Case Management Weekly is a free e-mail newsletter brought to you by Case Management Monthly, a newsletter that provides case managers with extended stay solutions to real problems, best practices, case studies, and resources to help you move patients more efficiently, safely, and cost effectively through the health care continuum and communicate better with physicians. It features behind-the-scenes ideas, tips and solutions from case managers in every practice, plus important news analysis, including regulatory updates and information related to preadmission, discharge planning, quality, payment denials, physician relations, and much more.
UPGRADE to a premium subscription of Case Management Monthly today and save 10%.
CMW News: Drug companies dramatically raise prescription drug prices
Imagine your baby needs medication to control a condition that causes spasms. Now imagine that the price of this medication is more than $23,000.
The cost of the drug Acthar, which is made by Questcor and controls infantile spasms, increased this year from $1,650 to $23,269—a 1,310% jump.
Already this year, the wholesale price of 16 other drugs has increased by 100% or more. Last year, 26 drugs saw the same increase, and in 2004, 15 drugs were increased to this degree, according to a recent study done by researchers from the University of Minnesota. Some drug prices are increasing by as much as 3,400%, the researchers say.
Balancing the rising costs of these medications affects the entire healthcare system. Some of the drugs are administered in hospitals, leaving the facilities to either eat the cost or bill insurance companies, which in turn raise premiums. Insured consumers sometimes pay a flat co-pay of around $20 and other times, a percentage of the total price of the drug, which can be costly.
Drug companies argue they need to increase prices to stay viable in the market, and that medication, even when expensive, is often more reasonable than other treatments such as surgery.
Source: USA Today
Back to top
CMW News: Uninsured immigrant population multiplies
The uninsured population in the United States increased every year between 1994 and 2006 due to a variety of factors. One major reason was the immigration population.
A recent study done by the Employee Benefit Research Institute reports there was an 80% increase in the number of uninsured immigrants during a 12-year span, from 6.9 million in 1994 to 12.3 million in 2006. Immigrants accounted for 18.8% of the entire uninsured population in the United States in 1994 and 26.6% of it in 2006.
The study found the most common factor contributing to uninsured immigrants is their employment status. Immigrants are more likely to take low-paying jobs that don’t offer health insurance. However, the study reports, the longer the immigrants are in the country, the more likely it is that they will obtain health insurance.
Sources: Kaiser Daily Health Policy Report, Employee Benefit Research Institute
Back to top
CMW Tip of the Week: Shift your focus away from LOS
Concentrating on LOS as the main indicator of a hospital’s quality of patient care and financial viability is an out of date tactic, says Stefani Daniels, RN, MSNA, CMAC, ACM, in her July article The Myth of Length of Stay for HealthLeaders Media.
Daniels argues that with all of the data available that provide evidence of certain physicians overusing resources, and the roadblocks which hinder patients’ navigation through acute care, the center of attention should shift. Instead of LOS, hospitals should focus on delivery-of-care processes and resource management using physician specific margins, costs per case, and data that demonstrate system inefficiencies.
Daniels recommends that facilities stop pointing fingers at hospital staff for insufficient LOS performance. She recommends that hospitals improve their information systems, give case managers access to resources such as potentially avoidable day (PAD) reports, and begin to take steps to find where improvement opportunities lie.
To read the full article, visit HealthLeaders Media.
Have a question for our experts? Email it to editor jmcginley@hcpro.com. Your question could be featured in the next issue of Case Management Weekly!
Back to top
CMW Sneak peek: Improving access to care for the self-pay population
Across our nation, many face the challenge of finding, keeping, and affording medical insurance.
In Tucson, AZ, case managers and others at St. Mary’s Hospital’s ER screen daily to locate and help those who are uninsured or who have no primary care provider and are using the ER for routine healthcare. These patients are provided information about eligibility for Medicaid, sliding-fee health centers, and the State Children’s Health Insurance Program (SCHIP) access in the community. Then patients receive follow-up to encourage eligibility assessments and enrollment at the local St. Elizabeth’s Health Center.
This project demonstrates success with about 19% of the referred patients completing eligibility and establishing care either through Medicaid, SCHIP, or sliding-fee care with team follow-up. Case managers can create systems within their organizations and communities to optimize awareness and enrollment in government-funded programs for the uninsured who qualify, therefore helping to decrease the numbers without access to healthcare.
Check out the July 2008 issue of Case Management Monthly to get the full story, and check out all the benefits of being a Case Management Monthly subscriber!
Back to top
