Emergency Visits Are Increasing, New ACEP Poll Finds; Many Patients Referred By Primary Care Doctors

/PRNewswire/ -- More than 80 percent of emergency physicians responding to an ACEP poll said emergency visits are increasing in their emergency departments, with half reporting significant rises, and more than 90 percent expecting increases in the next year. Almost all (97 percent) reported treating patients on a daily basis who were referred to them by primary care doctors, going against a widely-held assumption that people are choosing to go to the emergency department instead of seeking primary care.

At the same time, 97 percent of emergency physicians also report treating Medicaid patients on a daily basis who could not find any other doctor to accept their health insurance. If the new health care reform legislation provides insurance coverage that reimburses doctors at Medicaid rates, this could exacerbate a lack of access to medical care.

"This poll confirms what we are witnessing in Massachusetts — that visits to emergency rooms are going to increase across the country, despite health care reform, and that health insurance coverage does not guarantee access to medical care," said Dr. Sandra Schneider, president of the American College of Emergency Physicians. "Emergency medicine provides lifesaving and critical care to millions of patients each year and yet only represents 2 percent of the nation's health care expenditures. Emergency physicians command the resources of a hospital to provide the best care for patients, but we must be prepared for increasing numbers of patients, not fewer, especially given our growing elderly population."

ACEP conducted the poll from March 3 to March 11, 2011. E-mails were sent to 20,687 emergency physicians, and 1,768 responded. The survey has a theoretical sampling error range of plus/minus 2.23.

While 79 percent of responding emergency physicians said their emergency departments use resources efficiently, nearly half of respondents (44 percent) said the fear of lawsuits was the biggest challenge to cutting emergency department costs. More than half (53 percent) of emergency physicians reported that fear of lawsuits is the main reason for ordering the number of tests they do.

"Emergency departments need more resources, not fewer, and medical liability reform would help reduce overall costs by reducing the need for defensive medicine," said Dr. Schneider.

Two-thirds of emergency visits occur after business hours, when doctor's offices are closed and patients have nowhere else to turn. Visits to ERs reached an all-time high of nearly 124 million in 2008, according to the Centers for Disease Control and Prevention (CDC) and are expected to rise nationwide.

Physicians responding to the poll attribute the overall increase in emergency patients to patients without health coverage (28 percent) and a growing elderly population (23 percent) are seen by physicians as the most important reasons for the overall increase in ER patients.

An overwhelming 89 percent of physicians believe the number of visits to the emergency department will increase as health care reforms are implemented with 54 percent of them expecting to see a significant increase.

"Emergency visits have increased at twice the rate of the U.S. population, and less than 8 percent of those patients have nonurgent medical conditions, meaning the vast majority need to be there," said Dr. Schneider. "At the same time, hundreds of emergency departments have closed. The new health care reform law does not address these problems and with the elderly population and more emergency departments forced to shut down, this crisis will only get worse."

More than 1,400 (82.5 percent) responding to the poll said that lives were saved every day in their emergency departments. "Emergency medicine is critical at any hour of the day. It must be there when you need it," said Dr. Schneider.

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Obama Administration issues rules requiring parity in treatment of mental, substance use disorders

/PRNewswire/ -- The U.S. Departments of Labor, Health and Human Services (HHS), and the Treasury today jointly issued new rules providing parity for consumers enrolled in group health plans who need treatment for mental health or substance use disorders.

"Today's rules will bring needed relief to families faced with meeting the cost of obtaining mental health and substance abuse services," said U.S. Secretary of Labor Hilda L. Solis. "The benefits will give these Americans access to greatly needed medical treatment, which will better allow them to participate fully in society. That is not just sound policy, it's the right thing to do."

"The rules we are issuing today will, for the first time, help assure that those diagnosed with these debilitating and sometimes life-threatening disorders will not suffer needless or arbitrary limits on their care," said Secretary of Health and Human Services Kathleen Sebelius. "I applaud the longstanding and bipartisan effort that made these important new protections possible."

"Workers covered by group health plans who need mental health and substance abuse care deserve fair treatment," said Deputy Treasury Secretary Neal Wolin. "These rules expand on existing protections to ensure that people don't face unnecessary barriers to the treatment they need."

The new rules prohibit group health insurance plans -- typically offered by employers -- from restricting access to care by limiting benefits and requiring higher patient costs than those that apply to general medical or surgical benefits. The rules implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

MHPAEA greatly expands on an earlier law, the Mental Health Parity Act of 1996, which required parity only in aggregate lifetime and annual dollar limits between the categories of benefits and did not extend to substance use disorder benefits.

The new law requires that any group health plan that includes mental health and substance use disorder benefits along with standard medical and surgical coverage must treat them equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review. These practices must be based on the same level of scientific evidence used by the insurer for medical and surgical benefits. For example, a plan may not apply separate deductibles for treatment related to mental health or substance use disorders and medical or surgical benefits. They must be calculated as one limit. MHPAEA applies to employers with 50 or more workers whose group health plans choose to offer mental health or substance use disorder benefits. The new rules are effective for plan years beginning on or after July 1, 2010.

The Wellstone-Domenici Act is named for two dominant figures in the quest for equal treatment of benefits. The late Sen. Paul Wellstone, D-Minn., who was a vocal advocate for parity throughout his Senate career, sponsored the ultimately successful full parity act. He was joined by former Sen. Pete Domenici, R-N.M., who first introduced legislation to require parity in 1992. Champions of the legislation also included the bipartisan team of Rep. Patrick Kennedy, D-R.I., and former Rep. Jim Ramstad, R-Minn.

The issue of parity dates back more than 40 years to President John F. Kennedy, and also was supported by President Clinton and the late Sen. Edward Kennedy.

The interim final rules released today were developed based on the departments' review of more than 400 public comments on how the parity rule should be written. Comments on the interim final rules are still being solicited. Sections where further comments are being specifically sought include so-called "non quantitative" treatment limits such as those that pertain to the scope and duration of covered benefits, how covered drugs are determined (formularies) and the coverage of step-therapies. Comments are also being specifically requested on the regulation's section on "scope of benefits" or continuum of care.

Comments on the interim final regulation are due 90 days after the publication date. Comments may be emailed to the federal rulemaking portal at http://www.regulations.gov/. Comments directed to HHS should include the file code CMS-4140-IFC. Comments to the Department of Labor should be identified by RIN 1210-AB30. Comments to the Treasury's Internal Revenue Service should be identified by REG-120692-09. Comments may be sent to any of the three departments and will be shared with the other departments. Please do not submit duplicates.

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New Study Shows That American Public is Willing to Accept Major Reforms in Medicare Program

/PRNewswire/ -- Although Americans see Medicare as a key part of the country's social contract and want to preserve it in some recognizable form, they are willing to consider significant changes in the program to hold down its costs as the U.S. population ages.

In day-long "Choice-Dialogues" in which Americans from all walks of life considered the pros and cons of a range of choices for reforming Medicare, common ground was found in several key areas:

-- Allow Medicare to negotiate prices for prescription drugs (94 percent
support).
-- Encourage hospice care instead of heroic end-of-life measures (85
percent support).
-- Only cover treatments that are scientifically proven to be effective
(68 percent support).
-- Emphasize preventive care and personal responsibility (89 percent
consider preventive care very important or essential).
-- Gradually increase the Medicare eligibility age from 65 to 67 (68
percent support).


If additional money is needed to maintain Medicare in a way that is familiar in the future, Americans would rather see the government raise taxes than increase the federal debt.

These are among the central findings in a report released today by The Concord Coalition and Viewpoint Learning, Inc. The report is entitled "Medicare: It's Not Just Another Program."

The report, which was written by Viewpoint Learning, also underscores public dismay at the health care system in general. It comes as Congress and the Obama administration are working on massive changes in the entire system.

"Participants repeatedly expressed concerns over what they saw as a Byzantine and unaccountable health care system," the Medicare report says. "Most felt that the medical industry (especially the pharmaceutical companies) puts profits before people."

Robert L. Bixby, executive director of The Concord Coalition, says the report shows that Americans are prepared to accept significant changes in the program that plays a central role in the federal government's long-term fiscal problems.

"Medicare is on an unsustainable path and must be reformed," Bixby said. "According to conventional wisdom, however, the public is not ready to accept any change in the status quo. The good news from these Choice-Dialogues is that the conventional wisdom is wrong; the public is ready and willing to consider some very fundamental Medicare reforms so long as the program is preserved as a vital part of the social contract."

"Politicians who are truly interested in saving Medicare should stop the scare tactics and start engaging the public in a dialogue on the real trade-offs that must be confronted," Bixby added. "Changes will still be difficult, but the results will be more acceptable."

Viewpoint Learning conducted the dialogues with randomly selected representative samples of 35-40 citizens in Oak Brook, Illinois; Columbia Maryland; Phoenix and Houston. This project builds on the findings of a broader two-year project, "The America We Want," that examined public opinion on a broader range of federal programs and budget issues.

The new report found that many Americans lacked a strong understanding of the Medicare program, how it is funded, and the severity of the fiscal challenges facing the United States in the years ahead.

Yet most participants in the dialogues, after studying these issues in depth and spending much of a day discussing the problems and possible solutions with others, were able to agree on a set of Medicare changes.

But to win public support, the report cautions, "proposals for major reform to Medicare need to recognize the extent to which Americans see Medicare as an essential part of the social contract and not just as another government program."

Steven Rosell, president of Viewpoint Learning, said "The findings from these daylong dialogues with Americans from very different backgrounds and perspectives reveal deep disconnects between how Washington talks about Medicare and health care reform and how the public talks about them. In case after case, the report shows how leaders and the public are talking past each other, and how this deep disconnect and misunderstanding lead to the heat and the rancor that have made advancing real reform so difficult."

When most people talk about the "cost of health care," for example, they are focused on what they pay in premiums, co-pays and drug expenses. When health care experts talk about costs, however, they usually focus on the costs to businesses, government and other institutions.

Rosell also noted that many Americans do not realize that they are essentially paying for the cost of care for the uninsured already.

The new report, he said, provides insight for leaders about how best to bridge such disconnects and begin to create a learning curve that could lead to public support for significant Medicare reform.

Some elements in the new report also echo the findings of The Concord Coalition's fiscal advisory councils that met in early December in Washington. Working in six different parts of the country on Concord's Fiscal Stewardship Project, these advisory councils called for sweeping reforms in the health care system and some changes in Medicare to put the government on a more sustainable fiscal path. More information on the advisory councils' work is available at:

http://concordcoalition.org/fiscal-stewardship-project/fiscal-stewardship- project.

The full report, entitled "Medicare: It's Not Just Another Program," is available at: http://www.concordcoalition.org/files/uploaded-pdfs/Medicare_Report_Dec09_PRIN T.pdf

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$10 Million in Grants Aimed at Enrolling American Indian, Alaska Native Kids in Health Care to be Awarded

HHS Secretary Kathleen Sebelius today announced the availability of up to $10 million in grants to help reach American Indian and Alaska Native (AI/AN) children who qualify for, but are not yet enrolled, in Medicaid and the Children's Health Insurance Program (CHIP).

These new grants are part of a broader effort to find and enroll uninsured children who are eligible for Medicaid or CHIP but not enrolled. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) set aside $100 million for fiscal years 2009-2013
expressly to help find and enroll eligible uninsured children, including $10 million specifically for Indian health providers.

As called for in CHIPRA, grants will be awarded by the Centers for Medicare & Medicaid Services (CMS) to applicants whose outreach, enrollment and retention efforts will target geographic areas with high rates of eligible but uninsured American Indian and Alaska Native
children, who often live in isolated areas and are uninsured at higher-than-average rates.

"American Indian children are often uninsured, although many are eligible for Medicaid and CHIP," Secretary Sebelius said. "These grants will help Tribes and Indian health providers reach out to children and families to ensure more children get the health care they need."

Grants will be awarded to applicants that will be able to demonstrate increases in enrollment and improved retention of children already in Medicaid and CHIP. Grantees will report to CMS the number of new enrollees and those who retained coverage that are directly attributable
to the grant activities. Grantees will also report activities they believe were the most effective in finding, enrolling and maintaining coverage for eligible children.

"States have been effective in enrolling over 28 million children in Medicaid and more than 7 million children in CHIP, but there are still millions of uninsured, low-income children who are not enrolled in these programs even though they are eligible" said Cindy Mann, the director of
the CMS Center for Medicaid and State Operations. "We are looking forward to innovative grant proposals that will put new outreach, enrollment and renewal systems in place to ensure that uninsured Indian children get enrolled and stay enrolled for as long as they are eligible."

Applications are due by Jan. 15, 2010, and the grants will be awarded on April 15. Grants will be available to:

* The Indian Health Service;
* Tribes and Tribal organizations operating a health program; and,
* Urban Indian organizations operating a health program.

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HHS Strengthens HIPAA Enforcement

The U.S. Department of Health and Human Services (HHS) issued an interim final rule with request for comments today to strengthen its enforcement of the rules promulgated under the Health Insurance Portability and Accountability Act (HIPAA). The Health Information Technology for Economic and Clinical Health (HITECH) Act, which was enacted as part of the American Recovery and Reinvestment Act of 2009, modified the HHS Secretary's authority to impose civil money penalties for violations occurring after Feb. 18, 2009. These HITECH Act revisions significantly increase the penalty amounts the Secretary may impose for violations of
the HIPAA rules and encourage prompt corrective action.

Prior to the HITECH Act, the Secretary could not impose a penalty of more than $100 for each violation or $25,000 for all identical violations of the same provision. A covered health care provider, health plan or clearinghouse could also bar the Secretary's imposition of a civil money penalty by demonstrating that it did not know that it violated the HIPAA rules. Section 13410(d) of the HITECH Act strengthened the civil money penalty scheme by establishing tiered ranges of increasing minimum penalty amounts, with a maximum penalty of $1.5 million for all violations of an identical provision. A covered entity can no longer bar the imposition of a civil money penalty for an unknown violation unless it corrects the violation within 30 days of discovery.

The interim final rule with request for comments published today conforms the HIPAA enforcement regulations to these revisions made by the HITECH Act. It may be viewed and commented on at: www.regulations.gov. This rulemaking will become effective on Nov. 30,
2009, and HHS will consider all comments received by Dec. 29, 2009.

"The Department's implementation of these HITECH Act enforcement provisions will strengthen the HIPAA protections and rights related to an individual's health information," said Georgina Verdugo, the director of HHS Office for Civil Rights (OCR). OCR is responsible for
administering and enforcing HIPAA's privacy, security and breach notification rules.

"This strengthened penalty scheme will encourage health care providers, health plans and other health care entities required to comply with HIPAA to ensure that their compliance programs are effectively designed to prevent, detect and quickly correct violations of the HIPAA rules,"
said Verdugo. "Such heightened vigilance will give consumers greater confidence in the privacy and security of their health information and in the industry's use of health information technology."

This interim final rule with request for comments is the first of several steps HHS is taking to implement the HITECH Act's enforcement provisions. The remaining provisions, which have yet to become effective, will be addressed in the next few months in forthcoming rulemakings.

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New Rules Protect Patients' Genetic Information

Individuals' genetic information will have greater protections through new regulations issued today by the U.S. Departments of Health and Human Services (HHS), Labor, and the Treasury.

The interim final rule will help ensure that genetic information is not used adversely in determining health care coverage and will encourage more individuals to participate in genetic testing, which can help better identify and prevent certain illnesses.

"Echoing the late Senator Ted Kennedy, our efforts to protect Americans undergoing genetic testing from having the results of that testing used against them by their insurance companies is one of the 'first major new civil rights' of the new century," said HHS Secretary Kathleen Sebelius. "Consumer confidence in genetic testing can now grow and help researchers get a better handle on the genetic basis of diseases. Genetic testing will encourage the early diagnosis and treatment of certain diseases while allowing scientists to develop new medicines, treatments, and therapies."

The interim final rule with request for comments and the notice of proposed rulemaking implement Title I of the Genetic Information Nondiscrimination Act of 2008 (GINA). Under GINA, and the interim final rule, group health plans and issuers in the group market cannot:
increase premiums for the group based on the results of one enrollee's genetic information; deny enrollment; impose pre-existing condition exclusions; or do other forms of underwriting based on genetic information. In the individual health insurance market, GINA prohibits issuers from using genetic information to deny coverage, raise premiums, or impose pre-existing condition exclusions.

Further, under GINA and the new interim final regulations, group health plans and health insurance issuers in both the group and individual markets cannot request, require or buy genetic information for underwriting purposes or prior to and in connection with enrollment.
Finally, plans and issuers are generally prohibited from asking individuals or family members to undergo a genetic test.

"Today's genetic technologies yield data that are vital to helping Americans make personal, medical decisions. It is essential that we protect such information and ensure it is not misused by health plans or insurers," said Labor Secretary Hilda L. Solis. "The rules issued today protect individuals against the unwarranted use of information related to their personal health because no one should have to fear that disclosure of their medical data will put their job or health coverage at risk."

Additionally, HHS, through its Office for Civil Rights (OCR), issued a notice of proposed rulemaking with a 60-day comment period, to propose changes to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule to prohibit health plans from using or disclosing genetic information for underwriting purposes.

The proposed rule published today modifies the HIPAA Privacy Rule pursuant to GINA Title I to clarify that genetic information is health information and to prohibit the use and disclosure of genetic information by covered health plans for eligibility determinations, premium computations, applications of any pre-existing condition exclusions, and any other activities related to the creation, renewal, or replacement of a contract of health insurance or health benefits. In combination with the new penalties for violations of the HIPAA Privacy Rule, as provided for by the American Recovery and Reinvestment Act of 2009, a use or disclosure of genetic information in violation of the HIPAA Privacy Rule could result in a fine of $100 to $50,000 or more for each violation.

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CAHI Says Health Insurers Are Not the 'Problem'

/PRNewswire/ -- Today, Dr. Merrill Matthews, executive director of the Council for Affordable Health Insurance (CAHI), released the following statement:

After months of several health care industry groups bending over backward to work with the Obama administration and the Democratic leadership in Congress on health care reform, the Democrats have apparently decided to make a pariah out of one (at least for now) of those groups: health insurers.

"Of course they've been immoral all along in how they have treated the people that they insure," House Speaker Nancy Pelosi was quoted last week as saying. "They are the villains. They have been part of the problem in a major way."

One might have thought all that industry willingness to work closely with Congress and the administration would have earned a little respect. Apparently not.

And these aren't the ramblings of some rogue politician, nor are they off-the-cuff gaffes. I received some internal Democratic strategy memos last week; attacking health insurers is official Democratic policy now.

Democrats are losing their effort to dramatically restructure the health care system -- not just the health insurance industry -- and they have made a political decision to villainize health insurers in hopes of recapturing their earlier momentum.

Well, CAHI intends to defend the health insurance industry, which has been paying health care bills -- about $616 billion in 2008, according to the actuarial firm Milliman -- saving lives and protecting families' assets for decades. And, of course, picking up the cost shift from Medicare and Medicaid underpayments.

The vast majority of health insurers, the people working for them, and the agents who sell their products are dedicated professionals who, unlike most members of Congress and the Obama administration, actually understand the health care delivery and financing systems.

These folks dedicate their lives to making a difference, and those efforts appear in poll after poll showing that the large majority of Americans like their health coverage. It is outrageous that a group of politicians now plan to ridicule and demonize health insurance professionals and agents for no other reason than to pass legislation that won't solve the fundamental problems while costing the country more than a trillion dollars.

Had the Democratic leadership and the Obama administration wanted to simply address the problem of the uninsured, they could have done it with wide bipartisan and public support. Had they wanted to address health insurance access problems or growing health care costs, they could have done it with wide bipartisan and public support.

But they have taken an opportunity to pass needed reforms and turned it into a wish list of everything they could pack in a bill with the hope of slipping it by the public with little or no scrutiny. That plan has backfired. Indeed the public has turned on the plan, so the plan creators are turning on health insurers in an effort to deflect the anger.

Health insurers are not the "problem," as Speaker Pelosi asserts, and they certainly aren't "villains." They have done their best to play a constructive role. What's killing health care reform is the cost and scope of change she and the president are demanding, and the fact that almost everything they claim will improve the health care system will actually make it worse. If the Speaker wants to find a villain in health care reform, she might start with her own party's proposal.

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Sen. Judson Hill (GA): All Health Care Reform is Not Created Equal

With Democratic control of both the White House and Congress, national health care reform has a better chance of passing now than any time in recent history. Americans agree that change in our health care system is necessary. Escalating health care and insurance premiums are unsustainable for most families, businesses and all levels of government. Every day it becomes more and more evident that all health care reform is not created equal.

Conservatives have worked for years to change the fundamentals of health care and health care financing to achieve a patient centered, prevention focused, free market system. Many moderates and liberals want government-based health care reform in which the government provides for everyone and health care is “free.” National leaders are advancing numerous reform proposals. Yes, America needs health care reform, but be careful which version you ask for because as the saying goes, “choose your rut in the road carefully since you’ll be in it for the next 100 miles”.

Political experts today will tell you that some sort of health care reform will pass. Any national health care reform measures that survive the political hurdles necessary to become law will be very difficult to change in the future. You and I have a vested interest in which reform proposal actually becomes law.

Early free market successes have begun in several states. These conservative initiatives offer healthier outcomes, stabilized costs, and tax savings and incentives for individual responsibility. For example, Georgia law now incentivizes people to choose healthy behaviors by actually allowing health insurance companies to partially refund premiums to people who stay healthy. But to date, no insurance company has refunded premiums. It’s time we ask them why not?

Three simple conservative steps would improve health care, lower costs and reduce the number of people without health insurance. First, all insurance should be owned by the individual so your financial security and health care coverage is not at risk just because you left your job and lost your company’s insurance. Second, everyone should be able to pay for health care and health insurance with before tax dollars. And third, we should reward personal responsibility and healthy choices with lower insurance premiums.

Governments can and should transform their health care programs. Taxpayers cannot afford to expand and sustain Medicare and Medicaid programs. Instead millions of dollars can be saved by allowing qualified, lower income earners to use their government health care assistance subsidy as a scholarship to buy private health insurance through their employer. In most cases this is a much less expensive option that provides better and more accessible health care. Under such a plan, physician reimbursements for government programs are higher and state taxpayers would save millions of dollars.

If America chooses a national more socialized plan similar to government plans in Western Europe, there will be a huge price to pay. The consequences of this choice are monumental and long-term. European and Canadian health care is characterized by delayed treatments, rationing of care, exorbitant taxpayer costs and sometimes the loss of life. In these countries people with higher incomes purchase private insurance to get to the” head of the line” for better treatment for themselves and their families. Those who chose to buy private insurance continue to pay much higher taxes for national care to cover everyone else. Europeans and Canadians even come to the U.S. to find better health care with easier access for treatment, and yet our government wants to put forth a similar government plan.

Earlier this year the Obama Administration and the Democrat controlled Congress quickly rushed through billions of government spending in the federal “stimulus” bill. Health care reforms cannot be rushed. Health care delivery and financing is too complex. Although Democrats in Congress may have the votes, now is not the time to “just pass” health care reform legislation and then fill in the blanks later. This is not the time to experiment. The details matter too much because lives are at risk.

As we work toward health care reform, everyone should answer three questions and then call their representatives. “What type of reform do you want - patient centered or government centered?” “Should our government be in the health care business or should we incentivize physician-patient relationships?” And finally, “Which health care reform measure encourages and incentives personal responsibility for your health?” Your answers to these questions are vital because if you think health care is expensive now, just wait until you see the costs when it is “free.”
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Employers Support Non-Payment for Hospital-Acquired Infections

/PRNewswire/ -- The non-profit Midwest Business Group on Health (MBGH) released the results of a survey of employers and health care industry stakeholders on their knowledge and intentions to improve the safety and quality of health care by no longer paying for "never events" - serious and costly preventable hospital errors and hospital-acquired infections. The findings were presented at a meeting of key health care industry stakeholders including public and private employers, hospitals, health plans, doctors, consumer organizations and government hosted by MBGH in Chicago last week.

"There are currently several separate efforts taking place in our community aimed at reducing hospital-acquired conditions," said Larry Boress, president and CEO of the MBGH. "We invited key stakeholders to come together for an in depth discussion on "never events" in the hopes that we can bring continuity to these efforts and make faster progress toward improving the safety and quality of health care for everyone."

Survey findings
-- More than 60 percent of employers believed they should pay for
conditions that arose after the covered patient was admitted to a
hospital, if the facility was not at fault.
-- However, once employers became aware that Medicare had identified
conditions which should never happen to a patient and will not pay for
services related to such situations, close to 80 percent of health
care purchasers agreed that their health plans should adopt the same
payment policies as Medicare related to those conditions.
-- Nearly 100 percent of employer respondents indicated hospitals should
refrain from billing patients for services not paid for by their
benefits for events that experts say should not happen in a hospital.
-- Sixty-eight percent of employers agreed that MBGH should bring
together plans, hospitals, employers, consumer and government agencies
to define and address as a community what conditions hospitals should
focus on from the "never events" and Medicare hospital-acquired
conditions lists.


MBGH is a Regional Roll-Out Leader for The Leapfrog Group and is actively involved in hospital performance and public reporting efforts in Chicago, including the Leapfrog Hospital Survey. A section of this survey addresses 28 serious preventable errors or "never events" as set forth by the National Quality Forum (NQF). Currently, less than 47 percent of hospitals in Illinois participating in the Leapfrog Hospital Survey have agreed to meet the Leapfrog "never events" policy. Efforts are also being looked at by national groups to consider payment policies that refrain from paying for such events in physicians' offices.

"Most small- and mid-size employers are unaware of the impact of "never events" to their growing costs for health care," said Joseph Balasa, chief operating officer for the Chicagoland Chamber of Commerce. "We are looking to the large employers, hospitals and health plans to make progress in solving this problem so the entire community can benefit from improved quality and safety of health care."

MBGH's survey and the meeting were supported by sanofi-aventis. The survey was submitted electronically, with more than 50 employers and other health care stakeholders responding. More than 160 people participated in the meeting.

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SCHIP Provides Health Coverage to 7.4 Million Children in 2008

Some 7.4 million children were enrolled in the State Children's Health
Insurance Program (SCHIP) in 2008 -- a four percent increase over the
previous year, the U.S. Department of Health and Human Services
announced today. The announcement comes as Congress is debating
reauthorization of SCHIP, which is projected to expand coverage to an
additional four million children.

"With unemployment numbers rising and the economy struggling to regain
momentum, more and more American families are relying on SCHIP to insure
their children get the health coverage they need," said Acting HHS
Secretary Charles Johnson. "It is no surprise that SCHIP enrollment
went up in 2008 and we expect this trend to continue well into 2009 if
the program is reauthorized."

Created in 1997, SCHIP is a state and federal partnership designed to
help uninsured children. SCHIP received $40 billion in federal funds
over 10 years through 2007. The Medicare, Medicaid and SCHIP Extension
Act of 2007 extended the program until March 31, 2009, with an
appropriation of $5 billion for each of fiscal years 2008 and 2009, with
fiscal year 2009 funding available only through March 31, 2009. The
legislation also provided $1.6 billion in funding for states with SCHIP
budget shortfalls for fiscal year 2008 and $275 million for state
shortfalls through the first two quarters of fiscal year 2009.

Enrollment data, compiled by the Centers for Medicare & Medicaid
Services (CMS), and based on state reports, show that 7.4 million
children were enrolled in SCHIP at some point during federal fiscal year
(FFY) 2008, compared to 7.1 million for fiscal 2007. During FFY 2008,
334,616 adults were covered with SCHIP funds.

"While more children are relying on the program, we know millions more
children need health care coverage and that is why we need a strong
SCHIP to meet the nation's growing need," said Acting Secretary Johnson.
"President Obama believes that healthy children are the key to a healthy
economy and a healthy future for our country. We look forward to
working closely with Congress to reauthorize SCHIP and to working with
the States to do every thing we can to enroll every eligible child in
the program."

The SCHIP targets uninsured children who live in families with incomes
generally around 200 percent of the federal poverty level ($42,000 for a
family of four in 2008), which is too high in most states to qualify for
Medicaid, but in many cases, too low to afford private coverage.

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