Rule would require notice of noncovered services

The Centers for Medicare & Medicaid Services has published a proposed rule that would require hospitals to give all Medicare beneficiaries a standard notice of non-covered services the day before discharge.

The notice would be similar to those home health agencies and skilled nursing facilities must provide, and would include the patient's prospective discharge date, the date coverage ends and financial responsibility for continued services would begin, and the right to an expedited review and other appeals.

If the beneficiary wishes to dispute his or her discharge, the hospital or Medicare managed care organization would be required to deliver a more detailed notice that explains why the services no longer are required, according to the proposed rule's provisions.


AHRQ study looks at admissions from ED

Fifty-five percent of admissions to the nation's community hospitals for conditions other than pregnancy, childbirth, and neonatal care begin in the hospital emergency department, the Agency for Healthcare Research and Quality reports.

More than one-quarter (26%) of the 29.3 million patients admitted through the ED in 2003 had heart or blood vessel diseases; 15% had respiratory diseases; 14% had digestive disorders; and 11% had injuries, according to the agency's Nationwide Inpatient Sample database.

Pneumonia led the top 20 specific conditions warranting hospitalization through the ED, with 935,000 admissions. Other leading conditions included congestive heart failure, chest pain, hardening of the arteries, and heart attack.

More information is available at www.ahrq.gov.


Number of competing insurers declining

A new study by the American Medical Association (AMA) shows growing evidence of health insurance market concentration across the country.

A single commercial insurer covered at least 30% of the HMO and PPO enrollees in 95% of the 294 metropolitan areas studied, and in 56% of the markets a single insurer covered at least half of the enrollees.

"Given the troubling trends in health insurance nationwide, federal regulators need to take a hard look at whether patients are being harmed as mergers and takeovers reduce the number of competing health insurers," said AMA board member James Rohack, MD.