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Reforming Medicare Physician Payment: Fixing SGR While Improving Care

Brookings Institute -- Medicare - Wed, 01/28/2015 - 9:15am

Event Information

January 28, 2015
9:15 AM - 1:00 AM EST

Room SVC 201-00
Capitol Visitor’s Center
First St SE
Washington, DC 20515

The Medicare Sustainable Growth Rate (SGR) is poised to trigger a 21 percent across-the-board cut to physician payments if Congress does not act by March 30. Each year since 2003, Congress has bypassed the draconian cuts by implementing a short-term “doc fix” legislation; an approach that leads to unpredictability for providers, Congressional inefficiency and missed opportunities for improvements in care delivery. In 2013, a tri-committee bill was developed to permanently fix the SGR, including the adoption of value-based payment models such as bundled payments, medical homes and accountable care models. However, due to the surmounting cost of a permanent solution -- over $100 billion -- the prospect of a long-term solution is daunting.

On January 28, the Engelberg Center for Health Care Reform hosted an event that convened clinicians, payers and policy experts to discuss feasible strategies for permanently solving the SGR problem. It included remarks from Patrick Conway of the Centers for Medicare and Medicaid Services and Hon. Michael Burgess (R-TX) and Gene Greene (D-TX) from the U.S. House of Representatives.

Download the discussion paper from the event, "Medicare Physician Payment Reform: Securing the Connection Between Value and Payment."

Download Alice Rivlin's prepared testimony to the House Energy and Commerce Committee Subcommittee on Health, "A Permanent Solution to the SGR: The Time is Now."

Event video coming soon.

Event Materials         
Categories: Elder

If Supreme Court Rules Against Insurance Subsidies, Most Want Them Restored

Kaiser Health News - Wed, 01/28/2015 - 5:00am

A new poll finds that most people think Congress or states should act to restore health insurance subsidies if the Supreme Court decides later this year they are not permitted in states where the federal government is running the marketplace.

The court in March is set to hear King v. Burwell, a lawsuit arguing that the wording of the Affordable Care Act means that financial assistance with premiums is available only in the 13 states that created and are running their own online insurance exchanges. If the court sides with those challenging the law, millions of people in the 37 states that use the federal Healthcare.gov site would lose the help they have been getting. A decision in the case is expected in late June.

Less than half the respondents in the monthly tracking poll by the Kaiser Family Foundation said they had heard about the case. (Kaiser Health News is an editorially independent project of the foundation.) But if the court were to invalidate subsidies in the federally run states, 64 percent said Congress should restore them, and 59 percent said states should create their own exchanges.

This KHN story can be republished for free (details).

Democrats and Independents are most strongly in favor of ensuring that subsidies are available in every state if the court rules otherwise. But 40 percent of Republicans said Congress should act to address the issue, and 51 percent of Republicans said states should act if the Supreme Court makes subsidies unavailable in states using Healthcare.gov.

In fact, it may not be that easy. Republicans in Congress say they are preparing their own health law alternative in the event the court invalidates the subsidies, while in several states, legislative action would be needed. Most legislative sessions conclude by late June.

The poll also found that many of those at risk of losing their financial aid aren’t aware of it. Only a third of those in federally run states know their exchange is run by the federal government, while 39 percent incorrectly thought their state runs its own exchange. Another 28 percent said they didn’t know. Meanwhile, the U.S. Department of Health and Human Services reported Tuesday that just over 7 million people are signed up for coverage through the federal marketplace, with less than a month to go in the current open enrollment season. An estimated 87 percent of those people are eligible for subsidies, with coverage at risk depending on how the court rules.

Overall, awareness of the law and its requirements continues to lag. Only 17 percent of those without insurance were able to correctly identify Feb. 15 as the last day to sign up for coverage for 2015, and only 42 percent are aware that financial help is available to pay premiums.

Kaiser polled a nationally representative sample of adults by phone between Jan. 15 and 21. The poll has a margin of error of plus or minus three percentage points for the full sample.

Categories: Health Care

Industry Group to Back Results-Focused Care

Medicare -- New York Times - Wed, 01/28/2015 - 12:00am
The new coalition said it is committed to finding a way to change financial incentives, moving the bulk of payments to so-called “value-based” arrangements by 2020.
Categories: Elder, Medicare

Texas Court Denies Death Penalty Appeal of Intellectually Disabled Man

ACLU -- Death Penalty News - Tue, 01/27/2015 - 5:15pm

Court Standards for Determining Intellectual Disability Drawn From Novella 'Of Mice and Men'

January 27, 2015

FOR IMMEDIATE RELEASE
CONTACT: 212-549-266, media@aclu.org

NEW YORK – Robert Ladd, an intellectually disabled person with an IQ of 67, was denied a stay of execution today by the Texas Court of Criminal Appeals. Although in any other state he would be considered ineligible for the death penalty because of his intellectual disability, Ladd doesn't meet the Texas courts' standards to determine whether a person is intellectually disabled, which were drawn in part on the character Lennie Small in "Of Mice and Men" by John Steinbeck. Ladd will be executed by the state of Texas at 6:00 pm CT on Thursday, January 29, unless courts intervene.

"This case is indeed stranger than fiction. Anywhere else in the country, Mr. Ladd's IQ of 67 would have meant a life sentence, not death," said Brian Stull, senior staff attorney with the ACLU's Capital Punishment Project and Ladd's attorney. "But the Texas courts insist on severely misjudging his intellectual capacity, relying on standards for gauging intelligence crafted from 'Of Mice and Men' and other sources that have nothing to do with science or medicine. Robert Ladd's fate shouldn't depend on a novella."

The Supreme Court has twice ruled to protect the intellectually disabled from capital punishment: Atkins v. Virginia (2002) and Hall v. Florida(2014). Those decisions should exempt Mr. Ladd from the death penalty, as he was labeled "fairly obviously retarded" at age 13 by the Texas Youth Commission in 1970. After the Atkins decision, the psychiatrist who had examined Mr. Ladd reviewed his notes and reaffirmed his initial diagnosis in an affidavit, stating his IQ test and "three separate interviews confirmed my diagnosis of mental retardation." At age 36, Mr. Ladd qualified for services at the Andrews Center in Tyler, Texas, which assists the intellectually disabled as well as the mentally ill.

"Robert Ladd's life is full of evidence of his intellectual disability, and he doesn't belong on death row," said Stull. "We will continue to ask the courts to uphold the protections of Atkins and Hall to spare him from execution."

For more information about the case Ex Parte Ladd, visit: https://www.aclu.org/capital-punishment/ex-parte-ladd

For information about the ACLU’s Capital Punishment Project, visit: https://www.aclu.org/capital-punishment

Categories: Prisoners Rights

FALQs: Cuban Legal System

In Custodia Legis - Tue, 01/27/2015 - 4:01pm

The following is a guest post by Gustavo Guerra, a foreign law specialist covering a number of Spanish-speaking jurisdictions at the Law Library of Congress.  It is the second post in our “Frequently Asked Legal Questions” series, following on from our post yesterday on French terrorism laws.  As always, we welcome your feedback and suggestions for this series!

Photo by Flickr user Stewart Cutler, Sept. 1, 2009. Used under Creative Commons License, https://creativecommons.org/licenses/by-nc-sa/2.0/.

In light of initiatives to improve relations between the United States and Cuba, and the recent visit of a U.S. government delegation to Havana, I decided to provide answers to a few questions about the Cuban legal system and where one could locate Cuban laws and information about them. Most of the links used in this post lead to websites maintained by the Cuban government, and we cannot be sure that all information is recent or up to date. Please use this post for information purposes only.

1.  What are some of the major principles of the Cuban legal system?

Cuba is governed by a legal system based on principles derived from European Continental law, also known as civil law, which has been adapted to the socialist system. According to the Cuban Constitution, major principles include strict regulation of personal property, an economic system based on the “socialist property of the people over the fundamental means of production” (arts. 14, 21), government control of the economy (art. 16), and certain rights for citizens, including the right to education and health (Chapter VII, arts. 50, 51). The Constitution states that the Communist party is the leading and guiding force in the Cuban society (art. 5). The Constitution of Cuba was passed in 1976, and then substantially amended in 1992 and 2002. Among other major principles, the Cuban government states that the legal system includes:

  • Independence of judges;
  • Administration of justice by professional judges with support from citizens; and
  • Availability of an appeal process for all disputed judicial decisions.

2.  How are legal disputes resolved in Cuba?

Disputes are adjudicated by Cuba’s judiciary, which is comprised of courts at the municipal and regional levels with authority to hear cases on criminal and civil matters, and by the Supreme Court, the highest judicial body in the country.  The Supreme Court has the authority to hear appeals derived from cases originated in the lower courts as well as having original jurisdiction for certain cases that fall under its authority. Information on the Cuban judicial system is available on EcuRed, a website maintained by the Cuban government.

We are often asked for help locating information on cases adjudicated by the Cuban Supreme Court. The Supreme Court publishes select recent decisions on its website. Additionally, the Court publishes a biannual review of its rulings and practices in applying and interpreting the law. It is mandatory for all lower courts to follow guidance issued by the Supreme Court.

3.  How are Cuban laws codified?

Cuba has enacted a number of codes that compile rules on specific topics and serve as major legal acts regulating a particular area of law. For example, personal and real property, intestate successions, wills, and contracts are governed by the Civil Code.

The Family Code regulates domestic relations, including marriage and parentage, and is available in Spanish on the website of Cuba’s Supreme Court.

The Criminal Code defines acts that constitute criminal offenses and provides for applicable penalties.

Cuba’s Labor Code is the main body of law on labor matters in Cuba. It regulates unions, labor contracts, salaries, overtime pay, workers’ compensation, dispute resolution procedures, master labor agreements. This code is available on Cubadebate, an online news service maintained by Cuban journalists.

In addition to codes, the body of Cuban legislation consists of laws passed by the National Assembly of the People’s Power (legislature), regulations, executive resolutions, and circulars issued by the government.

4.  What laws are relevant to doing business in Cuba?

Those who are interested in doing business in Cuba have to comply with a number of statutes, including Law No. 118 on Foreign Investments, which includes guarantees for investors, a special tax regime applicable to foreign investments, and dispute resolution procedures. Additional information can be found on the website of the Cuban Center for Promoting Foreign Investment.

Technical requirements applicable to food products, agricultural machinery, environmental protection, etc., are included in a catalog of Cuban technical standards.

Authority over intellectual property issues is exercised by the Cuban Office on Industrial Property (OCPI). A comprehensive list of statutes and regulations on industrial property, including patents, trademarks and relevant treaties, is available on OCPI’s website (click on “Legislación”).

The Cuban Customs authority has published a list of customs regulations in force.

5.  Can Cubans receive money transfers from abroad?

Cuba’s financial rules can be found in the Banking Regulation Manual, which is a comprehensive compilation of financial regulations issued by Cuba’s Central Bank. The Manual governs several aspects of Cuba’s financial system, including monetary policy, banking oversight, and bank accounts.

The website of Cuba’s Savings Bank (Banco Popular de Ahorro, a Cuban commercial bank) provides information on the steps that must be followed by Cuban nationals in order to receive monetary transfers from abroad.

Money transfers sent to Cuba from the United States or from individuals subject to U.S. jurisdiction are governed by applicable U.S. regulations. More information on this topic is available on the website of the U.S. Department of the Treasury (Frequently Asked Questions Related to Cuba, January 15, 2015. IV. Remittances, page 8) and on the website of the U.S. Department of Commerce.

6.  Are statistics on Cuba available online?

Yes. Cuba’s National Office on Statistics publishes statistical information on a wide variety of topics, such as population, jobs and salaries, education, etc., on its website.  This includes information related to the 2012 Census of Population and Housing.

7.  Where can I find more information on Cuban law?

A good starting point for a research on Cuban laws is the Law Library of Congress’s Guide to Law Online, an annotated collection of government and legal sources of information. A collection of short articles on legal developments in Cuba can be found in the Law Library’s Global Legal Monitor. Another blog post that will highlight the Law Library’s collection of Cuban legal materials will be published soon. Also, our readers can always submit reference requests through our Ask A Librarian Service, and we will respond.

Categories: Research & Litigation

One South Florida ZIP Code Leads The Nation In Obamacare Enrollment

Kaiser Health News - Tue, 01/27/2015 - 2:04pm

In one Hialeah ZIP Code, just outside Miami, where signs selling “Obamacare” are plastered across storefronts and cover freeway billboards, more people have selected a plan on the Affordable Care Act insurance exchange than in any spot in the country, according to the data release by the U.S. Department of Health and Human Services last week.

Despite the political rancor associated with the health care reform law, residents of Hialeah signed up in record numbers for coverage in 2015. A total of 12,330 people in Hialeah’s 33012 ZIP Code selected a plan or were re-enrolled as of mid-January, the highest number in any ZIP Code in the 37 states that use the Healthcare.gov platform.

This copyrighted story comes from the Miami Herald, produced in partnership with KHN. All rights reserved.

The other ZIP Codes in the top five: 33126 in Miami, 33313 in Fort Lauderdale, 33015 in Hialeah and 33165 in Miami, each with enrollment between 8,000 and 9,000.

The streets and stores in Hialeah show how far the Obamacare brand has extended. Consumers can sign up for coverage in a mall, at a discount store, at a shoe store, and even at a barber shop.

Ammer Cabrera, manager at one of two Sunshine Life & Health Advisers storefronts in Westland Mall, helped sign up the flood of consumers who came to his location last year seeking coverage. This year, he said, the market is more competitive with enrollment centers setting up shop just about anywhere.

“My barber was asking me what I was doing and I told him, and he’s like, ‘Oh yeah, us too,’” Cabrera said. “I’m like, ‘Are you serious? You’ve been cutting hair for 25 years and now you’re an insurance agent?’ That’s a microcosm of what’s going on specifically in Miami.”

Drive down West 49th Street and you’ll see the signs. In one 12-block stretch, two insurance agencies display Obamacare signs in their windows and a mustard yellow Obamacare sign entices consumers on the front of a Bank of America building.

The saturation seems to be working. Auri Barrios, a cashier at Palm Springs General Hospital in the top enrollment zip code, encouraged her boyfriend, Osdrey Lopez, to sign up for coverage after she was handed a flyer for Tropical Insurance Agency while stopped at a red light. She showed it to Lopez.

“He got here from Cuba a year ago and he got Medicaid but then after, he didn’t have anything else,” Barrios, 42, said. “He went to apply and it went really well. He got a plan for $20 a month.”

Now she refers patients at the hospital to the agency from the flier or to nearby Westland Mall.

While sign-ups in Hispanic-heavy Hialeah are high, Hispanics nationwide are still lagging behind other groups in signing up for coverage.

By the end of 2014, only 8 percent of people who had signed up nationwide were Hispanic, according to the latest federal data.

The numbers are likely to be different in Miami-Dade, where the population is predominantly Hispanic, said Felipe Pinzon, vice president of programs at Hispanic Unity of Florida, a nonprofit social service agency based in Hollywood.

“There are more uninsured clients eligible in Miami-Dade,” Pinzon said. “And more marketing material. For this kind of service, you have to have more grassroots outreach.”

According to the latest U.S. Census data from 2013, Miami-Dade has the second-highest rate of uninsured residents under 65 with 34.4 percent — behind only Hendry County with 35 percent — and the highest overall number of uninsured people in the state, at about 744,000. Broward County reported an uninsured rate of 26 percent.

Nicholas Duran, state director for Enroll America, a nonprofit that advocates for people to get coverage, said that healthcare activists know Hialeah has a high proportion of uninsured people and are focusing their activities there.

Duran also said that people who signed up last year have been spreading the word about the availability of affordable coverage.

“It’s a ripple effect,” he said. “They’re talking to their friends, families, neighbors and churches about their coverage.”

As the program rolls into its second year, misconceptions about eligibility and increased awareness on the opportunity for low-priced plans has brought more people out to apply, Pinzon said.

At Sunshine Life & Health Advisers in Hialeah Thursday morning, Martha Hernandez said the marketing efforts pushed her to come in.

Hernandez, a housekeeper in Flagler Street, who didn’t have health coverage before last year, drove to Hialeah just to re-enroll.

“Through the TV, through the radio, I’ve read about it in the newspaper,” Hernandez said. “I came here because it was the one they were announcing the most on TV.”

Categories: Health Care

How 3D-Printing Helped A Little Girl With A Rare Facial Defect

CommonHealth (WBUR) - Tue, 01/27/2015 - 1:53pm
[Watch on YouTube]

Check out this excellent story and video about a little girl named Violet born with a rare defect, a Tessier facial cleft, that left a fissure in her skull, and how 3D-printing is helping doctors take on these kind of complicated surgeries. The piece is in today’s The New York Times andwritten by health reporter and CommonHealth contributor Karen Weintraub, who offers a little background:

Violet Pietrok was born nearly two years ago without a nose. Her eyes were set so far apart that her mom compared her vision to a bird of prey’s. There was a gap in the skull behind her forehead.

There was no question she would need drastic surgery to lead a normal life. But few surgeons have seen patients with problems as complex as Violet’s. Her parents, Alicia Taylor and Matt Pietrok, who live near Salem, Oregon, brought her to Boston Children’s Hospital, to Dr. John Meara, who had operated before on kids with Tessier facial clefts.

As part of Children’s Pediatric Simulator Program, Meara was able to get several 3D printed models made of Violet’s skull. By handling and slicing up the models, he got a better sense of what had gone wrong and how best to fix it.

Such 3D-printing is becoming more commonplace in complex surgeries, allowing doctors views and knowledge they can’t get on their screens.

From the Times story:

Such 3-D-printed models are transforming medical care, giving surgeons new perspectives and opportunities to practice, and patients and their families a deeper understanding of complex procedures. Hospitals are also printing training tools and personalized surgical equipment. Someday, doctors hope to print replacement body parts.

“There’s no doubt that 3-D printing is going to be disruptive medicine,” said Dr. Frank J. Rybicki, chief of medical imaging at the Ottawa Hospital and chairman and professor of radiology at the University of Ottawa. He is the former director of the applied imaging science lab at Brigham and Women’s Hospital, a few blocks from Boston Children’s.

“It makes procedures shorter, it improves your accuracy,” said Dr. Rybicki, who has used 3-D printing in his work with face transplants. “When bioprinting actually hits, it will change everything.”

For now, the printer extrudes a layer of liquid plastic instead of ink. It adds a second layer, and then another, and a skull or rib cage — or whatever the surgeon dials up — slowly emerges.

The same process can also print layers of human cells. So far, researchers have also printed blood vessels, simple organs and bits of bone.

Categories: Health Care

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