Author

Brook Raflo

  • Operations

    Bring It On

    One of the most famous commentaries on the pursuit of happiness came from a group of shaggy rock stars in 1969: “You can’t always get what you want,” The Rolling Stones told us. But not getting what we want is only part of the problem, according to Daniel Gilbert, a psychology professor at Harvard. When it comes to predicting happiness, Gilbert says, “The problem is you can’t always know what you want.” At the heart of Gilbert’s theory is the idea that humans tend to overestimate the impact of events — both good and bad — on their lives. We predict that winning the lottery will solve all of our problems. We predict we’ll never recover from the loss of a job or the end...

    Read More →

  • Legislation & Regulation

    Medicare Reform Progress Slow, But Still Going

    Washington After weeks of partisan wrangling, conferees from the House and Senate have reached agreements on several of what they called “non-controversial” Medicare-reform issues, including expansion of the “homebound” definition. With “glass-is-half-full” optimism, Conference Chairman Bill Thomas, R-Calif., touted the accomplishment as a promising sign for the prospect of a final agreement. “We’ve made headway on scores of provisions in eight titles,” he said, “and I am pleased to announce nearly one-third of the Medicare bill has been resolved.” But Thomas’ fellow House Republicans were more inclined to point out the empty half of the glass when they sent a letter to House Speaker Dennis Hastert, R-Ill. In the letter, conservatives warned they would vote against any compromise bill that does not include provisions for...

    Read More →

  • CMS/Medicare

    Medicare Implements HIPAA Contingency Plan

    Baltimore To avoid what one Medicare spokesman called a possible “health care system collapse,” the Centers for Medicare and Medicaid Services will implement a contingency plan that bends a rule the agency itself set in stone more than three years ago. The “transaction and code set” or TCS rule, which federal lawmakers described in the Health Insurance Portability and Accountability Act of 1996, requires that all health care transactions take place electronically and use the same code sets by Oct. 16, 2003. But by mid-September, fewer than 11 percent of the electronic claims that Medicare received were HIPAA-compliant, CMS said, and the threat of a massive backlog forced an agency decision to put the contingency plan in place on the deadline date. The plan will...

    Read More →

  • CMS/Medicare

    Proposed Medicare Cuts Ignore Service

    Baltimore Bi-level respiratory-assist devices with backup, designed to treat patients with severe respiratory conditions, should fall under Medicare’s capped rental reimbursement policy — not under the government’s policy for items requiring “frequent servicing,” the Centers for Medicare and Medicaid Services said. Attempting to rectify what CMS called the “erroneous” classification of these items, the agency published a proposed rule Aug. 22 in the Federal Register. The move essentially would cut Medicare reimbursements for bi-level respiratory-assist devices with backup by approximately 13 percent, CMS explained. However, device manufacturers and home medical equipment providers argued at a 1999 public meeting that these devices merit reimbursement under the “frequent servicing” classification, because ensuring patients’ compliance requires frequent visits from respiratory therapists. CMS disagreed. “No information was presented at...

    Read More →

  • CMS/Medicare

    Scully Acted Improperly, GAO Says

    Washington For the second time this year, Tom Scully, administrator of the Centers for Medicare and Medicaid Services, found himself under the microscope for allegedly compromising Medicare’s contract-procurement process. This time, the U.S. General Accounting Office stepped in to investigate and found that Scully’s actions regarding a nursing home survey contract were “improper.” The GAO’s report, which focused on a September 2002 contract CMS awarded the RAND Corporation, found that Scully undermined the integrity of the contracting process by excluding RAND’s subcontractor — the University of Wisconsin’s Center for Health Systems Research & Analysis — from the contract. While Scully insisted that he based his decision to exclude the Center on the Center’s poor performance on past and ongoing CMS contracts, the GAO found no...

    Read More →