Oregon fines insurer for denying women's exams
The State of Oregon requires that health insurers pay for breast exams and Pap smears for women, and the MEGA Life and Heatlth Insurance Company has been fined $40,000 for denying over 800 claims.
“Oregon has decided that breast exams and Pap smears are important elements of a woman’s routine health care, and that’s why they must be included in insurance policies,” says Teresa Miller, Oregon's insurance division administrator.
MEGA Life and Health Insurance company is based in Texas, and has reimbursed those who were denied the claim.
This judgment by the state of Oregon is another example of why it is important for consumers to contact a government agency when they are unhappy with business practices. As shown last month with the United Telecom decision and this decision against MEGA Life, agencies may see patterns to business practices that an individual consumer may not.
“Fortunately, a consumer who was denied coverage brought this to our attention and our investigation was able to help many others," says Miller.
Read more:
Insurer fined for denying breast exams and pap smears. The Lund Report, June 2011.Choosing the right nursing home
Do you have a loved one who needs nursing home services? In Oregon, you have many protections that will help make the tough transition to assisted living more safe and help you make a confident, informed decision.
The State of Oregon coordinates volunteers under a Long-Term Care Ombudsman Program mandated by the Federal Older Americans Act. The office responds to complaints made by or on behalf of the the residents of Oregon's long-term care facilities and helps to seek solutions. Each month, the volunteers make contact with nearly 1,000 of the over 42,000 long-term care residents in Oregon.
The Ombudsman office recommends you take several factors into consideration when choosing a long-term care facility including:
- Reviewing as much data as possible. There are many resources available which will help you get a full picture of the facility: investigation reports, inspection reports, costs and coverage, and complaints. This tool from Medicare allows you to find and compare nursing homes in your area based on quality ratings, health inspection results, staffing data, quality measures, and fire safetry inspecition results.
- Visiting the facility several times. The Ombudsman office suggests that visiting the facility at several different times -- weekends, evenings, mealtimes -- will help paint a more detailed picture of how the facility operates. Larry Minix, chief excecutive of the American Association of Homes and Services for the aging advises "Trust your five senses ... Does it smell like cleaning fluid and urine when you walk in or fried chicken and apple pie? You also want to see an ant farm of activity. Are the staff friendly and interacting with the residents?"
- Reviewing disclosure documents carefully. Long-term care facilities are required to give you a written copy of all policies.
- Asking questions of key facility staff. This questionnaire from Medicare will give you some ideas for questions to ask.
- Contacting the Ombudsman office directly to find out what their interaction has been with the facility, including licensing, investigations and comlaints
In addition to the Oregon state services, the federal government has provided several resources for families looking for a nursing home. This handout (PDF) from Centers for Medicare and Medicaid Services provides information about different levels of facilities dependent on level of help needed, and how to choose and pay for long-term housing.
Additional Resources
Stressful but vital: picking a nursing home. New York Times, 03/20/2010.
Assisted living: Weighing the Options. AARP, 09/2010
The National Consumer Voice for Quality Long-Term Care, a national advocacy group for consumers of long-term care.
The Eldercare Locator, a tool provided by the Department of Health and Human Services which helps you locate local support resources.
32 Oregonians killed from preventable errors last year
In the last year, at least 32 people were killed by preventable medical errors, according to a recent report published by The Oregon Patient Safety Commission.
The Commission was established in 2003 as a join effort between Oregon health care professionals and state legislators. Their goals are to improve patient safety by the creation of a voluntary, confidential adverse event reporting system and sharing evidence-based prevention practices to improve outcomes.
According to their report, hospitals reported 136 incidents in 2009. In 22 percent of cases, patients suffered minimal or no detectable harm. But half of the incidents resulted in serious injury or death. In nine cases, a surgical team operated on the wrong body part or the wrong patient. Surgeons accidentally left objects in patients 21 times – despite the commission setting a target of eliminating this type of error.Oregon hospitals made progress in three other patient safety targets set by the 17-member commission: establishing electronic medical records, adopting evidence-based safety practices, and promoting a workplace culture of safety. According to the report, 61 percent of Oregon hospitals have developed electronic medical record systems with built-in error checking and decision support, significantly more than the national average of 51 percent.
And 87 percent of Oregon hospitals met targets for giving surgical patients antibiotics on time, up from 75 percent compliance at the beginning of 2008. Oregon's performance is about equal to the national average on this measure, the report noted.
However, even with some progress, the process of notifying patients affected by medical errors in writing, is almost nonexistent it Oregon. The report stated that though hospitals verbally inform patients of the mistake, following through with a written report is rare.
Eight hospitals have shown that compliance is possible. They've notified patients of adverse events in writing for every serious harm event since reporting began in 2006, according to the commission.
Read more about how we can make hospitals safer and the full article from The Oregonian.
More nurses per patients lead to safer hospitals
The Minnesota Nurses Association had a tumultuous month. After their demands for a set nurse-to-patient ratio were refused, they planned a strike. Asserting that patient safety was at stake, when the hospitals refused to accept their proposals, the nurses moved ahead with a one-day strike on June 10. The hospitals still refused to budge and the nurses planned to begin an open-ended strike on Tuesday, July 6.
However, Union leaders decided to dropped their demands for rigid nurse-to-patient ratios and established a tentative agreement with the hospitals the day the strike was supposed to begin. (Read more). The hospitals argued that they could not afford to have a set nurse-to-patient ratio and still pay their nurses wages and pensions. But is that true?
