Medical Errors, Physician Shortage, Medicare, The Uninsured
HHS' proposed 2002 budget includes up to $72 million for efforts to improve patient safety. To that end, the department has created a task force that will collect and analyze data on medical errors and adverse events. Composed of representatives from CDC, FDA, HCFA, and the Agency for Healthcare Research and Quality, the panel's key goal will be the creation of an Internet database combining patient-safety information collected by the four federal agencies with data gathered by states and private sources. Fifteen states currently have laws or regulations that require reporting of medical errors or adverse events in hospitals; five others have voluntary reporting systems.
Medical professional organizations and state licensing boards are among the groups expected to provide ongoing input on how to enhance the value of the data collected without creating new federal reporting requirements or jeopardizing confidentiality for patients and providers.
The power shortage isn't California's only crisis. Although one study shows an overall increase in doctors, there's a dearth of physiciansparticularly pediatricians and orthopedic surgeonsin outlying areas. Indeed, the situation has become so acute that earlier this year, physicians from the Santa Barbara area organized a series of "mercy missions" to bring care to needy children in the northern part of the state.
Now two legislators want to turn that grassroots effort into a state program. They've introduced a bill that would require the Department of Health Services to recruit physicians to participate in the program and solicit private funding. Lawmakers worked with the California Medical Association in crafting the bill.
The federal government's efforts to combat fraud and abuse have cut improper payments to Medicare fee-for-service providers almost in half since 1996. Nevertheless, those claims accounted for nearly 7 percent ($11.9 billion) of Medicare expenditures last yearat least according to a government audit.
Processors had no problem weeding out claims with visible errorssuch as ineligibility and noncovered servicesbut they generally lacked the expertise to detect errors involving coding and appropriateness of clinical services, says the HHS Office of Inspector General. Ninety-two percent of the inappropriately paid claims weren't discovered until after medical professionals (including PRO physicians and nurses) reviewed patient records.
Companion bills in Congress would create a new federal program modeled after Medicare, but with benefits tailored for children. Under the MediKids Health Insurance Act of 2001, all children would be enrolled at birth and remain in the program until age 23. Coverage would match the full benefits in Medicaid today.
MediKids would be financed like the Medicare Part B program. Families would pay a premium equal to 25 percent of the value of the program, collected when parents file their taxes or through adjustment of a family's earned-income tax credit. The rest of the program would be financed through general revenues. Children eligible for the State Children's Health Insurance Program (SCHIP) and Medicaid would continue to be enrolled in those programs and exempted from paying MediKids premiums.
Joan Rose. Practice Beat. Medical Economics 2001;12:19.