Akeso Care Management®, Inc. (ACM®), announced today that it has been awarded Health Utilization Management Accreditation by URAC, a Washington, DC-based health care accrediting organization that establishes quality standards for the health care industry.
This accreditation assures the adequacy and quality of ACM’s health utilization management program through evaluation against broadly recognized standards and measures. ACM provides medical management services to domestic and international insurance carriers, self-insured employers and third party administrators. These services include utilization review, large case management, emergency medical evacuations, discharge planning and medical bill review, all designed to provide appropriate, cost-effective patient care.
URAC’s Health Utilization Management Standards establish consistency in UM processes. The standards ensure that appropriately trained clinical personnel conduct and oversee the utilization review process, that a reasonable and timely appeals process is in place, and that medical decisions are based on valid clinical criteria.
America’s changing healthcare industry is beginning to reshape the non-physician healthcare work force, with certain jobs evaporating while others are blooming, according to results of the 2013 Staff Salary Survey by Physicians Practice , America’s Leading Practice Management Magazine.
As practices automate their billing processes with outside service providers, and digitize their recordkeeping with electronic health records systems, they reported big drops in their employment of medical billers, billing managers, and medical records clerks. Those positions declined by 25 percent, 23 percent, and 37 percent, respectively, since 2011.
As practices adapt to wrenching changes in their industry by retooling their staffs, they’re challenged to find ways to keep the staff they do have motivated.
But new jobs are being created as healthcare providers become increasingly accountable to drive positive patient outcomes. More than one in five practices now employ care coordinators—professionals whose role is to help patients access diverse services needed to maintain their health, from nutrition counselors to social workers and more. This is the first year that Physicians Practice asked about care coordinators, a position that had previously been almost unheard-of outside of large institutions or health insurance companies. Another employment trend: when it comes to non-physician healthcare providers, critical private practices are increasingly employing nurse practitioners over physician assistants, with employment of the latter declining by 26 percent in the last two years. However, that may be driven by labor shortages among PAs.
Staff salaries, meanwhile, have remained flat or declined in most areas, with one important exception: nurse managers are earning 10 percent on average more than they were two years, even as their ranks swelled at practices by 25 percent during the same period.
Physicians Practice surveyed nearly 1,000 practices during the fourth quarter of 2012 for its fourth annual Staff Salary Survey.
GlaxoSmithKline is set to open its new double LEED® platinum certified facility in Philadelphia’s Navy Yard Corporate Center this Saturday, ushering in a new era of how people work in Philadelphia.
The 208,000 square foot building at Five Crescent Drive represents an $80 million investment by Liberty Property/Synterra, and an investment of approximately $70 million by GSK. GSK has signed a 15.5-year lease at the building, which includes a four-story central atrium, a monumental stairway, a coffee shop, cafeteria, fitness center, meeting centers and a large multi-purpose room.
– 4-story, 208,000 rentable square feet, inclusive of over 53,000 square feet of amenity space
– The first double LEED®® Platinum rating from the U.S. Green Building Council in Philadelphia
(Core & Shell™ and Commercial Interiors™).
– Project developed on a rehabilitated brownfield site within The Navy Yard Corporate Center fronting the beautifully landscaped 3.5-acre Crescent Park and Rouse Boulevard.
– 80-foot high central atrium with dramatic architectural lighting and a 4-story monumental stained maple veneer stair
– Amenities include cafeteria, coffee bar, central pantries, fitness center, health clinic, virtual bank teller, conference center, quiet rooms, production studio, a help lounge, roof garden, and a company store.
– 10,300-square-foot cafeteria with fresh offerings from a salad bar, deli, grille, chef’s table and a coffee kiosk 900 parking spaces on site and additional on-street parking.
– Five Standards (Dazzle), a dynamic exterior sculpture by Philadelphia native Virgil Marti commissioned by the Mural Arts Program
– Timeline: Construction commenced June 2011; initial occupancy February 2013; grand opening April 6, 2013
The four-story, glass-encased building with an open floor plan and grand central staircase has been awarded both Core & Shell™ and Commercial Interiors™ LEED® Platinum certification from the U.S. Green Building Council. It is the first double LEED® Platinum building in Philadelphia. It is anticipated that the innovative building systems will save as much as 30% of energy use when compared to a traditional building.
These substantial energy savings are the result of the state-of-the-art building facade and high-performance glass which maximize daylight in winter while reducing heat gain and providing shading in summer. ENERGY STAR®-rated lighting and equipment, as well as an astronomical time clock and cloud sensor program, activate the automatic shades on windows to control glare. In addition smart meters track and monitor the building’s energy and water use and provide ongoing accountability for utility consumption and performance.
Human beings have been laughing for as long as we have been human. In fact, recent evidence suggests that apes and other animals also laugh in their own way. And although humor is experienced across all ages and cultures, scientists are still not in agreement about the root causes of humor and laughter. For more in-depth information about humor and laughter, please check this out: http://en.wikipedia.org/wiki/Humor_(positive_psychology)#Humor_and_Health
Health and laughter
There is widespread agreement among scientists that humor in general, and laughter in particular, are very good for us. In fact, laughter provides a number of very powerful physical and emotional health benefits.
Ten powerful physical and emotional benefits of laughter:
1. Reduces pain and allows us to put up with discomfort
2. Improves oxygen flow to the brain and heart
3. Reduced blood sugar levels
4. Helps blood vessels work better
5. Helps bereaving people deal with grief
6. Dampens negative emotions like anger
7. Serves as a distancing mechanism in coping with adversity
8. Helps to achieve a sense of satisfaction with life
9. Provides higher self-esteem and lower levels of depression
10. Releases stress and anxiety
Laughter, work and relationships
In addition to these wonderful physical and emotional health benefits, laughter also improves your job performance, especially if you are called on to be creative or solve complex problems. It also strengthens marriages and other relationships between people. It literally synchronizes the brains of two people talking so that they are emotionally tuned in to each other. For more information on the benefits of laughter, check out this link: http://www.psychologytoday.com/articles/200504/laughter-the-best-medicine
Laughter does a body good
Scientists are just beginning to understand how laughter affects us physically, but studies have already shown that laughter does as much good to arteries as strong aerobic activity. This doesn’t mean that you should laugh instead of exercise, but it does suggest that you try to laugh regularly. One of the more amazing recent findings is that laughing helps to regulate blood flow and assists the blood’s ability to form clots and coagulate. In addition, it causes our bodies to secrete healthy chemicals in response to infection. Finally, studies have shown that laughter can help reduce the risk of atherosclerosis and other cardiovascular diseases.
Researchers don’t clearly understand how laughter generates these heart benefits. It’s possible that they come from the forceful movement of the diaphragm as you laugh. In addition, laughter might activate the brain’s release of hormones like endorphins, which have a positive effect on blood vessels, organs and other body parts.
Prescription for health
Medical experts studying the health benefits of laughter suggest a simple prescription to improve your health: thirty minutes of exercise three times a week, coupled with fifteen minutes of daily laughter.
It’s clear that laughter is very good for the body as well as the soul. So what should we do with this newfound information about the benefits of laughter? Well, we suggest you start by checking out local comedy venues. To find comedy events near you, please visit: http://www.comedyworld.com
About the author
Bill Hartzer is a freelance writer based in Texas, and writes for Health Plan News.
Most people think of a treadmill as an exercise device. In reality treadmills were invented over 4,000 years ago and used animal and human power to perform labor intensive tasks like drawing water and grinding grain. For an overview of the history of treadmills: http://en.wikipedia.org/wiki/Treadmill
Strangely enough, treadmills were also used in prisons as punishment. Inmates were made to walk on a large vertical wheel like a paddle wheel. They’d walk in drudgery for up to eight hours per day, which equated to climbing 10,000 vertical feet or more. To learn more: http://www.uh.edu/engines/epi374.htm
Treadmill health benefits
Running or walking on a treadmill is one of the healthiest activities anyone can do, especially if it’s done consistently. Some people prefer to run or walk outside because they’re in the fresh air and they might soak up some sunshine. But when all is said and done there are more good reasons for running or walking on a treadmill than doing the same thing outside.
Here are eight good reasons for using a treadmill:
1. Less dangerous. The user isn’t exposed to cars and other obstacles, making running safer.
2. Smooth surface. Running on a consistent surface is easier than running on trails or streets.
3. Weather no obstacle. The user can exercise regularly regardless of the weather.
4. More control. Settings on a treadmill allow for more controlled pacing than running outside.
5. Easier to focus when running on a treadmill because you’re not worried about traffic, obstacles, etc.
6. More fun. Treadmill users can watch TV or read, making walking or running more fun.
7. Lower impact. Treadmills are cushioned, providing lower impact than streets or trails.
8. It’s all uphill. Treadmills can be adjusted for all uphill running, providing a more beneficial run.
In fact, the advantages of using a treadmill are so great that once people start using one they are more inclined to stick with it, meaning they’ll get more consistent health benefits from this very aerobic exercise.
Common health benefits of using a treadmill:
Using a treadmill strengthens your cardiovascular system, making your lungs and heart stronger. Working out on the treadmill three to five times each week for at least 30 minutes each time, can lower your risk of diabetes, cancer and heart disease, and other health problems.
Bone Density Benefits
Weight bearing exercise is best for strengthening bones and preventing and managing osteoporosis. A treadmill is a wonderful way to get this much needed weight bearing exercise on a very consistent basis, without being put off by the weather.
Working out on a treadmill at the right intensity will burn calories as fast as or faster than the same workout outside, especially if you have the treadmill on more difficult settings.
Improves Range of Motion
A mild walking or light jogging program on a treadmill will assist in loosening joints and regaining flexibility.
Combats Depression and Insomnia
The aerobics gained from using a treadmill helps combat depression and insomnia.
With so many positives, it’s hard to ignore the benefits of using a treadmill. Being able to run and walk in any weather while staying out of traffic is a huge plus. And when you couple this with the excellent cardiovascular and other health benefits, it makes treadmills the obvious choice of active, healthy people.
About the author
Bill Hartzer is a freelance writer based in Texas, and writes for Health Plan News.
MetroHealth System has signed a multi-year agreement with Press Ganey to provide improvement solutions for its medical center, rehabilitation hospital, outpatient surgery center and network of 16 health centers.
More than 500 primary care and specialty care physicians practice within MetroHealth. Each year, MetroHealth provides nearly one million inpatient and outpatient visits, with revenue of more than $700 million. MetroHealth’s network of health centers incorporates a patient-centered medical home team-care approach to optimize patient outcomes through chronic disease management. The system’s major medical center is a leader in trauma, emergency and critical care; women’s and children’s services, including high-risk obstetrical care and neonatal intensive care; comprehensive medical and surgical subspecialties; heart and vascular care; cancer care; senior health; stroke and rehabilitative health care services.
Press Ganey and MetroHealth will be able to identify areas of opportunity and implement targeted action plans to enhance the patient experience. MetroHealth is one of the largest, most comprehensive providers in Northeast Ohio, serving the greater Cleveland community for more than 175 years.
The Emirates Group comprised of Emirates airline and dnata, which has multiple business interests in the aviation, travel, tourism and leisure industries (Emirates Group), chose ESKADENIA Software Medical Insurance System to run the medical operations of more than 104,000 employees with their dependants.
The Emirates Group chose ESKADENIA’s Medical System due to its powerful claims audit tools and efficient network management that gives full details on the medical providers (Doctors, Pharmacies, Laboratories, and Hospitals) used by the Group.
ESKADENIA’s Medical Insurance System was customized to handle its employees’ medical claims in the most efficient and comprehensive manner. The Emirates employees can access their medical profile online and monitor their benefits, limits and utilization. In addition, they can submit claims directly from the web, request for medical approvals, and appeal for rejected claims.
It is worth to mention that ESKADENIA Medical Insurance system works for both individuals and groups, also it complies with governmental regulations, which makes it an easy to- use tool for the recording and manipulation of insurance policy production, medical networks, claims, policy renewals, and reinsurance operations.
Anthera Pharmaceuticals, Inc. (Nasdaq: ANTH) today announced that it intends to offer and sell shares of its common stock in an underwritten public offering. The Company expects to grant the underwriters a 30-day option to purchase up to an additional 15% of the shares of common stock offered in the public offering. The Company intends to use the net proceeds from the offering for general corporate purposes. The offering is subject to market and other conditions, and there can be no assurance as to whether or when the offering may be completed, or as to the actual size or terms of the offering.
Jefferies & Company, Inc. is acting as sole book-running manager in the offering and Leerink Swann LLC is acting as co-manager.
Uroplasty, Inc. (NASDAQ: UPI), a medical device company that develops, manufactures and markets innovative proprietary products to treat voiding dysfunctions, today reported financial results for the third quarter of fiscal 2013 ended December 31, 2012. The Company also announced the completion of a purchase agreement for both Urgent PC and Macroplastique with KP Select, Inc., which provides contract management services for all Kaiser Permanente and affiliated health care facilities.
Fiscal Nine Months 2013 Financial Results
For the nine-month period ended December 31, 2012, sales grew 13% to $16.9 million, reflecting a 25% increase in U.S. sales and an 11% decrease in sales outside the U.S. In the U.S., sales of Urgent PC increased 45% to $8.0 million and Macroplastique sales increased 1% to $4.3 million. At December 31, 2012, cash, cash equivalents and cash investments totaled $15.6 million
KP Select Purchase Agreement and Additional Expanded Coverage
The recently-completed purchase agreement with KP Select, Inc. for sales of Urgent PC and Macroplastique to Kaiser Permanente is a three-year contract and begins on March 1, 2013. Kaiser Permanente provides services to more than nine million members in 10 states through 37 hospitals and 611 medical offices and clinics, though not all locations treat urinary incontinence.
The Bankruptcy Court for the Southern District of New York today approved Montefiore Medical Center’s bid to acquire the facilities of New York Westchester Square Medical Center (NYWSMC), a Bronx, N.Y., neighborhood hospital that has operated under Chapter 11 bankruptcy protection for nearly seven years.
The new facility will be renamed Montefiore Westchester Square. The plan is to have a full-service emergency department, an ambulatory surgery center and, over time, comprehensive primary and specialty care services.
A federal lawsuit filed by prominent Delaware Valley cardiologist Nicholas L. DePace, M.D., sparked a multi-year investigation by the United States Department of Justice and the New Jersey Attorney General’s Office that has resulted in New-Jersey based Cooper Health System, and Cooper University Hospital paying $12,600,000 to settle Medicare and Medicaid fraud allegations.
According to Dr. DePace’s Complaint, since 2004, Cooper funneled illegal kickbacks to referring physicians through an advisory board known as the Cooper Heart Institute Advisory Board (“CHIAB”). Cooper established the CHIAB in 2004, with the stated purpose of utilizing prominent New Jersey physicians to advise the Cooper Heart Institute regarding innovative technologies, new management strategies, community needs, and appropriate educational and research initiatives.
In reality, the CHIAB was a sham, in which Cooper paid physicians with high-volume medical practices upwards of $18,500 each to do little more than watch four lectures per year hosted at an elegant banquet facility. These lectures consisted mostly of marketing presentation on cardiac care at Cooper. Additional lectures included generic subjects that were irrelevant to the stated mission of the CHIAB, including a 2008 lecture entitled: “The Healthcare Plans of the Two Presidential Candidates.”
In the spring of 2007, Cooper invited Dr. DePace to join the CHIAB. After attending his first CHIAB lecture, Dr. DePace quickly realized that the CHIAB was a thinly-veiled kickback scheme. Dr. DePace observed that the other CHIAB members were family physicians with high-volume practices. These physicians were all in the position to direct millions of dollars in patient care to Cooper.
Dr. DePace also observed that the CHIAB physicians were paid $18,500 for doing nothing more than sitting and listening to marketing presentations and lectures on irrelevant topics. The physicians did not discuss the lecture topics, and were not required to perform any additional work in exchange for the payments from Cooper.
In exchange for Cooper’s kickback payments, CHIAB physicians referred their patients to the Cooper Heart Institute for expensive in-patient and out-patient cardiac services. At least one CHIAB member admitted to Dr. DePace that, when making referrals, he knew that Cooper, through the CHIAB, “butters his bread.”
The settlement with the United States, and the State of New Jersey, announced today, will require Cooper to pay the United States $10,000,000 and the State of New Jersey $2,600,000. The settlement is one of the largest against a hospital for operating a kickback scheme, and is one of the largest recoveries for the State of New Jersey under its recently passed state False Claims Act. Cooper denies that it is liable for violating federal or state laws.
The American Center for Law and Justice (ACLJ), a pro-life legal organization that focuses on constitutional law, today filed its fourth direct challenge to the mandate of the Department of Health and Human Services (HHS) on the basis that the mandate violates the religious beliefs of business owners. The lawsuit was filed today in the U.S. District Court for the District of Columbia and contends that the HHS mandate violates constitutional and statutory rights by requiring two Ohio companies and their owners to purchase health insurance for employees that include coverage for contraception, sterilization and abortion-inducing drugs.
The lawsuit, posted here: http://c0391070.cdn2.cloudfiles.rackspacecloud.com/pdf/complaint-declaratory-injunctive-relief-freshway-v-hhs.pdf, argues that the HHS mandate violates the First Amendment, the Religious Freedom Restoration Act, and the Administrative Procedure Act.
The lawsuit contends the HHS mandate forces the owners to “violate their religious beliefs and moral values” or face crippling fines and penalties. For the two companies combined, the fines and penalties would total nearly $40,000 a day, amounting to $14.4 million annually, which the owners contend will be “ruinous” for their businesses.
The Quality Adjusted Life Years (QALY) approach to deciding which treatments are available on health services – used by the UK and generating much interest across Europe – is dangerously flawed and should be abandoned, according a European Commission funded research project.
HTA agencies are charged with recommending whether new treatments are publicly funded. NICE uses QALY – an economic theory which mathematically weighs number of life years by quality of life provided by different treatments. Based on this calculation, decisions are made about whether treatments are offered by the National Health Service. In the UK, if the incremental cost per QALY (= cost for one additional year in perfect health) is below £30,000, the treatment is usually made available. Many European countries are currently considering replicating the NICE model.
The research surveyed 1,300 respondents in Belgium, France, Italy and the UK, and is the largest investigation into QALYs ever undertaken.
ESKADENIA Software has successfully deployed its comprehensive package of General Insurance and Financial Insurance Systems at the short-term insurance operation of Botswana Insurance Holdings Limited in short period of time.
ESKADENIA Insurance Management Systems are designed to reduce operational cost, speed up work, maintain historical data and ensure a high level of security at Botswana Insurance Holdings Limited; The systems support real-time integration with the financial modules of ESKADENIA® Business Manager, including the General Ledger, Accounts Payable, Accounts Receivable, and Cash Management Systems to maintain Botswana’s needed financial information and accounts updates.
The ESKADENIA Insurance Software package (General, Financial, Approval System, Notification Engine, Management Information System, & ESKA Insures for Agents & Brokers) provide a collaborative environment for information management across Botswana Insurance Holdings’ departments and allows users to capture up-to-the-minute information whenever required.
The software package also, provides Botswana Insurance‘s users with advanced up-to-date reports and statistics to analyse operational performance and make proper management decisions.
Developed on Microsoft .Net Objected Oriented technology and using Oracle Database, the web-based systems, securely accessed from wherever an Internet service is available, which allows Botswana Insurance Holdings Limited employees to define insurance products, manage production, and run daily insurance transactions in an efficient and simple manner. Through the systems’ location-independent interface, the company can efficiently handle greater volumes of operations and smoothly manage work processes.
John Haenen, the CEO of BIHL Sure! commented that “ESKA® Insures provided us with the best platform for our business, we were impressed by the collaborative way in which ESKADENIA Software handled the deployment of our system – on time, on budget, and faultlessly functional at first switch-on.”
“We are proud to be selected as their technology partner by the largest financial service Group in Botswana – BIHL Sure! and to consolidate our position in the African Insurance market. The systems were deployed in record time indicating our ability to provide advanced and stable products to customers and the market “said Nael Salah, Managing Director of ESKADENIA Software.
About BIHL Sure!
The Company is a wholly-owned subsidiary of the BIHL Group, which is in turn a subsidiary of Sanlam, the largest insurance group in Africa with revenues exceeding US$5 billion. It writes some 38 lines of business in client-definable packages, or on custom designed forms for complex risks. The market in which it operates requires interaction with brokers, tied agents and bulk on-sellers such as banks. Systems are required to cater for all of these channels as well as the emerging direct market that demands access via the internet or smartphone. One of the Company’s leading strategies is to provide high standards of customer care 24/7/365, driven primarily by its electronic platforms. For this reason the relationship with its systems supplier is regarded as strategic and mission critical.
About ESKADENIA Software
ESKADENIA® Software is a CMMI® level 3 certified company that is active in the design, development and deployment of a range of software products in the Telecommunications, Insurance, Enterprise, Education, and Internet application areas. The company is based in Jordan and has sales activities in Europe, the Middle East and Africa; more than 85% of its sales are exported to the global market. ESKADENIA Software is a product and market-oriented organisation that assists enterprises and promotes businesses by use of highly effective IT strategies, solutions and tools. ESKADENIA Software strongly believes that a company’s achievement is based on the success of its Human Resources and the commitment to quality and excellence that each one holds strong to. ESKADENIA endeavours as a team to maintain quality and customer respect, build up perseverance, and foster innovation.
Buying health insurance coverage is a big decision. It’s complex, it’s costly, and it could have big monetary implications. Similar to a lot of other things, it’s simpler if you break up the job into lesser tasks and find your way out through them.
a) Create a list of solutions you and your household may need.
Take into consideration your gender, age, and family medical record. Are there any ongoing medical conditions? Is There anyone regular medical prescription?
At the lowest, plan to purchase ‘a high insurance deductible health plan’, which is usually termed as ‘catastrophic coverage’. Simply speaking, this coverage provides a reduced premium, and you make payment for most routine costs out of your pocket. If you’ve a critical accident or become severely ill, your insurance plan will activate when you attain your deductible.
b) Understand the way your state manages insurance.
The organizations approved to sell health insurance coverage where you reside and which among those firms provide individual policies.
1) Alerts about the latest frauds or organizations which have been having consumer complaints.
2) Details regarding state mandates. Get to know what a health insurance policy must include in your state.
c) Learn your rights under the reform.
The “Affordable Care Act” or (ACA) is already functioning in favor of health-care-consumers. For instance, insurance providers are now restricted from imposing life time restrictions on most benefits
d) Comparison shop.
Contact an agent or also check the web for quotes. Take note that dealing with an agent might not give you the complete picture. Brokers usually work with a sub-set of the readily available insurance providers. Utilizing an online website will give you more alternatives to consider.
Also, remember that each organization offers an assortment of policies. Compare the individual covers, not just the providers.
e) Do not ignore out of pocket costs.
Look at the premium and cost sharing specifications, such as deductibles, co-payments or co-insurance. If the plan doesn’t cover the things you may most probably need, it is not a deal. On the other hand, you might end up paying out over and above what you’ve to if the cover features the things you don’t need.
Look at what the coverage includes …
Types of services – Listed here are some typical healthcare services to think about when assessing health insurance coverage:
Office visits to your doctor
Surgery (inpatient and outpatient)
Emergency room visits
Mental health care
Vision care and glasses
Dental care and braces Amenities and Doctors – What medical centers, clinics and physicians are in a network for the coverage you are considering? Do you require a recommendation to visit a specialist?
Medications – If you frequently use a specific drug, is that medication on the policy`s preferred or formulary drug list?
What is not include in the coverage
Health insurance plans might have a listing of services which are excluded. When assessing a plan, look for exclusions, limitations, and restrictions.
Read the terms and conditions.
Just before you think you’ve a winner, go through the policy. Study all of it. Check out any words you don’t comprehend. The details matter.
If you don’t have the funds for health insurance coverage, explore the federal government health coverage resources for your state.
Unisys Corporation (NYSE: UIS) today announced that it has received a contract to provide IT managed services to a new client, the American Red Cross, a leading provider of humanitarian services.
The contract has a potential value of approximately $80 million over its initial five-year term. It also has two one-year renewal options.
Under the terms of the contract, Unisys will provide a full range of customer support and data center managed services to support approximately 20,000 Red Cross workers throughout the U.S. and Puerto Rico. The workers are engaged in disaster relief, blood-supply management and other activities critical to the organization’s humanitarian mission.
The contract includes on-site services, IT asset management and service desk support delivered through Unisys Managed Services Centers in Salt Lake City, Utah and Rochester, New York. Unisys will deliver these end-user services in an integrated IT services management (ITSM) environment that enables Red Cross workers to use the most convenient channel to obtain support, including telephone, chat, e-mail and the Web.
Unisys will provide data center services from its facility in Eagan, Minnesota, with disaster recovery backup in Salt Lake City. The services include implementation of Unisys remote infrastructure management services, which use automated capabilities to monitor and correlate events across all segments of a managed infrastructure – from servers to mobile devices – to orchestrate both pre-emptive and preventive action against potential IT faults.
The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) today sent a letter to House and Senate leaders urging both chambers to reject a proposal to pay for Stafford student loan subsidies with reductions in the Medicaid provider tax rates, also known as provider assessments.
Last week, House and Senate Republican leaders sent a letter to the President offering reduction in the Medicaid provider assessments as a way to offset the cost of keeping student loan interest rates low. The House of Representatives could vote on the measure as early as June 29.
A copy of the letter is below.
June 6, 2012
The Honorable John Boehner The Honorable Harry Reid
Speaker of the Majority Leader
House of Representatives United States Senate
Washington, D.C. 20515 Washington, D.C. 20510
The Honorable Nancy Pelosi The Honorable Mitch McConnell
Democratic Leader Republican Leader
House of Representatives United States Senate
Washington, D.C. 20515 Washington, D.C. 20510
The Honorable Eric Cantor The Honorable Richard Durbin
Majority Leader Assistant Majority Leader
House of Representatives United States Senate
Washington, D.C. 20515 Washington, D.C. 20510
The Honorable Steny Hoyer The Honorable Jon Kyl
Minority Whip Republican Whip
House of Representatives United States Senate
Washington, D.C. 20515 Washington, D.C. 20510
Dear Members of the House and Senate Leadership:
On behalf of the American Health Care Association, the National Center for Assisted Living (AHCA/NCAL), and our more than 12,000 member centers and communities nationwide, I’m writing today to express our opposition to a proposal that would use Medicaid provider assessment savings to offset subsidies to the Stafford student loan program.
As a former governor, I realize the challenge to find appropriate savings in an increasingly tight budget often seems insurmountable. There are never any “easy” decisions to cut programs. However, the current proposal from House and Senate Republicans to pay for offsets in student loan interest rates by reducing the Medicaid provider tax threshold from 6 percent to 5.5 percent would cause a ripple effect in every state where our care centers operate.
A vast majority of nursing home residents rely on Medicaid for their nursing home care. This program is particularly critical for those seeking skilled nursing care. About 63 percent of nursing home residents have their stays funded by Medicaid, yet the program fails to fully reimburse facilities for the costs they incur. Facilities lose nearly $20 a day for each Medicaid resident, totaling a $6.3 billion loss in 2011, according to a report released late last year. This insufficient reimbursement for skilled nursing centers demonstrably threatens access to care for the more than 60 million people – largely children, the elderly and the disabled – who rely on Medicaid for health care coverage.
The proposed reduction to provider assessments would add an additional strain to a sector that has already been rattled with rounds of government reductions and threaten our ability to provide care to vulnerable seniors. More than 3.1 million Americans work in long term care centers, making our sector one of the nation’s largest employers. Long term care centers are a meaningful job base in our communities. The federal government projects that there will be 72 million people age 65 or older in the U.S. by 2030, making the demand for long term care services and the people we employ only increase.
Limiting states’ ability to use provider assessments to support their Medicaid programs would do nothing to reduce the cost of health care or make Medicaid more efficient. While we know that Congress must find ways to reduce federal spending and fund a wide variety of programs, we strongly encourage you to consider more appropriate methods to encourage efficiency in federal health programs, rather than arbitrarily cutting important programs. We want to work with Congress to find a more permanent solution to the continuous underfunding of Medicaid.
AHCA/NCAL agrees that steps need to be taken to reduce the federal deficit and address the nation’s long term debt challenge. Our association is committed to working with members in both chambers of Congress to find long-term solutions for our nation’s funding needs.
But we must tackle the looming federal budget challenges in a careful and deliberate manner – one that does not undermine the core values to care for our nation’s seniors, including those who require long term care.
AHCA/NCAL President & CEO
Enterologics, Inc., (OTCBB: ELGO.OB) a biotechnology company, is dedicated to the development of live biotherapeutic products for gastrointestinal (GI) disorders that it believes are poorly addressed by current therapies. Key examples include pouchitis, irritable bowel syndrome (IBS), Crohn’s disease, ulcerative colitis and Clostridium difficile infections.
Enterologics intends to license or acquire technology to build a product pipeline based on producing probiotic bacteria in novel, shelf-stable, high potency formulations that are delivered orally. Unlike probiotic bacteria that are sold over-the-counter as dietary supplements or in food products such as yogurt, we intend to develop products to meet the exacting standards necessary to gain FDA approval as prescription drugs and biologics, with demonstrated safety and clinical benefits for specific GI indications.
Probiotics are live microorganisms (in most cases, bacteria) that are similar to or derived from beneficial microorganisms found in the human gut. They are also called “friendly bacteria” or “good bacteria.” Probiotics are available in foods such as yogurt and as dietary supplements (for example, capsules, tablets, and powders). Brand names that imply wellness or regularity in bowel function, coupled with ambiguous marketing claims to promote health, create interest but also confusion for consumers and physicians as to the real benefit of the specific product.
Enterologics believes that broader medical use of probiotics will follow convincing clinical tests of the type used to obtain regulatory approval for drugs and biologics to treat specific conditions. The Company intends to identify, in-license and develop unique probiotic strains for specific medical conditions, obtain regulatory approval and market these probiotics products as FDA-approved prescription drugs for specific label indications. Predictable product potency is a critical feature of a live biotherapeutic. Subject to UST’s technology meeting the Company’s specifications and our funding resources, we intend to license UST’s bacterial vitrification process, which we believe is far superior to other drying techniques and which we believe will enable us to meet the high potency standards necessary for prescription drug approval. This technology will be used to create highly stable dosage forms of our probiotic candidate products.
Enterologics will pursue its business plan to develop prescription biologics and drugs for treating various gastrointestinal disorders,subject to the availability of funding. We intend to finance the development of our business, including our prescription drug development efforts, from outside sources including through the sale of equity, debt or convertible securities, third party financing and strategic partnering. Our goal is secure sufficient financing to acquire and move a pipeline of products forward in clinical development as efficiently as possible.
At a Capitol Hill briefing today, the Blue Cross and Blue Shield Association (BCBSA) highlighted the innovative collaborations among Blue Cross and Blue Shield companies, local providers and patients to help improve care delivery through patient-centered medical home (PCMH) programs. Today there are Blue Cross and Blue Shield PCMH initiatives in 39 states, the District of Columbia, and Puerto Rico, serving more than 4 million Blue members.
The PCMH is a model of healthcare based on an ongoing, personal relationship between a patient, a primary care physician and the patient’s care team that aims to assure comprehensive, coordinated care across all aspects of the healthcare system. For example, the PCMH-based care team personally manages, facilitates and coordinates care with appropriate qualified professionals – such as hospitals, nursing homes, pharmacies and related community resources – as well as engages patients in promoting wellness and prevention and managing any chronic conditions they may have.
Joining BCBSA today were representatives from Blue Cross and Blue Shield of North Carolina (BCBSNC) and a physician from Carolina Advanced Health, a new primary care physician practice and innovation of BCBSNC and UNC Health Care.
Additionally, Horizon Healthcare Innovations (HHI), a Horizon Blue Cross and Blue Shield of New Jersey company, was joined by a representative from the Duke University School of Nursing to provide insight on HHI’s successful PCMH initiative throughout New Jersey as well as an innovative collaboration with both Duke University School of Nursing and Rutgers College of Nursing to train nurses and serve as PCMH-based Population Care Coordinators.
BCBSA was among the first organizations to promote the advancement of the PCMH model with the Patient-Centered Primary Care Collaborative – a collaboration created in 2006 with national employers and major U.S. primary care physician associations and non-profit healthcare entities dedicated to building an effective and efficient healthcare system with the PCMH as the foundational component.
In collaboration with providers, the Blues have made significant impacts in patient care through the various PCMH models. Examples of successful PCMH models shared at today’s briefing include:
Blue Cross and Blue Shield of North Carolina’s Blue Quality Physicians Program® (BQPP) includes a PCMH initiative designed to recognize and reward qualifying physicians for taking steps to further improve the quality of care being delivered. BCBSNC partners with primary care doctors to provide patients with culturally sensitive, effective healthcare. In 2011, among patients receiving care in the BQPP, 52 percent experienced fewer visits to specialists, and 70 percent experienced fewer visits to the emergency room.
The HHI PCMH by Horizon Blue Cross and Blue Shield of New Jersey aims to produce high-quality patient care and an improved experience by supporting patients through a care team of health professionals. This model is also designed with input from participating physicians and reforms current payment structures to reward primary care physicians for coordinating care as well as meeting specific quality and outcomes benchmarks. Additionally, the HHI PCMH collaboratively created a PCMH nursing education program with Duke University and Rutgers nursing schools. This partnership will train over the next two years a minimum of 200 nurses as Population Care Coordinators in PCMHs throughout New Jersey. In 2011, HHI reported that members experienced an 8 percent improvement in managing their diabetes, a 10 percent lower cost of care for members enrolled in the PCMH, and 26 percent less emergency room visits.
To learn more about PCMH initiatives in your area, please contact your local Blue Cross Blue Shield company or visit http://www.bcbs.com/why-bcbs/patient-centered-medical-home/.
Registered Nurses from two Baystate Health System bargaining units will take action Saturday morning outside the Democratic State Convention in Springfield. The nurses will be joined by labor and community supporters. Convention delegates will be asked to join the nurses in condemning Baystate’s anti-union behavior.
Members of the Massachusetts Nurses Association/National Nurses United who work at the Baystate Visiting Nurse Association & Hospice (BVNAH) in Springfield and Baystate Franklin Medical Center (BFMC) in Greenfield will highlight Baystate’s ongoing attempts to undercut their fundamental right to bargain over such basic issues as wages and health insurance.
Baystate also is attempting to force BFMC nurses to work mandatory overtime – even beyond twelve hours – a practice that has been shown to put nurses and patients at risk.
In addition, the National Labor Relations Board has determined that Baystate has repeatedly violated federal labor law in their anti-union campaign against nurses.