individuals have become all too familiar, Robison recounted TAFP's recent renewal shocker, when the Academy was slapped with a 23.5-percent hike in its premium quote for 2008. "Tom Banning, the academy's CEO, said frustration worsened when administrators learned that only 74 percent of premiums they had paid to the former insurer had been spent on medical care."
Robison went on to report that Texas ranks third in the nation when it comes to how much health insurance premiums have risen in recent years. He noted that while the Texas Department of Insurance doesn't have much power to regulate insurers, the Lege could do something about it during the department's impending sunset review.
"Expect a big fight, with doctors and insurers, former allies in the so-called 'tort reform' coalition, squaring off against each other," Robison wrote. "Small-business owners, another important part of the tort army, probably will jump in with the doctors."
To illustrate the rate increases with which employers and individuals have become all too familiar, Robison recounted TAFP's recent renewal shocker, when the Academy was slapped with a 23.5-percent hike in its premium quote for 2008. "Tom Banning, the academy's CEO, said frustration worsened when administrators learned that only 74 percent of premiums they had paid to the former insurer had been spent on medical care."
TAFP President Comments on Insurance Premium Hike Story in AAS
After Austin American Statesman reporter Mary Ann Roser filed her story about skyrocketing health insurance premiums in Texas, (AAS April 29, "Report: Texas insurance premiums jump 40 percent from 2001 to 2005"), TAFP President Linda Siy, M.D., sent a letter to the editor. It hasn't been published yet, so we're publishing it here:
"Mary Ann Roser’s story, 'Report: Texas insurance premiums jump 40 percent from 2001 to 2005,' cites a fact that bears repeating: health insurance premiums for Texans in employer-sponsored plans rose 10 times faster than their wages from 2001 to 2005. These unsustainable increases force employers to shift more costs to their employees, to enroll in plans that offer less coverage, or to stop providing health coverage entirely. At a time of record profits for health insurers, are these premium increases justified? What portion of the premium dollar pays for medical care and how much goes to fill the health plans’ coffers? The next Legislature must ensure price transparency and consumer protections to ensure health insurance companies are not taking advantage of hard working Texans."
"Mary Ann Roser’s story, 'Report: Texas insurance premiums jump 40 percent from 2001 to 2005,' cites a fact that bears repeating: health insurance premiums for Texans in employer-sponsored plans rose 10 times faster than their wages from 2001 to 2005. These unsustainable increases force employers to shift more costs to their employees, to enroll in plans that offer less coverage, or to stop providing health coverage entirely. At a time of record profits for health insurers, are these premium increases justified? What portion of the premium dollar pays for medical care and how much goes to fill the health plans’ coffers? The next Legislature must ensure price transparency and consumer protections to ensure health insurance companies are not taking advantage of hard working Texans."
Texas Insurance Premiums Climb 10 Times Faster Than Wages
Insurance rates for Texas families increased 40 percent from 2001 to 2005, according to a recent report by the Robert Wood Johnson Foundation. That rate of increase puts Texas in third place nationally behind Oklahoma and Idaho. Median earnings for family health policyholders in Texas climbed only 3.5 percent during those years.
"This study makes plain what every working parent knows — that providing insurance coverage takes a bigger bite from the family budget every year," said Dr. Risa Lavizzo-Mourey, president and CEO of RWJF in a statement released with the study.
The Texas Department of Insurance told the Austin American Statesman that premiums in Texas doubled between 1997 and 2004, but the department did not have data to report what insurance company profits were during those years.
Your own TAFP recently felt the squeeze of a huge premium increase. You can read all the sordid details in the cover story for the most recent issue of Texas Family Physician, but here's the gist. TAFP's insurance carrier announced that the renewal rate for 2008 would be 23.5 percent higher than in 2007, an amount that would have capped a 74.8-percent hike since 2003.
When we requested information from the insurer on how much of the premiums collected were spent on medical care, Academy staff and leaders were shocked by what we found. Only 74 percent had been spent on medical care, leaving the rest for "administrative costs" and profit.
In an opinion column published in a few of the state's major dailies, TAFP President Linda Siy, M.D., wrote: "Something is seriously wrong with our health care system. In a time of record health insurance profits and obscene executive compensation, how are these health insurance costs justified?"
TAFP faced the same tough choices other small employers confront at renewal: do we eat the increase or do we shift cost to the employees and buy less coverage? TAFP changed carriers and opened a high-deductible plan tied to a health savings account, but with these sorts of benefit hikes happening every year, is it any wonder wages are stagnant? If you missed it in 2006, Families USA published a very similar report to the new RWJF report, called "Premiums Versus Paychecks." It's definitely worth a read.
"This study makes plain what every working parent knows — that providing insurance coverage takes a bigger bite from the family budget every year," said Dr. Risa Lavizzo-Mourey, president and CEO of RWJF in a statement released with the study.
The Texas Department of Insurance told the Austin American Statesman that premiums in Texas doubled between 1997 and 2004, but the department did not have data to report what insurance company profits were during those years.
Your own TAFP recently felt the squeeze of a huge premium increase. You can read all the sordid details in the cover story for the most recent issue of Texas Family Physician, but here's the gist. TAFP's insurance carrier announced that the renewal rate for 2008 would be 23.5 percent higher than in 2007, an amount that would have capped a 74.8-percent hike since 2003.
When we requested information from the insurer on how much of the premiums collected were spent on medical care, Academy staff and leaders were shocked by what we found. Only 74 percent had been spent on medical care, leaving the rest for "administrative costs" and profit.
In an opinion column published in a few of the state's major dailies, TAFP President Linda Siy, M.D., wrote: "Something is seriously wrong with our health care system. In a time of record health insurance profits and obscene executive compensation, how are these health insurance costs justified?"
TAFP faced the same tough choices other small employers confront at renewal: do we eat the increase or do we shift cost to the employees and buy less coverage? TAFP changed carriers and opened a high-deductible plan tied to a health savings account, but with these sorts of benefit hikes happening every year, is it any wonder wages are stagnant? If you missed it in 2006, Families USA published a very similar report to the new RWJF report, called "Premiums Versus Paychecks." It's definitely worth a read.
Might the Bubble Burst for Retail Health Clinics?
While retail health clinics have claimed for years that they'll soon be openning thousands of new clinics in drug stores and supermarkets across the country, it appears the investment dollars for such expansion may be drying up. According to a May 7, 2008 Wall Street Journal article, "retail healthclinic operators based in New York, Nevada, Indiana and Alabama have closed their doors, shuttering 69 clinics in 15 states, including ones operating inside outlets of Shopko Stores, Meijer Inc., Bi-Lo LLC, Wal-Mart Stores Inc. and the Medicine Shoppe unit of Cardinal Health Inc."
The biggest name in retail health clinics, CVS Caremark Corp., told the Journal it's scaling back expansion plans for MinuteClinic and may close some locations that aren't in CVS pharmacies.
Tom Charland of Merchant Medicine, LLC and former VP for strategy with MinuteClinic told the Journal: "We have seen fallout in this industry, on a smaller scale, that is not unlike the dot-com bubble. ... The big mistake was for people to think they could reach break-even in six months. People are learning this is an 18-to-24-month process to get to break-even."
The biggest name in retail health clinics, CVS Caremark Corp., told the Journal it's scaling back expansion plans for MinuteClinic and may close some locations that aren't in CVS pharmacies.
Tom Charland of Merchant Medicine, LLC and former VP for strategy with MinuteClinic told the Journal: "We have seen fallout in this industry, on a smaller scale, that is not unlike the dot-com bubble. ... The big mistake was for people to think they could reach break-even in six months. People are learning this is an 18-to-24-month process to get to break-even."
Tester, Tester, Tester Some More
Here's a video test for the blogosphere. Hopefully we can use flv files, but if not, we may have to use wmv files. WMV files are larger and we only have 100 MB of space. We might be able to upgrade that, but for now, this is what we have. The Doctor's Orders vid is 80 MB by itself! Whoops, looks like I have an error. WMV files it looks like it will have to be.
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