Obeisity Extremely Expensive For Employers

http://hr.cch.com/

Obesity is responsible for 2.1 percent of all diagnosed medical claims dollars for men, and 2.8 percent for female employees, according to a study published in the March Journal of Occupational and Environmental Medicine. The study further indicated that the highest obesity-related costs, from employees and their dependents, comes from the healthcare sector, while the lowest obesity-related costs can be found in the finance and consulting sectors.

Researchers point out that the differences by business sector could have as much to do with benefit plan design as health status differences. "Medical costs are dependent on both supply and demand pressures," said Adam Long, PhD, director of Health Management Research, Gordian Health Solutions. "These business sector differences may be driven therefore as much by insurance plan design differences as health status differences." According to the study, healthcare sector members have greater access to care, while financial and consulting sector members are more educated on average, which is a predictor of lower obesity rates.

NYC Making Efforts To Shut Down "Medical Mills"

http://www.insurancejournal.com/

The New York City Council is looking for ways to shut down certain fraudulent medical clinics that critics say take advantage of the state's no fault insurance system and drive up auto insurance rates.

One prominent critic, the Property Casualty Insurers Association of America, urged the Consumer Affairs Committee to pass Introduction Number 243A, a bill to help close the doors on medical mills and dismantle no-fault fraud organized crime enterprises.

"New York state's no-fault fraud problem is among the worst in the nation, with no-fault fraud costs reaching $1 billion per year when the problem was at its worst," maintained Kristina Baldwin, PCI regional manager and counsel.

Medical Audits In Malta

http://www.timesofmalta.com/

The government recently said it planned to introduce medical audits within the health system, something it has had on the cards since the early 1990s.

Sadly, the immediate reaction of the Medical Association of Malta was to warn that if such a practice were introduced, doctors would not want to see difficult cases.

Clinical or medical audit, however, is nothing to do with holding big sticks over the heads of medical practitioners but everything to go with ensuring that health care is effective, efficient and credible.

Jamacian Hospital Lawsuit

http://www.jamaica-gleaner.com/

THE FAMILY of 75-year-old Vilma McLaughlin, who died at the Cornwall Regional Hospital in Montego Bay, St. James after she was reportedly refused a drug until it was paid for, has instructed their lawyer to begin legal proceedings against the institution.

"It's not about the money, it's the principle of the matter," her grandson, Brian Smart said. "It hurts so much to know that 'Mums' was denied a drug that could have saved her life."

British Hospital Deals With Hospital Bed Management Issues

http://www.borehamwoodtimes.co.uk/

Simon Weldon, director of operations for emergency care for Barnet and Chase Farm NHS Trust, admitted that the hospital's bed management system needed to be improved to avoid patients waiting more than four hours for a bed.

"Making efficiencies is our biggest challenge and I will be doing everything I can to improve the service," he said.

Questions were raised about the shortage of hospital beds this week after an Elstree pensioner who had suffered a heart attack was kept on a trolley for a day and a half.

Medical Utilization Review For Prisoners

http://www.commercialappeal.com/

Representatives of Correctional Health Plan Network, which has nine Mississippi counties as clients, indicated they may be able to reduce costs 27 percent or more.

County government is responsible for medical, dental and psychiatric care of prisoners in Sheriff's Department custody. The prisoners aren't part of the health plan that covers county employees.

"It's a self-funded plan for inmates, that's what it is," said John Hill, a company official.

The escalating cost of prisoner health care has drawn increasing attention across the state and nation. County officials suspect some prisoners may get thrown in jail as a way of obtaining free medical attention.

More New York Medical Patients Winning Appeals

http://www.insurancejournal.com

A new report shows that more New Yorkers are challenging and winning reversals of decisions that deny them insurance coverage for certain medical conditions.

A new report chronicles the increased utilization of New York State's external appeal law, which allows New Yorkers to potentially overturn their insurer or health maintenance organization's denial of coverage.

The process allows consumers to challenge denials of coverage on the grounds that a procedure, treatment or piece of medical equipment is deemed experimental, investigational, or not medically necessary.

"More New Yorkers are learning about the state's External Appeal mechanism and about 45 percent of the cases are being resolved in the consumer's favor, giving more residents access to health care services that they might not have otherwise received," said Superintendent of Insurance Howard Mills.

Medical Technology & Utilization Review

http://biz.yahoo.com/

Medical management programs have undergone a significant transformation over the past three decades. Utilization review came into vogue, case management entered the scene, disease management established a foothold, and now predictive management is knocking at the door. Today, these services are being integrated into a seamless platform.

"Technology has enabled predictive modeling, evidence-based medicine, enhanced clinical interventions, financial outcomes and consumer-directed care services to thrive," noted conference co-chair, Joel V. Brill, MD. "This new approach will transform how medical management decisions are made -- by getting the correct information to the right person at the appropriate time and guiding the patient through the system," observed Dr. Brill.

New Guidelines Help Clinicians Assess Risk Of Post-surgical Pulmonary Complications

http://www.medicalnewstoday.com/

Pulmonary complications, including pneumonia and respiratory failure, are a common - and dangerous - problem for patients following major surgery. To address this issue, a comprehensive systematic review and meta-analysis in the April 2006 issue of The Annals of Internal Medicine provides clinicians with new guidelines to use prior to surgery in assessing a patient's risk of developing pulmonary problems postoperatively.

"Independent of surgical complications, such as infections and bleeding, there are three major types of medical risks that accompany major surgery," explains the study's lead author Gerald W. Smetana, MD, an internist in the division of general medicine and primary care at Beth Israel Deaconess Medical Center (BIDMC) and Associate Professor of Medicine at Harvard Medical School. "These include cardiac risks such as a heart attack, the risk of blood clot formation, and pulmonary risks."

URAC CEO Says Credibility and Trust are Essential to Gain Consumer Confidence (Press Release)

http://www.prnewswire.com/

Hospitals and health organizations host many of the 2 billion-plus health information sites on the World Wide Web, but they battle a lack of consumer confidence in the privacy and security practices of online health portals.

In this give-and-take environment where consumers want more Web-based
health information but don't know whether they can trust the source, Web
portals need to offer tangible evidence of solid privacy and quality
practices. Alan Spielman, president and chief executive officer of URAC,
will make the business case for Web site privacy, security and accuracy
when he addresses the 18th Annual National Managed Health Care Conference
during sessions April 25 and 26 at the Washington, D.C. Convention Center.

A March 23, 2006 report released by Forrester Research revealed that
consumers visiting health Web sites tie their confidence in privacy and
security to their trust of the organization hosting the site. The report
specifically examined government health Web sites, often touted as one of
the better sources for reliable health information. But in February, a
widely circulated report from the Government Accountability Office (GAO)
documented significant weaknesses in controls designed to protect privacy
and security on Department of Health and Human Services and Centers for
Medicare and Medicaid Services sites. With so much doubt circulating about
the security of even government-sponsored health Web sites, consumers need
even more assurance about security from hospital and health plan portals.

"As hospitals and other health organizations become more engaged in
providing Web resources to aid in health outreach and care coordination,
they need to be aware that credibility and trust are essential to this mix
of high- touch and high-tech health care," Spielman said. "Organizations
need to address what it takes to create portals that serve as trusted,
reliable resources for consumers seeking health-related information."

URAC, an independent, nonprofit organization, is well known as a leader
in promoting health care quality through its accreditation and
certification programs. URAC pioneered Health Web Site accreditation in
2001 to assess the quality and privacy practices of accredited sites. The
accrediting organization also offers HIPAA Privacy and HIPAA Security
accreditation. URAC, the nation's only organization that accredits health
Web sites, updated those accreditation standards in January 2006, including
additional protection of consumer information and more rigorous standards
for editorial content review.

"Accreditation is a valuable tool for the industry, because it offers a
seal of approval from a neutral third party that consumers can trust,"
Spielman said. "As consumer-directed health plans become more popular, more
and more consumers will use the Internet to research health plans,
hospitals and other providers, and to seek health information.
Accreditation is a credible way for organizations to demonstrate to
consumers that they meet URAC's high standards."

External Medical Review Usage Increasing In New York

http://albany.bizjournals.com/

The New York State External Appeal Program report chronicles the increased use of the state's external appeal law which allows residents to potentially overturn their insurer's or health maintenance organization's denial of coverage.

The process allows consumers to challenge denials of coverage on the grounds that a procedure, treatment or piece of medical equipment is deemed experimental, investigational or not medically necessary.

In 2004, the external appeal program ruled in favor of the consumer in 45 percent of the cases involving medical-necessity denials and 51 percent of cases in which consumers were denied coverage on the grounds that a treatment was experimental or

Monitoring Those Who Monitor Doctors

http://www.portlandtribune.com/

The Oregon Board of Medical Examiners, which licenses the state’s physicians, recently decided it needed to look at how well its monitoring program has served enrollees and protected the public. The board hired Kent Neff, a local psychiatrist with an extensive background in monitoring programs and physician addiction treatment, to look through its case files and interview people who have been involved with the program.

After three to four months, Neff will present the board with the results of his investigation, with expected suggestions to improve the system, according to Susan McCall, medical director of the Board of Medical Examiners’ health professionals monitoring program.

McCall, a physician, said this is the first time the physicians board has authorized such an audit. She supports the concept. “I think it’s a wonderful idea, but it’s expensive,” she said. “It needs to be done periodically. It’s part of accountability.”

Have Physician Insurance Premiums Peaked?

http://www.thedailyreview.com/

On the road ahead, the clouds of crisis are clearing, as premiums stop rising and lawsuits decline. "If 'crisis' means unavailable insurance and rates rising at 20 to 30 percent (per year), then this particular year that's not the case," said Mark Piasio, M.D., president of the Pennsylvania Medical Society.

For the first time in at least five years, the two largest physician insurers in Pennsylvania did not seek to raise premiums in 2006. One of them, PMSLIC, started writing new insurance policies in Pennsylvania for the first time in about four years.

"We are seeing that the major players in the state that write medical malpractice (insurance) are opening up their doors," Pennsylvania Insurance Commissioner Diane Koken said.

Big Issue In Australian Medicine: Out of Pocket Medical Expenses

http://www.theage.com.au/

But an Australian Medical Association (AMA) spokesman says Health Minister Tony Abbott had promised to delay any move to make it mandatory for doctors to inform patients of the gap fees, urging them to comply voluntarily instead.

The AMA spokesman says 19 per cent of doctors - almost one in five - failed to tell patients of out-of-pocket expenses beforehand.

The taskforce has also recommended that the government commission an independent review of the regulation of private health insurance, introduce a more transparent process to consider rises in premiums, and replace the $3 billion-a-year tax rebate with explicit subsidies.