KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Hospitals, Consumer Groups Object To Medicare Rule On Observation Care

They say the government's effort to set rules for when someone is considered an admitted patient compromises care and still leaves many seniors with costly bills. In other Medicare news, a look at the unraveling of one scam and coverage of sex-reassignment surgery.

USA Today: Hospitals, Regulators Spar Over In-Patient Care Policy
Fewer patients linger for days in hospitals without being admitted because of a new federal rule, but hospital and consumer groups are suing the government because they say the policy compromises Medicare patients' care, and patients are often stuck with costly, unexpected bills. Doctors now have to certify that a patient has a serious enough condition to need at least two overnight stays for Medicare to cover an inpatient admission under the rule, which took effect in October. However, patients can remain in an outpatient or "observation" status — that can even include staying overnight for several nights in a typical hospital room — even though they haven't been formally admitted as an inpatient (O'Donnell, 7/13).

NPR/ProPublica: How A Fanny Pack Mix-Up Revealed A Medicare Drug Scam
Last year, ProPublica chronicled how lax oversight had led to rampant waste and fraud in Medicare's prescription drug program, known as Part D. As part of that series, we wrote about Dr. Carmen Ortiz-Butcher, a kidney specialist whose Part D prescriptions soared from $282,000 in 2010 to $4 million the following year. ... She stumbled across a sign of trouble last September, after asking a staffer to mail a fanny pack to her brother. Instead of receiving the pack, he received a package of prescriptions purportedly signed by the doctor, lawyer Robert Mayer said last year. ... Since then, investigators have uncovered a web of interrelated scams that, together, cost the federal government up to $7 million, documents show (Ornstein, 7/11).

Politico: Momentum Grows For Sex Reassignment Surgery Coverage
Medicare’s recent decision to cover sex-reassignment surgery was a victory for transgender advocates seeking broader access to medical care for a condition that still carries social stigma. After all, the federal health program was one of the first to exclude such treatments more than 30 years ago (Wheaton, 7/13).

On another issue, The Associated Press examines new rules that will let all patients find out what ties their doctors have to drug companies.

The Associated Press:  Sunshine Act Will Reveal Drug Companies Giving Gifts To Your Doctor
[N]early 95 percent of U.S. physicians accept gifts, meals, payments, travel and other services from companies that make the drugs and medical products they prescribe, according to the New England Journal of Medicine. ... Starting in September the federal government will make available an exhaustive online database of payments to U.S. physicians and hospitals, under a section of the health-care overhaul passed in 2010. The measure, known as the Sunshine Act, requires most makers of drugs and medical supplies to report all payments, gifts and other services worth $10 or more that they provide to health professionals (Perrone, 7/9).

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