A new report by federal analysts found that the reduced spending in 2010 (the last year for which data is available) was due to a combination of high unemployment, lower household income, a reduction in the number of people with private insurance and some folks opting to skip needed care (or choose cheaper options) because they simply couldn’t afford the preferred treatment.

According to the report by CMS, in 2010, health spending grew just 3.9%, only 0.1 percentage point faster than 2009. Total health spending in 2010 was $2.6 trillion, about $8,402 per person. To date, 2009-2010 had the slowest rate of growth of any two-year period in the 51 years this data has been tracked.

More troubling, although this rate is “slowing,” health spending still grew exceptionally faster than the rest of the economy. About 45% of the spending was shouldered by government agencies at all levels — up from 41% in 2009. That increase is largely the result of growing Medicaid enrollment and enhanced federal matching rates from the American Recovery and Reinvestment Act.

At the household level, spending was up 2.8% in 2010. One-third of such spending was employee contributions to private health insurance. People weren’t necessarily getting more for their money though. A significant portion of the increased spending was due to higher cost-sharing requirements for some employees, a trend toward plans with higher deductibles and/or co-payments, and many people having to pay out-of-pocket for health care after losing their health insurance coverage.

Hospitals’ incident reporting systems are only registering about 14% of patient injuries, according to a new study. 

That’s the conclusion of a new statement from the Office of the Inspector General. According to the report, hospitals investigate the patient harm events that are most likely to help them make safety or quality improvements and they made relatively few policy changes based on the events that were reported.

As for the other 86% of incidents, hospitals said 61% were events that the staff didn’t perceive as a reportable event. The rest were normally reported but not reported in that specific instance.

OIG noted that all the hospitals reviewed had incident reporting systems in place and that hospital managers say they rely on the systems to monitor quality of care and catch potential problems.

Because incident reporting is so vital to hospitals, OIG recommended that CMS take the following steps:

• collaborate with the Agency for Healthcare Research and Quality (AHRQ) to create a list of potentially reportable incidents that hospitals could use
• provide guidance to accreditors regarding their assessments of hospital efforts to track and analyze events
• suggest that surveyors evaluate the information collected by hospitals using AHRQ’s Common Formats, and
• scrutinize survey standards for assessing hospital compliance with the requirement to track and analyze events and reinforce assessment of incident reporting systems as a key tool to improve event tracking.

To see the full report as a downloadable PDF click here.

Will those steps actually improve incident reporting and make it easier for hospitals to improve overall patient care? Share your thoughts in the comments.

The total for 2011 includes a record $2.8 billion in recoveries under the whistleblower provisions of the False Claims Act, which is the government’s primary civil remedy to redress false claims for federal money or property, such as Medicare benefits, payments on military contracts, and federal subsidies and loans. $2.4 billion of that money came from cases involving fraud against federal health care programs.

Berwick, known for implementing controversial rules regarding the implementation of last year’s health reform law, was appointed by President Barack Obama in 2010, despite Republican opposition. Now Republicans on the Finance committee are examining the views and record of Obama’s new appointee, Marilyn Tavenner, who was previously Virginia’s secretary of health and human resources.

Tavenner, according to the White House, spent “almost 20 years in nursing, 3 years as a hospital CEO and 10 years in various senior executive level positions for Hospital Corporation of America.”

While it appears that there is much support for the nomination of Tavenner, The Association of American Physicians and Surgeons (AAPS) believes that the “new CMS pick [is] no better than Berwick.”

The suit was filed by the Arizona Hospital and Healthcare Association in the U.S. District Court in Phoenix.

The suit claims that the 5% rate cut will limit patient access to health care providers in violation of federal law that requires Medicaid payments to hospitals be sufficient to ensure “that beneficiaries have equal access to services.”

The Medicaid rate cut is expected to save the state $95 million this year.

The committee was set up to find a compromise on how to cut $1.2 trillion in federal spending over the next decade. Failure to do so — which the committee officially announced on Nov. 21 — means the back up plan of “sequestration” takes effect. That means automatic cuts of that $1.2 trillion is cut from domestic and defense programs starting with 2013 spending.

Most directly affecting the health industry are planned cuts to Medicare — capped at 2%. Understandably, providers are worried about the effect that’ll have on their bottom lines.

The American Medical Association released a statement by President Peter W. Carmel, M.D., noting that cuts triggered by sequestration, along with the planned Jan. 1 physician payment cut of 27%, mean physicians may be forced to limit the number of Medicare patients they serve.

Similarly, the American Hospital Association’s statement warned that the cuts to Medicare will affect not just the elderly and disabled who rely on Medicare but their families who have to pick up the slack, as well as hospitals’ ability to provide essential services. The statement is available here (downloadable PDF).

“Sequestration means that arbitrary reductions in resources for patient care under Medicare will now be set to take effect under the law for the remainder of the decade,” Richard Umbdenstock, president and CEO of the American Hospital Association (PDF), said in a statement. “This will have an impact not just on the elderly and disabled beneficiaries of the program, but on their families,” he continued. “It will also have an impact on the ability of hospitals to provide essential public services to the communities they serve given the impact that Medicare has on the entire healthcare system. It is likely that Congress will reconsider whether this approach should take effect in January 2013 as required under current law.”

Hospitals that are for-profit, that serve higher rates of blacks, and/or serve higher numbers of Medicaid patients are far more likely to close.

The researchers looked at data from California hospitals during the period from1998-2008. Their report is available for download here.

According to the researchers, for every 10% increase in black patients served by a hospital, the risk of closing the emergency department increased by a whopping 40%. For every 10% increase in Medicaid patients, the risk jumped 17%.

For-profit hospitals in general had a 65% higher chance of closing their emergency departments than non-profits.

The study is especially troubling since emergency departments are increasingly the only provider of preventive care — especially in the poorer neighborhoods where they’re more likely to close.

Wesley Warren Jr. is seeking treatment for his roughly 100-pound scrotum. While the need for the surgery is obvious, his ability to have Medicaid cover it is less clear.

Warren described how the deformity requires him to rest his scrotum on a milk crate when he sits. He’s unable to use a regular bathroom, has difficulty getting around and is, unsurprisingly, pretty depressed about the state of affairs.

The complications have aggravated his already less-than-stellar health, and Warren has gained weight and now suffers from high blood pressure and asthma.

The cause of the deformity isn’t clear. He shows no signs of the viral or bacterial infections that are the most common causes. Trauma, from an injury Warren says he suffered when his testicles got caught between his legs as he awoke one morning, is a potential cause.

Dr. Mulugeta Kassahun, a Las Vegas urologist who examined Warren said Medicaid would cover the needed surgery, but that there’s a chance neither his testicles nor penis could be saved.

A team from UCLA provided Warren with more hope for a better outcome, but according to Warren, they said Nevada Medicaid wouldn’t cover the costs of the surgery there — which he estimates at $1 million.

Warren is currently raising money to have the surgery. He’s gone on Howard Stern to discuss his plight, and is taking donations through benefitballsack@yahoo.com. He won’t say exactly how much he’s raised so far, but noted that “it’s a start.”

Federal prosecutors allege the hospitals violated the Stark Law between 2005 to 2010 by using  improper compensation agreements with local doctors.  In addition to the fines, the three companies will also have to cooperate with an ongoing investigation into individuals who may have violated the law.

Farah Maria Perez pleaded guilty  to one count of conspiracy to commit health care fraud, according to a joint announcement by the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Perez worked for Florida Home Health Care Providers Inc., a home health care agency. The agency was supposed to provide home health and therapy services to Medicare patients. In truth, the company existed primarily to bill Medicare for physical therapy and other services that either weren’t needed and/or were never provided.

According to prosecutors, between January 2006 and March 2009, Perez and her co-defendants falsified patient files for Medicare beneficiaries to make it appear that they qualified for home health care and therapy services.  Perez admitted she knew the beneficiaries didn’t qualify for and didn’t receive the services and that the files were being changed so that the Medicare program could be billed for medically unnecessary therapy and home health related services.

Perez also admitted recruiting Medicare beneficiaries who agreed to let the agency bill Medicare for services that were unnecessary or never provided.

Four of her co-conspirators who were charged in the February 2011 indictment, Jose Nunez, M.D.; Lisandra Alonso; Luisa Morciego; and Vicente Guerra, have also pleaded guilty.

Perez’s sentencing is scheduled for November of this year. She faces a maximum prison sentence of 10 years in addition to fines, supervised release, and forfeiture of any property or proceeds derived from her criminal activities.