HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Thursday, October 11, 2007

Medicaid Enrollment Drops

ThinkProgress reports on a drop in Medicaid enrollment.   The story states,

Enrollment in Medicaid, the public health insurance program for our most vulnerable population, declined in 2006 for the first time in nearly a decade. A new report by the Kaiser Family Foundation finds that enrollment growth among the elderly and disabled was 40 percent less in 2006 than it was in 2005. Additionally, the number of children and parents enrolled in Medicaid decreased by 113 percent during this same period.

While this decline is in part due to two positive factors — an improved economy and low unemployment — another factor is at play: the conservatives’ cumbersome new regulation requiring proof of citizenship and identity when applying for Medicaid coverage.

This law was enacted in large part to prevent undocumented immigrants from enrolling in public programs such as Medicaid illegally even though evidence showed that illegal enrollment of undocumented immigrants into the program is not a problem.

What the law has done, however, is caused a drop in enrollment of eligible individuals. Reports are showing that the new rules have “contributed to slower enrollment growth in fiscal year 2007 and caused significant delays in processing applications and increased the administrative burdens placed on states” and individuals. . . . .

October 11, 2007 | Permalink | Comments (0) | TrackBack (0)

Wednesday, October 10, 2007

Quality of Children's Health Care

McClatchy News reports on a study in the latest issue of the New England Journal of Medicine discussing the quality of childcare in the United States.  It writes,

In the largest study of its kind, researchers found that America's children received appropriate medical care only 46 percent of the time when they visit health professionals, faring even worse than adults and raising serious questions about the quality of care delivered by the world's most expensive health system.

The study, to be published in the Oct. 11 issue of the New England Journal of Medicine, was conducted by the RAND Corp., the Seattle Children's Hospital Research Institute and the University of Washington School of Medicine.

It followed the health care experiences of 1,536 children from 12 metropolitan areas over a four-year period. By interviewing the youngsters' parents, reviewing the children's medical records and comparing their treatments to established care standards, researchers found that even basic care was a hit-or-miss proposition for children who visit hospitals and pediatricians.

The study found only 19 percent of seriously ill infants with fevers had the right lab tests done, only 44 percent of youngsters with asthma were on the right medications and only 38 percent of youngsters were screened for anemia in their first two years of life.
In addition, only 31 percent of children ages 3-6 have their weight measured at  annual checkups.

Failure to provide proper care makes it harder to reverse illnesses and increases the chance that youngsters will carry health problems into adulthood. "How do we catch a child at risk for obesity if we don't look," said co-author Dr. Rita Mangione-Smith, an associate professor of pediatrics at the University of Washington School of Medicine.

The results are surprising, not least because most of the youngsters in the study were white, middle-class and had health insurance.  "These are the kids who most people assume are getting excellent care in this country, and unfortunately they're not," Mangione-Smith said. 
Ironically, the study's dearth of low-income and ethnically diverse youngsters likely skewed the final data, resulting in an "overly rosy" picture, Mangione-Smith said.

The entire McClatchy piece provides a good overview of the study printed in the NEJM (free full text article available).

October 10, 2007 | Permalink | Comments (0) | TrackBack (0)

Suspensions over Sneaking Peek at Clooney's Medical Records

Oops!  Those darn medical privacy laws - how are people supposed to get good gossip.  Huffington Post reports on recent suspensions at the hospital that treated actor George Clooney after his recent motorcycle accident.  These suspensions result from from allegedly peeking at Mr. Clooney's medical records.  Huffington Post states,

WCBS-TV in New York reported Tuesday night that as many as 40 staffers, including doctors, were suspended without pay, accused of accessing Clooney's medical records and possibly providing information to the media, a violation of federal law.  The Jersey Journal of Jersey City reported that 27 employees, but no doctors, had been disciplined, and only for looking at the records without authorization.

The investigation was not prompted by a complaint from Clooney, who said he only learned of it on Tuesday.  "This is the first I've heard of it," Clooney said in a statement. "And while I very much believe in a patient's right to privacy, I would hope that this could be settled without suspending medical workers."

A spokeswoman for the union representing some of the workers said they had been suspended without pay for four weeks.  "We believe this is a harsh penalty and an overreaction," said Jeanne Oterson, a spokeswoman for the Health Professionals and Allied Employees union, adding that a grievance could be filed pending further investigation.

Eurice Rojas, the hospital's vice president of external affairs, told The Jersey Journal that hospital officials do not believe any employees leaked Clooney's medical information, but some staffers did improperly access his records.  Federal law mandates that only direct caregivers _ including doctors, nurses, technicians and support staff involved in a patient's care _ see such information.

October 10, 2007 | Permalink | Comments (0) | TrackBack (0)

Tuesday, October 9, 2007

A Day in the Life - Without Government

Ezra Klein points to a website by Douglas J. Amy, Professor of Politics at Mount Holyoke College, which examines how the government provides assistance to individuals everyday.  Here is a brief section from his Government is Good blog: 

Ask yourself this question: “What has government done for me lately?” If you are like most Americans, you will probably answer: “Not much.” Surveys show that 52% of Americans believe that “government programs have not really helped me and my family.”1 But let’s see if that is really true. Let’s examine a typical day in the life of an average middle-class American and try to identify some of the ways that government improves that person’s life during that 24 hour period.

6:30 a.m. You are awakened by your clock radio and listen for a few minutes to the news before getting up. But you can listen to your favorite station only because the Federal Communications Commission brings organization and coherence to our vast telecommunications system. It ensures, for example, that radio stations do not overlap and that stations signals are not interfered with by the numerous other devices – cell phones, satellite television, wireless computers, etc. – whose signals crowd our nation’s airwaves.

6:35 a.m. Like 17 millions other Americans, you have asthma. But as you get out of bed you notice that you are breathing freely this morning. This is thanks in part to government clean air laws that reduce the air pollution that would otherwise greatly worsen your condition.

6:38 a.m. You go into the kitchen for breakfast. You pour some water into your coffeemaker. You simply take for granted that this water is safe to drink. But in fact you count on your city water department to constantly monitor the quality of your water and to immediately take measures to correct any potential problems with this vital resource.

6:39 a.m. You flip the switch on the coffee maker. There is no short in the outlet or in the electrical line and there is no resulting fire in your house. Why? Because when your house was being built, the electrical system had to be inspected to make sure it was properly installed – a service provided by your local government. And it was installed by an electrician who was licensed by your state government to ensure his competence and your safety.

6:45 a.m. You sit down to breakfast with your family. You are having eggs – a food that brings with it the possibility of salmonella poisoning, a serious food borne illness affecting tens of thousands of Americans every year. But the chance of you getting sick from these eggs has now been greatly reduced by a recently passed series of strict federal rules that apply to egg producers.

7:00 a.m. You go into your newly renovated bathroom – one of a number of amenities that you enjoy in your house. But the fact that you can even own your own house is something made possible by government. Think about this: “ownership” and “private property” are not things that exist in nature. These are legal constructs: things created by laws that are passed and enforced by government. You couldn’t even buy your home without a system of commercial laws concerning contracts and a government that ensures that sales contracts are enforced. So the fact that you live in your own home is, in part, a benefit of government and the rule of law.

October 9, 2007 | Permalink | Comments (0) | TrackBack (0)

Website Accessibility

Last week, a federal judge permitted a class action lawsuit to proceed against Target Corporation that concerns the lack of access by the blind to its website.  Reuters reports,

According to the lawsuit, plaintiff Bruce Sexton, a California resident, uses screen reading software to access the Internet but has been unable to use certain features of Target's site. The software vocalizes text and describes the content of the Web page. The plaintiffs, including the federation, say redesigning the Target site to be readable by blind people would be technologically easy and not economically prohibitive.

Minneapolis-based Target said in a statement that it was disappointed that the judge had granted class-action status to the case, but said the decision was a procedural ruling only.  "We will request an immediate review of the ruling granting class certification and we are confident that we will prevail on the merits of this case," the company said. . . .  In the decision, the judge said that after the lawsuit was filed, Target has made some modifications to its Web site to make it more accessible to the blind. . . .

The case was filed in February 2006. The court threw out a portion of the suit in September 2006, dismissing the plaintiffs' claims to the extent that they are based on Web site features that were unconnected to the physical stores.  Martin Wymer, a partner at law firm Baker & Hostetler LLP who represents companies in litigation matters, said that other retailers are likely taking a hard look at the accessibility of their Web sites.  In addition to trying to avoid lawsuits, "there's a business benefit from opening up your doors to that many more customers," he said.

The case is:  National Federation of the Blind v. Target Corp., 2007 WL 2846462
(N.D.Cal.,October 2, 2007).

October 9, 2007 | Permalink | Comments (0) | TrackBack (0)

Monday, October 8, 2007

Nobel Prize for Medicine Awarded to Gene Researchers discusses the winners for the 2007 Nobel Prize for Medicine:

Two American scientists and a British researcher share this year's Nobel Prize in Medicine or Physiology for devising the tools to figure out what individual genes do and how to fix them.

Mario Capecchi of the University of Utah, Oliver Smithies of the University of North Carolina and Sir Martin Evans of Cardiff University in Wales will share the $1.5 million prize this year.

The Nobel Committee says these scientists laid the groundwork for the main work in biology today: figuring out what each of the 30,000 human genes does. Capecchi invented a way to target single genes and turn them off to see what they do. Smithies used gene targeting to correct defective genes. Evans showed that embryonic stem cells can integrate corrected genes into living animals.  Together, these techniques are a big reason why scientists are so excited about the potential for embryonic stem cell research to cure a wide range of human ailments.

October 8, 2007 | Permalink | Comments (0) | TrackBack (0)

Daily Show on the SCHIP Veto

Ok, I promise to stop always posting on the SCHIP issue after this (at least until we find out what Congress plans to do with the veto) but here is Jon Stewart of the Daily Show discussing the veto.

October 8, 2007 | Permalink | Comments (0) | TrackBack (0)

Law School Musical

Just for fun - here is a creative take on the law school experience.  Unfortunately, I don't think that Disney plans to pick this up and make a full fledged movie/musical.  I am not sure that it would appeal to the masses.  Thanks to Professor Caron at TaxProfBlog for the link.

October 8, 2007 | Permalink | Comments (0) | TrackBack (0)

Sunday, October 7, 2007

Medicare Cheats

The New York Times has a front page story about some problems in the administration of the Medicare Part D program.  It reports,

Tens of thousands of Medicare recipients have been victims of deceptive sales tactics and had claims improperly denied by private insurers that run the system’s huge new drug benefit program and offer other private insurance options encouraged by the Bush administration, a review of scores of federal audits has found.

The problems, described in 91 audit reports reviewed by The New York Times, include the improper termination of coverage for people with H.I.V. and AIDS, huge backlogs of claims and complaints, and a failure to answer telephone calls from consumers, doctors and drugstores.

Medicare officials have required insurance companies of all sizes to fix the violations by adopting “corrective action plans.” Since March, Medicare has imposed fines of more than $770,000 on 11 companies for marketing violations and failure to provide timely notice to beneficiaries about changes in costs and benefits.

The companies include three of the largest participants in the Medicare market, UnitedHealth, Humana and Wellpoint. 

The audits document widespread violations of patients’ rights and consumer protection standards. Some violations could directly affect the health of patients — for example, by delaying access to urgently needed medications.

The article discusses some typical problems found in the audits:

¶UnitedHealth, which serves more than six million Medicare beneficiaries, did not have an “effective program” to supervise its marketing representatives, agents and brokers. In some cases, United improperly denied claims without giving any explanation to beneficiaries. Peter L. Ashkenaz, a company spokesman, said, “We terminated a few agents and brokers for misrepresenting our products.”

¶WellPoint, one of the nation’s largest insurers, had “a backlog of approximately 354,000 claims” at certain Medicare plans offered through its UniCare subsidiary. The company’s call center took an average of 27 minutes to answer phone calls from its members and 16 minutes to answer calls from health care providers. More than half the callers hung up before speaking to a company representative. Karen Brown, a spokeswoman for WellPoint, had no immediate comment.

¶In March, Sierra Health Services ended drug coverage for more than 2,300 Medicare beneficiaries with H.I.V./AIDS, saying they had not paid their premiums. In many cases, the premiums had been paid, and beneficiaries had canceled checks to prove it. Sierra initially refused to reinstate them, but eventually agreed to do so after repeated requests from federal officials. Peter O’Neill, a vice president of Sierra, said this particular drug plan, which attracted people with very high drug costs, would not be offered in 2008.

¶Humana, which covers more than 4.5 million people on Medicare, promised to investigate every complaint about its marketing practices, but it received so many complaints that it could not keep up. Many beneficiaries said they had received incorrect information from Humana agents. Medicare officials said some agents had not been adequately trained or supervised. Thomas T. Noland Jr., a senior vice president of Humana, said the company had taken “corrective action to improve the situation.”

¶Humana did not always tell beneficiaries about changes in its list of covered drugs. In some cases, Humana did not explain its reasons for denying claims and did not inform beneficiaries of their appeal rights.

¶The Sterling Life Insurance Company, a subsidiary of the Aon Corporation, did not pay claims correctly or handle appeals in a timely way. The company has “a demonstrated pattern of failure” to meet Medicare performance standards. Problems were compounded by a rapid growth in enrollment. Sterling said it had taken steps to improve compliance.

¶Two sponsors of popular Medicare drug plans, MemberHealth and Bravo Health, did not act on requests for coverage of specific drugs within 72 hours, as required by the government. Bravo did not comply with federal rules requiring doctors to review all claims denied for a “lack of medical necessity.”

Chris in Paris, writing at Americablog asks a good question, "Why are these companies even allowed to continue doing business with the US government? If they are cheating the US government and cheating their customers, cut them off completely. Let them round up business elsewhere, but of course, they love working with the government and raking in government money so they won't be going anywhere. They all may talk about the fear of national health care, but in a hybrid public-private system (as in France) they do just fine and still make healthy profits. Cut these companies out of government contracts for five years,  . . . make it two or even one year, and let's see how they react. I'd be able to hear the screaming and crying all of the way over here in Paris. If only someone would stand up to these America-hating businesses."

October 7, 2007 | Permalink | Comments (0) | TrackBack (0)