A selection of health policy stories from Alabama, California, Washington, Texas, Georgia, Minnesota and Oregon.
The Associated Press: Worst TB Outbreak In 5 Years Hits Alabama Prisons
Alabama’s prison system, badly overcrowded and facing a lawsuit over medical treatment of inmates, is facing its worst outbreak of tuberculosis in five years, a health official said Thursday. Pam Barrett, director of tuberculosis control for the Alabama Department of Public Health, said medical officials have diagnosed nine active cases of the infectious respiratory disease in state prisons so far this year (8/14).
Kaiser Health News: Capsules: Wide Variation In Hospital Charges For Blood Tests Called 'Irrational'
One California hospital charged $10 for a blood cholesterol test, while another hospital that ran the same test charged $10,169 — over 1,000 times more. For another common blood test called a basic metabolic panel, the average hospital charge was $371, but prices ranged from a low of $35 to a high of $7,303, more than 200 times more (Rabin, 8/15).
Seattle Times: Ban On Boarding Mentally Ill In ERs Could Force Release Of Many
More than 100 severely mentally ill patients in need of care could be released from Washington hospitals before the end of the month, as the state struggles to comply with a recent ban on warehousing psychiatric patients in emergency rooms. The state has been scrambling for a week to respond to the state Supreme Court’s ruling, but so far has been able to free up only a fraction of the long-term beds that will be needed when the decision goes into effect Aug. 27, said Andi Smith, Gov. Jay Inslee’s policy adviser on health and human services. ... This poses a serious dilemma for hospitals. By adhering to the order and knowingly discharging dangerous or unstable patients, they fear they could be in violation of the federal Emergency Medical Treatment and Labor Act (EMTALA), said Taya Briley, general counsel for the Washington State Hospital Association (Mannix, 8/14).
Reuters: The Other Texas Border Deployment: Doctors, Dentists, Opticians
For the Texas State and National Guard, Operation Lone Star is a disaster preparedness exercise. For public health experts, it is a humanitarian mission. And for Itzel, a teenage schoolgirl, it is a chance to finally get glasses so she can read textbooks. Operation Lone Star started 16 years ago to help the guard prepare for emergencies such as hurricanes or pandemics in south Texas. Since then it has expanded its medical care component, treating thousands in a region that hugs the Mexican border, including some who come because no identification papers are required. "It feels weird to see things in focus," Itzel said as she tried on newly made prescription glasses (Herskovitz, 8/14).
Georgia Health News: State Health Plan Choices For 2015 Draw Praise
Many state employees and teachers will see no increase in their health insurance premiums next year under rates approved by a state agency’s board Thursday. The State Health Benefit Plan members will have choices among plans offered by three health insurers, rather than a single insurance company this year. The SHBP covers 650,000 state employees, teachers, other school personnel, retirees and dependents. With those numbers, the members of the health plan have proved to be a potent political force in this election year (Miller, 8/14).
Minnesota Public Radio: Minnesota Security Hospital Gets OSHA Citation
The Minnesota Occupational Safety and Health Administration has issued a citation related to working conditions at the Minnesota Security Hospital in St. Peter, which has faced repeated problems over the years connected to employee and patient safety. The state Department of Human Services confirmed that OSHA inspectors visited the site on Aug. 1. Deputy Commissioner Anne Barry wasn't available for comment, but released a statement about OSHA's findings. "Everyone deserves to work in a safe environment. Over the past two years, Minnesota Security Hospital has made significant progress in employee safety by increasing the amount of staff and providing specialized training," Barry said (Collins, 8/14).
The Oregonian: Oregon Adds Transgender Procedures To Oregon Health Plan
A full range of state medical coverage for low-income transgender people will be offered for the first time starting early next year. The Health Evidence Review Commission, a 13-member board charged with setting Oregon Health Plan priorities, made that decision Thursday during a meeting in Portland. The decision was hailed by advocates, who called it an historic step toward equality in medical care (Tims, 8/14).
Today’s guest post is by Betty Lupinacci, supervisor in the Processing Section of the Law Library Collection Services Division.
How could a 3-inch piece of plastic stir up so much excitement?
Well, if you perform technical services in a law library that doesn’t have everything online, you will recognize this as the only practical means of updating Bloomberg/BNA’s Tax Management Portfolios (or any of their other portfolio titles).
But no longer.
We have what we need to keep our collection current and decrease the time it takes to get the volumes into patrons’ hands.
Now, where did I put that box of rubber fingertips?
Medicare beneficiaries may get speedier coverage for a newly approved screening test for colorectal cancer under a pilot project in which two federal agencies reviewed the product at the same time instead of one after the other.
The Cologuard test, which detects the presence of DNA mutations that may be cancers in the stool, was approved by the Food and Drug Administration this week. The same day, the Centers for Medicare& Medicaid Services issued a proposal to cover the test once every three years in asymptomatic people over age 50 who are at average risk for the disease.
It’s the first time the agencies have undertaken a parallel review, and it could trim up to six months off the time it takes to offer Medicare coverage for a medical device, according to Nancy Stade, deputy director for policy at the FDA’s Center for Devices and Radiological Health in the FDA news release.
Although CMS has proposed covering the test, a final decision won’t be made until after a 30-day comment period.
Advocates say parallel review could be good for patients. "The American Cancer Society Cancer Action Network is in support of the parallel review process as it has the potential to accelerate access to evidence-based tests," says Mona Shah, associate director of federal affairs for the group. The organization, however, hasn’t taken a position on the new test yet.
If Medicare covers the test, private insurers will generally follow suit, say experts. The new test will reportedly cost between $500 and $600.More From This Series Insuring Your Health
The U.S. Preventive Services Task Force, which under the health law determines which preventive treatments should be covered by private health plans without cost sharing, said in 2008 there was not enough evidence to recommend DNA screening for colorectal cancer at that time. Some advocates expect the task force to re-evaluate its recommendation in the near future.
In a clinical trial, Colorguard detected 92 percent of colorectal cancers and 42 percent of advanced adenomas, large polyps that are more likely than small polyps to lead to cancer. A traditional (fecal occult) stool test was less accurate, detecting 74 percent of cancers and 24 percent of advanced adenomas. A consumer using Cologuard would receive a kit from the manufacturer, collect a stool sample at home and mail it in the kit to the Cologuard maker. If a Cologuard test comes back positive, patients are advised get a diagnostic colonoscopy.
So why not just get a colonoscopy in the first place? Even though it’s a lot more expensive than a stool test, a screening colonoscopy it will generally by covered without cost sharing by Medicare and private insurers.
“A lot of [asymptomatic] people won’t get a colonoscopy, and this is an effective, less invasive screening method,” says Eric Hargis, CEO of the Colon Cancer Alliance. “We believe the best method is the one that gets used.”
Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.
Today's headlines include a variety of updates regarding health policy and the health care marketplace.
Kaiser Health News: Capsules: Wide Variation In Hospital Charges For Blood Tests Called ‘Irrational’
Now on Kaiser Health News’ blog, Roni Caryn Rabin writes: “One California hospital charged $10 for a blood cholesterol test, while another hospital that ran the same test charged $10,169 — over 1,000 times more. For another common blood test called a basic metabolic panel, the average hospital charge was $371, but prices ranged from a low of $35 to a high of $7,303, more than 200 times more” (Rabin, 8/15). Check out what else is new on the blog.
The Wall Street Journal: How Agents Hunt For Fraud In Trove Of Medicare Data
Eleven armed FBI agents crept around a stone-and-glass house here just before dawn. An AR-15 rifle and four other guns were registered to the man in the house. … It was no drug lord. The target was a doctor who moonlighted as a movie producer with an Alec Baldwin comedy to his credit. The Justice Department charged the doctor, Robert A. Glazer, with writing prescriptions and certifications resulting in $33 million of fraudulent Medicare claims. The raid in May capped a year-long investigation by the Medicare Fraud Strike Force, a joint effort by the Justice Department and Department of Health and Human Services. Raids that day in six cities resulted in the busts of 90 Medicare providers, including 16 doctors, who were separately charged with generating a total of $260 million of false Medicare billings (Stewart, 8/14).
Los Angeles Times: Medi-Cal Struggles To Provide Services To Ever-Growing Clientele
Concerns about access to care have taken on a new urgency since Medi-Cal enrollment began to swell in the wake of President Obama's federal healthcare overhaul. The program, the state's second-largest expense after schools, is expected to cover one in three Californians by next year. But the current state budget continues a 10% cut in reimbursements to some healthcare providers, a lingering sore point for advocates, lobbyists and lawmakers who have pushed to reverse the reduction (Megerian, 8/14).
The Washington Post’s Wonkblog: Wal-Mart Wants To Be Your Doctor
Wal-Mart's newest effort to make a play in the booming health clinic space comes after the big-box retailer has fallen far behind its rivals. And this time, Wal-Mart is shaking up its approach with a new model that's getting some attention in the health-care world. Wal-Mart this year has opened six clinic locations across South Carolina and Texas in which the retailer is providing a broad range of primary care services, as described in a recent New York Times story. The company plans to have a dozen of these clinics open by the end of this fiscal year, executives said on a Thursday earnings call (Millman, 8/14).
The Wall Street Journal: Health Costs, Weak Store Traffic Hinder Wal-Mart
One unexpected headwind came from health care, where costs are rising quickly as more employees sign up for coverage. The company said it now expects to shell out an additional $500 million in health-care expenses related to increased employee enrollment and higher costs, up from the $330 million in increases it originally expected. "Health-care costs increased approximately $180 million versus last year and were well above our initial estimates," said Wal-Mart U.S. CEO Greg Foran, who stepped into the role this week following the departure of Mr. Simon (Banjo and Calia, 8/14).
The Associated Press: VA chief: Firings Of Workers A Deliberate Process
The Veterans Affairs Department is in the process of holding bad employees accountable amid a scandal about long wait times for patients and other problems, VA Secretary Robert McDonald said Thursday, but he declined to say how many people were being fired and who they were. McDonald visited with veterans and employees at the Memphis VA hospital on Thursday, a day after addressing the American Veterans national convention (8/14).
The Associated Press: Candidates Clash In Colorado Congressional Debate
Coffman said he opted out of the congressional health plan and bought his insurance on the Affordable Care Act exchange, which was significantly worse. “If every member of congress did what I did, Obamacare would not be standing today,” he said, earning cheers and boos when he called for repealing the law. Romanoff replied: “It’d be a good idea to fix the law rather than repeal it and replace it with nothing but empty phrases.” Romanoff supports abortion rights and Coffman opposes them (8/14).
The Wall Street Journal’s Pharmalot: CMS Fixes Tech Glitch That Hobbled Pharma Payment Disclosures
The federal government is back online with a website where U.S. doctors and teaching hospitals can review information about payments they have received from drug and device makers, about 11 days after a government agency shut it down to investigate a data mix-up. In a brief statement Thursday afternoon, the Centers for Medicare and Medicaid Services said: “The Open Payments system is once again available for physicians and teaching hospitals to register, review and dispute financial interaction information received from health care manufacturers and Group Purchasing Organizations.” CMS plans to provide additional details about the program “by tomorrow” (Loftus, 8/14).
The New York Times: Pharmacies Turn Drugs Into Profits, Pitting Insurers Vs. Compounders
Compounded medicines are the Savile Row suits of the pharmacy, made to order when common treatments will not suffice. Pharmacists say it is the doctors who decide what to prescribe. But many pharmacies have standard formulations and some promise six-figure incomes to sales representatives who call on doctors (Pollack, 8/14).
The Wall Street Journal’s Pharmalot: UK Recommends Covering Sovaldi Hepatitis C Pill
The U.K. agency that evaluates the cost effectiveness of prescription drugs has recommended the government pay for the controversial Sovaldi hepatitis C treatment, although not for all patients. The move, which still requires a final endorsement, comes as the medicine causes a ruckus in the U.S. The price tag–$84,000 for a 12-week regimen–has insurers and state Medicaid directors worried that the Gilead Sciences medication will become a budget buster and helped to fuel a national debate over the rising cost of prescription drugs (Silverman, 8/14).
The Washington Post: Ebola Striking Women More Frequently Than Men
As the number of lives claimed by the Ebola epidemic in West Africa rises above 1,000, the rate of infection among women is outpacing that among men because women are the caregivers, nurses and cross-border traders, health officials report. Outbreaks are thought to originate through contact with infected forest animals, often making men who hunt for bushmeat or handle the meat the first targets of infection (Hogan, 8/14).
The Associated Press: Worst TB Outbreak In 5 Years Hits Alabama Prisons
Alabama’s prison system, badly overcrowded and facing a lawsuit over medical treatment of inmates, is facing its worst outbreak of tuberculosis in five years, a health official said Thursday. Pam Barrett, director of tuberculosis control for the Alabama Department of Public Health, said medical officials have diagnosed nine active cases of the infectious respiratory disease in state prisons so far this year (8/14).
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A digital surveillance program used Twitter feeds and news headlines to pick up on the Ebola outbreak in West Africa a full nine days before the World Health Organization proclaimed it an epidemic.
But that doesn’t mean the outbreak could have been prevented.
Dr. Alessandro Vespignani, a professor of computer science and physics at Northeastern University, uses network science to model and forecast the spread of disease. Like HealthMap, the online tool cited above, Vespignani’s computer simulations cannot anticipate an outbreak before it actually begins.
“They don’t have a crystal ball either,” he says. “HealthMap is really a novel way of doing disease surveillance that can provide a real edge in the early detection of outbreaks by monitoring news articles, journals, Twitter or other digital sources. But they can’t do this before the actual occurrence of the event. There was already a situation in West Africa. HealthMap was just able to pick up the anomaly before anyone else.”
As the death toll climbs over 1,000 in West Africa, I was curious to know what makes this particular outbreak so relentless and what the global community can do to contain its spread. My conversation with Dr. Vespignani, lightly edited:
First of all, what exactly are big data and network science research? And how do you use them to track disease outbreaks?
We create large-scale models for disease forecasting by creating a synthetic world in the computer that integrates all data about human mobility. Then we plug an infectious individual into the model and look at the spread of the disease. You can look at different levels of granularity—whether locally or internationally. Network science is important because most disease now spreads by human mobility. What you hear many times is, “We’re all one hop away from West Africa,” although it’s thousands of kilometers away. No one has a crystal ball, so we cannot say when there will be an Ebola disease outbreak. As soon as we have the data on the outbreak, what we can do is try understanding how it will evolve in the next few weeks or months, which is what we do with this modeling.
When you talk about human mobility data, what exactly do you mean? Where does this information come from?
There are many data that we use to create the synthetic simulations of the world. We use data from various projects that map the population, so we have a grid covering the world’s surface and know how many people are in each of the cells—big cities, rural areas, etc. We have information on all of the flights, from the International Aviation Association, that bring people from any airport in the world. We have commuting data from the census—like how people commute from one county to another in the U.S. We’ve accumulated these data for 10 years, so now we have basically a representation of the whole world. Obviously, some places have data of a much higher quality and granularity, like the U.S. and Europe. Then in places like West Africa we have a much coarser understanding of the factors we need in the model. But we have accumulated a good deal of data. This is the first part. This allowed us to create the synthetic model.
OK, so then how do you use the model to predict the spread of disease?
Then we need the data about the disease—these are the data that are most difficult to obtain. Initially, when the outbreak is not clear, you get reports of cases but you don’t actually know the details about the disease, like how long the person has been in the incubation period or the transmissibility of the disease. The more data we get from the field, then the more we can calibrate our models and start using them to predict the outbreak’s evolution.
These data on the disease come from health agencies, the WHO, people in the field, as well as historical data from previous outbreaks.When you pack all those data together, finally you have a computational model. We simulate 7 billion individuals in the world—how they travel by plane, how they get infected and come in contact with others. We do that on a scale of one day then we try to figure out what will happen in next weeks or months.
Obviously, the farther away you project, the less realistic the forecast is. Because of the large international effort to contain and mitigate the Ebola outbreak, any kind of projection about the future should be redone every two weeks because the transmissibility of the disease changes—people are more aware or the hospitals are able to do better procedures. There are many things you have to factor in continuously to update your models.
What’s different with this Ebola outbreak? How did it spread so fast and so far?
We’re starting to have a better understanding, because we are getting more and more data from the field. We’re not happy about that. What we would like to see instead is evidence that the containment and mitigation measures are effective. Unfortunately, this is not happening, so we keep getting new data on the number of cases and deaths from the various regions. So then we calibrated the model, which is a very complicated procedure. For technical reasons, you basically have to try thousands of different models to see which best approximates what has actually happened with the outbreak so far. Then from those models you can project what will happen in the future.
To understand the local spread of Ebola, you must understand that it can be transmitted through three different settings. First, it can be transmitted in the general population if the symptoms are very general and the infected individual doesn’t go to the hospital right away. For instance, you may vomit in a public bathroom and someone may come in after you and be infected by the fluid. Generally this transmissibility is low, because people who are not very symptomatic do not have a high viral load or stay at home. The second component is hospital transmission. These individuals are highly infectious, and unless the hospital is following strict procedures and has all of the necessary equipment to contain the virus, this type of transmission is highly likely. Third, the virus can be transmitted through dead bodies since they have a very high viral load. All of these three components of Ebola transmissibility are active in West Africa. Efforts should focus on the hospital and funeral components because the disease doesn’t have enough transmissibility in the community to create a huge outbreak.
Should we worried about an Ebola outbreak in the U.S. or other Western countries?
The three components of transmissibility explain the widespread outbreak in West Africa, and also explain why we’re optimistic of what would happen in the U.S. if cases are imported here. In our hospitals we have full isolation of infected patients, and the burial of an infected body would be done in the appropriate way. These things are not being done in Africa.
Based on our results that project two weeks into the future, we see that the probability of an outbreak in the Western nations is statistically very small. This does not mean it’s not going to happen, but we are talking about a probability of 1 to 5 percent in next two to three weeks. This is very small in terms of risk. Even if we get one or two cases in the U.S., we have the infrastructure to cope with it and stay completely safe. It’s like rolling the dice with 100 faces and if you hit the number one, maybe we’ll have this event.
What about other areas of the world?
The probability of international spread is much greater for West African countries, like Ghana, because they’re closer and more connected to the outbreak. This is concerning because these countries are also much less equipped to respond to an outbreak. In the U.S. and European countries we expect to see one to three cases—no more than that—which we can cope with easily. This is not the same for other countries in Africa, where you have to assume a very different health response system.
A good example is Nigeria. They got one case imported through the airport which should have been easy to contain, but they already have more than seven suspected cases and it’s not clear whether they’ll be able to contain the outbreak. Another thing we see from our models is that if Nigeria is not able to contain the outbreak, things are going to be much worse since it is a well-connected country with a large population. The number of cases in that country might be a big problem. As soon as you have a known outbreak in Nigeria, the probability of cases being imported to other countries is greatly increased.
What are your recommendations for containing the disease so it does not spread any farther?
The battle right now is in West Africa. The issue is not here. The epidemic is still in the early stages. We need to work in the African region to create the opportunities and means for those countries to bring the outbreak under control. Basic things—like sending isolation tents, sanitary gloves, doctors and nurses—are crucial. We need to pull resources so that health system can finally cope with outbreak. There is also lot to explain to these populations about doctors, taking care of sick patients, and dealing with funerals. It’s a massive campaign. The risk is there, not here. If the outbreak in West Africa spins out of control, then it would be a global problem for everyone.
What are your projections about the course of the outbreak over the next couple of weeks?
So far, based on new points from the field, we have seen an exponential increase. This is not good. What we’re hoping to see is the number of cases plateauing or decreasing—a deviation from this epidemic that is continuously growing. But there is a time delay. Now that we see the danger and threat of the outbreak, there is more proactive action from everybody. It will take time to see the effects of those efforts. In the last week, things have not changed that much and I don’t expect to see big changes in the next week. But then I hope to see the number of cases declining by the end of the month. If not, then the situation needs to be reassessed.
What’s the worst-case scenario?
The worst scenario is if we see that Nigeria is unable to control the outbreak, as well Ghana or other countries in the region having outbreaks and being unable to contain them. At that point, the whole system is put under stress and is difficult to cope with in terms of international aid. There are not infinite resources to help them. First of all, that would be a major tragedy for African region and then it would start to affect us.
But worst-case scenarios are very speculative. Each country has a different response capability that we need to test, so we cannot make too much inference at this stage about things farther than two to three weeks down the road. I don’t like doing these worst-case or best-case scenarios because you don’t want to be too pessimistic or even too optimistic, because you don’t want to relax things happening locally.
I’m very optimistic for the near future of the U.S. and Europe. For the African region, it is very difficult to predict what will happen, and a lot will depend on the kind of support we can provide them. The worst-case scenario might happen if you see this kind of toppling—one country, then another, then another. Hopefully this is not what we will see in the near future.
What can we learn from this large-scale outbreak in order to prevent similar ones in the future?
There is one lesson that I think is for everybody. We need to help those countries create a much better health infrastructure. An outbreak of this proportion should not have happened in those places. It’s important that we become the enabler for those countries to create a different health approach and infrastructure.
Unfortunately, emerging infectious diseases are something that we’ll always have to cope with. We have Ebola, but also Middle East Respiratory Syndrome Coronavirus, the H7N9 in China and chikungunya in the Caribbean. The diseases are there. All we can do is create the health infrastructure to cope with them and to help countries have the monitoring resources to detect outbreaks as soon as possible and provide timely data. They need to be able to perform containment and mitigation measures right away. We need to have collective responses to these emergencies.
Nobody can tell you there will be no Ebola outbreak in the future—that’s impossible. It’s also impossible to say there won’t be another pandemic of influenza. Those things happen. It’s the way we respond to those emergencies that is changing, and we also need to change that in other regions of the world, like West Africa and remote places of Southeast Asia. That is the way to prevent large-scale outbreaks.
...........the now familiar mantra of the dedicated, long term Market Basket employee. The ongoing Market Basket labor crisis is very much in the news and is affecting consumers as well as employees and distributors within our own communities. With negotiations seemingly at a standstill for weeks on end the many non-union employees are left wondering about their workplace rights. In response to numerous calls the Office of the Attorney General has created both a dedicated hotline and an informational webpage to answer some of the most frequently asked questions.
Another excellent resource is our own webpage: 'Massachusetts Law About Employment'. With links to all aspects of employment law including 'Massachusetts Law About Employment Termination' .
Here at the Lawrence Law Library one of our many print publications particularly on point at this time is 'Labor Law for the Union and Non-Union Workplace', an informative book published by the Boston Bar Association. A Trial Court Law Library Card is all that's required to borrow this and other books and cd's from our extensive collection of legal materials. Open to the public, we serve the bench, the bar, the public and, of course, Market Basket employees!
The Law Library is holding a series of lectures in conjunction with the upcoming exhibition, “Magna Carta: Muse and Mentor.” Cosponsored by the American Bar Association Standing Committee on the Law Library of Congress, the lecture series will provide further context on how the Great Charter fits into expansive historical and contemporary topics, such as legal representation and the status of women.
The next program in the series, “Magna Carta: Selecting and Conserving Primary Sources,” will begin at 1 p.m. on Wednesday, Aug. 20, in the Mary Pickford Theater on the sixth floor of the Library’s James Madison Building, 101 Independence Ave., S.E., Washington, D.C. The event is free and open to the public; tickets are not required.
The program will feature a panel of Library of Congress staff members who will discuss how materials are prepared and selected for exhibitions and educational-outreach curriculum. Speakers will include Nathan Dorn, rare book curator in the Law Library of Congress; Stephen Wesson, an educational resource specialist in the Office of Strategic Initiatives; and Holly Krueger, head of the Paper Conservation Section in the Preservation Directorate.
Future programs in the series include:
“Magna Carta and the American Constitution,” scheduled for 1 p.m. on Tuesday, Sept. 16 in the Montpelier Room, will feature Akhil Reed Amar, Sterling Professor of Law and Political Science at Yale University. Professor Amar will discuss Magna Carta and its historical connection to the U.S. Constitution. This event will also celebrate Constitution Day.
“Magna Carta: Women in Medieval Europe in 1215,” is scheduled for 1 p.m. on Wednesday, Jan. 14, 2015 in the Mumford Room. This event will feature Ruth M. Karras, chair of the History Department at the University of Minnesota. Professor Karras will discuss the social interactions between men and women in medieval Europe, with a special emphasis on how marriage and the status of women changed as English statutory law began to take shape in the 13th century following the adoption of Magna Carta.
We hope you can join us! For those readers who will not be able to attend the program, we will have a member of the In Custodia Legis team live tweet the event via Twitter @LawLibCongress, using #1215MCLC.
The exhibition “Magna Carta: Muse and Mentor” will celebrate the 800th anniversary of the first issuance of Magna Carta. Opening November 6, 2014 and running through January 19, 2015, the 10-week exhibition will feature the Lincoln Cathedral Magna Carta, one of four remaining originals from 1215, along with other rare materials from the Library’s rich collections to tell the story of Magna Carta’s influence on the history of political liberty.
Massachusetts will ask the federal government for another $80 million to build a new health insurance shopping website tied to the Affordable Care Act.
Massachusetts received $174 million for multi-state planning and a website that never worked.
The state has about $65 million left, but says it will need the additional money to build a new site.
So the total cost of the site — which is expected to be ready for the next open enrollment period that begins Nov. 15 — will be roughly $254 million. If the federal government agrees to the additional expense, it would end up spending about $191 million for the insurance exchange, or 75 percent of the total. The balance, about $64 million, would come out of the state’s capital budget.
Project directors from hCentive, the company building out the new site, walked the Health Connector board through a demo Thursday morning. There were a few glitches, but a sample user was able to compare plans and enroll. The site has not been tested yet with the hundreds of users who are expected to log in when the next open enrollment period begins on Nov. 15.
As work continues on the website, the number of residents seeking free or subsidized coverage has grown to 267,000. It’s not clear whether these people have been uninsured for some time, recently lost coverage or have been dropped by their employers in the last year or so.
In all, between 400,000 and 450,000 Massachusetts residents who either bought or tried to sign up for coverage through the Connector will need to re-enroll for coverage that begins on Jan. 1, 2015. The state expects to spend between $15 and $19 million on advertising, mailing and one-to-one outreach to remind residents that they must re-enroll, and to help them review insurance options.
That total includes almost $2 million that will go to the advocacy group Health Care for All. Staff aim to knock on 200,000 doors of residents who are, have been or might be, eligible for free or subsidized coverage.
The other day, I got going a little harder than I meant to on the stairclimber, huffing and puffing hugely at a setting a bit too high. Amid other vague thoughts (“I wonder at what point this becomes dangerous?”) was this one: “Funny, once I would have perceived being out of breath like this as unpleasant, but lately it’s neutral or even kind of fun.”
I thought of that moment when I saw the latest Phys Ed column in The New York Times: How Exercise Helps Us Tolerate Pain. Gretchen Reynolds writes:
“Regular exercise may alter how a person experiences pain, according to a new study. The longer we continue to work out, the new findings suggest, the greater our tolerance for discomfort can grow.”
It has long been known that endorphins released during exercise diminish pain in the short-term, but what about the longer-term pain effects of exercise? She describes a small study of 24 adults, and the striking — though of course preliminary — results. A control group that did not exercise saw no change in pain tolerance.
But the volunteers in the exercise group displayed substantially greater ability to withstand pain. Their pain thresholds had not changed; they began to feel pain at the same point they had before. But their tolerance had risen. They continued with the unpleasant gripping activity much longer than before. Those volunteers whose fitness had increased the most also showed the greatest increase in pain tolerance.
“To me,” said Matthew Jones, a researcher at the University of New South Wales who led the study, the results “suggest that the participants who exercised had become more stoical and perhaps did not find the pain as threatening after exercise training, even though it still hurt as much,” an idea that fits with entrenched, anecdotal beliefs about the physical fortitude of athletes.
Readers who exercise, have you experienced anything similar? How do you explain it? My thought: Aside from the myriad health effects, it’s heartening to think that exercise may also help people wade through a life that can sometimes seem a vale of tears.
Modern Healthcare reports that this website, which is designed to report industry payments to physicians and teaching hospitals, was temporarily suspended last week but is scheduled to be publicly accessible Sept. 30. Meanwhile, the Des Moines Register explores issues related to the National Practitioner Data Bank.
Modern Healthcare: Is the Sunshine Act Website Repeating HealthCare.Gov’s Mistakes?
A mix-up of information about two physicians with the same name in different states has opened a window on wide-ranging technical problems the CMS is facing with its Open Payments website reporting industry payments to doctors and teaching hospitals. Registration for the system, which was scheduled to be publicly accessible Sept. 30, was temporarily suspended last week after a Kentucky doctor discovered that his data had been commingled with data on another doctor with the same name. The site that was shut down had been open only to healthcare providers since last month. It allowed them to check the information that manufacturers were reporting about them and dispute any errors (Tahir, 8/13).
Des Moines Register: There Is A Database, But It Costs To Search
The case of a former Iowa doctor accused of malpractice in West Virginia illustrates why Americans should have easier access to information about physicians' histories, a national advocate said. Lisa McGiffert, an analyst for Consumers Union, said it's too difficult for the public to find out if a doctor in one state has been in trouble in another state. She expressed sympathy for relatives of Asa Carson, who said they had no clue that Dr. Robert Finley III had been accused of incompetence in Iowa. "If I'm in West Virginia, and I'm going to see this doctor, how the heck am I supposed to know he was from Iowa?" McGiffert said. The most likely place a West Virginia resident would look for information would be that state's medical board, McGiffert said. But Finley's West Virginia record includes no notice of serious allegations filed against him in 2010 in Iowa (Leys, 8/14).
Robert McDonald tells American Veterans national convention that his department is quickly moving to significantly increase the number of veterans referred to doctors outside the system. Also, the department announces that veterans with Lou Gehrig's Disease will be eligible for a government housing program.
The Associated Press: VA Referrals To Private Doctors On Rise
The Department of Veterans Affairs is significantly increasing its referrals of veterans to private doctors following a scandal over lengthy patient waiting times at many VA hospitals and clinics and falsified appointment records, VA Secretary Robert McDonald said Wednesday. McDonald spoke to a few hundred people at the American Veterans national convention. He is scheduled to visit [Memphis'] VA hospital on Thursday (Sainz, 8/13).
The Hill: Soldiers, Vets With Lou Gehrig's Disease Win Housing Subsidies
Veterans and active-duty service members who suffer from Lou Gehrig's disease will have immediate access to a government-funded housing program under new rules from the Department of Veterans Affairs. The VA announced Wednesday that soldiers who suffer from Lou Gehrig's disease, formally known as amyotrophic lateral sclerosis (ALS), will be eligible for its specially adapted housing program. The housing program provides grants to soldiers with disabilities, now including ALS, so they can buy new homes or fix up homes they already own to accommodate their disabilities (Devaney, 8/13).
The main way companies are seeking to curb health care costs is by moving workers into high-deductible health plans, according to the survey by the National Business Group on Health. Nearly a third are offering such plans as the only option to their workers in 2015, the survey found.
Reuters: U.S. Benefits Enrollment Season To Bring More Cost Cutting
When benefits enrollment season arrives this fall, employees around the country can expect to see the impact of corporate cost-cutting on their finances. Benefits costs will rise only 5 percent for employers that take certain cost-reduction measures, instead of 6.5 percent for companies that do not, according to a June survey of employers representing 7.5 million workers by the National Business Group on Health. Although costs are not rising as quickly, employees are still being squeezed. The main way companies are keeping healthcare costs in line is by shifting workers into high-deductible health plans, defined by the Internal Revenue Service as having deductibles above $1,250 for an individual (Pinsker, 8/13).
Fox News: Report: Companies Desperate To Avoid Obamacare ‘Cadillac Tax’ Shifting Costs To Workers
A national business group representing the nation’s large employers reported Wednesday that companies desperate to avoid a 40 percent ObamaCare “Cadillac tax” are finding ways to shift the costs to workers. The so-called “Cadillac tax,” now four years away, will affect health plans that spend more than $10,200 per worker (Angle, 8/14).
Kaiser Health News: 16% Of Large Employers Plan To Offer Low-Benefit 'Skinny' Plans Despite ACA: Survey
Nearly one company in six in a new survey from a major employer group plans to offer health coverage that doesn't meet the Affordable Care Act's requirements for value and affordability. Many thought such low-benefit "skinny plans" would be history once the health law was fully implemented this year. Instead, 16 percent of large employers in a survey released Wednesday by the National Business Group on Health said they will offer in 2015 lower-benefit coverage along with at least one health plan that does qualify under ACA standards (Hancock, 8/13).
CQ Healthbeat: Companies Jockey to Avoid 2018 Tax on Health Plans
Many companies are changing their health benefits to try to avoid a tax slated to hit in 2018 on more generous insurance coverage, a survey found. The National Business Group on Health on Wednesday released results from a survey of 136 companies, most of which have more than 10,000 employees. The survey found that almost a third, 32 percent of those surveyed, plan to offer high-deductible, or consumer driven, health plans. Only 22 percent have done so this year (Young, 8/13).
The Wall Street Journal reports on reaction to the Obama administration's announcement that coverage would be cut off for as many as 310,000 people if they don't prove they are citizens or legal residents by Sept. 5. Other news outlets offer local takes on the issue.
The Wall Street Journal: Health Law Spurs Paperwork Crunch
Backers of the health-care law say they are rushing to make sure tens of thousands of people provide more documents to prove they are in the U.S. legally and therefore entitled to the coverage they obtained through HealthCare.gov. Immigrant advocates say they felt the Obama administration moved hastily ... The federal government is taking the steps to comply with a requirement in the health law that bars unauthorized immigrants from using the online exchanges to shop for coverage, as well as from receiving federal tax credits to offset the cost of premiums (Radnofsky, 8/13).
Des Moines Register: Obamacare Officials Ask 700 Iowans For Citizenship Proof
About 700 Iowans could lose their government-subsidized health insurance next month unless they send in documents proving they are citizens or legal immigrants, federal officials said today. The issue affects people who purchased private insurance policies via healthcare.gov, which is a key part of the Affordable Care Act. ... About 29,000 Iowans obtained health insurance this year via healthcare.gov, including nearly 25,000 who received subsidies (Leys, 8/13).
The Arizona Republic: Immigration Status Jeopardizes Obamacare Coverage For 6,600 Arizonans
The federal government sent letters this week to 6,600 Arizona residents who must clear up questions about their citizenship or immigration status or they could lose their Affordable Care Act health insurance next month. ... These people have not responded to repeated attempts to reach them by mail, phone or e-mail, according to the U.S. Department of Health and Human Services (Alltucker, 8/13).
Meanwhile, the success of California's enrollment drive has created a new set of challenges -- how to provide high-quality health care to 11 million Medi-Cal beneficiaries while keeping costs down.
The Associated Press: Texas Lawmakers To Discuss Market-Based Alternatives To Medicaid Expansion Today
A legislative committee is examining market-based alternatives to providing low-income Texans with health care since the state has rejected the expansion of Medicaid under the federal Affordable Care Act. Members of the state Senate Health and Human Services committee plan Thursday to discuss alternatives to the law critics call “Obamacare” (Weissert, 8/14).
Kaiser Health News: Analysis: California's Enrollment Success Is Its Greatest Challenge
Even as sign-ups continue, state health officials are struggling to figure out how to serve a staggering number of Medi-Cal beneficiaries while also improving their health and keeping costs down. Many are chronically ill and have gone without insurance or regular care for years, and some new enrollees have higher expectations than in the past. Medi-Cal is the largest version of the nation's Medicaid program for low-income and disabled people. Created as an anti-poverty program in 1965, Medicaid for years primarily served families, seniors and people with disabilities. Now, in the states that chose to expand their programs, the coverage is available to single adults without children and to those who make slightly higher incomes. Real questions remain, however, about whether California is up to the task of covering so many more people, and about whether it has the health care infrastructure to handle the needs of the new enrollees. And the costs to the state will be significant (Gorman, 8/14).
Small and stand-alone nonprofit hospitals are facing mounting pressure from weak operating margins and lower patient volumes, according to a report from Standard & Poor's Rating Services. Meanwhile, hospitals cope with the changing healthcare landscape by exploring ways to help low-income consumers pay their Obamacare premiums and offering no-interest payment plans for those with high-deductible insurance policies.
Reuters: Nonprofit Hospitals At A Tipping Point From Mounting Challenges
Small and stand-alone nonprofit hospitals are facing mounting pressure from weak operating margins and lower patient volumes, with more signals of stress on the way, according a report released Wednesday from Standard & Poor's Rating Services. The rating agency warned the healthcare sector was at "a tipping point where negative forces have started to outweigh many providers' ability to implement sufficient countermeasures." Beginning in 2013 and continuing into this year, credit downgrades outpaced upgrades at an accelerating rate. In particular, stand-alone providers are under greater pressure from physician departures, rising bad debt, and higher employee benefit costs (Respaut, 8/13).
Marketplace: What’s Behind No-Interest Medical Credit
A bigger and bigger chunk of the money hospitals get comes from you and me, thanks to a rise in what are known as deductible health plans, in which consumers are spending more out-of-pocket for their own care. With millions more newly insured under the Affordable Care Act holding those plans, hospitals are thinking hard about the best way to collect from us when we can't pay our bills. In some cases, that means no-interest payment plans (Gorenstein, 8/13).
Kaiser Health News: Hospitals Seek To Help Consumers With Obamacare Premiums
Some hospitals in New York, Florida and Wisconsin are exploring ways to help individuals and families pay their share of the costs of government-subsidized policies purchased though the health law’s marketplaces – at least partly to guarantee the hospitals get paid when the consumers seek care. But the hospitals’ efforts have set up a conflict with insurers, who worry that premium assistance programs will skew their enrollee pools by expanding the number of sicker people who need more services (Appleby, 8/14).
The experts expressed concern, however, that Medicare rules may hamper some people from getting the new vaccine if they have already had an older version. Also in drug issues, some patient advocates report that insurers are balking at paying for a costly drug to treat hepatitis C if the patients are in drug treatment programs.
Reuters: U.S. Advisory Panel Recommends Prevnar 13 Vaccine For Elderly
An influential U.S. medical advisory panel on Wednesday recommended that people 65 and older be given Pfizer Inc's blockbuster Prevnar 13 vaccine to protect against pneumococcal bacteria that can cause pneumonia and other infections. The Advisory Committee on Immunization Practices (ACIP), in a 13-2 vote, recommended that elderly patients take Pfizer's vaccine, even if they had previously been vaccinated with Merck & Co's leading Pneumovax vaccine. ... A Medicare official, speaking to the panel in Atlanta, said his agency would have to change its rules in order to qualify such patients for reimbursement, and that its evaluation would likely extend until January 2016 (Pierson, 8/13).
The Wall Street Journal’s Pharmalot: Sovaldi Debate Hurts Access For Opioid Treatment Patients
The tussle over the cost of the Sovaldi hepatitis C medication may prevent yet another segment of the population from being treated – people who are enrolled in opioid treatment programs. Although the drug has shown evidence of curing nine of 10 sufferers and the product labeling does not suggest Sovaldi is not safe for these patients, payers are balking at covering the medicine for people with a history of a substance use disorder, according to Alcoholism & Drug Abuse Weekly (Silverman, 8/13).
U.S. District Judge Lee Yeakel promised to rule in the case as quickly as possible. Whichever side loses is likely to appeal.
Dallas Morning News: Judge Notes Travel Texans Face With Abortion Clinic Laws
New abortion restrictions that would cause many Texas women to drive hours to end unwanted pregnancies left a federal judge Wednesday signaling unease. “I have a problem believing it is reasonable for anyone to travel 150 miles for medical care when they could get the medical care closer,” U.S. District Judge Lee Yeakel said. He made the comment during closing arguments in an Austin trial of a challenge to a major piece of a sweeping anti-abortion bill signed by Republican Gov. Rick Perry last year. If the law requiring abortion facilities to meet the same standards as hospital-like surgical centers is upheld and goes into effect Sept. 1, abortions will be banned at more than a dozen clinics currently available to Texas women (8/13).
Texas Tribune: In Abortion Trial, Judge Questions "Undue Burden" Standard
As attorneys wrapped up their arguments Wednesday in a trial over a new abortion regulation, the judge presiding over the trial questioned whether the “undue burden” standard being considered in the case should be the same standard used in smaller states. The focus of the trial is a regulation, which takes effect Sept. 1, that requires abortion clinics to meet the same standards as ambulatory surgical centers. The rule applies to the facilities’ room and doorway sizes, locker room requirements, and additional infrastructure like pipelines for general anesthesia. Lawyers representing a coalition of abortion providers claimed that the measure would create an “undue burden” for women seeking access to abortion while state attorneys argued that the requirements would not create barriers for a majority of women seeking the procedure (Ura, 8/13).
Reuters: Texas Emblematic Of National Battle Against Abortion Providers
Conservative state legislatures are waging an effective fight to close down the nation’s abortion clinics, and nowhere is that battle more evident than in Texas, with one of the most restrictive abortion laws in the country. If a challenge to the state law fails in federal court, as of Sept. 1, there will be seven abortion providers left in Texas, the country’s second largest state by population and area, with 26 million people in an area about three times the size of the United Kingdom. That is a plummet from 41 providers in May 2013. “This has been an ongoing, unprecedented level of attacks on access to women’s health services,” said Sarah Wheat, vice president for community affairs at Planned Parenthood of Greater Texas, which operates in the northern and central regions of the state. Currently there are 19 abortion providers, according to the Texas Policy Evaluation Project (TxPEP) (Anderson, 8/13).
And in Mississippi -
The Associated Press: Mississippi Seeks New Ruling On Abortion Law
Mississippi is asking a federal appeals court to uphold a 2012 state law requiring abortion clinic doctors to obtain hospital admitting privileges. In late July, a panel of the 5th U.S. Circuit Court of Appeals ruled 2-1 that the law is unconstitutional because it would close Mississippi's only abortion clinic. Democratic Attorney General Jim Hood filed papers Wednesday asking the full court to reverse the three-judge panel's ruling and allow Mississippi to enforce the law (Pettus, 8/13).
While some state marketplaces are adding insurance carriers -- and The Urban Institute calls Colorado's marketplace "very competitive" -- several plans will not be returning to Covered California.
The Denver Post: Colorado’s Health Marketplace Competitive, Low-Priced, Study Says
Colorado's health insurance marketplace is "very competitive" and offers relatively low premiums, especially in its urban markets, according to a recent analysis by a health policy research group. The Urban Institute, a nonpartisan, nonprofit center has been tracking the effects of the Affordable Care Act with funding from the Robert Wood Johnson Foundation. In the Denver area, eight carriers offer coverage in the individual marketplace. The lowest-cost "silver" plan through the state exchange, called Connect for Health Colorado, costs $201 a month for a 27-year-old and $343 for a 50-year-old. Both were offered by Kaiser Permanente (Draper, 8/13).
California Healthline: Most Insurance Exchanges Just Got Bigger. Covered California Is Getting Smaller.
Kynect. Maryland Health Connection. The Washington Health Benefit Exchange. Every one of those state insurance exchanges added new carriers in preparation for Obamacare's second open enrollment period this fall. Covered California did not. Instead, the Golden State took a different approach: Its exchange is getting smaller (Diamond, 8/13).
The Star Tribune: Officials Say MNsure Will Be Ready For Open Enrollment
State officials offered assurances Wednesday that software fixes to the flawed MNsure health insurance exchange are happening as planned, and that the system should be in good working order by the Nov. 15 start of open enrollment. Still grappling with consumer fallout and political pressure over last year’s troubled rollout, MNsure officials said changes are being made to the system that will allow more time for testing and that sufficient backup plans are in development if things go wrong. MNsure is preparing for the “worst case, if that comes about,” interim Chief Operating Officer Wes Kooistra told the agency’s board of directors, but he added that all hands are on deck to ensure an “improved user experience for 2015” (Crosby, 8/13).
State Highlights: Mass. Hospitals See 70% Jump In Mistakes; Changes Coming To Md.'s State Employee Health Plan
A selection of health policy stories from Massachusetts, Maryland, Texas, California, Wisconsin and Illinois.
The Boston Globe: Mass. Hospitals’ Mistakes List Widens
Massachusetts acute-care hospitals reported 753 serious medical errors and other patient injuries last year, a 70 percent annual jump that health officials attributed mostly to expanded definitions of what constitutes medical harm. So-called serious reportable events in other types of hospitals, including those that provide psychiatric or rehabilitative care, rose 60 percent from 2012, to 206. Instances where patients underwent a procedure on the wrong body part, were burned by an operating room fire or a too-hot heating pack, or were subject to contaminated drugs or improperly sterilized equipment saw some of the largest increases in reporting since 2012 (Kowalczyk, 8/14).
Baltimore Sun: Changes Coming To State Employee Health Plan
Maryland officials approved $16 billion in contracts Wednesday that are intended to change the way state employees use health care by offering rewards for taking steps to stay well — and imposing penalties for refusing to comply. Rewards would come in the form of free doctor visits and procedures, while penalties for failing to follow medical advice could go as high as $375 (Dresser, 8/13).
Chicago Tribune: Walgreens To Open More Health Clinics In Texas
Walgreen Co. said Wednesday it will expand its retail health clinics into the Dallas-Fort Worth metro area, part of a nationwide push to extend its health care offerings. Walgreen has expanded the clinics into stores in five new states over the past 15 months, seeking to pivot from the mold of the traditional corner drugstore into a full-service primary care provider. The Deerfield-based drugstore chain plans to open clinics in 13 stores in the Dallas-Fort Worth area and 14 others in Houston by the end of the year. Nationwide, Walgreen operates more than 400 clinics in 23 states and Washington, D.C. Typically staffed with nurse practitioners or physicians assistants, the clinics are equipped to handle minor illnesses and injuries, as well as vaccinations and diagnosis and management of chronic diseases like diabetes, asthma and hypertension (Frost, 8/13).
The Sacramento Bee: MinuteClinic Opens Its First Walk-In Health Care Clinics In Sacramento Area
Increasingly, a trip to the local drugstore offers another option besides buying cold remedies, hair care products or energy drinks. Add medical care to the list. On Wednesday, Rhode Island-based MinuteClinic opened its first two walk-in medical clinics in the Sacramento region, both inside CVS pharmacies. Patients can see a licensed nurse practitioner for treatment of minor ailments, aches and pains; get a vaccination; have their blood pressure, cholesterol and diabetes checked; or complete their child’s school, camp or sports-required physicals (Glover, 8/13).
The Milwaukee Journal Sentinel: New Health Plan May Be Coming To Southeast Wisconsin
Froedtert Health is considering getting into the business of selling health insurance, a move that would put it in direct competition with the likes of UnitedHealthcare, Humana and Anthem Blue Cross and Blue Shield in Wisconsin. The health system is negotiating with Ministry Health Care to buy an interest in Network Health, an insurer based in Menasha, with the goal of introducing a new health insurance plan in southeastern Wisconsin. The health plan would be tied to a network of hospitals and physicians — including Froedtert, Columbia St. Mary's and Wheaton Franciscan Healthcare — that would compete with a similar new network tied to Aurora Health Care (Boulton, 8/13).
Chicago Sun Times: Oak Park Man Joins Health Care Innovation Charge
Adam Piotrowski got stuck when he tried to start a medical device company here three years ago. "I knew Chicago was a great place to start a business, but it was hard to find a place to be based where I could develop and set up prototypes, work with a variety of resources nearby and get in touch with all of the people I needed to," the Oak Park native said. "I had to find my own office space, start everything from scratch, and it was hard to find and hire talent. It was hard to have conversations and network because no life science hub existed." Piotrowski is trying again, and this time he is excited to apply for membership in Chicago’s newest innovation incubator, Matter, expected to open in early 2015 next to digital tech hub 1871 at the Merchandise Mart. On Tuesday, officials with Matter — an incubator for biopharma, health IT and medical device companies — announced at a news conference that they are taking membership applications at matterchicago.com (Guy, 8/13).