State roundup: Calif. hospital allegedly overbilling Medicare; Wash. hospitals ER 'boom'; Rehab scams in Florida?

Nov 28 2011

Health policy news from California, Florida, Washington state, Oregon, Vermont and Texas.

California Watch / San Francisco Chronicle / Sacramento Bee: Heart Failure Cases Surge Among Prime Hospital's Medicare Patients
For three years, a small hospital east of Los Angeles has billed Medicare for the costs of confronting what appears to be a cardiac crisis of unprecedented dimension. From 2008 through 2010, Chino Valley Medical Center in San Bernardino County claimed that 35.2 percent of its Medicare patients were suffering from acute heart failure – a dangerous, often-deadly breakdown in the heart's ability to pump blood. That's six times the state average, according to a California Watch analysis of Medicare billing data ... The hospital appears to have taken advantage of Medicare rule changes that authorized bonus payments for treating patients with major complications. ... Prime attorney Anthony Glassman said in a letter that the heart failure diagnoses at Chino Valley were accurate and were made by treating physicians, not the hospital itself (Williams, Doig and Jewett, 11/27). 

California Watch follow-up story: Hospital Reports Simultaneous Cases Of Heart Failure, Blood Infection (Williams, 11/28). 

Modern Healthcare: Inspectors Conduct Sweep Of Comprehensive Outpatient Rehab Sites In Florida; Many Not Operational
South Florida is home to a disproportionate number of comprehensive outpatient rehabilitation facilities (CORFs), and a review has found that nearly 20% of them were not operational despite receiving more than $2 million in Medicare payments, a new review says. ... officials at the CMS said they will increase the number of unannounced site visits to South Florida CORFs (Carlson, 11/28).

The Seattle Times: ER Building Boom Is Wrong Prescription, Critics Say
With medical costs spiraling upward and state-paid insurance coverage evaporating, you might think hospitals would discourage patients with sprains and cuts from coming to their emergency rooms for care that would cost much less in clinics or urgent-care centers. But you'd be wrong. ... [some lawmakers and advocates of affordable health care] complain that nearly all Washington hospitals get substantial tax breaks and construction financing through tax-exempt bonds (Ostrom, 11/26).

Los Angeles Times: Taking Healthcare To Students
In California, there are 183 school health centers, up from 121 in 2004. Twelve more are expected to open by next summer, according to the California School Health Centers Assn. The centers have become a small but important part of the nation's healthcare safety net, experts say, treating low-income patients who might otherwise not have regular medical care. Now, they add, campus clinics are serving as a model for health officials trying to reduce costs (Gorman, 11/28).

The Texas Tribune: Interactive: State Employees On Drug Company Payrolls
It's no secret that thousands of Texas medical professionals are paid by drug companies to do everything from study new treatments to pitch their wares at conferences and conventions. And it's certainly not illegal. But it's more surprising that at least 114 of them are state employees paid with taxpayer dollars -; some of them already making salaries that exceed $500,000 (Murphy, 11/25). Read a related Texas Tribune story.  

Burlington Free Press: Vermont Hearings To Focus On Health Care Funding
The long-awaited debate over how to pay for a government-run healthcare system begins this week with the first of four "listening sessions" hosted by the Shumlin administration. In the 2011 legislative session, lawmakers passed a law that sets the state on a course toward a consolidated health insurance system. The law requires the executive branch to propose a plan to pay for a reformed health insurance system in January 2013 (Remsen, 11/28).

The Lund Report: Mental Health Contracts Changed to Reflect New Funding Formula
[Richard Harris, the director of the Oregon Health Authority's Addictions and Mental Health division] said that that amount of money counties receive for mental health services will now be based upon their population and the prevalence of mental illness. Previously, those dollars were based on a wide variety of factors, including whether some services were available in some counties but not others (Waldroupe, 11/23). 

The Miami Herald: Labor Tensions Mount At Jackson Health System
Labor tensions are mounting at the Jackson Health System, with the public hospitals almost two months into the new fiscal year without crucial union contracts. ... [There were] recent announcements of two-week furloughs and the elimination of 240 positions. …  Jackson Chief Executive Carlos Migoya said he's doing what he must to cut labor costs by $120 million in order to meet his break-even budget for a fiscal year that began Oct. 1 (Dorschner, 11/27).