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Health Care

State Highlights: States Seek Health Care Autonomy; L.A. Nursing Home Audit; Promoting Overdose-Reversal Drug

Kaiser Health News - Fri, 08/29/2014 - 9:06am

McClatchy: 9 States Sign Compact To Run Health Care Without Congress
Kansas, Missouri and seven other states have signed on to a movement that would wrest regulation of most of the nation's health care insurance systems from the federal government. Those state legislatures want to be part of a proposed interstate Health Care Compact. The compact would let participating states use federal funds -- in the form of block grants -- to design and operate their own Medicare, Medicaid and other health care programs, except the military's (Stafford, 8/28).

Earlier KHN coverage: Some States Seeking Health Care Compact (Gugliotta, 9/18/11).

Los Angeles Times: Audit Finds Some L.A. County Nursing Home Cases Prematurely Closed
Los Angeles County auditors have found problems with the way the public health department investigates nursing home complaints involving issues of safety, neglect and other problems that could jeopardize the well-being of residents. After reviewing a sampling of cases from 2012 to this year, they found that some were "inappropriately" closed without a full investigation, according to an audit report released this week. In others -- including five that involved patient deaths -- inspectors wrote up problems or issued citations, but the findings were downgraded by department supervisors, sometimes without discussing the changes with the issuing inspector (Sewell and Brown, 8/28).

California Healthline: Statewide Rural Health Association Returns
The numerous far-flung health care providers and community organizations that make up California's rural health landscape may soon once again have a single, integrated association working to bring a cohesive voice to all. After closing last year with insufficient funding and soaring debt, the California State Rural Health Association is slowly becoming active again. A website was launched this week, a 13-member board has been established and the group is planning a conference by the end of the year (Mack, 8/28).

PBS NewsHour: On The Front Lines Of Care For Undocumented Children Who Cross The Border
The U.S. Border Patrol has apprehended nearly 63,000 unaccompanied children at the southwest border just this year.  Many of them are then relocated to various cities across the country, creating a growing need for health care and education (8/28).

Kaiser Health News: Calif. Bill Would Protect Estates Of Many Who Received Medicaid
A bill passed by the California legislature this week is putting Gov. Jerry Brown in a delicate position: Sign the measure and support consumer demands for a change in the state’s policy on recovering assets from Medicaid enrollees or keep the current system that generates about $30 million used to provide Medicaid benefits to more residents (Bartolone, 8/28).

Kaiser Health News: Capsules: In Texas, New Doctor-Restrictive Abortion Law Could Kick In Monday
A federal judge in Austin, Texas, will issue a decision in the next few days about whether clinics that perform abortion in the state must become outpatient surgery centers. The Texas law is part of a national trend, in which state legislatures seek to regulate doctors and their offices instead of women seeking abortions" (Feibel, 8/28).

The Wall Street Journal: States Expand Access To Overdose-Reversal Drug
Faced with an unrelenting epidemic of heroin and pain-pill deaths, many states are pushing to make more widely available a drug called naloxone that can reverse overdoses from such opioid drugs within minutes. ... There are now 24 states, along with the District of Columbia, that have passed laws expanding access to naloxone, 17 of them in the last two years, said Corey Davis, deputy director of the Network for Public Health Law's Southeastern region, who tracks such policies. The measures vary, but common provisions include allowing doctors to prescribe naloxone to a drug user's friends and family members, and removing legal liability for prescribers and those who administer the medication (Campo-Flores and Elinson, 8/28).

The Washington Post: Justice Officials Call For Release Of Monitoring Of St. Elizabeths
The Justice Department said Thursday that St. Elizabeths Hospital has made "significant improvements" in the care of its patients and asked a federal judge to discontinue the agency's monitoring of the facility (Alexander, 8/28).

Miami Herald: Low-Income Patients Face Hurdles To Care At Public Hospital In Miami
Demanding onerous paperwork from low-income applicants is just one way that Jackson has barred eligible Miami-Dade residents from accessing the charity care program, according to administrative complaints filed this week with the Internal Revenue Service and the U.S. Department of Health and Human Services. The complaints lodged by Florida Legal Services and the National Health Law Program, nonprofit groups that provide civil legal help to the indigent, allege that Jackson fails to meet new requirements for nonprofit hospitals under the Affordable Care Act and other laws (Chang, 8/28).

Georgia Health News: State Health Agency Outlines Spending Increases
A state health agency is budgeting an extra $24 million this fiscal year, and a similar amount next year, to pay for costly hepatitis C drugs in Georgia's Medicaid program. The state is also expected to pay $14.1 million more this year, and $37.9 million in fiscal 2016, for lengthening the time between eligibility reviews for Medicaid and PeachCare beneficiaries, as required by the Affordable Care Act (Miller, 8/28).

Boston Globe: Boston EMS Workers OK Pay Raise
Workers in Boston's Emergency Medical Services will receive a pay raise of nearly 15 percent over six years under a newly settled contract with Mayor Martin J. Walsh. The deal will cover roughly 315 paramedics, emergency medical technicians, and their supervisors. It includes 14 percent in raises spread over six years in addition to a 0.75 percent increase in weekly compensation for hazardous duty pay in July 2016 (Ryan, 8/29).

Categories: Health Care

Viewpoints: GOP's 2015 Obamacare Plan; The Need For Community Health Workers

Kaiser Health News - Fri, 08/29/2014 - 9:05am

The Washington Post's Plum Line: Another Big Boost For Obamacare
In another sign that the politics of Obamacare continue to shift, the Medicaid expansion is now all but certain to come to another big state whose Republican governor had previously resisted it: Pennsylvania. ... The details of the final deal will matter. But broadly speaking this looks like another sign of just how hard it is for Republican governors in non-deep-red states to resist the expansion — and of how the politics of this issue continue to change (Greg Sargent, 8/28).

Bloomberg: The Republican Obamacare Battle Plan For 2015
Public opinion suggests people are more interested in "fixing" Obamacare than in completely scrapping it; and by 2015, almost 25 million Americans will be relying on it for health coverage. Those are reasons Republicans should aim to reform or replace portions of the Affordable Care Act .... At the end of the day, congressional Republicans have a chance to show they are prepared not just to oppose Obamacare but also to pass policies to help lower health-care costs, expand access to affordable private coverage and improve the system generally. All of these efforts should begin with the states (Lanhee Chen, 8/28).

The New York Times: Is 'Obamacare' No Longer A Big Deal?
It looks as though Republicans are no longer betting on the Affordable Care Act as a surefire political weapon. The Upshot reported on Wednesday that, in the summer of 2013, lawmakers churned out 530 news releases using the term "Obamacare." So far this summer, in advance of the mid-terms when one might expect that number to go up, it's fallen dramatically, to 138 (Juliet Lapidos, 8/28).

The New York Times: What Doctors Can't Do
Many poor countries use [community health workers] on an enormous scale — in rural areas, where doctors and nurses are scarce, a C.H.W. often serves as the doctor. In the United States, their role is different. ... They're chosen for their ability to listen, support and encourage, without judgment. ... This is a crucial role in a country where vast numbers of people are sick with chronic lifestyle-related diseases. Doctors can't help patients change their behavior in the 15 minutes they spend with each patient. But community health workers can (Tina Rosenberg, 8/28).

The New York Times: An Ominous Ebola Forecast
The World Health Organization warned on Thursday that the Ebola epidemic in West Africa, already the largest outbreak ever recorded, is going to get much worse over the next six months, the shortest window in which it might conceivably be brought under control. By then, the organization said, the virus could infect more than 20,000 people, almost seven times the current number of reported cases. It is a frightening prospect that requires an urgent infusion of aid from public and private donors around the world (8/28).

Los Angeles Times: WHO's Misplaced Ebola Priority
The World Health Organization is nothing if not opportunistic, impulsively jumping on every public health issue that makes the front page. And, of course, it always calls for lots more money to throw at the disease-of-the-month. The latest on WHO's radar is the Ebola virus outbreak in West Africa, which has tallied about 1,500 cases. To address it, WHO wants more than $430 million ... in a world of limited healthcare resources, we need to make hard decisions that will deliver high-impact outcomes for the most people at the least cost (Dr. Henry I. Miller, 8/28).

The Washington Post's Federal Diary: VA Is Looking For A Few Good Doctors And Nurses
One of the first steps to rebuilding confidence in the scandal-plagued Department of Veterans Affairs is getting enough of the right people to do the job. VA Secretary Robert A. McDonald is trying to do that by launching a new recruitment effort to boost the number of medical professionals. ... Working against him is an agency image that has been battered by a series of congressional hearings and reports about employees gaming the system to make it appear vets were getting care much sooner that they really did (Joe Davidson, 8/28).

JAMA: The PCORI Perspective On Patient-Centered Outcomes Research  
The Patient-Centered Outcomes Research Institute (PCORI) was established as part of the US Patient Protection and Affordable Care Act of 2010 to fund patient-centered comparative clinical effectiveness research, extending the concept of patient-centeredness from health care delivery to health care research. In the United States, patient-centered outcomes research is new and not defined in the legislation, and the rationale is unclear to many. In this Viewpoint, we address 2 related questions: What does patient-centeredness in research mean? Why conduct patient-centered outcomes research? (Lori Frank, Drs. Ethan Basch and Joe V. Selby, 8/28)

Categories: Health Care

Research Roundup: Benefits Of Hip Surgery; Preventing Surgical Infections

Kaiser Health News - Fri, 08/29/2014 - 8:58am

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Clinical Orthopaedics And Related Research: Surgery For Hip Fracture Yields Societal Benefits That Exceed The Direct Medical Costs
Surgical treatment of hip fractures can achieve better survival and functional outcomes than nonoperative treatment, but less is known about its economic benefits. ... We estimated the effects of surgical treatment for displaced hip fractures through a Markov cohort analysis of patients 65 years and older. ... Estimated average lifetime societal benefits per patient exceeded the direct medical costs of hip fracture surgery by $65,000 to $68,000 for displaced hip fractures. With the exception of the assumption of nursing home use, the sensitivity analyses show that surgery produces positive net societal savings (Gu, Koenig, Mather and Tongue, 8/5).

JAMA Surgery: The Preventive Surgical Site Infection Bundle In Colorectal Surgery
Surgical site infections (SSIs) are associated with increased morbidity, length of hospitalization, readmission rates, and health care costs. They represent a particularly important problem in colorectal surgery, for which SSI rates are disproportionately high, ranging from 15% to 30%. ... To a large degree, the focus [of reducing SSIs] has been on improving adherence to evidence-based practices ... The preventive SSI [systemic, evidence-based measures called] the bundle was associated with a substantial reduction in SSIs after colorectal surgery. The increased costs associated with SSIs support that the bundle represents an effective approach to reduce health care costs (Keenan et al., 8/27).

Medicare and Medicaid Research Review: Financial And Quality Impacts Of The Medicare Physician Group Practice Demonstration
[The health law's Accountable Care Organization program] was built directly on its predecessor, the Medicare Physician Group Practice (PGP) demonstration .... This article presents the results of the comprehensive CMS-funded evaluation of the PGP demonstration ... The overall impact ... was a savings of $171 per assigned beneficiary person year during the demonstration performance period .... This represents a savings of 2.0 percent of assigned beneficiary expenditures. CMS paid performance bonuses to the participating PGPs that averaged $102 per assigned beneficiary person year across the five demonstration years (Pope et al., 8/28).

Medical Care: The Intended And Unintended Consequences Of Quality Improvement Interventions For Small Practices In A Community-based Electronic Health Record Implementation Project
Despite the rapid rise in the implementation of electronic health records (EHR), commensurate improvements in health care quality have not been consistently observed. ...  The study included 143 practices that implemented EHRs .... 71 practices were randomized to receive financial incentives and quality feedback and 72 were randomized to feedback alone. ... Technical assistance and financial incentives—alongside EHR implementation—can improve quality of care. Financial incentives for quality may not result in similar improvements for incentivized and unincentivized measures (Ryan et al., 8/27).

Infection Control and Hospital Epidemiology/Rand Corp.: The Association Of State Legal Mandates For Data Submission of Central Line–Associated Bloodstream Infections In Neonatal Intensive Care Units With Process And Outcomes Measures
[This cross sectional study was designed] to determine the association between state legal mandates for data submission of central line–associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) with process and outcome measures. ... Among 190 study NICUs, 107 (56.3%) were located in states with mandates, with mandates in place >3 years in 52 (49%). ... Mandates were predictors of ≥95% compliance with all practices (Zachariah et al., 8/22).

Here is a selection of news coverage of other recent research:

MedPage Today: Surgery No Help For Mild Knee OA
Arthroscopic surgery for degenerative meniscal tears in patients with mild knee osteoarthritis had no benefit for function or pain, a meta-analysis determined. In randomized trials that included 805 patients, the standardized mean difference for function at 6 months was 0.25, which was converted to a Knee Injury and Osteoarthritis Outcome Score of 5.6. That did not reach the minimally important difference of 10 (Walsh, 8/27).

Fox News: Teens With Depression Benefit From 'Collaborative Care'
For teenagers with depression, finding and sticking with an effective treatment strategy can be an uphill battle. Their families often struggle to find a professional who can treat depression in adolescents, is accepting new patients and is covered by their insurance. ... But an idea called "collaborative care" — which increases communication between families and doctors — may help bridge that gap, said [Dr. Laura Richardson, a professor of pediatrics at Seattle Children's Hospital and the University of Washington in Seattle], who co-authored a new study detailing the findings, published today (Aug. 26) in the journal JAMA (Geggel, 8/26).

MinnPost:  Study Links Early-To-Midlife Obesity To Increased Risk Of Dementia
People who are obese in their early to midlife adult years have an increased risk of developing dementia, and the risk is especially high for people who are obese in their 30s, according to a study published [last] week. The study also found that people who become obese late in life have a decreased risk of developing dementia, particularly Alzheimer’s disease (Perry, 8/22).

Reuters: More Parents Think Their Overweight Child Is 'About Right'
Between 1988 and 2010, the number of parents who could correctly identify their children as overweight or obese went down, according to a new study. ... In the 1988 to 1994 data set, 78 percent of parents of an overweight boy and 61 percent of parents of an overweight girl, identified the child as "about the right weight." That number increased to 83 percent for boys and 78 percent for girls in the 2005 to 2010 period (Doyle, 8/26).

Reuters: Medicaid Payouts For Office Visits May Influence Cancer Screening: Study
In states where Medicaid pays doctors higher fees for office visits, Medicaid beneficiaries are more likely to be screened for breast, cervical or colorectal cancer, according to a new study. “States tend to vary in their reimbursement rates for different types of medical care services; some states may have low reimbursements for certain services and higher reimbursements for others,” said lead author Dr. Michael T. Halpern of the Division of Health Services and Social Policy Research at RTI International (Doyle, 8/26).

Medscape: Futile Treatment Delays Care For Others Waiting For ICU Beds
Patients in intensive care units (ICU) receiving futile treatment delayed or prevented ICU treatment for others in need of intensive care, a study published in the September issue of Critical Care Medicine has revealed (Laidman, 8/28).

Categories: Health Care

NIH To Begin Trials For Experimental Ebola Vaccine

Kaiser Health News - Fri, 08/29/2014 - 8:54am

The announcement about the testing comes as the outbreak in West Africa grows. The World Health Organizations says it could have infected more than 20,000 people.

The Wall Street Journal: Testing On Experimental Ebola Vaccine To Begin in U.S.
The National Institutes of Health said Thursday it will begin testing an experimental Ebola vaccine in humans next week, accelerating research as an epidemic caused by the deadly virus continues to ravage West Africa (McKay, 8/28).

Los Angeles Times: NIH To Launch Ebola Vaccine Trials In Humans
The National Institutes of Health has announced the first clinical trial of a vaccine to protect healthy people from infection by the Ebola virus, which is responsible for an estimated 1,550 deaths throughout West Africa. NIH director Francis Collins on Thursday called the human safety trials, which are to start next week in Bethesda, Md., the latest in a series of the "extraordinary measures to accelerate the pace of vaccine clinical trials" for the public health emergency in Africa (Healy, 8/28).

The Hill: NIH Accelerates Ebola Vaccine Development
The government is speeding up its development of several potential Ebola vaccines in response to the largest ever outbreak of the virus in West Africa. The National Institutes of Health (NIH) confirmed Thursday that it will start testing a vaccine candidate on humans next week for the first time ever (Viebeck, 8/28).

The New York Times: Ebola Could Strike 20,000, World Health Agency Says
The World Health Organization said on Thursday that the Ebola epidemic was still accelerating and could afflict more than 20,000 people -- almost seven times the current number of reported cases -- before it could be brought under control (Cumming-Bruce and Cowell, 8/28).

Categories: Health Care

FDA Plan To Diversify Clinical Trials Raises Some Concerns

Kaiser Health News - Fri, 08/29/2014 - 8:42am

Women's advocacy groups complain that the plan doesn't have "teeth" needed to make a change.

The Wall Street Journal: FDA Is Chastised Over Its 'Action Plan' To Diversify Clinical Trial Participation
In response to a law passed two years ago, the FDA was directed to assess the extent to which women and minorities are represented in clinical trials and also devise a plan to bolster their participation. ... the FDA released its plan the other day and it was met with what could best be described as faint praise. In particular, a pair of women's advocacy groups says the biggest issue is that the so-called Action Plan lacks the sort of teeth needed to generate real change. They also complain the plan fails to require drug and device makers to contain specific demographic information in product labeling (Silverman, 8/28).

Categories: Health Care

Texas Hospitals Complain Insured Patients Moving To Urgent Care Centers

Kaiser Health News - Fri, 08/29/2014 - 8:39am

The hospitals complain that the shift is a problem because they are getting less funding for the uninsured.

The New York Times/Texas Tribune: Texas Hospitals Say They've Lost Insured Patients To Urgent Care
Opting to skip the wait at hospital emergency rooms, an increasing number of Texans are choosing to use urgent care centers that are popping up in strip malls and shopping districts. ... The increasing number of urgent care centers is problematic for Texas hospitals. Hospitals say they are competing with the clinics for the same pool of insured Texans, at a time when they are also getting less money to cover the cost of treating uninsured patients (Ura, 8/28).

Also, KHN examines a change mandated by the health law on ER services.

Kaiser Health News: Beware Of Higher Charges If You Go To An Out-Of-Network Emergency Room
When you need emergency care, chances are you aren't going to pause to figure out whether the nearest hospital is in your health insurer's network. Nor should you. That's why the health law prohibits insurers from charging higher copayments or coinsurance for out-of-network emergency care. ... But there are some potential trouble spots that could leave you on the hook for substantially higher charges than you might expect (Andrews, 8/29).

Categories: Health Care

First Edition: August 29, 2014

Kaiser Health News - Fri, 08/29/2014 - 7:24am

Today's early morning highlights from the major news organizations, including reports about the Obama administration and Pennsylvania reaching an agreement to expand Medicaid in that state.

Kaiser Health News: Beware Of Higher Charges If You Go To An Out-Of-Network Emergency Room
Kaiser Health News' consumer columnist Michelle Andrews reports: "When you need emergency care, chances are you aren’t going to pause to figure out whether the nearest hospital is in your health insurer’s network. Nor should you. That’s why the health law prohibits insurers from charging higher copayments or coinsurance for out-of-network emergency care. ... But there are some potential trouble spots that could leave you on the hook for substantially higher charges than you might expect" (Andrews, 8/29). Read the story.

Kaiser Health News: Calif. Bill Would Protect Estates Of Many Who Received Medicaid
Capital Public Radio’s Pauline Bartolone, working in collaboration with Kaiser Health News and NPR, reports: "A bill passed by the California legislature this week is putting Gov. Jerry Brown in a delicate position: Sign the measure and support consumer demands for a change in the state’s policy on recovering assets from Medicaid enrollees or keep the current system that generates about $30 million used to provide Medicaid benefits to more residents (Bartolone, 8/28). Read the story.

Kaiser Health News: Capsules: In Texas, New Doctor-Restrictive Abortion Law Could Kick In Monday
Now on Kaiser Health News' blog, KUHF's Carrie Feibel, working in collaboration with Kaiser Health News and NPR, reports: "A federal judge in Austin, Texas, will issue a decision in the next few days about whether clinics that perform abortion in the state must become outpatient surgery centers. The Texas law is part of a national trend, in which state legislatures seek to regulate doctors and their offices instead of women seeking abortions" (Feibel, 8/28). Read the story.

The New York Times: Pennsylvania To Purchase Private Care For Its Poor
Pennsylvania will become the 27th state to expand Medicaid under the Affordable Care Act, the Obama administration announced Thursday, using federal funds to buy private health insurance for about 500,000 low-income residents starting next year. Gov. Tom Corbett, a Republican, had proposed the plan as an alternative to expanding traditional Medicaid under the health care law, which he opposes. Now that federal officials have signed off, Pennsylvania will join Arkansas and Iowa in using Medicaid funds to buy private coverage for the poor (Goodnough, 8/28).

The Wall Street Journal: Obama Administration, Pennsylvania Governor Reach Deal To Expand Medicaid
Pennsylvania Gov. Tom Corbett reached a deal with the Obama administration to extend the state's Medicaid program to half a million low-income residents under the Affordable Care Act, officials said Thursday. Pennsylvania is now the 27th state to agree to broaden Medicaid to include everyone earning up to a third more than the federal poverty level, or around $16,000 for a single adult. The agreement makes Mr. Corbett, a Republican, the ninth GOP governor to go along with a central part of the 2010 health-care law (Radnofsky, 8/28).

The Washington Post: Pennsylvania's Republican Governor Expands Medicaid
Pennsylvania Gov. Tom Corbett had sought the Obama administration's permission to use money authorized by the Affordable Care Act to purchase private health insurance for poor adults. With Thursday's announcement, Corbett and the federal Centers for Medicare and Medicaid Services instead agreed to a plan to expand the program through managed care organizations. ... Medicaid coverage for Pennsylvania adults earning below 133 percent of the federal poverty line, or about $15,500, will begin in January. Starting in 2016, adults earning above the federal poverty line will have to pay premiums worth no more than 2 percent of household income. Those adults can be dropped from the program for failing to pay premiums, but they can also receive discounts for healthy behaviors, like going for a check-up (Millman, 8/28).

Philadelphia Inquirer: Feds Approve Corbett's Pa. Medicaid Expansion Proposal
In what was described as a five-year demonstration project, Pennsylvania got the go-ahead to use federal money to pay private insurers to provide health care to uninsured individuals - many in low-wage jobs. ... But whether the Healthy PA program will roll out Jan. 1 as scheduled could depend on voters. Polls show Corbett facing a double-digit deficit in his bid for reelection. His Democratic challenger, Tom Wolf, has said he supports the traditional Medicaid expansion that 26 states and the District of Columbia have already approved (Worden, 8/28).

The Wall Street Journal: CBO Director: Political Divide Makes Fiscal Progress 'Very Hard'
[Congressional Budget Office Director Douglas] Elmendorf said it was impossible to tell whether his agency’s 2009 and 2010 assessments of the Affordable Care Act were – in retrospect – accurate, because parts of the law are only beginning to take effect and also because it is difficult to measure what programs like Medicare would look like without the ACA changes. “We don’t know, and I think in some important ways, we will never know,” Mr. Elmendorf said. He said CBO’s projections for the number of people who would enroll in insurance exchanges established by the ACA have turned out to be very accurate. He also said they stand by their estimate that the law – in its entirety – will reduce the government’s deficit over its first two decades (Paletta, 8/28).

The New York Times/Texas Tribune: Texas Hospitals Say They've Lost Insured Patients To Urgent Care
Opting to skip the wait at hospital emergency rooms, an increasing number of Texans are choosing to use urgent care centers that are popping up in strip malls and shopping districts. ... The increasing number of urgent care centers is problematic for Texas hospitals. Hospitals say they are competing with the clinics for the same pool of insured Texans, at a time when they are also getting less money to cover the cost of treating uninsured patients (Ura, 8/28).

USA Today: If 'Clean,' Big Data Can Improve U.S. Health Care
Less medical privacy may be good for your health. A growing body of research has found that information Americans share on social media websites about their health and lifestyle is more up to date and accurate than what they share with doctors, employers, insurance companies and government agencies. In other words, we're more honest with our friends than we are with those who control our access to medical care (Shinal, 8/28).

The Wall Street Journal: States Expand Access To Overdose-Reversal Drug
Faced with an unrelenting epidemic of heroin and pain-pill deaths, many states are pushing to make more widely available a drug called naloxone that can reverse overdoses from such opioid drugs within minutes. ... There are now 24 states, along with the District of Columbia, that have passed laws expanding access to naloxone, 17 of them in the last two years, said Corey Davis, deputy director of the Network for Public Health Law's Southeastern region, who tracks such policies. The measures vary, but common provisions include allowing doctors to prescribe naloxone to a drug user's friends and family members, and removing legal liability for prescribers and those who administer the medication (Campo-Flores and Elinson, 8/28).

The New York Times: Ebola Could Strike 20,000, World Health Agency Says
The World Health Organization said on Thursday that the Ebola epidemic was still accelerating and could afflict more than 20,000 people — almost seven times the current number of reported cases — before it could be brought under control (Cumming-Bruce and Cowell, 8/28).

The Wall Street Journal: Testing On Experimental Ebola Vaccine To Begin in U.S.
The National Institutes of Health said Thursday it will begin testing an experimental Ebola vaccine in humans next week, accelerating research as an epidemic caused by the deadly virus continues to ravage West Africa (McKay, 8/28).

Check out all of Kaiser Health News' e-mail options including First Edition and Breaking News alerts on our Subscriptions page.

Categories: Health Care

Beware Of Higher Charges If You Go To An Out-Of-Network Emergency Room

Kaiser Health News - Fri, 08/29/2014 - 5:03am

When you need emergency care, chances are you aren’t going to pause to figure out whether the nearest hospital is in your health insurer’s network. Nor should you. That’s why the health law prohibits insurers from charging higher copayments or coinsurance for out-of-network emergency care. The law also prohibits plans from requiring pre-approval to visit an emergency department that is out of your provider network.  (Plans that are grandfathered under the law don’t have to abide by these provisions.)

That’s all well and good. But there are some potential trouble spots that could leave you on the hook for substantially higher charges than you might expect. 

Although the law protects patients from higher out-of-network cost sharing in the emergency room, if they’re admitted to the hospital, patients may owe out-of-network rates for the hospital stay, says Angela Gardner, an associate professor of emergency medicine at the University of Texas Southwestern in Dallas who is the former president of the American College of Emergency Physicians.

“Even if the admission is warranted, you are subject to those charges,” she says

More From This Series Insuring Your Health

If you live in a state that permits balance billing by out-of-network providers, your financial exposure could be even greater. In a balance-billing situation, a hospital may try to collect from the patient the difference between what the hospital billed and what the health plan paid for care. Such practices aren’t generally allowed if a consumer visits an in-network provider.

Consumers shouldn’t expect that the hospital will inform them of potential out-of-network coverage issues, so they need to inquire, says Gardner.

“At least being informed and knowing what you’re getting into can set you up to handle it with your insurer,” she says.

And while you’re at it check into being transferred to an in-network facility if it’s feasible.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

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