“67.6% of the centers had at least one infection control lapse.”

As background, the authors note that the use of ASCs has increased dramatically.  Between 2001 and 2008, the number of ASCs certified by Medicaid has more than doubled, with the current number exceeding 5,000.  In 2007 more than 6 million procedures were performed in these centers nationally.

Findings included the following:

-  46 of the 68 centers had at least one infection control lapse (67.6%)

-  12 ASCs were found to have at least 3 infection control deficiencies (17.6%)

-  the most common findings were reuse of single-dose medication vials (28.1%), improper equipment reprocessing (28.4%), and mishandling blood glucose monitoring equipment (46.3%)

The research team speculated that misuse of the single-dose vials was a cost-saving measure, whereby “facilities have purchased single-dose medications in packaging larger than that required for single-patient use and then used the contents for multiple patients.”

In an accompanying editorial, Philip Barie, M.D. from New York-Presbyterian Hospital/Weil Cornell Medical Center calculates that an extrapolation of the study’s findings reveals that “several million U.S. patients may be at risk for infections in ASCs.”

Source:  Infection Control Assessment of Ambulatory Surgical Centers, Journal of the American Medical Association, 2010;303(22):2273-2279.

The study population consisted of 187,233 participants and was based on self-reported diabetes among adults 18 years of age and older.  Researchers used data collected through the National Health Interview Survey (NHIS).

“Those with less than a high school education were approximately 60% more likely to have diabetes than participants with at least a bachelor’s degree.”

The research team found that individuals with less than a high school diploma had the highest overall incidence of diabetes (10.2%), followed by those with a high school diploma or GED (6.2%), some college (4.5%), and at least a bachelor’s degree (3.4%).

The researchers also examined the effect of education on diabetes after controlling for variables such as survey year, age, gender, race/ethnicity, foreign birth, marital status, income, health insurance and body mass index.  They found that study participants with less than a high school education were approximately 60% more likely to have diabetes than study participants with at least a bachelor’s degree, while those with a high school diploma, GED or some college were approximately 30% more likely (all differences were statistically significant).

After adjusting for confounding variables, both non-Hispanic White and Hispanic participants with less than a high school education had statistically significantly higher odds of developing diabetes compared to their peers with at least a bachelor’s degree (70% more likely and 60% more likely, respectively).  Among non-Hispanic Black participants, however, the connection between diabetes and educational attainment was not statistically significant.

Additionally, the results revealed that compared to those with at least a bachelor’s degree, both women and men with less than a high school education had a greater incidence of diabetes.  However, the impact of education was greater among women than men (90% vs. 40% more likely to have diabetes, both statistically significant).

According to the authors, not checking the prevalence of diabetes by subgroup in each race/ethnicity presented a limitation in this study.  For instance, among Hispanic adults, Mexican Americans had the highest incidence of diabetes, so the authors believe that “it is possible that the estimates presented here are a better reflection of the prevalence of diabetes among Mexican Americans than among Hispanics as a whole.”

Source: Borrell, Luisa N., et al., Education and Diabetes in a Racially and Ethnically Diverse Population, American Journal of Public Health. Vol. 96 (2), Pgs. 1637-1642.
Note: There is an email link embedded within this post, please visit this post to email it. Note: There is a print link embedded within this post, please visit this post to print it. ]]> http://medicaidletter.com/research-findings/education-level-tied-closely-to-incidence-of-diabetes-among-whites-and-hispanics-but-not-blacks-study-finds/feed/ 0 http://medicaidletter.com/research-findings/uninsured-%e2%80%93-study-finds-uninsured-more-likely-to-die-from-trauma-when-compared-to-insured-patients/ http://medicaidletter.com/research-findings/uninsured-%e2%80%93-study-finds-uninsured-more-likely-to-die-from-trauma-when-compared-to-insured-patients/#comments Mon, 02 Jan 2012 13:58:35 +0000 rbrown http://medicaidletter.com/research-findings/uninsured-%e2%80%93-study-finds-uninsured-more-likely-to-die-from-trauma-when-compared-to-insured-patients/ A research team from the University of Buffalo has compared outcomes among trauma patients by insurance status and race.  The most significant, and perhaps most surprising, finding was that uninsured patients were more likely to succumb to their traumatic injuries than those patients with insurance.  In fact, this difference existed, irrespective of the type of insurance, including Medicaid.  Race was also an independent factor responsible for differences in outcomes.

Nearly 200,000 patients from 649 different facilities were followed after suffering injuries from auto accidents and gunshot wounds.  Study data was extracted from the National Trauma Data Bank from the years 2001-05.

“Uninsured patients were more likely to succumb to their traumatic injuries than those patients with insurance, irrespective of the type of insurance, including Medicaid.”

The researchers noted that the insurance status of trauma patients is generally not known when initially treated in the emergency department (ED), and so the findings relating to the uninsured were, at first, surprising.  However, it was also pointed out that “uninsured adult patients, in general, have a 25% greater mortality rate than insured adults for all medical conditions.”

Among the many possible factors influencing the mortality of the uninsured after suffering trauma were:

-  potential delays in seeking any medical care

-  language barriers

-  fear of seeking care, especially in an ED setting

-  increased risk-taking behaviors, including less likelihood of wearing seat belts

-  greater likelihood of driving an older, less safe vehicle

The sum affect would be that the uninsured “have poorer health status in general, which would lessen their ability to survive a traumatic injury.”  The study’s authors pointed out that “universal health coverage could change these statistics… for instance, there would be no need for patients to delay treatment with universal health coverage, and such coverage could improve the overall health status of injury victims and increase their survival rates.”

Source:  Uninsured More Likely to Die from Trauma than Patients with Insurance, Study Finds, News Release, University of Buffalo, The State University of New York, June 11, 2010.
Note: There is an email link embedded within this post, please visit this post to email it. Note: There is a print link embedded within this post, please visit this post to print it. ]]> http://medicaidletter.com/research-findings/uninsured-%e2%80%93-study-finds-uninsured-more-likely-to-die-from-trauma-when-compared-to-insured-patients/feed/ 0 http://medicaidletter.com/research-findings/physicians-found-to-be-less-likely-to-accept-poor-blacks-versus-whites-into-their-practices/ http://medicaidletter.com/research-findings/physicians-found-to-be-less-likely-to-accept-poor-blacks-versus-whites-into-their-practices/#comments Sun, 01 Jan 2012 21:40:55 +0000 rbrown http://medicaidletter.com/?p=395 A research team from the University of Oregon and New York University investigated factors affecting the likelihood of urban physicians accepting Medicaid coverage at their practice.  The analysis revealed that “physicians are more likely to participate in Medicaid in counties whose poor are white and in areas that are racially integrated.”

Researchers utilized data from the 2000/2001 Community Tracking Study Physician Survey and the 2000 U.S. Census.  The 9,178 study participants were physicians that had practices in metropolitan statistical areas and that were taking new patients.

“Physicians are more likely to participate in Medicaid in counties whose poor are white and in areas that are racially integrated.”

The study showed that 81% of all urban physicians accepted Medicaid patients (75% of primary care physicians and 84% of specialists).   Additionally, Black physicians participated the most (90%), followed by Asian physicians (87%), White physicians (80%), and Latino physicians (78%).  The authors noted that “those practicing in institutional settings, in lower-income counties, and in states with higher Medicaid/Medicare reimbursement rates were also more likely to participate in Medicaid.”

Researchers found that when less than 25% of the poor in the physician’s county were White, only 72% of all physicians participated in Medicaid.  However, when the percentage of poor that was White was greater than 65%, there was an 88% participation rate.  The racial makeup of the county’s poor had a greater impact on specialists than on primary care physicians.  The effect was also larger for White and Asian physicians than for Black and Latino physicians.

Primary care physicians appeared to participate in Medicaid at a similar rate regardless of whether racial segregation levels were high or low.  However, specialists’ participation levels actually decreased as racial segregation increased.

“Specialists’ participation levels in Medicaid decreased as racial segregation increased.”

Specifically, the results showed that if all other variables were held constant, both primary care physicians and specialists would be significantly more likely to accept Medicaid patients in counties that were in the highest quartile for the portion of poor that were White than in counties in the lowest quartile (83% vs. 72% and 97% vs. 86%, respectively).

The authors suggested that the study results may reveal that in some cases physicians’ conscious or subconscious “racial bias or stereotyping influenced his or her decision to participate in Medicaid.”  Physicians in some locations may also be apprehensive about integrating nonwhite patients on Medicaid with those who are White and privately insured “because of the perception (real or otherwise) that their established patients would be uncomfortable sharing the waiting room with low-income minority patients.”

Source: Greene, Jessica, et al., Race, Segregation, and Physicians’ Participation in Medicaid, Millbank Quarterly. Volume 8 (2), Pgs. 1-16.
Note: There is an email link embedded within this post, please visit this post to email it. Note: There is a print link embedded within this post, please visit this post to print it. ]]> http://medicaidletter.com/research-findings/physicians-found-to-be-less-likely-to-accept-poor-blacks-versus-whites-into-their-practices/feed/ 0 http://medicaidletter.com/commentary/the-social-role-of-the-emergency-department/ http://medicaidletter.com/commentary/the-social-role-of-the-emergency-department/#comments Sun, 18 Dec 2011 12:55:02 +0000 rbrown http://medicaidletter.com/?p=840 James A. Gordon, M.D., M.P.H.
Division of Emergency Medicine
Harvard Medical School
Department of Emergency Medicine and Institute for Health Policy, Massachusetts General Hospital

The hospital emergency department (ED) is perhaps the only unrestricted site of universal health care in America, a notion that is often understated in policy discussions concerning the health care safety net.  Traditionally viewed as an expensive, non-primary care site, the ED’s provision of often cost-effective, basic health care among vulnerable populations is easily overlooked.

“The hospital emergency department is perhaps the only unrestricted site of universal health care in America.”

Yet, visits to the ED in the United States have risen to over 100 million per year.  Managed care has not had the expected impact on ED use, nor has improved access to primary care eliminated preferential ED use among the disadvantaged.  Although Medicaid beneficiaries and the uninsured are already overrepresented in the ED, even more of the country’s uninsured are being forced to seek ED care as community clinics face an increasingly competitive health care marketplace.

As hospitals become increasingly “over-crowded”, worried ED patients continue to experience barriers to convenient alternative care.  Both health and social reform policies have forged this path.  Under the welfare reform laws of 1996, for example, Medicaid benefits were denied to new legal immigrants for at least five years, regardless of age, health, disability, or work status.  While the legislation denied or reduced food assistance, welfare payments, disability income, and health insurance, it made on curious exception: “No state may deny coverage of emergency medical services to either illegal or legal aliens.”  Just as the federal Emergency Medical Treatment and Labor Act (EMTALA) singles out the ED as the only component of the medical system required to provide universal medical services, the ED is also identified as the only component of the entire welfare system protected by law for the most disadvantaged.

“It is precisely because of its unique position at the interface of health and welfare that the ED can help bridge the gaps between medicine, public health, and social work.”

While health and social welfare concerns are often critically interrelated among disadvantaged patients, little is known about the social needs of vulnerable ED populations.  More of the disadvantaged may pass through the door of the ED than through any other community institution, yet community efforts to address serious social deprivation, like the lack of food or home heating, typically do not involve the ED.  However, it is precisely because of its unique position at the interface of health and welfare that the ED can help bridge the gaps between medicine, public health, and social work, especially as such collaboration enhances the success of integrated Medicaid health plans.  Pilot programs for ED-sponsored primary care referral, insurance outreach, and other preventive efforts have been particularly promising among disadvantaged ED populations.

While the viability of many safety-net providers is threatened in the current health care environment, EDs have become an expected, guaranteed entity.  Most communities will continue to support the ED, for both basic and acute care, regardless of the prevailing reform scenario.  The nature and scope of that support, however, will shape the kinds of contributions that the ED can make to a fully integrated health care marketplace.

This commentary is an excerpt based on a letter to the editor of Health Affairs, Gordon JA, Emergency care as a safety net [letter]. Health Affairs, 19(2):277.
Note: There is an email link embedded within this post, please visit this post to email it. Note: There is a print link embedded within this post, please visit this post to print it. ]]> http://medicaidletter.com/commentary/the-social-role-of-the-emergency-department/feed/ 0 http://medicaidletter.com/jobs/medicaid-analyst-1-shreveport-la/ http://medicaidletter.com/jobs/medicaid-analyst-1-shreveport-la/#comments Wed, 14 Dec 2011 21:13:56 +0000 rbrown http://medicaidletter.com/?p=913

Medicaid Analyst 1

For further information about this vacancy contact:
DHH Region 7
Human Resources
3020 Knight Street, Suite 290
Shreveport, LA 71105
318-862-9879

Application Deadline:
06-28-2010
Apply Online:
No
Posting ID:
J21855Duties:
Perform complex criminal and civil investigations into allegations of fraud, waste and abuse within the Medicaid program. Perform audits, examine documents and records of Medicaid providers, vendors and others to determine the existence of fraud and unlawful receipt of funds. Responsibilities will include conducting complex data analysis assignments, interviewing witnesses, collecting and securing evidence, assisting AAGs in case preparation, and completing investigative reports. Will work under the direct supervision of the Chief of Investigations.Qualifications:
Bachelor?s degree. Business, accounting, auditing, book keeping, and investigative work experience preferred. Familiarity with Massachusetts Medicaid Management Information System and health care financing laws and regulations. Working knowledge of Massachusetts criminal law and procedure, good organization and analytical skills, strong interpersonal skills, and communication skills.Comments:
The Office is an Equal Opportunity Employer. The Office actively seeks to increase the diversity of its workforce.
Please visit the Job Opportunities section of the Attorney General?s web site at WWW.MASS.GOV/AGO for all job postings.

Salary: Commensurate with experience; to be discussed at interview.

If applying for more than one position, send separate cover letters and resumes. Use #10-047 to refer to this position.

How To Apply:
Apply by submitting cover letter and resume to:

Sandra L. Macdonald
Recruitment & Hiring Coordinator
Human Resource Management
Office of the Attorney General
One Ashburton Place
Boston, MA 02108

Inquiries regarding position & status may be made to: Timothy St. Laurent,
Chief of Investigations
(617) 963-2363

Agency Web Address:
http://www.mass.gov/agoDiversity Officer:
n/a
An Equal Opportunity/Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply. ]]> http://medicaidletter.com/jobs/data-analyst-medicaid-fraud-division-boston-ma/feed/ 0 http://medicaidletter.com/jobs/medicaid-rep-mahwah-nj/ http://medicaidletter.com/jobs/medicaid-rep-mahwah-nj/#comments Wed, 14 Dec 2011 20:48:05 +0000 rbrown http://medicaidletter.com/?p=901 Job ID 205969 Company Name MedAssets, Inc. Job Category Clerical/Administrative Location Mahwah, NJ Position Type Full-Time, Employee Experience 2-5 Years Experience Date Posted May 17, 2010 (Reposted Jun 16)

Career Level (Internal Use Only): PGRN3

Job Purpose:

The Medicaid Representative is responsible for assisting the provider with collection of payment due for the hospital service from the payer and/or patient. The ideal candidate should have 2 years Medicaid reimbursement experience in a hospital or provider setting.

Duties & Responsibilities:

• Follow up on all Medicaid claims from billing through final resolution.
• Review and prepare claims for electronic and/or hard copy billing submission.
• Identify billing errors for correction and resubmit via adjustment or new submission.
• Review Medicaid Remittance advice for payment errors and denials.
• Act cooperatively and responsibly with patients, visitors, co-workers, management and clients.
• Keep current with Medicaid regulations and procedures.
• Maintain a professional attitude.
• Maintain confidentiality at all times.

Minimum Knowledge, Competencies & Qualifications:

• 2 years experience in Medicaid insurance collections.
• Experience with billing hospital claims.
• Experience with ICD-9 and CPT coding is required.
• Strong computer skills in medical billing systems.
• Ability to work well in a team environment.
• Strong computer skills.
• Strong communication skills.

Call Med Assets
(678) 624-7420

The main responsibility of the Senior Analyst would be to keep abreast of all regulations, procedures, and interpretations of Cost Report Based payers, and recommends methods for maximizing reimbursement to management. (Again, this is a high visibility role?presentation and strategizing skills are the keys to success!) They would also:

• Provide Medicare/Medicaid reimbursement/regulatory support
• Prepare & file Cost Reports to obtain appropriate reimbursement in full compliance of federal & state regulations and Company policies & procedures
• Provide impact analysis and strategy regarding rate and regulation changes for Cost Report based payors
• Maintain accuracy & timely reconciliation of Medicare PIP & Remit Accounts, Contractual Allowance Accounts and Cost Report Reserve balance sheet Accounts
• Prepare weekly Flash Reports including projections for Gross Revenue, Key Volumes and Payor mixAs stressed a thorough and demonstrated understanding of Medicaid/Medicare Cost Reporting process is tantamount to the role. An undergraduate degree from an accredited university (or college) is also required. Compensation is flexible, but around $65-75K.

Please Contact:
MSI International
Andrew Bingham
800-804-6741

MEDICAID COMPLIANCE AUDITOR – MEDICAD

Show Instructions