In a unanimous decision (Sereboff v. Mid-Atlantic Med. Svcs.) released on May 15, 2006, the U.S. Supreme Court permitted a health insurer to enforce a reimbursement provision against a participant. The plan had paid approximately $75,000 for the treatment of injuries suffered by the participant, Marlene Sereboff, and her spouse, who subsequently received $750,000 pursuant to a third-party tort settlement. The health plan provided that a participant who is injured by another person and receives benefits under the plan for such injuries must reimburse the plan from any amount recovered, without reduction, for failure to receive the full damages claimed. When the participant refused to comply with this reimbursement provision, the insurer obtained an injunction requiring the Sereboffs to set aside sufficient funds from the settlement, pending a final ruling in the case.
Privatization of Medicare Part D has led to the emergence of many
players, both large and small. Navigating CMS regulations and
subsequent guidance has resulted in some administrative burdens, as
well as the inability to employ many managed care techniques, say
With its first phase of certification rolling, the Certification
Commission for Healthcare Information Technology (CCHIT) will
concentrate on maintaining its momentum while moving to the realm
of inpatient electronic health records (EHRs) in its second
certification phase, followed by the evolving EHR network
infrastructure in phase three.
Building and applying the technology of the electronic health
record (EHR) is a decidedly non-magical process far more complex
and less instantaneous than just making the paper disappear into a
wastebasket. Quality concerns about EHR systems must be addressed,
which is why the Certification Commission for Healthcare
Information Technology (CCHIT) exists. A voluntary, private-sector
initiative based in Chicago, CCHIT was established in 2004 to
foster the adoption of robust, interoperable health IT in the
United States through product certification. In 2005, CCHIT
received a three-year contract from the Department of Health and
Human Services, making it the key entity to develop and evaluate
criteria for the testing and certification of EHR systems in the
Sure, e-mailing your doctor about that tickle in your throat or the
recurring rash on your arm sounds like a great deal—no
appointment needed and no copayment. But what if there is a price
tag, albeit small, to e-mail your doctor about non-urgent medical
problems? Would you still choose this communication vehicle?
The push for electronic health records (EHRs) and their physician-originated counterpart, electronic medical records (EMRs), gained significant momentum in 2005. In fact, today's discussions now include subcategories to distinguish the interests of one group over another. We can expect the implementation of some versions of the EHR?including portable EHRs, payer-based EHRs, ambulatory EHRs and inpatient EHRs?to become more widespread.
Each year roughly 700,000 Americans suffer a new or recurrent stroke, a condition that arises when blood flow to the brain is disrupted. Nearly a quarter of those incidents are fatal, making stroke the third-leading cause of death behind diseases of the heart and cancer.
Are pharmacy benefits managers (PBMs) that rely on
revenue-generating mail-order prescription service going to get a
run for their money as 90-day retail programs hit the marketplace?
Walgreen Health Initiatives (WHI), a PBM headquartered in
Deerfield, Ill., is not particularly bothered by the new retail
product. WHI launched Advantage90, a 90-day retail fulfillment
program, in late 2003 with more than 26,000 pharmacies nationwide
now participating in the program.
Electronic Health Records (EHRs) are the future of health information management, and today the calls for a massive industrywide transition to EHRs are even louder.
If misery loves company, then Beverly Thomas of Carbondale, Ill.,
isn't alone. She is one of thousands of dual eligibles
(beneficiaries covered by both Medicaid and Medicare) who went to
the pharmacy after January 1, 2006, only to find that it would not
fill their prescriptions. Unfortunately, her medication for mental
illness is so critical that if she misses even a day, she could be
hospitalized. With the help of Southern Illinois Regional Social
Services, Thomas got squared away, but admits she still is confused
about how the new Medicare Part D benefit operates.