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This page will bring you news and notes from the business world of Pediatric Therapies.  Please check for frequent updates.

  • Would you buy health insurance in a store?

    01 May 2012 9:45 AM | Anonymous
    By Sarah Kliff, Published: April 25, © The Washington Post Company

    Andrew Harrer Bloomberg Scott Serota, president and chief executive officer of Blue Cross Blue Shield Association. Three years ago, Blue Cross
    and Blue Shield of Florida did something unexpected for an insurance company: It began opening stores.

    They weren’t clinics. They did not provide much in the way of medical care. Instead, the buildings housed something that feels almost antiquated: a place where consumers could walk in, meet a Florida Blue representative, and purchase an insurance policy.

    In many ways, the Florida health plan was making an odd choice: The Internet already provides a nearly free storefront. Health insurance companies regularly talk about getting squeezed financially, as the health reform law requires them to spend at least 80 percent of every premium dollar on medical costs.

    Why, then, put the other 20 percent towards brick-and-mortar buildings?

    “Why did Apple decide to open stores, when they could sell everything they sell online?” asks Patrick Geraghty, CEO of Florida Blue Cross Blue Shield. “There’s an experience attached to it. It puts a face on the organization.”
    The plan’s movement into retail, in many ways, responds to the health reform law: Come 2014, the health reform law will expand the individual health insurance market by an estimated 16 million new customers. Individuals will become increasingly involved with purchasing their own health care, putting a greater premium on customer service.

    “Traditionally, Blue Cross Blue Shield has been in a business-to-business environment,” says the company’s CEO, Scott Serota, when I spoke with him and Geraghty Tuesday afternoon. “Now our biggest challenge is to evolve into a consumer-focused company.”

    Right now, however, insurance companies aren’t in a great place in this front. In surveys, consumers have ranked the health insurance industry as the most complex and confusing to navigate. Americans put more time and effort into researching dishwashers than they do shopping for an insurance plan.

    Florida Blue Cross Blue Shield has opened nine “Florida Blue” centers so far, a number that will continue to grow. Two launched this year alone, with four more in the works by the end of 2012. The retail stores offer staff who can help enroll in a plan, assist with claims and offer a wellness assessment. One of the stores, in Pensacola, recently added a primary care physician on site.

    As the stores have opened, the demand seems to be there. When a Florida Blue storefront opened in Tallahassee recently, it had about 1,500 people come through over the first weekend.

    “Our members are interested in our online tools, but sometimes need to be walked through that,” says Geraghty. “You can come into this center with a stack of your claims that you have an issue with or a question about, and hand them over, and we walk through those claims and resolve those claims in front of you while you’re there. It’s very, very popular with our membership.”

    Florida Blue Cross Blue Shield was already on the way to retail stores before the Affordable Care Act passed, as fewer Americans received insurance through their employers may be turning to the individual market. The expansion of the insurance market, Geraghty says, only makes it more important for his insurance plan to have a strong retail presence moving forward.

    “We think we’re well positioned for that expansion,” he says. “We know we have to advance retail capabilities. That’s what you’re seeing here. A real investment in the retail side of our business to connect to our members on that one-to-one basis.”

  • Sebelius: Focus is on reform implementation

    25 Apr 2012 10:53 AM | Anonymous
    HHS Secretary Kathleen Sebelius reiterated the administration's position that it does not have a contingency plan ready should the U.S. Supreme Court rule this summer that the 2010 healthcare-reform law is unconstitutional.

    "We're confident that the law is constitutional and we are moving forward with implementation," Sebelius said after her keynote address at the Atlantic's Health Care Forum in Washington. "In the event that there is a different ruling, we'll be ready, but at this point, our energy is really focused on continuing to make sure that people know about the benefits and take advantage of what's out there," she said, adding that part of the planning now centers on making sure states are prepared when most of the law's provisions take effect in 2014.

    In a panel discussion moments later, Dr. Farzad Mostashari, HHS' national coordinator for health information technology, echoed the secretary's remarks when he saidundefinedand later repeatedundefinedthat the administration is confident the law is constitutional and is moving forward to implement it.

    Adding a provider perspective, Dr. Timothy Ferris, medical director at Massachusetts General Physicians Organization, said the uncertainty surrounding the law's fate has made work more difficult for physicians. For example, he said, it's difficult to convince a CFO to invest in innovation improvement if the CFO prefers to wait until the high court issues its ruling. Even so, his organizationundefinedwhich was named a Pioneer accountable care organization Jan. 1undefinedhas made some significant changes pertaining to the law in the past three months.

    "We've reorganized our management structure; we've started shifting the way we invest in our infrastructure; and we're changing the way we pay our doctors," said Ferris, who also participated in the panel discussion. "Those kinds of things take time. Those kinds of things take years before the implications of those changes play out."

    Read more: Sebelius: Focus is on reform implementation - Healthcare business news and research | Modern Healthcare http://www.modernhealthcare.com/article/20120419/NEWS/304199975#ixzz1t42XwP55 
    ?trk=tynt 

  • Number of children on Medicaid grows in Florida

    18 Apr 2012 5:02 PM | Anonymous
    By The News Service of Florida, Miami Herald

    The number of children covered through Medicaid, Florida Healthy Kids and other state health programs hit two million in March, according to totals released Monday by Florida KidCare.

    That was the first time the combined enrollment reached that level. As of the end of March, 1,721,220 children were enrolled in Medicaid.

    The Healthy Kids program, which offers subsidized insurance to children ages 5 to 18, had 230,976 enrollees. Two smaller programs, MediKids and the Children’s Medical Service Network, combined for 56,681.

  • Children’s agencies finding way to do screening

    17 Apr 2012 8:28 PM | Anonymous

    Snow Strategies has been working under contract with the Florida Developmental Disabilities Council (FDDC) to coordinate the task force and assist them in developing recommendations for screening. A report for Year 1 will be released soon.

    By Margie Menzel, The News Service Of Florida

    THE CAPITAL, TALLAHASSEE, April 16, 2012.....Florida children's agencies are finding ways to screen for developmental delays in infants and toddlers, despite the fact that few communities have the money to do it, and it hasn't been a funding priority for state lawmakers.

    They screen for vision, hearing, dental, cognitive, mental health and developmental problems that, untreated, can change the course of children's lives – and their families' – for the worse.

    Solutions range from a community-funded monthly screening in Hillsborough County to a twice-yearly effort in Leon County. Rural Jefferson County held its first screening in late March, serving 35 children.

    In Tampa, 65-75 children are screened monthly, supported by an ad valorem tax dedicated to the Children’s Board of Hillsborough County, a children's services council. Staffing and in-kind dollars come from the Hillsborough public schools. Faith based organizations donate the space. For the last three years, the Early Childhood Council of Hillsborough County has received about $20,000 in grants and awards for developmental screening.

    "It's like that old transmission commercial: 'Pay me now or pay me later,'" said Stephen Martaus, director of the Early Childhood Council. "If we put enough money into early learning and early intervention, then those kids are going to be more successful in school, be better citizens, be less inclined to drop out, be less inclined to commit crimes and more inclined to be productive citizens."

    In Tampa, developmental screening began in 1986, with 23 children served in the first year.

    While taxpayers are footing part of the bill in Tampa, in other parts of the state, absent significant funding from the government, much of the screening is done by volunteers working for free and with few resources.

    "It's really a community effort to do the right thing," said Angel Trejo, a retired district administrator of the Florida Department of Children and Families for twelve counties in the Big Bend, who now works with local children's programs as a volunteer.

    Eighteen percent of children have some type of developmental delay, Trejo said, and of those "we miss 50 percent.  Some studies say we're missing 60 to 80 percent."

    In Tallahassee, staffers from 20 children's agencies donate their time, Children's Medical Services donates space and at a recent screening, three dentists saw children for free. The group screens at least 50 children every six months.

    "The earlier we can find children that are having some challenges, the better off and the more prepared they'll be for kindergarten," said Susan Ellis, a clinical social worker who helped start Leon County's all-volunteer screening in 2008.

    Ellis said providers are learning that children who get early intervention have fewer behavior problems once they start kindergarten.

    "One of my goals as an infant mental health provider is to reduce the number of children in the juvenile justice system," she said. "Because a lot of these children that aren't getting services early on, usually we find when they're ten or twelve, having problems, that they've been having problems since they were two years old but they've just never been identified or treated."

    Now the screening concept is spreading statewide.

    Last fall the Florida Developmental Disabilities Council began a three-year initiative to develop a system of developmental screenings for children from birth to age five. The project springs from the Florida Children and Youth Cabinet's strategic plan, and the grant is funded by the federal U.S. Department of Health and Human Services, Administration on Developmental Disabilities.

    According to FDDC Director Debra Dowds, the goals for the grant's first year included researching other states with higher screening rates; researching Florida's system; identifying the screening and assessment tools used in Florida; and convening a statewide task force of pediatricians, parents and providers. She said the task force is about to release its first year's report.

    Asked if the state's economic woes will be a hurdle to delivering more services, Dowds said, "Maybe, but we're hoping to build a case as to why we need to spend the money."

    But Ted Granger, president of the United Way of Florida, said assessment is "just the first step. The next is referring children who need services, and we know there's a lack of services out there.

    If you assess a child and there's nowhere to send him, you really haven't accomplished a whole lot."

    Posting or forwarding this material without permission is prohibited.  Contact news@newsserviceflorida.com

  • Counties to fight state over Medicaid costs

    13 Apr 2012 9:51 AM | Anonymous
    By Jim Saunders of the News Service of Florida

    Posting or forwarding this material without permission is prohibited. Contact news@newsserviceflorida.com

    In what it described as an "accounting mess,'' the Florida Association of Counties said Thursday it will file a lawsuit challenging the state's decision to try to tap counties for tens of millions of dollars in disputed Medicaid money.

    The decision came two weeks after Gov. Rick Scott signed a bill that calls for the state to recoup the money --- and more than a month after counties frantically tried to fend off the measure in the Legislature.

    Legislative leaders contend that counties have failed to pay money that is owed to the state. But counties argue the state's billing system has major flaws, which has led to payment disputes.

    "From the outset, we've said that local taxpayers shouldn't be forced to pay for Tallahassee's accounting errors,'' Chris Holley, executive director of the Florida Association of Counties, said in Thursday's announcement of the upcoming lawsuit. "And to ensure that they are not, we will be pursuing legal action."

    Pasco, Polk, Manatee and Leon counties have voted to join the suit, and the association said it expects more counties to take part.

    The dispute stems from a requirement that counties reimburse the state for certain hospital and nursing-home costs for Medicaid beneficiaries. The Agency for Health Care Administration bills the counties for the money.

    Legislative leaders argue that counties during the past 

    few years have substantially reduced the percentage of bills paid, with legislative staff analyses indicating unpaid billings totaled as much as $325.5 million as of Dec. 31.
    The bill (HB 5301) calls for the state to gradually recoup money from the counties. A House staff analysis last month said the measure is expected to bring in $77.5 million for the state during the fiscal year that starts July 1.

    In finalizing the budget last month, Senate Budget Chairman JD Alexander, R-Lake Wales, said counties could go through an administrative-hearing process if they want to contest the amounts that the state tries to collect. But he was unmoved by the counties' objections to the bill.

    "They should have been paying it all along, and it wouldn't be a problem today,'' Alexander said at the time.

    But counties contend that the state started using a computer system in 2008 that has created inaccurate billings. As an example, counties say they have seen duplicative charges and incorrect rates.

    In signing the bill March 29, Scott said AHCA staff would travel to all counties to try to resolve issues with the billing process. Information on the Florida Association of Counties website indicates those meetings started last week.

    But in the statement Thursday, Holley said the counties still needed to go forward with the legal challenge, which will be filed in Leon County circuit court.

    "We appreciate the governor's promise to address these systemic Medicaid billing errors,'' Holley said. "However, HB 5301 has made this multimillion-dollar accounting mess the law of the land --- a reality we are forced to confront in the courtroom on behalf of Florida's communities and taxpayers."

  • For Many, Disabilities Still Conjure Stereotypes

    12 Apr 2012 10:28 AM | Anonymous
    By Shaun Heasley, disability scoop

    Even among caregivers of those with disabilities, new research suggests that the sight of someone with facial characteristics typical of Down syndrome triggers negative thoughts.

    In a study published this month in the journal PLoS ONE, researchers showed a group of 165 adults standardized images of children with Down syndrome and typically developing kids, all exhibiting neutral expressions.

    As the photographs flashed before them on a screen, participants were asked to use keys to respond as quickly as possible to assess both positive and negative character traits, judging for example whether or not a child appeared “affectionate” or “stupid.”

    While the adults in the study expressed more positive than negative thoughts about kids with and without Down syndrome, negative opinions became more frequent as a child’s facial features tended more toward those characteristic of Down syndrome.

    This trend held true even among the 55 study participants working as professional caregivers for people with intellectual disabilities, though these individuals held the most positive thoughts of all the study participants about kids with Down syndrome.

    Researchers from Aix-Marseille University in Marseille, France who were behind the study say that the findings are significant because their test measured implicit thoughts, or feelings that people may not freely divulge.

    “Research into the social perception of intellectually disabled persons has been largely one-sided, focusing predominantly on thoughts and feelings, which may be distorted by social desirability concerns. In the current research, we found evidence of subtle forms of prejudice toward children with special needs at both the explicit and implicit levels,” they wrote.

    The fact that professional caregivers were more likely to express positive impressions, however, suggests that relationships with individuals who have intellectual disabilities do make an impact, the study authors said.

  • New health care law provisions cut red tape, save up to $4.6 billion

    10 Apr 2012 3:15 PM | Anonymous
    April 9, 2012, HHS Press Office

    Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today announced a proposed rule that would establish a unique health plan identifier under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The proposed rule would implement several administrative simplification provisions of the Affordable Care Act.

    The proposed changes would save health care providers and health plans up to $4.6 billion over the next ten years, according to estimates released by the HHS today. The estimates were included in a proposed rule that cuts red tape and simplifies administrative processes for doctors, hospitals and health insurance plans.

    “The new health care law is cutting red tape, making our health care system more efficient and saving money,” Secretary Sebelius said. “These important simplifications will mean doctors can spend less time filling out forms and more time seeing patients.”

    Currently, when health plans and entities like third party administrators bill providers, they are identified using a wide range of different identifiers that do not have a standard length or format. As a result, health care providers run into a number of time-consuming problems, such as misrouting of transactions, rejection of transactions due to insurance identification errors, and difficulty determining patient eligibility.

    The rule simplifies the administrative process for providers by proposing that health plans have a unique identifier of a standard length and format to facilitate routine use in computer systems.  This will allow provider offices to automate and simplify their processes, particularly when processing bills and other transactions.

    The proposed rule also delays required compliance by one year– from Oct. 1, 2013, to Oct. 1, 2014– for new codes used to classify diseases and health problems. These codes, known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes, or ICD-10, will include new procedures and diagnoses and improve the quality of information available for quality improvement and payment purposes.

    Many provider groups have expressed serious concerns about their ability to meet the Oct. 1, 2013, compliance date. The proposed change in the compliance date for ICD-10 would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.

    The proposed rule announced today is the third in a series of administrative simplification rules in the new health care law. HHS released the first in July of 2011 and the second in January of 2012, and plans to announce more in the coming months.

    More information on the proposed rule is available on fact sheets at www.cms.gov/apps/media/fact_sheets.asp.

    The proposed rule may be viewed at www.ofr.gov/inspection.aspx. Comments are due 30 days after publication in the Federal Register.

  • Lawsuit claims state traps sick, disabled kids in nursing homes

    04 Apr 2012 9:53 AM | Anonymous
    By Bob LaMendola, Sun Sentinel

    Children warehoused for years by denial of services, families maintain

    Florida needlessly and illegally warehouses about 250 severely sick and disabled children in nursing homes rather than pay to help them live at home or in the community, families said in a lawsuit this week.

    The denial of home nursing care and other services has left the children living for months or years in institutions, even when doctors have cleared them to go home with their families, says the suit, filed in federal court in Fort Lauderdale.

    A second group of families filed a separate suit saying about 3,300 at-risk children still living at home fear the lack of services by Florida Medicaid will force them into nursing homes in the future.

    Florida's practices violate the Americans With Disabilities Act and a U.S. Supreme Court ruling that require states to provide services that can keep people in the least restrictive settings, including foster care or group homes, the suits said.

    Officials at the state Agency for Health Care Administration, which runs Medicaid, and the state Department of Health, which oversees many of the children, declined to comment.

    One child identified in the lawsuit is TH, a 16-year-old girl living at Kidz Korner, a wing in the Plantation Nursing & Rehabilitation Center. TH suffered brain damage when she was severely shaken as a baby. She doesn't walk or talk and needs a breathing tube for part of the day.

    She originally went to the nursing home for a brief illness. Her foster parents have wanted to take her home since March 2007, but they say they can't because the state allowed them only eight hours a day of home nursing.

    "Here's a girl who has been medically stable for years. There's really no reason she should not be living at home," said Paolo Annino, a Florida State University law professor who is the girl's attorney. He and Miami attorney Matthew Dietz filed the suits.

    The issue raised by the suits has flared in the past in Florida and nationwide, as states struggle with the cost of special-needs children. After past lawsuits, federal officials persuaded several states to expand services, advocates said.

    Florida pays nursing homes about $500 a day, or $180,000 a year, per medically at-risk child. That's less than the $250,000 a year cost of round-the-clock home nursing, but a higher cost than other combinations of services that many families use to keep kids at home, said Denise Wronowski, a spokeswoman for Broward Children's Center, a program for the disabled.

    States often find it easier to pay for institutional care, and nursing homes are happy to take children to fill beds, said Dr. Cecilia Rokusek, a Nova Southeastern University research director who once ran disabled programs.

    "These kids are so young to be in nursing homes," said Rokusek, who is not involved in the suit. "I was shocked by this. We're going backward."

    Nursing home officials described the children's units as kid-friendly, separated from elderly residents. Kidz Korner, with 57 children, has public school classes and many types of therapy, said Neil Sutton, administrator of the nursing home.

  • Poor children deserve equal care

    03 Apr 2012 9:54 AM | Anonymous
    The Miami Herald Editorial 

    When Florida and many other states began to close institutions for people with mental and developmental disorders 50 years ago, they held out great hope for families. In place of those dreary places, these vulnerable and their families would be supported by an array of services in the community. In all this sweeping change was promised to be better for families - and cheaper for taxpayers.

    This promise for families has hardly been fulfilled. For many states, cheaper trumps better. And being cheap continues to reap an expensive stream of lawsuits over the corner-cutting.

    The latest example came this week in a ruling from U.S. District Judge Joan Lenard. In a decision sizzling with outrage, she ordered that Florida provide the same opportunities for help to autistic children covered by Medicaid as its own Legislature has required for children covered by private insurance.

    The state agency administering Medicaid argued that the type of behavioral therapy required to be offered to children covered by private insurance is too "experimental" for poor kids. That's despite its wide acceptance and that state mandate for other families. Although this type of behavioral therapy may not be beneficial for all children with autism, it has been found by most (but not all) researchers to be a major tool for early intervention with young children.

    In too-brief a thumbnail description, children with this neurological disorder work intensively with a trained therapist to short-circuit behavior such as tantrums, to develop language skills and to understand and complete tasks. The goal is to promote normal behavior and move as close to independence as possible.

    Judge Lenard heard expert testimony that the therapy has resulted in South Florida children being able to attend mainstream classes while those who do not get help languish.

    In other words, not providing early, intense intervention is penny wise but damaging in both the short and long term.

    Her ruling may affect other states with the same disparity between mandated private coverage and no coverage under Medicaid. It should be no surprise that states would tolerate the disparity. As with many other mandated coverages, the private-insurer mandate sprang from concerted lobbying efforts by families devastated by the cost of an illness excluded from their policies.

    Insurance companies have a history of excluding or limiting coverage for mental or developmental conditions. Part of that is fear of high, endless coverage. Part of it (and government's failure to aid poor families with these conditions) seems to spring from stigma afflicting people with mental illness and disability.

    Lawmakers should not insist the private carriers or Medicaid pay for every new therapy that its proponents believe in. But here no one is asking Medicaid to provide gold-plated coverage when legislators, and now a judge, are sufficiently convinced to require it for other Florida families.







  • Doctors using social media more for job search, survey says

    02 Apr 2012 11:01 AM | Anonymous
    Friday, March 30, 2012 - Business Courier by James Ritchie, Staff Reporter

    Doctors and other health care providers are warming up to social media, a survey suggests.

    Nearly one third of respondents used social media when searching for a job in 2011, the San Diego-based staffing and consulting firm AMN Healthcare (NYSE: AHS) found. That compared with 21 percent in 2010.
    Nearly half of the health care professionals surveyed, including physicians, nurses, allied health practitioners and pharmacists, said they use social media for professional networking.

    Among the 2,790 respondents, physicians were health care’s heaviest users of mobile devices, including smartphones and tablets. More than 40 percent of them used such devices for health care-related content or jobs in 2011.
    Nicci Weber, manager of non-profit physician-recruiting group Cincinnati MD Jobs, sees social media use among doctors increasing.

    “It’s still not to the extent that other professionals are using social media. In their work lives, they’re not sitting on a computer other than to enter medical records,” Weber said. “But as the current residents and fellows finish up training, I think we’ll see it pick up more.”

    Facebook was the top social-media destination, with 75 percent of health care professionals choosing it as their favorite site for job-hunting.
    Hospital use of social media is also growing. More than 1,200 hospitals were using social media in 2011, compared with 291 in 2009, according to AMN Healthcare.

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