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New Law to Strip Social Security Numbers From Medicare Cards

Medicare -- New York Times - Tue, 04/21/2015 - 12:00am
After years of warnings about the risk of theft, a new way to identify beneficiaries will be devised under a broader measure signed last week.
Categories: Elder, Medicare

Blankets And Broth: Hypothermia The Main Medical Issue At 2015 Boston Marathon

CommonHealth (WBUR) - Mon, 04/20/2015 - 6:07pm

Lauri Perry, of Austin, Texas, is used to getting really hot when she runs. She thought she was being cautious ahead of Monday’s Boston Marathon, when she added a layer over her running top.

“I started out with something on and I threw it away at mile six because it was warmer. Then the rain started at about mile 10 or so, and then the wind got worse,” Perry said, her voice trailing off.

By the time Perry crossed the finish line on Boylston Street she was soaking wet, numb, blue and shaking.

“Uncontrollable shaking,” Perry repeated with emphasis. “I couldn’t even hold my drink because it was splashing out.”

Lauri Perry, of Austin, Texas, went into the medical tent to warm up after finishing the Boston Marathon Monday. (Martha Bebinger/WBUR)

Perry has run the Boston Marathon five times and notes with some pride that she has never needed medical assistance after the race. But Monday, when a member of the medical team asked if she wanted to step inside the big white tent, she gave in.

“I would normally say no,” Perry said, looking disappointed. “I’m a pretty strong person but I knew that I would not be able to walk all the way back to my hotel in the condition I was in.”

Perry and hundreds of runners on Monday fell victim to hypothermia, a condition where despite a runner’s hyper-exertion, their body temperature drops dangerously low. Inside a medical tent at the finish line, Perry peeled off her wet clothes and shoes and sat wrapped in multiple Mylar and cotton blankets, drinking warm fluids. But some runners needed more active warming.

“We use what’s called a ‘bear hugger,’ where you have this air flow system that goes around and warms them,” explained Dr. Pierre d’Hemecourt, co-medical director of the Boston Marathon.

Across the vast medical tent Monday afternoon there where signs of the standard post-race issues — some of the runners needed fluids or help with cramping. But for most the issue was standard hypothermia, with the body temperature of some runners falling into the low 90s.

“It’s interesting, we’re seeing more people than normal but far less acute,” d’Hemecourt said.
“It’s basically just babysitting and getting them warmed up.”

One of the medical tents filled up and had to close at one point Monday afternoon. The overflow of shivering runners were loaded onto buses to warm up. As of 5:30 p.m., 1,310 runners had been treated in the medical tents and 36 transported to area hospitals.

For d’Hemecourt, who’s been co-medical director since 2007, Monday was a first.

“I’ve never quite seen as many cold people come in at one time,” he said. “It just goes to show, every year you show up here you see something different.”

But on balance, the medical team says cold is easier on the body than heat.

Categories: Health Care

Cash-And-Carry Health Insurance For Some In Los Angeles

Kaiser Health News - Mon, 04/20/2015 - 2:44pm

The largest publicly run health plan in the nation, L.A. Care, will allow customers who do not have traditional bank accounts to pay their health insurance premiums with cash.

One in four Americans who were previously uninsured and eligible for federal insurance subsidies do not have a bank account, relying instead on pre-paid debit cards, money orders and cash to pay bills, according to a study by Jackson Hewitt Tax Service.

After advocates for low-income consumers raised concerns to the U.S. Department of Health and Human Services over how so-called ‘unbanked’ households would pay their monthly insurance premiums, the Obama administration ordered health plans to accept payment methods that didn’t require a credit card or checking account.

Starting Monday, customers of L.A. Care Covered, one of the health plans for sale on Covered California, the state’s insurance marketplace, can pay monthly premiums in cash at more than 680 locations, including 7-Eleven and Family Dollar Stores. At the register, customers scan a bar code sent to their smart phone and hand over their cash.   The payment posts to L.A. Care within 24 hours, and  the service is free to customers.

“It’s as quick as buying a Slurpee,” said Danny Shader, PayNearMe’s founder and CEO, the for-profit company that established the electronic cash transaction network.

L.A. Care, like most health insurers around the country, pays fees to Visa, MasterCard and banks to process debit and credit card transactions. Laura Jaramillo, Director of Commercial and Group Plan Operations at L.A. Care, said the health plan negotiated a similar surcharge to PayNearMe for cash payments.

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

“It should not increase our administrative costs,” Jaramillo said. L.A. Care estimates up to 25 percent of its marketplace customers mail in money orders each month. Now, members who don’t have a bank account can pay in cash, said Jaramillo, “instead of sending us money orders.”

Some low- and moderate-income households shun bank accounts, researchers find, because checking account and overdraft fees can wreak havoc on their precarious finances. These same households, however, rely heavily on cell phones—68 percent of unbanked households have mobile phones.

L.A. Care is the first health plan to use the PayNearMe network, although the company’s method of cash collection is already in use in other ways elsewhere: By Nebraska parents who owe child support, Pittsburg water customers and bike share riders in Philadelphia who can pay cash at local convenience stores to settle bills.

“What goes in is cash, and what comes out is an electronic payment,” said Shader. “We think everybody ought to do it.”

Categories: Health Care

Traumatic Turning Point: How The Marathon Bombing Shifted One Woman’s Depression

CommonHealth (WBUR) - Mon, 04/20/2015 - 9:55am

By Annie Brewster, M.D.

Jennifer on Marathon Monday 2013, before the runners started coming in. (Courtesy)

Jennifer’s depression was deep and at times debilitating. For years, she tried various treatments but succes was always temporary.

Something changed on the finish line at the Boston Marathon in 2013. It was, Jennifer says, “a turning point” in her life, but not in the ways you might expect.

As a marathon volunteer stationed a block from where the first bomb exploded, she witnessed the confusion and terror that ensued, and played an important role in helping one scared runner reunite with his family.

After the ordeal, Jennifer felt lucky to walk away alive. Her life goals changed that day and she says she now feels it’s her responsibility to help others. She continues to find concrete ways to do so.

Listen to Jennifer here:

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She had already signed up to participate in a program at the Henry-Benson Institute of Mind-Body Medicine at Massachusetts General Hospital the week following the bombing. Primed by her experience during and after the race, she devoured the course. It deepened her sense of self-acceptance and gave her skills to manage her own depression, but also strengthened her resolve to help others. She ultimately went on to become a peer counselor at the institute.

Now, her central message is this: while we can’t necessarily control what happens to us in life, we can control the meaning we make of our experiences.

Jennifer says she’s determined to make the events of April 15, 2013, mean something, and to translate this meaning into action. As far as her depression, she has come around to recognizing “some of the good things about depression” namely her appreciation for the small things in life, and her increased sense of empathy for others. “It’s like any other illness”, she says. “It doesn’t have to limit you. It’s all about making it mean something.”

Dr. Annie Brewster, M.D., is founder and executive director of Health Story Collaborative, a nonprofit in Boston.

Categories: Health Care

Obama Praises Congress on Iran and Trade, but Chides Senate G.O.P. Over Nominee

Medicare -- New York Times - Sat, 04/18/2015 - 12:00am
Mr. Obama lauded Congress’s recent bipartisanship on Friday, but he sharply criticized G.O.P. senators for delaying a vote on Loretta Lynch, his choice for attorney general.
Categories: Elder, Medicare

Jeb Bush Proposes Requiring Medicare End-of-Life Directives

Medicare -- New York Times - Fri, 04/17/2015 - 1:56pm
Jeb Bush’s remarks showed how public opinion has shifted since the firestorm over supposed federal “death panels” in 2009.
Categories: Elder, Medicare

A Look Back As Congress Repeals Medicare ‘Doc Fix’ Law

Kaiser Health News - Fri, 04/17/2015 - 1:44pm

https://kaiserhealthnews.files.wordpress.com/2015/04/20150416_atc_doc_fix_obit.mp3>>Don’t See the player? Click here to download the audio of this conversation.

AUDIE CORNISH, HOST: For the last 18 years, lawmakers have gone around and around and around trying to fix part of a Medicare law. Ironically, what they were trying to solve was originally supposed to be a fix. That issue – a law from the late 1990s that would cut Medicare payments to doctors to keep the program’s budget in check.

ROBERT SIEGEL, HOST: Lawmakers worried that the pay decreases might drive doctors away. So year after year, Congress scrambled to prevent these cuts from kicking in, and they called it the doc fix. This week – an end to the saga.

CORNISH: Congress finally repealed the controversial formula, and President Obama signed the new legislation this afternoon. Joining us now to say goodbye to the doc fix is Julie Rovner of Kaiser Health News. Hey there, Julie, welcome back.

JULIE ROVNER: Thanks, Audie.

CORNISH: Remind us the history here, I mean, this fix was supposed to be a good thing – right? – prevent overspending.

This copyrighted story comes from NPR’s Shots blog. All rights reserved.

ROVNER: Well, the history is that they changed the way they paid doctors in the late 1980s, but they wanted to make sure that doctors who were going to lose money didn’t make it up by just doing more services. So they put in what were called volume controls, so that doctors would take a hit if they did too much. And that didn’t quite work, so they reconfigured it in 1997. And as you mentioned, it was supposed to make cuts to the overall budget if they went over the budget. And the problem was they kept going over the budget, and Congress would really postpone the cut rather than cancel it.

So what happened is that over time, the cuts kept getting bigger and bigger and more draconian until they were over 20 percent. And Congress knew that it couldn’t cut payments to doctors by more than 20 percent ’cause they’d stop seeing Medicare patients. So it became this consistent headache for Congress doing what we all call kicking the can down the road. So finally, you know, Republicans and Democrats were really sick of this and they got together actually two years ago and came up with this compromise. It’s taken really almost two years to get it through and to the president’s desk.

CORNISH: So how did it become such a political problem? And what was the kind of big idea that this fight ended up being about?

ROVNER: The political problem was whether or not it should be paid for. Is if you’re going to cancel this cut, do you actually have to find offsetting cuts to do it? And I remember back in 2007, Sen. Max Baucus, who was the brand-new chairman of the Finance Committee, suggested at a hearing that they would have to take a mulligan on it, meaning not pay for it. Nobody ever did that until just now when they finally decided that they weren’t going to pay for it – at least they weren’t going to pay for all of it. And I think that was sort of the key because last year, they had the bill finished, but they couldn’t – Republicans and Democrats couldn’t agree on a way to pay for it. And in the end, they decided not to pay for all of it.

CORNISH: So politically, who are the victors here? I mean, did lawmakers just kind of give up?

ROVNER: (Laughter) I think politically the victors are lawmakers themselves, particularly on the health committees who are so tired of doing this every year or every six months or every month. And also, you know, the nation’s doctors and other health professionals who are paid according to what Medicare pays doctors, who are going to get a new payment system and not have this Sword of Damocles of cuts hanging over their heads, and, of course, then the Medicare patients themselves. I should add that this bill also extended for two years. The Children’s Health Insurance Program – that was setting up as a potential fight. Democrats wanted to extend it for four years, but the two years was a compromise. This was a real serious Democratic-Republican compromise of the type we don’t often see.

CORNISH: Julie, what does this mean for Medicare going forward? I mean, as we mentioned at the outset here, this was supposed to prevent overspending.

ROVNER: That’s right. And what it means is that Medicare is going to change on the doctor side. They’re going to try and encourage doctors to have alternate payment system that pay them according to outcomes, to how well they do to how healthy they keep their patient. It’s not a done deal. There will be a lot of, as usual, Medicare problems with the technicalities of how to do this, but I think everybody agrees it was a step forward that Medicare needed to take.

CORNISH: Julie, is there – I don’t know – something on the epitaph of the doc fix grave?

ROVNER: (Laughter) Good riddance.

CORNISH: That’s Julie Rovner of Kaiser Health News. She covered the doc fix for many, many years.

Categories: Health Care

15 States Extend Health Law’s Higher Medicaid Payments To Doctors

Kaiser Health News - Fri, 04/17/2015 - 12:27pm

Fifteen states are betting they can convince more doctors to accept the growing number of patients covered by Medicaid with a simple incentive: more money.

The Affordable Care Act gave states federal dollars to raise Medicaid reimbursement rates for primary care services—but only temporarily. The federal spigot ran dry on Jan. 1. Fearing that lowering the rates would exacerbate the shortage of primary care doctors willing to accept patients on Medicaid, the 15 states are dipping into their own coffers to continue to pay the doctors more.

It seems to be working.

Indiana Gov. Mike Pence speaks during a press conference March 31, 2015 at the Indiana State Library in Indianapolis, Indiana. (Photo by Aaron P. Bernstein/Getty Images)

In Indiana, which is spending about $40 million a year in state dollars to keep the higher reimbursement rate, an additional 335 doctors have started accepting Medicaid patients since the beginning of this year. So have more than 600 other medical providers, such as nurse practitioners and physician assistants.

“We’ve seen good results,” said Joe Moser, the state’s Medicaid director. “We are interested in seeing if the results continue, and we have every reason to think that it will.”

Colorado has had a similar experience. There the number of new providers participating in Medicaid is increasing by about 100 each month, according to Marc Williams, spokesman for the Department of Health Care Policy and Financing.

This copyrighted story comes from Stateline, the daily news service of the Pew Charitable Trusts. (Learn more about republishing Stateline content)

In addition to Indiana and Colorado, Alabama, Iowa, Maryland, Mississippi and New Mexico are keeping reimbursement rates where they were before the federal bump ended. Connecticut, Delaware, Hawaii and Maine, Michigan, Nebraska, Nevada, and South Carolina also are continuing to pay higher rates, though they aren’t as high as they were before the federal money disappeared, according to a March report to Congress from the Medicaid and CHIP Payment and Access Commission (MACPAC).

In the 23 states that have indicated they won’t continue to make the higher payments, payments for primary care will fall 47 percent on average this year, an Urban Institute analysisestimates.

David Schultz, a family physician who runs a clinic with a high percentage of Medicaid enrollees in southwestern Indiana, said low Medicaid reimbursement rates had made it increasingly difficult to maintain the practice.

“Frankly, we were losing money and losing personnel,” he said. “We had to increase the numbers of people we saw every day, stayed open much longer, worked through lunches, not taking half-days off.”

The higher rates haven’t changed his life enormously, he said, but the office has at least been able to cut back on the heavy scheduling.

Rejecting Medicaid

In 2012, a third of primary care doctors didn’t accept new patients with Medicaid coverage, according to a previous MACPAC report to Congress. Only 25 percent of patients covered by Medicare, the government health program for seniors, were turned away. And only 15 percent with private insurance were.

Before the federally subsidized higher reimbursements were paid, Medicaid paid only 59 percent of what Medicare did for primary care services, according to the Henry J. Kaiser Family Foundation.

When the federal subsidy ended, states had to decide whether to continue to pay higher rates with little hard data on whether doing so would persuade more doctors to accept Medicaid patients. Other factors, such as the relatively long time it takes doctors to receive their Medicaid payments, also may contribute to their reluctance to take on Medicaid patients.

A multistate study on the impact of the reimbursement increase published in the New England Journal of Medicine in February found that the availability of primary care appointments for Medicaid patients had increased 7.7 percent with the higher payments. But the study did not examine how many more doctors were accepting Medicaid patients.

There was, however, anecdotal evidence from individual states. Alaska, for example, has long paid Medicaid reimbursement rates that are higher than those for Medicare. Margaret Brodie, director of the Division of Health Care Services, said she believes that’s why the state hasn’t had a shortage of Medicaid providers.

And in Connecticut, the number of primary care doctors participating in Medicaid was 3,589 at the start of this year, up from 1,622 on Jan. 1, 2012, the year before the fee bump, according to David Dearborn, a spokesman for the Department of Social Services.

Paying for the Bump

The states that are continuing the higher payments are turning to a variety of sources to finance them.

Indiana will do it with an increase in the cigarette tax and an eventual increase in taxes on hospitals.

Nebraska is using state general funds for the $8.9 million it needs to pay the higher rate. Maine is redirecting $7.4 million in state tobacco settlement money to help pay the higher rates. To get the $18 million it will cost to fund the increase for six months, Colorado is relying on an advantageous recalibration of its federal-state Medicaid match.

Maia Crawford, a program officer at the Center for Health Care Strategies, a nonprofit that focuses on improvements in publicly financed health care, argues that maintaining the higher rates isn’t a heavy price for states to pay in return for “garnering good will among Medicaid providers and working to ensure that Medicaid stays well stocked with providers.”

Categories: Health Care

Massachusetts Court Upholds $63M Judgment In Motrin Lawsuit

CommonHealth (WBUR) - Fri, 04/17/2015 - 12:27pm

The highest court in Massachusetts has upheld a $63 million judgment against the manufacturer of Children’s Motrin awarded to a family whose daughter developed a life-threatening disease after taking the over-the-counter medicine.

A Superior Court jury ruled in 2013 that Johnson & Johnson failed to provide sufficient warnings about the potential side effects of Motrin.

Samantha Reckis was 7 in 2003 when she was given the ibuprofen product to reduce a fever. She suffered a rare skin disease known as toxic epidermal necrolysis and was blinded.

Johnson & Johnson appealed on several grounds, including that the family failed to prove the medicine caused the disease and that damages were excessive.

The Supreme Judicial Court rejected those arguments in Friday’s decision.

A company spokeswoman woman did not immediately respond to an email seeking comment.

Categories: Health Care

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