According to the senior author of the study, Adil H. Haider, M.D., M.P.H., an assistant professor of surgery at the Johns Hopkins University School of Medicine, “It’s a double whammy. Minorities are much more likely to get injured by this mechanism and much more likely to die by this mechanism.”

Haider, along with Rubie Sue Maybury, M.D., M.P.H., reviewed information on over 26,000 patients who were hit by motor vehicles between 2002 and 2006. The research, which was provided by the National Trauma Data Bank, showed that African-American patients had a 22% greater risk of death, and Hispanic patients had a 33% greater risk than white patients who were involved in similar accidents. In addition, those patients who are uninsured had a risk of death that was 77% greater than that of those with insurance, even if they received treatments in hospital emergency rooms, which have long been assumed to be the health care industry’s great equalizer.

Haider, who also holds the position of co-director of the Johns Hopkins Center for Surgical Trials and Outcomes Research, reiterated that the greater death risks for minorities and the uninsured are not accounted for by increased rates of injury. “Do we treat minorities and the uninsured differently? I don’t think so, but we’ve got to ask the question. We don’t actually know what is leading to these disparities.”

Other studies have shown that both ethnicity and insurance status may increase the risk of mortality because of differences in available services, or delay in treatment. As well, a greater prevalence of (or lack of treatment for) common comorbidities such as diabetes, hypertension, or obesity, may be factors that increase the risk of death among injured crash victims who are uninsured or belong to ethnic minorities.

Haider pointed out that since underlying causes for these risk disparities can’t be easily addressed, policymakers need to focus on accident prevention programs for pedestrians, especially in inner cities, where a significant number of these deadly crashes happen. He held up the great success with regard to the use of seat belts and safety seats for children as innovations that have saved lives, and said that pedestrian education could also help, though, he conceded, the problem of injury to pedestrians may be more complicated.

Other Johns Hopkins researchers who worked on this study are Cassandra Villegas; Elliott R. Haut, M.D.; Kent Stevens, M.D., M.P.H.; and David T. Efron, M.D.

The California Senate passed two bills which provide the functions and mechanisms of the exchange. One, which is waiting for the governor’s approval, sets up an online exchange where consumers will be able to compare participating insurance plans. The exchange will be operated by a state-appointed five-member board.

The second bill, which has been sent back to the state Assembly for its approval, details the exchange’s role in health care insurance, and creates a California Health Trust Fund which would finance the exchange.

Unsurprisingly, both bills passed along party lines, with Democrats approving, and Republicans opposing the initiatives.

According to the Patient Protection and Affordable Care Act, state-based exchanges for both small businesses and individuals to purchase health care insurance must be up and running by January 1, 2014, though either non-profit groups or government agencies may administer them.

While Governor Arnold Schwarzenegger announced in April that we would support health care reform, stating he would “…work with the federal government to get this done…” he has not stated whether or not he would be signing either of these bills.

The sad truth, and the one HHS Secretary Kathleen Sibelius hit squarely on the head, is that premiums are set without much in the way of accountability or transparency. As a result, over the last decade rates have doubled, pricing many consumers out of even the most minimal coverage.

While 26 states and the District of Columbia already have the power to reject unfair premium increases, they don’t necessarily have the money to enforce those decisions. That’s where federal oversight and federal funds are sorely needed as the nation moves into the next phases of insurance and health care reform.

The monies, in this case, are part of $250 million included in the Affordable Care Act for grants to provide health insurance premium reviews over the next 5 years.

By 2014, the hope is that increased competition in the insurance marketplace coupled with lower overhead and the establishment of insurance-exchanges for high-risk customers will mitigate the need for what amounts to price gouging with coverage rates.

The states that receive the money can use it in multiple ways to improve the premium review process, but overall, it’s a positive step forward in protecting consumers from steep health care rates as the broader health care reform program is set in place.

The named companies, entities and individuals were ordered to cease and desist from all unauthorized insurance business, including delivering, issuing, mailing, offering, or soliciting any resident of Louisiana any kind of certificate, coverage, plan, policy, or “any other contract” which claims to provide insurance benefits or medical discounts for health benefits.

In addition to receiving C&D orders, the named people and companies were directed to provide a complete list of all Louisiana businesses or residents that had purchased any products from them, and report all premiums that were received in connection with those customers. In addition, they were required to notify any of the affected Louisiana consumers of the C&D order, and issue immediate refunds of any monies or premiums held in behalf of those consumers.

Along with the Louisiana Department of Insurance, the same scammers have had lawsuits and/or regulatory actions filed against them by the Federal Trade Commission and law enforcement agencies in 23 other states.

The FTC alone has filed three different lawsuits targeting fraudulent medical discount plans, and Attorneys General and Insurance Commissioners around the country have brought numerous actions to stop the scammers. Included among these lawsuits and actions are those addressing sham insurance, as well as illegal automated phone calls, fax blasting, and licensing violations.

According to the AMA, its report has data not available anywhere else, and includes information on how medical liability claims are impacted by age, gender, and type of practice for physicians.

According to the Insurance Journal highlights of the report include:

1. Nearly 61 percent of physicians age 55 and over have been sued.
2. There is wide variation in the impact of liability claims between specialties. The number of claims per 100 physicians was more than five times greater for general surgeons and obstetricians/gynecologists than it was for pediatricians and psychiatrists.
3. Before they reach the age of 40, more than 50 percent of obstetricians/gynecologists have already been sued.
4. Ninety percent of general surgeons age 55 and over have been sued.

The AMA’s immediate past-president J. James Rohack, M.D., talked about the report, saying, “Even though the vast majority of claims are dropped or decided in favor of physicians, the understandable fear of meritless lawsuits can influence what specialty of medicine physicians practice, where they practice and when they retire. This litigious climate hurts patients’ access to physician care at a time when the nation is working to reduce unnecessary health care costs.”

The AMA says that the number of medical liability claims is not an indication of the frequency of medical error, as the physician prevails 90 percent of the time in cases that go to trial, but even though 65% of claims are either dropped or dismissed they’re not without cost. The average defense of a medical liability claims ranges from $22,000 for the dropped or dismissed claims to more than $100,000 for those that go to trial, leading to increased costs for both physicians and patients.

Rohack said the findings “validate the need for national and state medical liability reform.”

The Foundation for Advancement of International Medical Education and Research, based in Philadelphia, had a team, including the Foundation’s president and CEO John Norcini, examine records for 244, 253 hospitalizations of patients with either acute heart attacks or congestive heart failure at 184 different Pennsylvania hospitals. These patients were seen between January 1, 2003, and December 31, 2006, by a total of 6,1113 cardiologists, family physicians, and internists. 75.5% (4,616) were trained in American medical schools while the other 1,497 trained at 391 different schools in 79 countries. Of the foreign-educated physicians, 374 of them were U.S. citizens studying abroad, while the other 1,123 (75%) were not U.S. citizens when they began medical school.

According to the patient files, the percentage of in-hospital deaths due to congestive heart failure was 3.1% for internationally trained doctors, and 3.4 percent for those who studied here in the States. Among the foreign trained physicians, the percentage of deaths was 3% for those who were not U.S. citizens during medical school, and 3.5% for those who were. For heart attack patients, the in-hospital death rate was 12.7% for internationally trained doctors and 13.1% for those who trained domestically, and the split in foreign-trained doctors was 12.2% for non-U.S. citizens and 14.4% for citizens.

In noting the statistics for U.S. citizens trained at foreign medical schools, the study concluded that it “suggests the importance of further research to clarify whether their performance is a result of their medical education experiences or their ability.”

In a press release, Norcini said, “Despite a rigorous U.S. certification process for international graduates, the quality of care provided by doctors educated abroad has been an ongoing concern. It is reassuring to know that patients of these doctors receive the same quality of care that they would receive from a physician trained in the United States.” He also said, “These findings bring attention to foreign-trained doctors and the valuable role they have played in responding to the nation’s physician shortage.”

Speaking to the press, California Insurance Commissioner Steve Poizner said, “We want as many people as possible scouring these rate filings to ensure they are mistake-free. The e-mail notification tool will expand access to these documents by informing the public of when there are new filings to peruse. This additional analysis, in conjunction with scrutiny by the Department of Insurance’s in house actuaries and independent actuaries retained by the Department, will help ensure that consumers are protected and insurers are spending 70 percent of premiums on medical benefits, as required by state law.”

Consumers who wish to participate in this program should visit http://www.insurance.ca.gov/email-updates/ and select which of the Department of Insurance’s updates they would like to receive.

Recently, Commissioner Poizner also that he wanted to create transparency by posting all health insurance rate filings for the individual market on the California Department of Insurance’s Web site. They can be found at http://www.insurance.ca.gov/0250-insurers/IndHlthRateFilings/, where interested readers are also able to post comments which will be read by CDI attorneys.

Additionally, Poizner announced that the rate filings of the four largest insurers in California’s individual health insurance will be subject to deeper scrutiny, by having them analyzed by an outside actuary. After today, the only large insurer that doesn’t have an active filing with the CDI is Health Net.

Health insurance rates in California do not require prior approval from the Department of Insurance the way homeowners and auto insurance rates do, but state law does require that seventy cents of every dollar collected in health insurance premiums must be spent on medical benefits. The actuarial review being instituted will allow verification that insurers are complying with this law.

Also in conjunction with the Miami summit, which gathered together insurance providers, consumer advocates, and patients as well as federal, state, and local authorities, came the announcement from HHS that the state of Florida has been granted a Medicaid waiver which will help fund a program allowing the state’s Medicaid Fraid Control Unit to scan insurance claims for patterns that are red flags for insurance scams. Currently, Federal law prohibits federal matching funds from being used in such fraud control efforts.

As of Friday morning, 36 alleged participants had been arrested in connections with schemes involving over $250 million in fraudulent claims, according to the Justice Department. The suspects include insurance company owners, medical assistants, and doctors, and the allegations against them fit the profile of the kind of healthcare fraud typical of South Florida over the last several years – fraud that is now spreading across the country, with scammers filing false claims for HIV infusion services, home healthcare, durable medical equipment, and physical therapy, and beneficiaries getting monetary kickbacks for their Medicare numbers.

There are plans for additional, similar healthcare fraud summits to be held in Boston, Detroit, Las Vegas, Los Angeles, New York, and Philadelphia.

Source: Modern Healthcare