Life Sciences

Part D admin costs 11% of total drug spend

Medicare & Reimbursement Advisor Weekly, August 26, 2009

Private Medicare Part D plans average 11.3% in administrative costs as a share of total drug spending, according to a recent Commonwealth Fund study. Private health plans’ administrative costs averaged 9% of premiums across all policies sold and are well below “vastly overstated” estimates offered by proponents of a government-run public plan, the Blue Cross Blue Shield (BCBS)-funded study found. Here’s the link:

North Carolina may mandate new preadmission screen

North Carolina may mandate a uniform screening program for Medicaid patients before they are admitted to skilled nursing facilities. Information on the PreAdmission Screening and Annual Resident Review tool can be found at

Against medical advice

A report that 39% more patients left their hospital beds against medical advice in 2007 compared with 10 years earlier caught one of the nation’s leading hospital quality experts off guard.

To read the full story, click on: http:// topic/WS_HLM2_QUA/Many-Hospitalized-Patients-Leave-Facilities-Against-Medical-Advice.html

Oregon embraces more holistic reimbursement system

The state’s Health Policy & Research meeting will be September 23. At its most recent meeting in July, the committee discussed the Four Quadrant Clinical Integration Model as a framework for assessing and treating patients with different levels of healthcare needs. The group also recommended a reimbursement framework that rewarded holistic care. The rationale: The current fee-for-service payment structure can be a hindrance for providers to use effective interventions. In the literature, this system is often cited as placing financial incentives behind medical overutilization and resource inefficiency by putting the full risk of care on the payer. Policies which further exacerbate this trend include the undervaluation of preventive services, as well as the overvaluation of non-preventive services; non-payment to physicians for services required to provide patient-focused, care coordination; and the provision of incentives for volume of services without regard to quality of care or resource utilization. Read details at: