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Alzheimer’s Costs Business Billions
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Business New Haven
2/8/1999
By: BNH
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According to a recent study sponsored by the Alzheimer's Association, Alzheimer's disease costs American businesses $33 billion per year.
The losses are due to absenteeism by employees caring for people with the disease, including spouses and parents. Additionally, businesses pay $7 billion toward the cost of care.
According to the study, a full-time employee with care-giving responsibilities is absent 12 full or partial days per year and is interrupted an average of 50 hours per year and has other time losses totaling 23 days per year. The study was conducted by Ross Koppel, a professor of sociology at Univesity of Pennsylvania.
Star For Priority Care
Priority Care Inc., a home health care agency headquartered in Stratford, has been awarded Accreditation with Commendation by the Joint Commission on Accreditation of Healthcare Organizations. According to Lee Rayzer, administrator for Priority Care, “Only 29 percent of accredited home-care organizations have received Accreditation with Commendation.”
Connecticut Hospital Association's Legislative Agenda
The Connecticut Hospital Association board of trustees gave unanimous approval for a five-point legislative program for 1999. The proposals will likely prove highly contentious as the battle between providers and HMOs heats up. The hospital association's proposals cover some longstanding complaints such as payments for uninsured patients to addressing payment problems that could result from Y2K conversion.
Distressed Hospital Fund–
Legislators will be asked to approve $20 million to $25 million to correct what the CHA calls “a long standing inequity in the state's uncompensated care pool.” CHA claims that small and medium-sized hospitals are disadvantaged by the federal distribution formulas used by the state. Approval of a permanent appropriation from $120 million of federal matching funds for the “pool” would insure that all hospitals receive less than 74 percent of the funds it contributes to the pool each year.
Managed Care Reforms
Draft legislation will be submitted seeking an unlimited right of patient appeal to the courts for damages caused by a managed care company's denial of payment or services.
Additionally, the CHA seeks to allow physicians and hospitals to appeal on patients' behalf directly to the courts, and adds “most notably in the cases of retroactive denials of payment for services which were later deemed to be 'medically unnecessary.'” The association specifically cites denial of coverage by HMOs for payment of what it calls “essential mental health services and substance abuse programs.”
Certificate of Need Reform: State Oversight & Approval of Ambulatory Surgery Centers
The CHA will be seeking licensing and certificate of need for all ambulatory surgery centers. CHA claims that the centers have proliferated in recent years without state oversight by the Department of Public Health or the Office of Health Care Access.
CHA's position is that “Hospitals and other health-care institutions are currently subject to licensure and certificate of need laws, and so should the entrepreneurs who have entered this field to provide similar services but treat only highly insured patients.”
Increases in Medicaid Payments for Hospitals and Physicians – The hospital association claims that current Medicaid fee schedules pay for services at 60 to 70 percent of costs, and are creating losses for all providers, hospitals and physicians. The CHA board cites the expansion of the state's Medicaid program in the HUSKY (Healthcare for Uninsured Kids and Youth) insurance plan and “expects losses to increase at a phenomenal rate.”
Interim Payment System If Y2K Problems Arise–
The CHA will ask the General Assembly to approve legislation that would activate a periodic payment system immediately if the payer was unable to pay claims or if the provider was unable to generate claims based on a system of paying 1/52nd of the previous year's billing each week.
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