Medicare program; revisions to payment policies under the physician fee schedule for calendar year 2001. Health Care Financing Administration (HCFA), HHS. Final rule with comment period. (33/546)

This final rule with comment period makes several changes affecting Medicare Part B payment. The changes include: refinement of resource-based practice expense relative value units (RVUs); the geographic practice cost indices; resource-based malpractice RVUs; critical care RVUs; care plan oversight and physician certification and recertification for home health services; observation care codes; ocular photodynamic therapy and other ophthalmological treatments; electrical bioimpedance; antigen supply; and the implantation of ventricular assist devices. This rule also addresses the comments received on the May 3, 2000 interim final rule on the supplemental survey criteria and makes modifications to the criteria for data submitted in 2001. Based on public comments we are withdrawing our proposals related to the global period for insertion, removal, and replacement of pacemakers and cardioverter defibrillators and low intensity ultrasound. This final rule also discusses or clarifies the payment policy for incomplete medical direction, pulse oximetry services, outpatient therapy supervision, outpatient therapy caps, HCPCS "G" Codes, and the second 5-year refinement of work RVUs for services furnished beginning January 1, 2002. In addition, we are finalizing the calendar year (CY) 2000 interim physician work RVUs and are issuing interim RVUs for new and revised codes for CY 2001. We are making these changes to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This final rule also announces the CY 2001 Medicare physician fee schedule conversion factor under the Medicare Supplementary Medical Insurance (Part B) program as required by section 1848(d) of the Social Security Act. The 2001 Medicare physician fee schedule conversion factor is $38.2581.  (+info)

Reasonable charges for medical care or services. Department of Veterans Affairs. Interim final rule. (34/546)

This document amends the Department of Veterans Affairs (VA) medical regulations concerning "reasonable charges" for medical care or services provided or furnished by VA to a veteran: (1) For a nonservice-connected disability for which the veteran is entitled to care (or the payment of expenses of care) under a health plan contract; (2) For a nonservice-connected disability incurred incident to the veteran's employment and covered under a worker's compensation law or plan that provides reimbursement or indemnification for such care and services; or (3) For a nonservice-connected disability incurred as a result of a motor vehicle accident in a State that requires automobile accident reparations insurance. This document amends the regulations to update databases and other provisions for the purpose of providing more precise charges.  (+info)

A pilot study of time allocation and reimbursement for routine obstetric ultrasonography. (35/546)

OBJECTIVE: To evaluate time allocation during initial and repeated ultrasonography and to formulate recommendations to improve unit efficiency. METHODS: Over a 2-year period, 51 comprehensive ultrasonographic examinations between 14 and 38 weeks' gestational age were observed by a single reviewer. Each patient-sonographer interaction was divided into timed segments, including setup, examination time, review, and turnover. Statistical analysis using descriptive statistics, Student ttest, and analysis of variance was performed to determine the effect of the number of ultrasonographic examinations, sonographer experience, estimated gestational age, and patient body mass index on examination time. RESULTS: The average time spent with each patient was 15 minutes 22 seconds: 2 minutes 10 seconds for setup, 9 minutes 38 seconds for examination, 1 minute 50 seconds for review, and 1 minute 44 seconds for turnover. Examination length was not significantly affected by estimated gestational age, body mass index, ultrasonography experience, or the number of ultrasonographic examinations (P > .05). No statistical significance in the duration of scanning was found between initial (15 minutes 3 seconds) and repeated (16 minutes 1 second) examinations (P = .609). Nonexamination activities, such as data entry and room cleanup, consumed 37% of the sonographer's time. CONCLUSIONS: Resource use within the ultrasonography department may be improved by reassigning clerical and custodial duties from sonographers to other personnel. Although differential reimbursement exists, no statistically significant difference in resource use between initial and repeated examinations was found.  (+info)

Palliative care by family physicians in the 1990s. Resilience amid reform. (36/546)

OBJECTIVE: To explore issues family physicians face in providing community-based palliative care to their patients in the context of a changing health care system. DESIGN: Focus groups. SETTING: Small (< 10,000 population), medium-sized (10,000 to 50,000), and large (> 50,000) communities in Nova Scotia. PARTICIPANTS: Twenty-five men and women physicians with varying years of practice experience in both solo and group practices. METHOD: A semistructured approach was used, asking physicians to reflect on recent palliative care experiences in order to explore issues of care. MAIN FINDINGS: Five themes emerged from the discussions: resources needed, availability of family support, time and money supporting physicians' activities, symptom control for patients, and physicians' emotional reactions to caring for dying patients. CONCLUSION: With downsizing of hospitals and greater emphasis on community-based care, the issues identified in this study will need attention, particularly in designing an integrated service delivery model for palliative care.  (+info)

Reimbursement of enoxaparin for outpatient therapy. Proceedings of regional meetings. (37/546)

Standard treatment of deep venous thrombosis (DVT) previously required hospitalization so patients could receive continuous intravenous infusion of unfractionated heparin. However, on Dec. 31, 1998, enoxaparin (enoxaparin sodium) became the first low-molecular-weight heparin (LMWH) to receive an indication from the FDA for outpatient treatment of DVT without pulmonary embolism (PE). The manufacturer of enoxaparin, Rhone-Poulenc Rorer (RPR), states that outpatient use of enoxaparin can help managed care organizations (MCOs) and other health care systems to reduce health care costs by curtailing some of the expenses previously associated with hospitalization to treat uncomplicated DVT. To ascertain the extent to which reimbursement policies within managed care might impede patients' access to enoxaparin, RPR conducted 15 regional meetings during the summer of 1999. During these meetings, medical directors and other personnel associated with MCOs provided anecdotal information suggesting that a dominant method of reimbursing enoxaparin for outpatient therapy has yet to emerge in the United States; and that reimbursement methods appear to be divided equally among the pharmacy benefit, the medical benefit, and a "blended" system combining attributes of the pharmacy and medical benefits.  (+info)

Clinical trials: are they a good buy? (38/546)

PURPOSE: Concern that clinical trials may be too costly has been used to justify traditionally restrictive insurer policies regarding clinical trials. Additionally, fear of insurer reimbursement denial can be a significant barrier to clinical trial participation. In this study, we reviewed the empirical data on costs of clinical trials versus standard care and summarized the current status of policy initiatives related to clinical trial insurance reimbursement. METHODS: Electronic and print data sources were searched for studies on the costs of oncology clinical trials. Information on policy initiatives for clinical trial reimbursement was obtained from the American Society of Clinical Oncology, the American Society of Hematology, and the Coalition of National Cancer Cooperative Groups and from searches of World Wide Web sites. RESULTS: Five pilot studies provided information for 377 patients on phase II/III clinical trials matched with controls on standard care. Cost estimates ranged from 10% lower to 23% higher costs/charges for clinical trials in comparison to standard medical care. Medicare, 14 states, and several private insurers now cover the costs of patient care in "qualifying" clinical trials. CONCLUSION: Findings from small pilot studies suggest that phase II and III clinical trials result in at most modest increases in cost over standard treatment costs. Also, an increasing number of policy makers have decided to support clinical trial reimbursement initiatives. It is hoped that economic data from large observational studies will facilitate widespread and permanent decisions that support reimbursement for phase I, II, and III clinical trial participation.  (+info)

Medicare program; replacement of reasonable charge methodology by fee schedules for parenteral and enteral nutrients, equipment, and supplies. Final rule. (39/546)

This final rule implements fee schedules for payment of parenteral and enteral nutrition (PEN) items and services furnished under the prosthetic device benefit, defined in section 1861(s)(8) of the Social Security Act. The authority for establishing these fee schedules is provided by the Balanced Budget Act of 1997, which amended the Social Security Act at section 1842(s). Section 1842(s) of the Social Security Act specifies that statewide or other area wide fee schedules may be implemented for the following items and services still subject to the reasonable charge payment methodology: medical supplies; home dialysis supplies and equipment; therapeutic shoes; parenteral and enteral nutrients, equipment, and supplies; electromyogram devices; salivation devices; blood products; and transfusion medicine. This final rule describes changes made to the proposed fee schedule payment methodology for these items and services and provides that the fee schedules for PEN items and services are effective for all covered items and services furnished on or after January 1, 2002. Fee schedules will not be implemented for electromyogram devices and salivation devices at this time since these items are not covered by Medicare. In addition, fee schedules will not be implemented for medical supplies, home dialysis supplies and equipment, therapeutic shoes, blood products, and transfusion medicine at this time since the data required to establish these fee schedules are inadequate.  (+info)

Duty to assist. Final rule. (40/546)

This document amends the Department of Veterans Affairs (VA) adjudication regulations to implement the provisions of the Veterans Claims Assistance Act of 2000 (the VCAA), which was effective on November 9,2000. The intended effect of this regulation is to establish clear guidelines consistent with the intent of Congress regarding the timing and the scope of assistance VA will provide to a claimant who files a substantially complete application for VA benefits or who attempts to reopen a previously denied claim.  (+info)