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Published 2/1/2008

Second Look—regulatory

ED overcrowding on the rise, projected to continue
An article in the Wichita Eagle examined the issue of overcrowded hospital emergency departments (EDs). Use of EDs has risen 7 percent over the last decade, and a report published in the Annals of Emergency Medicine found that the visit rate for those 65 and older increased by 26 percent between 1993 and 2003—faster than any other age group. The report projected that ED visits for senior patients could nearly double by 2013. One researcher stated that, given the needs of the senior population and the nature of their medical problems, the current state of overcrowding is likely to continue to escalate dramatically.

Medical liability rates generally holding steady
American Medical News
reports that for the second straight year, medical liability rates are easing, with nearly 84 percent of company-reported rates holding steady or dropping in 2007. In the latest edition of the Medical Liability Monitor survey, 53 percent of insurance companies reported that their premiums did not change, up from 47 percent of insurers in 2006. About one third (31 percent) of companies reduced rates in 2007 compared to less than a quarter (23 percent) of companies in 2006. In 2005, only one in 10 companies reduced its rates. Many experts point to liability tort reform as a primary factor in this trend.

Feb. 27 is deadline to submit claims in Highmark settlement
According to a Pittsburgh Business Times report, physicians have until Feb. 27 to submit claims in a settlement agreement with Highmark Inc. that will pay $9.9 million to approximately 900,000 physicians who allege the insurer shortchanged their reimbursements from 1999 through 2007. The deadline for physicians wishing to object or opt out of the settlement was Jan. 14. The amount each physician will receive is dependent on several factors, including the amount billed to Highmark during the time span. A hearing on the terms will be held Feb. 11 in Miami. Among other terms of the proposed settlement, Highmark will disclose fee schedules to participating physicians; expand arbitration provisions for claim disputes; stop attempting to recover overpayments after 18 months except in cases of fraud; and establish a 12-person physician advisory committee to consult on a variety of matters, such as clinical quality improvements.