Humana looses some Medicare Enrollees

As a result of premium bids that are higher than low income, government assigned members of Medicare, Humana expects to loose 10% of them at the beginning of 2009. However, according to the Wall Street Journal, they believe this could be positive for Humana due to the fact that higher prices would increase the bottom line, shares dropped 5% to $41.75 when it was announced that this could lead to a los of 380,000 eligible Medicare members. To ensure drug coverage for these dropped Medicare enrollees, the government will automatically re-enroll them in private drug care provider programs.

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CDC and Columbia find no link between autism and MMR vaccine

According to this post at the Wall Street Journal Health Blog, the Center for Disease Control and Prevention and Columbia University did a study that found that there is no connection between the Measles, Mumps and Rebella vaccine and autism.

The two researchers conducted a study based on:

The measles virus from the vaccine could reproduce in the intestinal tract, leading to inflammation and bowel permeability. That leaky bowel could permit the release of chemicals that would make their way to the nervous system, causing trouble.

When conducting the research, they looked at children with gastrointestinal problems who had autism and children with gastrointestinal problems with no autism. Studies showed there was no difference between the two sets of children.

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Medicare Pays Too Much for New Generics

According to this article on The Wall Street Journal Blog when the price of generic drugs plunges, Medicare is slow to reflect that price change.

A report published by the Health and Human Services’ inspector general looks at irinotecan, which is a cancer that went generic in February of this year. The average price of the drug factoring in sales of the branded version was $52. During the current quarter, Medicare was paying about $75 for irinotecan, which is still far above the average price.

Read the full report here.

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Oversight in Medicare Drug Fraud

As reported in this Wall Street Journal article, the Government Accountability Office released a report stating that some insurers do not have “in place all the fraud controls they’re supposed to.” This means that some of them have not “met the requirements for employee training and internal monitoring and auditing. The GAO also stated that this oversight “risks significant misuse of funds in this $39 billion program.” Acting administrator for Medicare, Kerry Weems, has stated that he disagrees, however, has admitted the funding cap for the Medicare Integrity Program has, “seriously degraded [Medicare’s] ability to meet its responsibilities in combating fraud abuse.”A copy of the full report can be found here.

New Study: Men over 75 shouldn’t be tested for Prostate Cancer

According to a recent study by the US Preventative Task Force, detailed here at the WSJ Health Blog, says it’s not healthy for men over the age of 75 to be tested for prostate cancer. Unless the man is showing signs that he is suffering from the disease, it’s not necessary to test for the disease due to the risks and stress that the test can cause. It’s far more likely at that point that the men will die of a non-prostate cancer related cause.

Mail-In prescriptions on the rise

Medco, one of the major suppliers of mail-in prescription drugs, is seeing a huge benefit to increased gas prices: more customers. Medco sites fewer people paying for gas to drive to the pharmacy have lead to an increase in their sales, which shows increased revenue of 27% leading profits to $5.45 billion. In the second quarter of 2008, earnings increased 12% and they dispensed 26.3 million prescriptions according to this blog at the Wall Street Journal. However, with the poor economy, they point out that are also loosing a high volume of patients, because as companies lay off their workers in this economic slump, they are loosing people paying for their prescriptions.

Aetna Ranked Number One In Paying Doctors On Time

In a recent article released by the Wall Street Journal, a study done by Aetnahealth, Aetna was the fastest insurer to pay doctors back for claims. The other fastest insurance companies were Humana at 30 days, Cigna at 33 days, Medicare-B and UnitedHealth at 35 days.

Other factors associated with ranking the fastest health care company were how long it took to pay their bills, percentage of claims solved after one submission and the rate of claim denials.

Other reasons Aetna was ranked at the top were 96% of their claims were solved after the first submission, and they also had the lowest denial rate at 10.6%.

eICU Helps Smaller Hospitals

A new device, the eICU, is allowing smaller hospitals to monitor their patients better. According to this article at the Wall Street Journal Health Blog, Visicu, Inc’s new product is being used by 156 hospitals around the nation, and those hospitals have a lower mortality rate as well as shorter stays in the ICU.

This machine monitors things such as a patient’s pulse, temperature, blood pressure, and blood oxygen content constantly. Even though this is an expensive way to monitor patients health levels, a 160 hospital bed in Kansas has seen dramatic improvement since implementing the use of the eICU. Although it costs $160,000 to keep in operation, they’ve seen a fall in nursing staff turnover and revenue at the hospital has risen by 15.3%.

Cash Up Front Please

In a recent blog post at the Wall Street Journal Health blog, they report on a serious crisis going on in today’s hospitals: patients are being rejected if they don’t pay their medical bills up front. With the hospital industry’s debt at $31.2 billion in 2006, and rising, the hospitals have a valid reason to ask for the money up front. But most of the time, medical bills more than double a person’s income for the year. Is there a happy median for this situation?

As WSBT TV reports, Lisa Kelly was requested to pay $105,000 before she received her leukemia treatment at M.D. Anderson Cancer Center in Houston. Her insurance did not cover the full amount, and so she had to pay cash before she could even be admitted to the hospital. This hospital is now demanding billing up front instead of invoicing patients later due to the increasing amount of charity cases and those who refuse to pay their doctors bills after they’ve left the hospital.