News & Information
Not All CPR Is Equal
Written by Editor   
Tuesday, November 18, 2014 01:56 PM

The effectiveness of performing cardiopulmonary resuscitation (CPR) in cardiac arrest cases may have influenced the outcomes in one clinical trial, researchers suggested.  Only about 40% of patients in the trial who performed CPR were guideline compliant in delivering proper compression rate, compression depth and compression fraction.  Research suggested that while performing chest compression at a rate of 80 to 120 compressions a minute was within guidelines, the failure to compress to a depth of more than 4-6 centimeters would make the number of compressions performed moot.  Similarly, if the compression fraction was less than 50% it would negate the compression rate and compression depth. All three factors had to be within guidelines in order to have quality CPR.

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Supreme Court to Hear Case on ACA Subsidies
Written by Editor   
Saturday, November 08, 2014 10:55 AM

The Supreme Court announced Friday that it will consider a controversial case involving subsidies paid to people participating in federally run health exchanges under the Affordable Care Act.

The case, known as King v. Burwell, is similar to a more well-known case called Halbig v. Burwell. In both cases, the plaintiffs argue that the subsidies being issued in the federally run exchanges to help people pay their insurance premiums are illegal because of the wording allowing for the subsidies in the ACA.

Section 36B of the law says that "The 'premium assistance amount' is based on the cost of a 'qualified health plan ... enrolled in through an Exchange established by the State under [section] 1311 of the [ACA].'"

It is the mention of only state-established exchanges -- and similar wording in other parts of the provision -- that is at issue. The plaintiffs contend that the wording means that only consumers who purchase insurance in state-run exchanges are eligible for subsidies, which would leave out consumers in the 34 states that have defaulted to the federally run exchange.

The defendant -- the federal government -- says it's clear from the general context of the law, as well as wording in yet other parts of it, that the ACA's intent was to make consumers in federal as well as state-run exchanges eligible for the subsidies.

A lot of money is at stake in the decision. Subsidies paid on the federal exchanges amount to about $10 to $12 billion per year.

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More Scrutiny Coming
Written by Editor   
Thursday, November 06, 2014 10:20 AM

Federal officials are planning a wide range of audits into billing and government spending on managed health care in the new fiscal year, ranging from private Medicare Advantage groups that treat millions of elderly to health plans rapidly expanding under the Affordable Care Act.

“Prior OIG reviews have shown that medical record documentation does not always support the diagnoses” (used to bill Medicare),” the Inspector General said. “Efforts for FY 2015 and beyond may include additional work examining the soundness of rates and risk and payment adjustments,” the Inspector General said.  Federal officials concede that billions of tax dollars are misspent every year because some Medicare health plans exaggerate how sick their patients are, a practice known as “upcoding.” At least six whistleblower lawsuits alleging that Medicare health plans inflated risk scores to overbill the government are pending in federal courts.

The Inspector General is continuing to pursue allegations of billing fraud and abuse by doctors, hospitals and medical suppliers, such as ambulance companies and sellers of diagnostic gear. But it appears to be placing more emphasis on managed care than in the past.

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Small–Business Lending Anticipated to Increase
Written by Brooke Shaw   
Thursday, November 06, 2014 10:18 AM

HEADS UP:  About 70% of banks foresee a healthy increase during the next year in retail small-business loans, according to a quarterly Federal Reserve survey of senior loan officers. Just over a quarter of those surveyed said small-business lending would be unchanged.

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Name-Calling
Written by Editor   
Thursday, November 06, 2014 09:50 AM

One who does not do as the medical community desires is "crazy" and those who ask questions that the medical community does not have answers to, or that makes the medical community feel uncomfortable, are described as painful, crazy, difficult, or demanding.  

Those who have less power or authority or who unquestioningly do as the medical community tells them are considered "adorable".  Think these are just flippant observations?  A recent article titled I, Intern: Nightly Name-Calling, by Shara Yurkiewicz, LINK highlights some of the concepts that go on behind "labeling" and some of the motivations behind them. 

What kinds of terms do physicians use with each other to communicate how it feels to take care of patients, and what do they mean?  "Sometimes your co-intern tells you that a patient is 'adorable,' or their 'favorite patient,' or 'crazy,' or 'painful,' or they'll say 'don't visit their room unless there's an emergency,'"  "It made me think about physicians and their responses ... and why people are called certain things."  "It's a shorthand way of communicating complex perceptions of patients to other health providers."

"But I don't know how fair it is to the patient to use those kind of descriptors beyond just stating why they're in the hospital and what their active medical problems are." "I'm trying to decide whether to adopt this culture blindly or, if I didn't want to, how to communicate these kinds of ideas."

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