Friday, December 30, 2011

Interesting Developments

Prescription benefits manager Express Scripts and pharmacy chain Walgreens continue to stare each other down. The AP reports this afternoon that
Walgreen CEO Greg Wasson said Friday chances are probably "slim to none" that the drugstore operator will reach an agreement with pharmacy benefits manager Express Scripts before their current contract ends Saturday.
Walgreen Co. announced that it is taking several steps to help patients covered by an Express Scripts pharmacy network to continue to use Walgreen locations after the agreement ends. It expects to keep more than 120 Express Scripts clients, which include employers and health plans.
Walgreen has said it expects about keep about 10 million of the prescriptions it fills for Express Scripts. It filled about 88 million prescriptions in fiscal 2011, so that would amount to a loss of almost 90 percent of the prescriptions.
That's a lot of revenue to lose.

CMS dropped Chickasaw Nations Industries as the Medicare Secondary Payer Recovery Contract effective September 30, 2011, and it has issued an RFP to combine the secondary payer recovery and coordination of benefits functions according to the Medivest Blog. In the meantime, GHI is performing this combined contract.  Senator Claire McCaskill explained the Government's dissatisfaction with CNI in this fact sheet. Personal injury lawyers with aged clients have been having problems with delays encountered in trying to settle Medicare liens against tort recoveries -- at topic discussed at Congressional hearing in June 2011.

The National Quality Forum has released a 2011 update to its list of Serious Reportable Events in Healthcare, such as wrong site surgeries and medication errors. The AMA News explains that
Hospitals in 24 states and the District of Columbia are required to report on some version of the National Quality Forum's list, and items from the list have been selected for nonpayment by private health plans, Medicare and many state Medicaid programs. Four new items -- part of the first update to the list since 2006 -- are:
  • Death or serious injury of a new born baby associated with labor or delivery in a low-risk pregnancy.
  • Patient death or serious injury resulting from the irretrievable loss of an irreplaceable biological specimen (e.g., for a biopsy).
  • Patient death or serious injury resulting from failure to follow up or communicate laboratory, pathology or radiology test results.
  • Death or serious injury of a patient or staff associated with the introduction of a metallic object into the magnetic resonance imaging area.
The list now contains 29 serious reportable events.
Happy New Year!

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