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Week in Review

by Kroger Burrus on January 7th, 2013


LifeCare Management Services v. Insurance Management Administrators
A third-party administrator of medical benefits denied claims submitted by two covered employees after determining that the LifeCare Management Services’ facilities they were treated at qualified as skilled nursing facilities. One plan capped the number of days of coverage available for treatment at a skilled nursing facility, while the other did not cover rehabilitative treatment at all. The employees filed suit alleging that the plan administrator abused her discretion in violation of ERISA and the district court agreed. In a published opinion, the 5th Circuit affirmed the district court’s determination that the third-party administrator incorrectly interpreted the plan and improperly denied the employees’ claims.


“Time Cost” of Health Care Bucks Trend for Consumer Goods
In 1959 an employee earning an average wage would have to work approximately 181 hours to afford a washer-dryer combination, while today the “time cost” for the same appliances has dropped to 31 hours. This trend is true among other consumer goods, but for health care the time cost has increased dramatically. An average worker in 1958 would have to work approximately 15 days to afford the $134 per capita annual cost of health care. Today, that same worker would have to work about 58 days to cover the $8,953 Americans spend on health care on a per capita basis.

Kelsey-Seybold Accredited as First Accountable Care Organization
Houston’s Kelsey-Seybold Clinic is the first organization in the United States to be accredited as an accountable care organization. Kelsey-Seybold received the recognition from the National Committee for Quality Assurance. “Accountable care” involves the use of an evidence-based approach to providing care, heavy investment in information technology, quality measurements, and a reformed payment system that moves away from patient volume.

Computers in the Exam Room a Mixed Blessing
The spread of health care information technology and spreading adoption of electronic health records systems offers many advantages to physicians and their patients, but actually using the technology may be cumbersome in examination rooms that were not designed with personal computers in mind. Patients prefer that their physicians maintain eye contact to help ensure that they are being heard and entering data promptly and accurately while also maintaining good bedside practices may prove challenging.

Texas Judge Rules Against Planned Parenthood in Funding Fight
A visiting judge has ruled that Texas’ Women’s Health Program may operate without funding Planned Parenthood clinics and clinics associated with the organization. Last week Planned Parenthood was denied a temporary restraining order that would have allowed it to participate in the Texas Women’s Health Program while the legal struggle between Planned Parenthood and the state continues.

Life Expectancy Increases More Costly for Adult Males in Low-Income Countries
Global lifespans have increased dramatically over the past 40 years, but while the costs associated with increasing the lifespan among children worldwide continues to drop, the price of increasing the lifespan of adults in lower-income countries is increasing. Researchers from the University of Toronto attribute the life expectancy disparity in part to investment in treating childhood diseases coupled with an increase in smoking and HIV prevalence among adult males.

Texas Children’s Hospital Announces Screening Clinic for Newborns
Texas Children’s Hospital has announced a new clinic that will immediately see newborns who have tested positive for immune disorders. The state of Texas has started screening for severe combined immunodeficiency disorder (SCID) as part of the standard newborn screening panel. SCID is a genetic commonly known as “Bubble Boy disease” that if undetected can result in life-threatening recurrent infections. The new screening will allow health care providers the opportunity to diminish organ damage caused by SCID and will provide more time to offer stem cell transplantation therapy.

Hendrick Health System Completes Expansion
Hendrick Health System has completed an extensive renovation that includes a two-story addition to a four-story patient tower, physicians’ office building, new dialysis unit, and new wound care center.

Bill Proposes New Guidelines for Abortion Pills
A bill to be introduced during the next Texas legislative session would impose new restrictions on the administration of abortion-inducing medication. Under the proposed bill, physicians would be required to personally administer each dose of the medication and would have to schedule a follow-up visit within 14 days of treatment to verify termination of the pregnancy.

Texas Chinese Medicine College Receives Master’s Degree Accreditation
The Texas College of Traditional Chinese Medicine has been accredited to offer a Master’s degree in acupuncture and traditional Chinese medicine. The college is the first school that offers an acupuncture program in the state to receive accreditation from the Accrediting Council for Independent Colleges and Schools.

Texas Children’s Hospital Building In Vitro Fertilization Clinic
Texas Children’s Hospital will begin construction next month on a $4.6 million in vitro fertilization clinic. Construction will take place at the main campus and is expected to last approximately six months.

Texas Stem Cell Center Posed for Showdown with FDA
The promotion of stem cell research in Texas could produce promising medical and economic results, but a pending jurisdictional showdown between the FDA and a Sugar Land-based stem cell company may stymie stem cell supporters. Texas law does not treat the development of stem cell lines for therapy as drug manufacturing, but the FDA disagrees and has asserted that it has jurisdiction over laboratories that prepare stem cell cultures.

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