Healthcare Financial News

From 1995 to 2006, hospital 30-day death rates decreased significantly for Medicare patients hospitalized for a heart attack, as did the variation in the rate between hospitals, according to a study in the Aug. 19 issue of the Journal of the American Medical Association.
 
“Over the last two decades, healthcare professional, consumer, and payer organizations have sought to improve outcomes for patients hospitalized with acute myocardial infarction [AMI],” the authors write. However, little has been known about whether hospitals have been achieving better short-term mortality rates for AMI or if there has been a reduction in between-hospital variation in short-term mortality rates, according to background information in the article.
 
Researchers examined 30-day risk-standardized mortality rates (RSMRs) for acute care hospitals in the United States in the period between 1995 and 2006 for Medicare patients. They found that the all-cause and in-hospital death rates decreased over the study period. “The 30-day mortality rate decreased from 18.9 percent in 1995 to 16.1 percent in 2006, and in-hospital mortality decreased from 14.6 percent to 10.1 percent. In contrast, the 30-day mortality rate for all other conditions was 9.0 percent in 1995 and 8.6 percent in 2006.” The RSMR, which takes into account the differences in the types of patients across hospitals and is currently being used by the Centers for Medicare & Medicaid Services (CMS) to profile hospital performance, decreased from 18.8 percent in 1995 to 15.8 percent in 2006, and a reduction in between-hospital differences in mortality rates was also observed.
 
“Between 1995 and 2006, the RSMR for patients admitted with AMI showed a marked and significant decrease, as did between-hospital variation. Although the cause of the reduction cannot be determined with certainty, this finding may reflect the success of the many individuals and organizations dedicated to improving care during this period,” the authors conclude.

Estimates of medical fraud losses range widely from $60 billion to $600 billion a year, National Public Radio (NPR) reports. According to the NPR account, Malcolm Sparrow of Harvard University says the order of magnitude is measured in hundreds of billions of dollars, but he can't say if it's $100 billion or $600 billion. Whatever the first digit is, it has 11 zeroes after it, he says. "It's just an extraordinary sum." Sparrow authored License to Steal: How Fraud Bleeds America's Health Care System (Westview Press, 2000).

The NPR segment also cites an estimate by National Health Care Anti-Fraud Association executive director Louis Saccoccio that fraud represents 3 percent of the nation's healthcare spending. Saccoccio’s estimate comes from members of the association, which include health insurers and the federal, state, and local agencies involved in fraud investigations. Given that healthcare spending is over $2 trillion a year, that's still $60 to $70 billion a year lost to fraud. "So it's a significant number no matter how you look at it," Saccoccio told NPR.

In May 2009, the Obama administration announced a new task force made up of officials from the U.S. Department of Justice and the U.S. Department of Health and Human Services to work on healthcare fraud. And the current House healthcare reform bill has a number of anti-fraud provisions. It would provide $100 million a year to fight fraud, increases penalties for perpetrators and would require that hospitals and other healthcare providers develop anti-fraud programs.