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State Highlights: Mass. Can't Ban Painkiller, Judge Rules; Kan. And Health Care Compact Bill

Kaiser Health News - Wed, 04/16/2014 - 9:12am

A selection of health policy stories from Massachusetts, Kansas, Florida, Michigan, Connecticut, Maryland, Arizona, Hawaii, Missouri and Georgia.

The Washington Post: Massachusetts Cannot Ban FDA-Approved Painkiller, Judge Rules
A federal judge on Tuesday blocked an effort by Massachusetts Gov. Deval L. Patrick to ban sales of a controversial new painkiller in the state, saying the governor’s move was preempted by federal law and could harm people who need the drug for pain relief. In a five-page order, U.S. District Judge Rya W. Zobel sided with the drug’s California-based manufacturer, Zogenix, which had argued that Patrick had no right to bar a medication that the Food and Drug Administration has deemed safe and effective (Dennis, 4/15).

Kansas Health Institute:  Governor Urged To Veto Health Care Compact Bill
Gov. Sam Brownback would be taking a political risk by signing a bill that could eventually give state officials control of Medicare and other federal health care programs, Kansas Insurance Commissioner Sandy Praeger said Tuesday. Praeger, a Republican in the final year of her third and final term, said because the bill could “jeopardize” the benefits of the nearly 450,000 Kansans enrolled in Medicare signing it could alienate senior voters (McLean, 4/15).

The Miami Herald:  Miami Lawmakers Make One More Push To Extend Health Care To Immigrant Children
A bill to extend subsidized health insurance to the state’s youngest legal immigrants has stalled in the Florida Legislature, due largely to the initial $27.5 million price tag. But Rep. José Félix Díaz, a Miami Republican says the actual price is a lot lower: between $7 million and $15 million. He’s fighting to have the measure included in the state budget (McGrory, 4/15).

The Wall Street Journal: Detroit Reaches Deal With Police, Firefighter Retirees
Other terms in Tuesday's police and firefighters pact include a voluntary employee beneficiary association plan, known as a VEBA, funded by Detroit to handle retiree health care, instead of the city. These retirees would also keep some representation on the board of their pension system, over which the city had proposed increasing independent oversight. All of the city's creditors will still have a chance to vote on the city's plan, including more than 20,000 city workers and retirees. But Judge Rhodes will have the final say on its approval (Dolan, 4/15).

The CT Mirror: Medical Fraud In CT Costs Feds Millions Of Dollars
Reporters and lawyers have become the latest front in Washington’s war against medical fraud that, in some way, is unwinnable, even as it has resulted in the prosecution of doctors and drug companies in Connecticut and across the country. Last year, James P. Ralabate, a Stratford-based general practitioner, agreed to pay $700,000 as part of an agreement with the Justice Department to settle allegations that he and his company, Primary Care Associates, engaged in fraudulent billing at several nursing homes in Connecticut. Each year, medical fraudsters steal at least $70 billion from the federal government -- probably a lot more (Radelat, 4/15).

The Washington Post: Gansler Takes Aim At Maryland’s ‘Bad Spending Habits,’ Says He Would Save The State Money
[Democratic candidate for governor Douglas] Gansler said major savings could be realized through reforms to the state’s procurement process, better management of the state Medicaid program and reduction of the non-violent prison population, among other strategies (Wagner, 4/15).

The CT Mirror: CT Legislative Panel OKs Contract With Personal Care Attendants
A legislative committee approved a controversial first contract Tuesday between the state and the union representing nearly 11,000 personal care attendants who help the elderly and disabled remain in their homes. The workers, who originally gained bargaining rights through an executive order by Gov. Dannel P. Malloy, receive hourly raises ranging from 40 to 50 cents in 2014, and from 35 to 50 cents in 2015. The agreement provides funds for worker training and orientation and limited paid time off. Though rules governing the latter still must be negotiated, workers could be eligible for limited stipends -- but not full pay -- when taking scheduled time off (Phaneuf and Becker, 4/15).

Kansas Health Institute News Service:  Mental Health Task Force Report Released
A 16-member task force that spent much of the past year looking for ways to improve the state’s mental health system released its findings today. “I looked forward to reading this report and working to determine which of their recommendations we want to implement,” Gov. Sam Brownback said in a prepared statement. Included in the 38-page report are an assessment of the system’s shortcomings and more than 40 recommendations for expanding access to treatment (Ranney, 4/15).

The Associated Press:  Plan Would Change Payments For Mental Health Care
The Florida Legislature is considering a plan that would change the way the state pays to treat people who need emergency mental health care, a move critics say would gut the current system to benefit large hospital systems. Under the current system, the state Department of Children and Families contracts with 117 public and private Crisis Stabilization Units around the state to provide emergency mental health treatment, paying nearly $300 a day per bed regardless of whether they are occupied. The system, which cost the state $61.3 million last year, guarantees that the crisis units have enough beds and staff to meet peak needs, supporters say (4/15).

The Associated Press:  Arizona Bill Would Regulate Health Care Navigators
The Arizona Senate has given initial approval to a measure that would require extra licensing and background checks for health exchange navigators who help people buy coverage. The Senate gave initial approval to House Bill 2508 on Tuesday. The bill that would require navigators to get a license through the state Department of Insurance and to pass a criminal background check (4/15).

The Associated Press:  Hawaii Weighs Expanded Coverage For Infertility
Hawaii lawmakers are weighing whether insurance companies should be required to cover more treatments for infertility and to update a law that some say discriminates against unmarried women. The resolution (SCR 35) calls on the state auditor to study the social and economic effects of the proposal. "Women are starting their families later, which raises all sorts of concerns about access to procedures," said Rep. Della Au Belatti, chairwoman of the House Health committee, which advanced the resolution (Bussewitz, 4/15).

Stateline: States Battle Asthma As Numbers Grow
In a valley wedged between the Mississippi and Missouri rivers, St. Louis often finds itself beset by a stationary air mass that only a severe storm of some kind can dislodge. St. Louis is also an industrial city with high humidity, so it’s no wonder it usually makes the list of worst places for asthmatics to live. But the state has also pioneered advances in addressing asthma treatment and costs (Ollove, 4/16).

Georgia Health News: State Seeking More Choice In 2015 Health 
State officials said Tuesday that they plan to increase the number of insurers and health plan options for state employees and teachers next year. The State Health Benefit Plan (SHBP) has been a target of fierce criticism since Jan. 1. That’s when changes to its benefit design, plus the use of just one insurer, sparked widespread complaints about a lack of choice of insurance plans and higher health care costs. Now, though, the Department of Community Health is asking for proposals for a second statewide insurer to offer a high-deductible health plan, a Medicare Advantage plan for retirees, and a statewide HMO (Miller, 4/15).

Georgia Health Plans: Standalone Rural ERs Face A Serious Hurdle
Gov. Nathan Deal’s plan to help financially ailing rural hospitals, announced last month, has drawn strong praise from legislators and health industry leaders. Deal proposed a change in licensing rules to permit a struggling rural hospital, or one that recently closed, to offer downsized services that would include an emergency department. But a drawback has emerged – one that, if unchanged, may lower the chances of these freestanding ERs being built (Miller, 4/15).

Categories: Health Care

With End-Of-Enrollment Surge Behind Them, Insurers See Health Law Positives

Kaiser Health News - Wed, 04/16/2014 - 9:11am

Politico reports that many insurers are contemplating expanding -- or initiating -- their participation in exchanges. Other news outlets examine tax day, the health law and the Internal Revenue Service.   

Politico: Insurers See Brighter Obamacare Skies
Health insurers got their first taste of Obamacare this year. And they want seconds. Insurers saw disaster in the fall when Obamacare’s rollout flopped and was a mess. But a strong March enrollment surge, along with indications that younger and healthier people had begun signing up, has changed their attitude. Around the country, insurers are considering expanding their stake in the Obamacare exchanges next year, bringing their business to more states and counties. Some health plans that skipped the new marketplaces altogether this year are ready to dive in next year (Cheney and Norman, 4/15).

Fox News: How Much Will ObamaCare Cost You In Taxes?
On this April 15, filers and accountants alike are finding a new array of taxes resulting from the president’s health care legislation. These include at least 20 ObamaCare-related tax increases totaling  $409 billion over the next ten years, according to the Joint Committee on Taxation. The new taxes are especially irksome to ObamaCare opponents, because they are imposed by a law that passed on a straight party-line vote and are being enforced by an agency that some accuse of party favoritism. "I think it's rather unfortunate that the IRS has this huge role in the Affordable Care Act because it's always controversial," said Mark Everson, a former IRS Commissioner (McKelway, 4/15).

Politico Pro: IRS Soon Becomes Point Guard For ACA
The IRS is already laser-focused on 2015, when they take the lead in carrying out Obamacare. The law’s pivotal individual mandate and subsidies kick in this year, so the IRS role will expand next filing season. A major goal? Avoid the fate of the Health and Human Services website “train wreck,” as the GOP so fondly calls it, quoting the early worries of a Democratic senator (Bade, 4/15).

Categories: Health Care

Arizona Takes Another Abortion Restriction Step

Kaiser Health News - Wed, 04/16/2014 - 9:10am

Now the state has the authority to "surprise" inspect clinics without a warrant.

Reuters:  Bill Signed Allowing Surprise Inspections Of Arizona Abortion Clinics
Arizona Governor Jan Brewer on Tuesday signed into a law a bill allowing state health authorities to conduct surprise inspections of abortion clinics without first obtaining a warrant, handing another victory to abortion foes.  The Republican-backed bill, which gained final legislative approval from the state Senate last week, removes a provision from state law requiring a judge to approve any spot inspections conducted at the nine clinics in Arizona licensed to perform abortions (Schwartz, 4/15).

The Associated Press: Governor Signs Surprise Inspection Abortion Bill
Litigation is likely because a 2010 lawsuit settlement over a 2004 state law calls for a search warrant to be obtained before an inspection. ... Republicans say the change is needed to ensure that abortion clinics can be inspected without delays. They say the bill is an effort to keep women safe. Democrats say that removing the warrant requirement would open clinics to harassment ... [and] also say the bill is unnecessary, since only one warrant has been issued in the past four years (Galvan, 4/15).

Categories: Health Care

Viewpoints: Cooking The Census Books; Immigrants Left Off Health Law; Abortion Still A 'Tripwire'

Kaiser Health News - Wed, 04/16/2014 - 9:10am

The Wall Street Journal: Cooking The ObamaCare Stats
You can't manage what you don't measure, as the great Peter Drucker used to say, and for the White House that seems to be the goal. Out of the blue, the Census Bureau has changed how it counts health insurance—at the precise moment when ObamaCare is roiling the insurance markets (4/15). 

Bloomberg: Is Obama Cooking The Census Books For Obamacare?
The New York Times reports that the Barack Obama administration has changed the [Census] survey so that we cannot directly compare the numbers on the uninsured over time. ... This is the biggest policy debate of the last 10 years, and these data are at the heart of that debate. It is implausible that everyone involved somehow failed to notice that they were making it much harder to know the effect of this law on the population it was supposed to serve (Megan McArdle, 4/15).

USA Today: Obamacare Doesn't Help Immigrants
I can't remember the last time I had a medical check-up; I'm 20, and it's been at least five years. When I was a little kid in South Los Angeles, my mother would only take my older sister and me to the doctor when we were already sick; whether we had a fever or any other illness, every visit cost $100, including treatments. Then a neighbor informed my mom of a community clinic that offered free visits for low-income families — but only, again, if we were already sick. The clinic was our best option because as undocumented immigrants we had no insurance and weren't eligible for benefits from state programs (Miguel Molina, 4/15).

Arkansas Times: Tom Cotton Avoids Taking Stance On Private Option
The private option — the state's unique plan using Medicaid funds to purchase health insurance for low-income Arkansans — has provided coverage to 150,000 Arkansans (and counting). The funding mechanism for the private option is Obamacare, and repealing Obamacare is at the top of Rep. Tom Cotton's agenda. Repeal Obamacare, and the private option dies with it. At today's presser, I asked Cotton about this. "We would repeal Obamacare and replace it entirely with many reforms for our health care program," Cotton said. I asked whether he had a specific replacement plan which would cover all the folks who would lose their coverage if Cotton succeeded in repealing the law. He trotted out some tried-and-true Republican talking points which would do no such thing, such as allowing insurance to be sold across state lines (David Ramsey, 4/13).

The Richmond Times-Dispatch: In Health Fight, Both Sides Told What They Want To Hear
At a town hall-type meeting Monday night organized by three Republican legislators who represent rural Louisa County, speaker after speaker questioned or criticized a proposal to bring as many as 400,000 uninsured Virginians under Obamacare through a private market set up by the state. In fact, after the lawmakers reprised their wins and losses during the winter session of the General Assembly, the coverage plan was the only topic the audience wanted to talk about. The scheme — caught up in the latest budget impasse that threatens a state government shutdown unless there’s a deal by June 30, the final day of the spending cycle — would be paid for over the next four years with nearly $7 billion from Medicaid, a health care program for the poor. Welcome to the echo chamber (Jeff E. Schapiro, 4/15). Corbett Medicaid Plan Puts Pennsylvanians At Breaking Point Over Cuts And Delays
With the federal public comment period ending this week on the Corbett Administration's Healthy PA proposal, Pennsylvanians delivered a loud and clear message to the Centers for Medicare and Medicaid. Healthy PA is overly complex, overly complicated and unnecessary. The best choice for Pennsylvania taxpayers and uninsured workers is to join all of our surrounding states by expanding Medicaid immediately (Antoinette Kraus, 4/16).

New Orleans Times-Picayune: Louisiana Taking Away Medicaid Lifeline For Disabled, Other Vulnerable Residents
It's well known that Gov. Jindal steadfastly opposes expanding Medicaid in the state under the Affordable Care Act, and that the Legislature voted against expansion in 2013. This is misguided, as Medicaid expansion would cover as many as 300,000 uninsured residents, with 100 percent of the costs picked up by the federal government through 2016 and at least 90 percent thereafter. But less widely known is that Medicaid in Louisiana is actually shrinking, through termination of programs and tighter eligibility requirements. In the state's view, since the Affordable Care Act's private insurance marketplace will cover people earning more than the federal poverty level, many people on Medicaid should pick up insurance on marketplace exchanges. But it's not that simple (Megan McLemore, 4/15).

The CT Mirror: Accessing Mental Health Care Still A Challenge In CT’s Rural Areas
The Affordable Care Act has brought ongoing changes in health care, but there are still issues surrounding those living with mental illness, particularly in rural areas, where there is a significant lack of mental health care available. In rural populations, the rates of depression exceed those in urban populations, and suicide rates among teenagers and adults are significantly higher in rural areas than in urban areas. As a mother and nurse living and working in rural of Connecticut, I have found that obtaining mental health services can be a time-consuming, frustrating process (Holly Atkinson, 4/15). 

Fox News: Kathleen Sebelius Quits: Can You Spell Scapegoat? offers two definitions for scapegoat: "1. A person or group made to bear the blame for others or to suffer in their place; 2. Chiefly biblical. A goat let loose in the wilderness on Yom Kippur after the high priest symbolically laid the sins of the people on its head. Lev. 16:8,10,26." Both definitions seem to fit last week's announcement of the "resignation" of Kathleen Sebelius, secretary of Health and Human Services, who presided over the disastrous rollout of the government's website,, which was supposed to provide easy access for people who wished to sign up for ObamaCare (Cal Thomas, 4/15).

On other health issues -

The New York Times: Abortion Endures As A Political Tripwire
Why is there such a difference in the durability of two foundational issues of American conservatism: gay marriage and abortion? Same-sex marriage burst onto the political scene in the early 1990s, lasted through the mid-2000s, and is now quietly fading. Abortion, as a political call to arms, has been around twice as long and shows no signs of disappearing (Thomas B. Edsall, 4/15). 

The Des Moines Register: Medicare Pay Info Helps With Accountability
For the first time since the 1970s, the federal government has released data on Medicare payments to individual physicians. The media have focused on a few doctors who collected from $10 million to $20 million in 2012 from the government health insurance program for seniors. About 2,000 providers were reimbursed at least $2 million. The information certainly does raise eyebrows (4/14).

Categories: Health Care

States Battle Asthma as Numbers Grow

Kaiser Health News - Wed, 04/16/2014 - 8:29am
In a valley wedged between the Mississippi and Missouri rivers, St. Louis often finds itself beset by a stationary air mass that only a severe storm of some kind can dislodge. St. Louis is also an industrial city with high humidity, so it’s no wonder it usually makes the list of worst places for asthmatics to live.

But the state has also pioneered advances in addressing asthma treatment and costs. Two years ago, the Missouri legislature became the first to allow schools to stock quick-relief asthma medications for emergencies. Missouri also became the first state to permit school nurses and other trained staff to administer that medication to any child suffering an asthmatic attack while at school, whether or not the child has an asthma diagnosis or a prescription at the school.

Now the state is poised to register another advance in its campaign against the respiratory disease. The House passed an appropriations bill late last month that would allow  Medicaid reimbursement for specialists to visit the homes of low-income patients with severe asthma to identify asthma triggers in those homes. Medicaid would also provide reimbursement for face-to-face sessions to educate severe asthmatics in the disease and ways to manage it. The Senate is now considering the measure.

If approved, Missouri would join a very small number of states, including Massachusetts, Minnesota and New York, that either provide Medicaid reimbursement for asthma education or home assessments or both.

“Missouri is doing the most innovative policy interventions on asthma at this time,” said Charlotte Collins, senior vice president for policy and programs at the Asthma and Allergy Foundation of America (AAFA). 

“There is lots of buzz inside the national asthma advocacy community about Missouri.”


The latest legislation would define eligible patients as those identified as frequent users of emergency rooms for asthma, frequently hospitalized as a result of asthma or frequently prescribed oral steroids for asthmatic emergencies.

What prompted Missouri to act was an informational bulletin from the Centers for Medicare and Medicaid Services last month that encouraged states to look for ways to cut down on health care cost by the so-called “super-utilizers,” or those patients who consume a disproportionately high share of health care costs because of chronic conditions or acute illness or trauma.

According to CMS, this 1 percent of the U.S. population accounts for 22 percent of total annual health care expenditures. The CMS encourages states to find ways to treat those patients more effectively and less expensively.

The new legislation would cost Missouri $524,033 in the first year with the federal government chipping in another $4.7 million in Medicaid dollars. Not exactly cheap, the measure is anticipated to save far more by reducing the number of paramedic calls and visits to emergency rooms. A study published in the American Journal of Preventive Medicine and other research have shown that home assessments are effective in reducing emergency room visits and health care costs.

“Without a doubt, we’ll be able to save the state money,” said John Kraemer, founder of the Institute for Environmental Health Assessment and Patient-Centered Outcomes at Southeast Missouri State University. The institute provides asthma training and assists with home assessments. 

One in Five Children

A chronic inflammatory disease of the airways characterized by breathing disorders, asthma afflicts 18.7 million adults and 7 million children in the U.S., according to the Centers for Disease Control and Prevention (CDC). And the numbers are going up.

The CDC says the number of Americans diagnosed with asthma increased by 4.3 million from 2001 to 2009, most steeply among black children, who are more likely to live in areas with greater pollution and environmental toxins. There were nearly 480,000 asthma-related hospitalizations in 2009, 1.2 million outpatient visits, 1.9 million emergency room visits, and 3,388 asthma-associated deaths. The CDC estimated health care costs related to those asthma incidents at $56 billion.

Nationwide, one in 10 children has asthma. In St. Louis, the rate for children is nearly one in five, according to the Missouri Department of Health and Senior Services.

Respiratory illness is the leading cause of hospitalizations for children between 1 and 10, according to the federal Health Resources and Services Administration.

Asthma ranked behind only mental illness in expenditures for childhood diseases, a 2011 survey by the U.S. Department of Health and Human Services found. Expenditures for treating asthma and chronic obstructive pulmonary disease in children totaled $11.9 billion. More than 12 million children were treated for asthma in 2011, and Medicaid paid about half the treatment costs. Hospitalizations accounted for 29.4 percent of these asthma expenditures.

The St. Louis chapter of AAFA pushed hard for the asthma-related legislation in 2012 and is also behind this year’s proposal, according to Joy Krieger, the chapter’s executive director. The organization already provides to the uninsured and underinsured asthma medications and nebulizers, which are drug delivery devices that transform liquid medicine into inhalable mist. 

“Elbow Grease”

Krieger also regards home assessments as key to improving the health of asthma sufferers and reducing health care costs.

“For too long, people have treated this as a crisis rather than as a chronic condition,” she said. In other words, many crises can be avoided if people can eliminate or reduce the asthma triggers in their homes, she said. They include tobacco smoke, dust, cockroaches, mites, mold, pets, fragrances, fireplaces and certain paints.

“A lot of this you can just get rid of with elbow grease,” Krieger said. It’s a matter of education, she added.

Despite the state’s policies addressing asthma, the Asthma and Allergy Foundation of America still does not consider Missouri one of the states doing the best job in schools. It didn’t include Missouri in the honor roll of states with the most comprehensive and preferred statewide public policies supporting people with asthma, food allergies, anaphylaxis risk and related allergic diseases in schools.

The organization grades states on whether they have adopted 18 specific policies related to medication, reporting, tobacco use and indoor quality. By those standards, only seven states made the foundation’s honor roll: Washington, Indiana, Vermont, New Jersey, Rhode Island, Connecticut and Massachusetts. (The District of Columbia also made the list).

While Collins, of the national office, said Missouri was deficient in school-related air quality and tobacco policies, its innovations in accessibility to medications in schools had gotten the attention of advocates across the country.

Categories: Health Care

First Edition: April 16, 2014

Kaiser Health News - Wed, 04/16/2014 - 7:18am

Today's headlines include a report detailing how changes in the Census Bureau's annual survey could mask the health law's impact.   

Kaiser Health News: FAQ On ACOs: Accountable Care Organizations, Explained
Kaiser Health News staff writer Jenny Gold writes: “One of the main ways the Affordable Care Act seeks to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks which coordinate patient care and become eligible for bonuses when they deliver care more efficiently. … While ACOs are touted as a way to help fix an inefficient payment system that rewards more, not better, care, some economists warn they could lead to greater consolidation in the health care industry, which could allow some providers to charge more if they’re the only game in town. Here are answers to some of the more common questions about how they work” (Gold, 4/16). Read the story.

Kaiser Health News: Capsules: Health Law Push Brings Thousands Into Colo. Medicaid Who Were Already Eligible
Now on Kaiser Health News' blog, Eric Whitney writes: “The big marketing push to get people enrolled in health coverage between October and March resulted in 3 million people signing up for Medicaid. Hundreds of thousands of those people were already eligible and could have signed up even before the Affordable Care Act made it much more generous” (Whitney, 4/16). Check out what else is on the blog.

The New York Times: Census Survey Revisions Mask Health Law Effects
The Census Bureau, the authoritative source of health insurance data for more than three decades, is changing its annual survey so thoroughly that it will be difficult to measure the effects of President Obama’s health care law in the next report, due this fall, census officials said. The changes are intended to improve the accuracy of the survey, being conducted this month in interviews with tens of thousands of households around the country. But the new questions are so different that the findings will not be comparable, the officials said (Pear, 4/15).

Politico: Insurers See Brighter Obamacare Skies
Health insurers got their first taste of Obamacare this year. And they want seconds. Insurers saw disaster in the fall when Obamacare’s rollout flopped and was a mess. But a strong March enrollment surge, along with indications that younger and healthier people had begun signing up, has changed their attitude. Around the country, insurers are considering expanding their stake in the Obamacare exchanges next year, bringing their business to more states and counties. Some health plans that skipped the new marketplaces altogether this year are ready to dive in next year (Cheney and Norman, 4/15).

The Wall Street Journal: Obama Administration Won't Extend Health-Insurance Enrollment
The Obama administration said on Tuesday that a midnight deadline for most people to finish health-insurance applications for private coverage this year wouldn't be extended amid signs that enrollment waits had dissipated. Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, confirmed there would be no further changes to an extension that pushed the end of insurance enrollment until April 15 for those who were "in line" on by March 31. The federally run site is the main portal for buying insurance under the Affordable Care Act (Radnofsky, 4/15).

Los Angeles Times: Health Sign-Ups In State Draw to A Close
After website troubles sparked a two-week extension, California officials wrapped up the first open enrollment for Obamacare coverage with nearly 1.3 million consumers signed up since October for the state-run exchange. Sign-ups ahead of Tuesday's enrollment deadline appeared to run more smoothly than they did March 31, the previous cut-off date (Terhune, 4/15).

NPR: Is Obamacare A Success? We Might Not Know For A While
After months of focusing on how many people have or haven't signed up for health insurance under the Affordable Care Act, we now have a rough total (7.5 million) and everyone's keen to get to the bigger questions: How well is the law working? How many of those who signed up have paid their premiums and are actually getting coverage? How many were uninsured before they signed up? And just how big has the drop been in the number of uninsured people? (Rovner, 4/16).

Politico: Poll: Uninsured Drops In Key States
States that have expanded Medicaid and opened their own exchanges have seen a higher rate of decline in the number of uninsured, compared with other states, a new poll show. The 21 states and D.C., which have done both, saw an average decline in uninsured of 2.5 percent, according to a poll released Wednesday by Gallup. The other 29 states that didn’t enact both measure had a dip in uninsured of less than 1 percent on average (McCalmont, 4/16).

The Associated Press: Va. House Republicans Reaffirm Medicaid Opposition
House Republicans say they remain resolute in their opposition to using federal Medicaid funds to provide health insurance to as many as 400,000 low-income Virginians. During a conference call with reporters Tuesday, House Speaker William J. Howell said he is optimistic that Gov. Terry McAuliffe and Democratic lawmakers would back down from their support of a proposed state budget that includes expanding Medicaid eligibility. State services could shutter if a state budget isn’t passed by July 1 (4/15).

Politico: Giving Anti-Obamacare Speeches To Enrollees
The two-week recess is the first extended break from Washington for lawmakers since the 2014 open enrollment season ended and coverage for many Americans kicked in. Many people with new plans received subsidies to make their health insurance more affordable, or they became eligible for expanded Medicaid. It’s not that red-state representatives and senators won’t come across negative stories about the Affordable Care Act from constituents who say the law caused their plans to be canceled, forced them to change doctors or raised costs for their businesses. It’s that other group, comprising the people being helped, that potentially poses a challenge (Cunningham and Kim, 4/16).

Los Angeles Times: Louisiana Democrat Highlights Independence From Obama In New Ad
The aggressive tone of Landrieu’s new ad mirrors that of her first ad last fall, which highlighted her legislative proposal to fix Obama’s healthcare law. Her campaign aired the ad after thousands of Louisiana residents received warnings that their health insurance policies would be canceled because they did not meet the new guidelines under the law. As a key target in the Republican quest to win back the Senate, Landrieu faces two Republican opponents in the November election and must win more than 50% of the vote to avoid a runoff (Reston, 4/15).

The Wall Street Journal: Health Law Poses A Test In New Hampshire Senate Race
New Hampshire's rollout of the Affordable Care Act has been one of the rockiest in the nation, putting Democratic Sen. Jeanne Shaheen on the front lines of Republican efforts to make the 2014 elections a referendum on the health law. Only a single insurer in the state offers policies through the new law. Ten of the state's 26 hospitals and one fifth of its primary care providers aren't in its network. Residents of Concord, the state capital, have to drive to other cities to get covered hospital care (Hook, 4/15).

The Washington Post: Scientists Embark On Unprecedented Effort To Connect Millions Of Patient Medical Records
Inside an otherwise ordinary office building in lower Manhattan, government-funded scientists have begun collecting and connecting together terabytes of patient medical records in what may be one of the most radical projects in health care ever attempted. The data — from every patient treated at one of New York’s major hospital centers over the past few years — include some of the most intimate details of a life. Vital signs. Diagnoses and conditions. Results of blood tests, X-rays, MRI scans. Surgeries. Insurance claims. And in some cases, links to genetic samples (Cha, 4/15).

USA Today: Doctors, Medical Staff On Drugs Put Patients At Risk
America's prescription drug epidemic reaches deep into the medical community. Across the country, more than 100,000 doctors, nurses, technicians and other health professionals struggle with abuse or addiction, mostly involving narcotics such as oxycodone and fentanyl. Their knowledge and access make their problems especially hard to detect. Yet the risks they pose — to the public and to themselves — are enormous. A single addicted health care worker who resorts to "drug diversion," the official term for stealing drugs, can endanger thousands (Eisler, 4/15).

Los Angeles Times: Supreme Court to Consider Challenge To Law Barring Campaign Falsehoods
The Supreme Court next week will consider for the first time whether states may enforce laws that make it a crime to knowingly publish false statements about political candidates. The justices will hear an antiabortion group's free-speech challenge to an Ohio law that was invoked in 2010 by then-Rep. Steve Driehaus, a Democrat. He had voted for President Obama's healthcare law and was facing a tough race for reelection. The antiabortion group Susan B. Anthony List launched a campaign to unseat Driehaus, preparing to run billboard ads saying, "Shame on Steve Driehaus! Driehaus voted for taxpayer-funded abortion." The statement was false, Driehaus said, since under the law no federal funds can be spent to pay for abortions (Savage, 4/15).

The Associated Press: Court To Weigh Challenge To Ban On Campaign Lies
The Ohio law makes it illegal to knowingly or recklessly make false statements about a candidate during an election. The high court is not expected to rule directly on the constitutional issue, instead focusing on the narrower question of whether the law can be challenged before it is actually enforced. The outcome could affect similar laws in at least 15 states. The case began during the 2010 election, when the Susan B. Anthony List, an anti-abortion group, planned to launch a billboard campaign accusing then-Democratic Rep. Steven Driehaus of supporting taxpayer-funded abortion because he backed President Barack Obama’s health care overhaul (4/16).

The New York Times: Arizona: Law Signed To Allow Surprise Inspections At Abortion Clinics
Gov. Jan Brewer on Tuesday signed a bill allowing health inspectors to carry out surprise inspections on abortion clinics without having to get a court-approved warrant (Santos, 4/15).

The Washington Post: Gansler Takes Aim At Maryland’s ‘Bad Spending Habits,’ Says He Would Save The State Money
Gansler said major savings could be realized through reforms to the state’s procurement process, better management of the state Medicaid program and reduction of the non-violent prison population, among other strategies (Wagner, 4/15).

The Washington Post: Massachusetts Cannot Ban FDA-Approved Painkiller, Judge Rules
A federal judge on Tuesday blocked an effort by Massachusetts Gov. Deval L. Patrick to ban sales of a controversial new painkiller in the state, saying the governor’s move was preempted by federal law and could harm people who need the drug for pain relief. In a five-page order, U.S. District Judge Rya W. Zobel sided with the drug’s California-based manufacturer, Zogenix, which had argued that Patrick had no right to bar a medication that the Food and Drug Administration has deemed safe and effective (Dennis, 4/15).

The Wall Street Journal: Detroit Reaches Deal With Police, Firefighter Retirees
Other terms in Tuesday's police and firefighters pact include a voluntary employee beneficiary association plan, known as a VEBA, funded by Detroit to handle retiree health care, instead of the city. These retirees would also keep some representation on the board of their pension system, over which the city had proposed increasing independent oversight. All of the city's creditors will still have a chance to vote on the city's plan, including more than 20,000 city workers and retirees. But Judge Rhodes will have the final say on its approval (Dolan, 4/15).

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Categories: Health Care

FAQ On ACOs: Accountable Care Organizations, Explained

Kaiser Health News - Wed, 04/16/2014 - 6:48am

One of the main ways the Affordable Care Act seeks to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks which coordinate patient care and become eligible for bonuses when they deliver that care more efficiently.

The law takes a carrot-and-stick approach by encouraging the formation of Accountable Care Organizations (ACOs) in the Medicare program.  Providers make more if they keep their patients healthy. About four million Medicare beneficiaries are now in an ACO, and, combined with the private sector, more than 428 provider groups have already signed up. An estimated 14 percent of the U.S. population is now being served by an ACO. You may even be in one and not know it. 

While ACOs are touted as a way to help fix an inefficient payment system that rewards more, not better, care, some economists warn they could lead to greater consolidation in the health care industry, which could allow some providers to charge more if they’re the only game in town.  

ACOs have become one of the most talked about new ideas in Obamacare. Here are answers to some of the more common questions about how they work:

What is an accountable care organization?

An ACO is a network of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending. At the heart of each patient's care is a primary care physician.

In Obamacare, each ACO has to manage the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years. 

Think of it as buying a television, says Harold Miller, president and CEO of the Network for Regional Healthcare Improvement and executive director of the Center for Healthcare Quality & Payment Reform in Pittsburgh. A TV manufacturer like Sony may contract with many suppliers to build sets. Like Sony does for TVs, Miller says, an ACO would bring together the different component parts of care for the patient – primary care, specialists, hospitals, home health care, etc. – and ensure that all of the "parts work well together."

The problem with most health systems today, Miller says, is that patients are getting each part of their health care separately. "People want to buy individual circuit boards, not a whole TV," he says. "If we can show them that the TV works better, maybe they'll buy it," rather than assembling a patchwork of services themselves. "But ACOs will need to prove that the overall health care product they're creating does work better and costs less in order to encourage patients and payers to buy it."

Why did Congress include ACOs in the law?

As lawmakers searched for ways to reduce the national deficit, Medicare became a prime target. With baby boomers entering retirement age, the costs of caring for elderly and disabled Americans are expected to soar.

ACOs make providers jointly accountable for the health of their patients, giving them financial incentives to cooperate and save money by avoiding unnecessary tests and procedures. For ACOs to work, they have to seamlessly share information. Those that save money while also meeting quality targets would keep a portion of the savings. Providers can choose to be at risk of losing money if they want to aim for a bigger reward, or they can enter the program with no risk at all.

In addition, the Centers for Medicare & Medicaid Services (CMS) created a second strategy, called the Pioneer Program, for high-performing health systems to pocket more of the expected savings in exchange for taking on greater financial risk.

ACOs are projected to save Medicare up to $940 million in their first four years. While that's far less than 1 percent of Medicare spending during that period, if the program is successful, it can be expanded by the secretary of the U.S. Department of Health and Human Services. 

How are ACOs paid?

In Medicare's traditional fee-for-service payment system, doctors and hospitals generally are paid for each test and procedure. That drives up costs, experts say, by rewarding providers for doing more, even when it’s not needed. ACOs don't do away with fee for service, but they create an incentive to be more efficient by offering bonuses when providers keep costs down. Doctors and hospitals have to meet specific quality benchmarks, focusing on prevention and carefully managing patients with chronic diseases. In other words, providers get paid more for keeping their patients healthy and out of the hospital.

If an ACO is unable able to save money, it could be stuck with the costs of investments made to improve care, such as adding new nurse care managers. An ACO also may have to pay a penalty if it doesn't meet performance and savings benchmarks. ACOs sponsored by physicians or rural providers, however, can apply to receive payments in advance to help them build the infrastructure necessary for coordinated care – a concession the Obama administration made after complaints from rural hospitals. 

In the first year of the Medicare ACO program, provider groups saved a total of $380 million, according to CMS. Of the 114 Shared Savings Program ACOs, 54 had lower spending than projected. But just 29 generated enough savings to qualify to keep some of it.

How would an ACO work for a patient?

Doctors and hospitals will likely refer patients to hospitals and specialists within the ACO network. But patients would still be free to see doctors of their choice outside the network without paying more. Providers who are part of an ACO are required to alert their patients, who can choose to go to another doctor if they are uncomfortable participating. The patient can decline to have his data shared within the ACO.

Who's in charge — hospitals, doctors or insurers?

ACOs can include hospitals, specialists, post-acute providers and even private companies like Walgreens. The only must-have element are primary care physicians, who serve as the linchpin of the program.  More than half of the current Medicare ACOs are actually run by physicians and don't include a hospital partner.

In private ACOs, insurers can also play a role, though they aren't in charge of medical care. Some regions of the country, including parts of California, already had large multi-specialty physician groups which became ACOs on their own by networking with neighboring hospitals. "A lot of health care organizations are going to dust off the existing structures they had in place" says Kelly Devers, a senior fellow at the Urban Institute.

In other regions, large hospital systems are scrambling to buy up physician practices with the goal of becoming ACOs that directly employ the majority of their providers. Because hospitals usually have access to capital, they may have an easier time than doctors in financing the initial investment, for instance to create the electronic record system necessary to track patients.

Some of the largest health insurers in the country, including Humana, United Healthcare and Cigna, are forming their own ACOs for the private market. Insurers say they are essential to the success of an ACO because they track and collect the data on patients that allow systems to evaluate patient care and report on the results.

If I don't like HMOs, why should I consider an ACO?

ACOs may sound a lot like health maintenance organizations. "Some people say ACOs are HMOs in drag," says Devers. But there are some critical differences – notably, an ACO patient is not required to stay in the network.

Steve Lieberman, deputy director for policy and analysis at the National Governors Association, explains that ACOs aim to replicate "the performance of an HMO" in holding down the cost of care while avoiding "the structural features that give the HMO control over [patient] referral patterns," which limited patient options and created a consumer backlash in the 1990s.

In addition, unlike HMOs, the ACOs must meet a long list of quality measures to ensure they are not saving money by stinting on necessary care.

What could go wrong?

Many health care economists fear that the race to form ACOs could have a significant downside: hospital mergers and provider consolidation. As hospitals position themselves to become integrated systems, many are joining forces and purchasing physician practices, leaving fewer independent hospitals and doctors. Greater market share gives these health systems more leverage in negotiations with insurers, which can drive up health costs and limit patient choice.

But Lieberman says while ACOs could accelerate the merger trend, consolidations are already "such a powerful and pervasive trend that it's a little like worrying about the calories I get when I eat the maraschino cherry on top of my hot fudge sundae. It's a serious public policy issue with or without ACOs."

Are ACOs the future of health care?

ACOs are already becoming pervasive, but they may be just an interim step on the way to a more efficient American health care system. "ACOs aren't the end game," says Chas Roades, chief research officer at The Advisory Board Company in Washington D.C.  

One of the key challenges for hospitals and physicians is that the incentives in ACOs are to reduce hospital stays, emergency room visits and expensive specialist and testing services — all the ways that hospitals and physicians make money in the current fee-for-service system, explains Roades. 

Roades says the ultimate goal would be for providers to take on full financial responsibility for caring for a population of patients for a fixed payment, but that will require a transition beyond ACOs.

In July, nearly a third of the Pioneer ACOs announced they were dropping out of that program in which providers take on the greatest financial risk. Some left because they didn’t save enough money, although seven said they would participate in a second Medicare ACO model with less risk of losing money.  

But there were also positive developments: All 32 Pioneers succeeded in improving quality and performed better than fee-for-service Medicare in 15 quality measures, according to CMS. And they generated a gross savings of $87.6 million in 2012, the first year of the program.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

Categories: Health Care

Medicare and Eye Doctors

Medicare -- New York Times - Wed, 04/16/2014 - 1:00am
The American Society of Cataract and Refractive Surgery responds to a news article, “Sliver of Medicare Doctors Get Big Share of Payouts.”
Categories: Elder, Medicare

Mass DOR delays filing deadline until Friday

Massachsuetts Trial Court Law Library - Tue, 04/15/2014 - 3:18pm
Because of delays with their online filing system, Massachusetts taxpayers have until midnight on Friday to file state returns.
"Filing Extension AnnouncedThe Department of Revenue’s WebFile tool, which allows individuals to electronically file state personal income tax returns, has experienced delays due to heavy volume over the past few days. DOR is actively working to resolve this issue, and has extended the deadline for taxpayers to file their Massachusetts Personal Income Tax returns, or to file for an extension, until midnight on Friday, April 18, 2014."Federal returns are due today, no change there.
Categories: Research & Litigation

Payment and Delivery Reform Case Study: Congestive Heart Failure

Brookings Institute -- Medicare - Tue, 04/15/2014 - 11:52am

Clinicians and hospitals across the nation struggle with providing and paying for optimal care for their congestive health failure (CHF) patients. However, there are opportunities to make care better. In fact, of the more than 10,000 pages in the Affordable Care Act (ACA) implementing regulations, the least talked about are the dozens of small experiments led by the Center for Medicare and Medicaid Innovation (CMMI) that test new ways to pay for medical services.

We use a case study approach to investigate and tell the story of what two academic medical centers, Duke University Health System (“Duke”) and University of Colorado Hospital (“Colorado”), are doing to innovate and improve CHF care while implementing alternative payment models offered by CMMI.

The Clinical Scenario: A Chronic, Disabling Illness

Robert Neelley Church had chest pains, persistent shortness of breath, and fluid buildup that caused extreme discomfort even during mild exertion, such as bending over to tie his shoes. After a visit with his primary care physician and cardiologist, Robert, an 86-year old Tennessee resident, learned his aortic valve (which helps the heart pump blood to the body) was not working efficiently and that he hadcongestive heart failure (CHF). Robert is one of the nearly 6 million Americans affected by this chronic condition, is the leading cause of hospitalization among adults over the age of 65, and well known for disproportionately affecting African American and Hispanic populations.

The Challenge: Moving Beyond Volume-Based Care

The high costs related to CHF (a staggering 17 percent of overall national health expenditures, $273 billion in direct medical costs, and $172 billion in indirect costs), like the costs associated with many chronic diseases, are driven by a deeply fragmented and uncoordinated health care system. This often results in patients like Robert seeking care from the emergency room, suffering from avoidable complications, and being readmitted to the hospital. In fact, 24 percent of CHF patients are readmitted to a hospital within 30 days.

However, clinicians have strategies to improve care and reduce costs for CHF, and other chronic conditions. These strategies rely heavily on shifting from high-intensity, expensive inpatient care to preventing, coordinating, and managing the illness in outpatient or primary care settings. Most importantly, lasting changes in CHF care require alternative payment models that support proper disease management, care coordination, and other activities that are not currently reimbursed in a fee-for-service, volume-based payment system.

The Key Levers: Supporting Change With Alternative Payment Models

Today providers have the opportunity to test new payment models that, if proven effective, may be implemented nationwide. The Bundled Payment for Care Improvement (BPCI) Initiative and the Medicare Shared Savings Program (MSSP) option for Accountable Care Organizations (ACOs) represent two such opportunities.

The BPCI consolidates all services provided in a patient’s episode of care, rather than paying each provider separately for individual services or procedures. It incentivizes care coordination across 30-, 60-, or 90-day episodes and across multiple settings. The price is set by consolidating historical prices per episode and discounting them by 3 percent. An MSSP is a group of providers that is paid a global, fixed amount per patient; the ACO provides all necessary services and reports certain quality measures, and it shares in roughly half of the savings generated compared to certain historical spending targets. (This is so-called “upside” risk; ACOs can also choose to incur “downside risk” as well, sharing in 60 percent of savings but also taking on risk for the same percentage of losses.).

In addition, the Centers for Medicare & Medicaid Services (CMS) administers the Hospital Readmission Reduction Program, which levies penalties on hospitals with higher-than-expected rates of 30-day readmissions after a heart attack, heart failure, or pneumonia discharge. The figure below compares the BPCI, ACO/MSSP, and readmissions penalties and their possible impacts on CHF care.

Figure 1: Financial Impacts and Payment Models in the Context of CHF Care

The Real World: How Did Two Large Academic Medical Centers Respond To These Incentives?

We profiled the choices made at Colorado and Duke to help provide practical solutions and guidance for clinicians interested in implementing chronic disease care redesign, and to highlight their alignment of clinical innovations and alternative payment models.

CHF presents specific challenges in choosing an alternative payment model. Some of these include:

  • Complexity and variability of CHF. BPCI episodes typically fall into one of two categories: medical or surgical. Surgical episodes, such as a knee replacement, can be easier to predict and have less variability regarding the care needed. Medical episodes, particularly chronic, complex conditions like CHF, have a much greater range in care needed — both inpatient and outpatient — which influences a system’s ability to predict costs.
  • Financial risk. Providers may be concerned that bundles would underpay for higher-acuity CHF patients. Also, cardiac care is generally lucrative for providers, and efforts to improve quality leading to less fee-for-service utilization may result in lower revenues (so called “demand destruction”).
  • Unknown costs. A large portion of CHF costs and care take place in outpatient settings — such as primary care offices, rehabilitation centers, community health centers, and skilled nursing facilities– in which hospital systems may not be able to exercise control.
Choosing Bundled Payments: University of Colorado Hospital

Colorado, which admits roughly 200 patients with CHF each year, focused on using technology as part of their care redesign strategy. They implemented real-time identification of high-risk CHF patients using electronic health records and best practice advisories to trigger standardized order and discharge sets. Clinicians used data to benchmark against national standards and used dashboards to track utilization and quality measures. In addition, they created a “heart failure university” to educate patients to reduce readmissions, ensured follow-up calls within 2 days of hospital discharge, and focused primarily on CHF patients admitted to the hospital.

Colorado selected a 30-day bundle for CHF under Model 4 of the BPCI that went into effect on January 1, 2014, and they expect to enroll 100 patients this year. Under this model, the hospital will receive a prospective, lump sum payment from Medicare and then distribute that payment among all of the providers involved in the episode of care — and if costs exceed the budget, Colorado will absorb the extra costs.  They chose not to engage in a riskier 60- or 90-day bundle, since they felt the rehabilitation centers (that is, post-acute care) were not under their control.  The major drivers of this decision were:

  • A single, highly selected bundle minimized risk and allowed a “dip-a-toe-in-the-water” learning opportunity. Leaders felt Model 4 provided a lower risk because it allows hospitals to bundle acute-care services while they ready themselves for taking risk for post-acute care services and hospital readmissions. The total financial risk was estimated to be only $30,000-$40,000 per year, which will be incurred as Colorado prepares for more risk by implementing innovations in electronic medical records, alerts and standardized order sets, and other changes.
  • Focus on a highly specified problem. Though long-term care and prevention were important, Colorado leaders wanted to focus specifically on direct innovations in a specific area under direct control — the inpatient setting.
  • Strong support from a convening organization. Colorado also relied on the Association of American Medical Colleges (AAMC), the facilitator convener contracted by CMMI, to help with complex data analysis and modeling for their BPCI pilot, which was critical logistical support.
Choosing Accountable Care: Duke University Health System

Concerned that the BPCI was not a scalable program, and instead interested in broader population health, Duke pursued the ACO/MSSP model. To address the spectrum of care, the major care innovations at Duke were the initiation of the Same Day Access Heart Failure Clinic to provide acute care outside of the hospital and the Heart@Home program that sought to improve outpatient care. Using a nurse practitioner-driven model, patients access a provider right away instead of showing up at the emergency department. After a patient visit, the clinic conducts a follow-up call or appointment within three days to ensure stability, reconcile medications, and address any patient questions.

Duke enrolled in a community-based, physician-led ACO/MSSP called Duke Connected Care. The following factors influenced Duke’s decision to pass on the CHF BPCI pilot:

  • Interest in gaining experience managing post-acute care, a major source of costs variation.The ACO/MSSP model creates strong incentives to minimize costs outside typical 30-90 day bundles. Duke felt this would strongly incentivize long-term structural changes in their care.
  • Baseline lower costs of CHF care. Because Duke’s existing CHF costs were low, they felt the margin collected from a short term bundle would be small and not generate substantial savings.
  • Broad strategic focus on population-based health. The ACO/MSSP model incentivizes providers to take a more global look at the care provided to the whole patient, and the institution’s vision was to focus strongly on enhanced primary care. Duke’s leadership believed this was a better step towards reform than more incremental changes achieved through the BPCI.
Policy Recommendations and Lesson Learned

Both Colorado and Duke are engaged in a process of care delivery reform, though they chose different alternative payment models to support their delivery innovations. In this manner, both centers took steps towards creating a culture of continuous improvement, which may drive further key innovations. In addition, each center was strongly motivated by the presence of clinical and administrative champions. However, in reviewing the Duke and Colorado experiences, future recommendations also emerged:

Directly reward or penalize clinicians for quality-related outcomes. The payment interventions thus far have not yet demonstrated major impact on meaningful outcomes, such as survival, comprehensive costs of care, readmission, or other quality of life measures.  For such small changes to lead to larger ones, clinicians must be rewarded or penalized with clearer connections to clinical outcomes under their control — which would require the creation of numerous financial “microenvironments” through a large organization, with well-designed supportive electronic medical records.

Encourage better coordination and best-practice sharing between various institutions. Though clinical leaders and hospitals pursued innovations in care, hospitals appeared to work in isolation, without clear standardization or sharing of best practices.

Improve long-term incentives for clinical leaders. Though expert clinical leaders spent a great deal of time and effort on redesigning care, those responsible for their institutional promotion (in academic centers) view production of research, grants, and publications as much more important than clinical redesign. As a result, over time, such innovators may “burn out” and not feel their important work is recognized.

Rethink existing Value-Based Purchasing and Pay-for-Performance programsThe ACA established Medicare’s Value-Based Purchasing (VBP) program. This has been seen as a separate burden, rather than part of an integrated plan, which dilutes clinician energy. Thus, a consolidation of the VBP program at some point into the BPCI or Shared Savings models would be beneficial.

Establish long-term funding for convening organizations. Though convening organization like AAMC played an important role in seeding CMMI pilot programs, there are no long-term, continuing sources of funding for this crucial role.

Authors Publication: Health Affairs
Categories: Elder

New Research Report: European Court of Human Rights and the Parot Doctrine

Law Library of Congress: Research Reports - Tue, 04/15/2014 - 10:00am
The Law Library of Congress is proud to present a new report, European Court of Human Rights and the Parot Doctrine.

In 2006, the Supreme Court of Spain adopted the so-called "Parot Doctrine" in which it established that sentence reductions for prison benefits, including remission for work performed, was to apply to each sentence individually and not to the maximum term. The Parot Doctrine was recently challenged before the European Court of Human Rights and upheld as in violation of the European Convention of Human Rights.

Visit to read the entire report. This report is one of many prepared by the Law Library of Congress available at
Categories: Research & Litigation

Wal-Mart Exec Who Led Health Care Expansion Steps Down

Kaiser Health News - Tue, 04/15/2014 - 9:33am

News emerged Monday in an internal staff memo that John Agwunobi would leave his post running the retailer's health and wellness division.

The Wall Street Journal: Executive Who Led Wal-Mart Expansion Into Health Care Steps Down
The executive who led Wal-Mart Stores Inc.'s expansion into providing health services has left the company, as the retailer plans to make another push at providing care through its stores. John Agwunobi stepped down from his job running the retailer's health and wellness division after seven years at Wal-Mart, according to an internal memo sent to staff earlier this month. He will be replaced by Labeed Diab, who most recently led Wal-Mart's U.S. Midwest division (Banjo, 4/14).

Also in the news, Medtronic is dealt an unexpected ruling by a federal court --

The Wall Street Journal: Medtronic Prevented From Selling Heart Valve In U.S.
In what doctors called a surprise ruling, a federal court has barred Medtronic Inc. from selling its new artificial heart valve to most patients in the U.S., despite finding that the device is "safer" and has "a lower risk of death" than a competing device. The ruling, issued Friday by U.S. District Judge Gregory M. Sleet of Delaware, would give Edwards Lifesciences Corp. a near-monopoly on the sale of a new type of aortic heart valve that is implanted via a minimally invasive procedure, instead of through open-heart surgery. Medtronic is appealing the ruling, but for now has stopped training new doctors in how to use the devices, and told surgeons already using the valves not to schedule any new procedures, the company said (Walker, 4/14).

Categories: Health Care

Disparity In Medicare Provider Payments In Oregon, Data Show

Kaiser Health News - Tue, 04/15/2014 - 9:33am

Information gleaned from the federal government's Medicare data dump shows that Oregon providers and provider groups were paid $508 million in 2012. However, some providers made more than others. Meanwhile the Milwaukee Journal Sentinel is reporting that arising from the data, Wisconsin Congressional members want physicians rated on quality of care. 

The Oregonian: Oregon Medicare Data Shows Disparity In Provider Payments
Medicare paid $508 million to Oregon providers and provider groups in 2012. But some providers made much more than others. New information released by the federal government shows 15 Oregon providers made more than $1 million from the government health care program set up for people 65 or older. But the typical provider made far less, with the median reimbursement coming in at $18,890. The data is broken down by provider, city, and procedure, letting consumers and researchers slice the information in different ways. The data release is the latest example of a larger transparency trend, meaning consumers have more access to health care spending data than ever, said John McConnell, a health economist who heads the Center for Health Systems Effectiveness at Oregon Health & Science University (Budnick, 4/14).

The Milwaukee Journal Sentinel: Wisconsin Congressional Members Want Physicians Rated On Quality Of Care
The government's unprecedented release of information about Medicare payments to doctors last week drew national attention, particularly spotlighting individual physicians who collected millions of dollars for treating Medicare patients in 2012. One Milwaukee eye doctor received more than $8.6 million in Medicare payments, by far the most received by an individual doctor in Wisconsin that year. A Florida doctor topped them all, receiving $20.8 million. But the information, which disclosed the total amounts of Medicare payments made to more than 880,000 physicians and other health care providers, did not include the detail needed to determine what really matters: Which doctors provide high-quality care in the most cost-effective way? (Boulton, 4/14). 

Categories: Health Care

U.S. Health Care Spending, Usage Rise

Kaiser Health News - Tue, 04/15/2014 - 9:33am

Americans' spending on medicines in 2013 rose 3.2 percent to nearly $330 billion, fueling speculation that a dip in overall health care spending may be over.

Los Angeles Times: More U.S. Consumers Are Seeking Medical Care, Report Shows
A historic slowdown in U.S. health care spending in recent years may be drawing to a close. An industry report published Tuesday and healthcare experts point to a steady rise in medical care being sought by consumers seeing specialists, getting more prescriptions filled and visiting the hospital. Other factors such as millions of newly insured Americans seeking treatment for the first time and higher prices from health care consolidation could also help drive up costs (Terhune, 4/14).

Reuters:  U.S. Health Care Usage And Spending Resumes Rise In 2013 
Americans used more health services and spent more on prescription drugs in 2013, reversing a recent trend, though greater use of cheaper generic drugs helped control spending, according to a report issued on Tuesday by a leading health care information company. Spending on medicines rose 3.2 percent in the United States last year to $329.2 billion. While that was far less than the double-digit increases seen in previous decades, it was a rebound from a 1 percent decline in 2012, the report by IMS Health Holdings Inc. found Berkrot, 4/15).

And the costs for some specialty drugs increase --

The New York Times: Prices Soaring for Specialty Drugs, Researchers Find
Even as the cost of prescription drugs has plummeted for many Americans, a small slice of the population is being asked to shoulder more and more of the cost of expensive treatments for diseases like cancer and hepatitis C, according to a report to be released on Tuesday by a major drug research firm (Thomas, 4/15).

Categories: Health Care

Fallout Continues Around Medicare Advantage Payment Rates

Kaiser Health News - Tue, 04/15/2014 - 9:32am
The Obama administration's decision to reverse a proposed Medicare Advantage payment cut has been panned by insurance analysts and governors, among others.

The Washington Post’s Wonkblog: Medicare Reversed Payment Cuts, And Not Many Are Happy About It
Medicare’s recent reversal of a proposed payment cut to private health plans -- the second such reversal in two years -- hasn’t won a lot of rave reviews. Insurance analysts say they still anticipate lower payments to private Medicare Advantage plans in 2015. Some editorial pages and supporters have criticized the Obama administration and lawmakers for easing off on Medicare Advantage cuts ordered by the president's health-care law (Millman, 4/14). 

The Associated Press:  3 GOP Governors Blast Medicare Advantage Rates
Three Southern Republican governors are writing President Barack Obama to complain about newly announced Medicare Advantage payments. Florida Gov. Rick Scott, Texas Gov. Rick Perry and Louisiana Gov. Bobby Jindal signed the April 15 letter that says changes to Medicare Advantage payments will harm "America's seniors." The changes are blamed on the nation's health care overhaul (4/15).

Categories: Health Care

Some Push To Sync Obamacare Deadline With Tax Day

Kaiser Health News - Tue, 04/15/2014 - 9:32am

This year's intersection of the deadlines to sign up for health insurance, as well as to file taxes, elevated the role of many tax preparers who have been educating uninsured clients about the health law. Some tax preparers contend the two deadlines should be permanently connected.

Politico Pro: Push To Keep Obamacare Deadline On Tax Day
Tax preparers got their wish: They’re helping to carry Obamacare enrollment across the finish line on Tuesday’s Tax Day. But they’re already worried about a deadline mismatch in 2015. The Obama administration effectively extended this year’s sign-up period for many Americans an extra two weeks, until April 15. That deadline’s intersection with the deadline for filing taxes elevated the role of many major tax preparers, who have been educating uninsured clients and directing them to brokers who could get them enrolled (Cunningham, 4/15).

The New York Times: Tax Preparers’ New Role: Health-Coverage Advisers
The tax system provides both the carrot and the stick for people to obtain coverage. Tax preparers like Jackson Hewitt and H&R Block say they have helped tens of thousands of people apply for tax credits to help defray the cost of private insurance bought through the exchanges. In addition, the big tax service companies and makers of tax preparation software like Intuit’s TurboTax are calculating potential penalties for those who do not have insurance (Pear, 4/14).

Categories: Health Care

CBO Shrinks Estimate Of Health Law Spending Based On Lower Subsidy Costs

Kaiser Health News - Tue, 04/15/2014 - 9:31am

Expanding health coverage under the health law will also slow premium growth, helping lower the total cost of the law, the nonpartisan office said.

The New York Times: Budget Office Lowers Estimate For The Cost Of Expanding Health Coverage
The insurance expansion under the Affordable Care Act will cost $1.383 trillion over the next decade, more than $100 billion less than previous forecasts, the Congressional Budget Office said Monday. The nonpartisan budget office's report, an update to projections from February, shows the law costing less than in previous estimates in part because of the broad and persistent slowdown in the growth of health care costs. The news might come as welcome to Democrats on Capitol Hill and in the White House who are struggling to defend the law in an election year (Lowrey, 4/14).

Los Angeles Times: Obamacare Cost Forecast Is Reduced 7% By U.S. Fiscal Watchdog
Lower-than-expected health insurance premiums under Obamacare will help cut the long-term cost of the program 7 percent over the next decade, according to the latest report from the Congressional Budget Office. The government's reduction of $104 billion in subsidies for those premiums was the main factor that led the nonpartisan fiscal watchdog to cut its projection of the nation's federal deficit by nearly $300 billion through 2024 (Memoli, 4/14).

The Wall Street Journal: CBO Estimates U.S. Deficit Will Shrink More Than Expected In 2014
CBO also reduced the government's projected 10-year deficit by $286 billion, to $7.6 trillion, mainly because of lower subsidies related to the health-care law. Future Medicare spending was also revised lower. The estimates come during a brief period of rapidly shrinking budget deficits, forcing both political parties to rethink their approaches to taxes and spending heading into the November midterm elections. The White House and Republican lawmakers have battled over the deficit for years, primarily through protracted debates over how much revenue to collect and how to structure government programs (Paletta, 4/14).

USA Today: CBO Lowers Estimate Of Health Care Law Costs
Net costs in 2014 are due almost entirely to subsidies paid out to those who make less than 400% of the federal poverty level who enrolled in the health insurance exchanges, as well as the Medicaid expansion in some states. The government will pay out $1.84 trillion through 2024 for health exchanges and subsidies, Medicaid, the Children's Health Insurance Program and tax credits for small employers. But the budget office expects $456 billion in penalty payments from those who do not have health insurance as well as excise taxes on high-premium insurance plans, income taxes for those who make more than $200,000 a year, and payroll taxes that come from changes in employer coverage (Kennedy, 4/14).

McClatchy: CBO Sees Lower Costs For Affordable Care Act Insurance Provisions
The Affordable Care Act’s insurance coverage provisions will be less costly to the federal budget than first projected and premiums for a key health plan are expected to rise by about 6 percent a year, the Congressional Budget Office said Monday. Updating estimates issued in February, the non-partisan CBO said the cost to the federal government for the insurance provisions is $5 billion less than thought earlier this year. From 2015 through 2024, the provisions should prove $104 billion less costly. That's 7 percent below earlier projections (Hall, 4/14).

The Fiscal Times: CBO Says Obamacare Will Cost Less Than Projected
The White House is kicking off the week with some more good news for Obamacare. The Congressional Budget Office said on Monday that the federal government will spend significantly less than expected on health insurance benefits under the new law. The CBO and the Joint Committee on Taxation said the law’s insurance coverage provisions will now cost about $1.4 trillion over the next 10 years -- about $104 billion less than previously estimated. This year alone the government will spend $5 billion less than projected. The CBO said lower spending on the health care law is helping shrink deficits overall (Ehley, 4/14).

Politico: Smaller Premium Hikes Forecast In 2014 For Obamacare
Coverage through the law will cost the federal government about $5 billion less than expected this year. And overall, the law’s 10-year cost for the coverage provisions is pegged at $1.383 trillion -- $104 billion less than prior calculations. Both figures are lower than prior estimates mostly because the CBO and JCT anticipate premium subsidies being smaller (Haberkorn and Norman, 4/14).

Other highlights from the report include that the deficit will shrink as a result of the lower health care costs and that 6 million will be the average number getting coverage in health law marketplaces --

The Associated Press: CBO: Deficits To Drift Lower On Lower Health Costs
A Congressional Budget Office report Monday said this year's deficit will now be $492 billion, $23 billion less than previously estimated. Last year’s deficit registered $680 billion, the first year in President Barack Obama’s tenure that the deficit was less than $1 trillion (4/14). 

CBS News: Report: Average Of 6 Million In Obamacare Marketplaces In 2014
Over the course of 2014, an average of 6 million Americans will have health insurance through the new Obamacare marketplaces, according to the latest estimate from the nonpartisan Congressional Budget Office (CBO). All told, the CBO said that 12 million more nonelderly people will have health insurance in 2014 than would have had it in the absence of the Affordable Care Act. That includes the 6 million in private Obamacare plans, 7 million more enrolled in Medicaid or the Children's Health Insurance Program (CHIP), and the subtraction of 1 million losing coverage on the nongroup market (Condon, 4/14).

But a survey also says premiums are going up --

Fox News: Survey Shows Obamacare Sending Premiums Rising At Fastest Clip In Decades
A recent survey of 148 insurance brokers shows that Obamacare is sending premiums rising at the fastest clip in decades. "For the last, about, five years they've been doing this survey, so this was the largest percentage increase in any quarter since they've been doing (it)," said Scott Gottlieb of the American Enterprise Institute. "But at 12 percent, 11 percent increase on average across all the states -- that puts it at the upper end of any increase we've seen for decades." That is the national average in a survey done by Morgan Stanley. … The reported hikes are for the first policies issued under Obamacare in 2014 (Angle, 4/14).

Categories: Health Care

Survey: Signing Up For Obamacare No Walk In The Park

Kaiser Health News - Tue, 04/15/2014 - 9:31am

California enrollees said they had trouble getting through to call centers, calculating their income and gathering the required documentation, among other difficulties, according to a survey by the California HealthCare Foundation. Meanwhile, media outlets note that Tuesday is the last chance to sign up in California, while April 22 is the deadline in Minnesota.

Kaiser Health News: Capsules: Survey: Health Insurance Enrollment In California More Complex Than Anticipated
Newly insured Californians felt relieved after signing up for health coverage but encountered numerous obstacles with technology and communication during the enrollment process, according to a report released Monday by the California HealthCare Foundation. Surveyed in interviews and focus groups, consumers said they had trouble getting through to the call center, choosing a health plan and calculating their income. They also had problems with the online chat program, and many were surprised by the amount of documentation required to enroll, according to the report (Gorman, 4/15).

Los Angeles Times: Last Chance For Obamacare Ends Tuesday For Most Californians
After many deadline extensions and grace periods, Tuesday will mark the end of the first open enrollment for Obamacare in California. California's health insurance exchange is encouraging thousands of people who have started an application to finish before midnight Tuesday (Terhune, 4/14).

The San Jose Mercury News: Obamacare: Tuesday Midnight Deadline Looms For Last-Minute Health Care Applicants
That ticking sound you're hearing isn't just the clock counting down to Tuesday's deadline to file your taxes. Californians who started but were unable to finish their applications for a health care plan by the original March 31 open enrollment deadline have until midnight Tuesday to complete the process. "People have had since October to enroll. These are the final hours," said Larry Hicks, a spokesman for Covered California, the state's health care exchange (Seipel, 4/14).

The Star Tribune: MNsure Sets April 22 Deadline To Complete Enrollment
MNsure officials have set an April 22 deadline for Minne­sotans who indicated that technical problems prevented them from buying health insurance by the end of March. The deadline applies only to those who filled out an online form alerting MNsure of their troubles, but hadn’t previously created an account on the new online health insurance exchange. At least 8,200 people are known to be affected by the decision, according to a MNsure spokeswoman, but the number is expected to grow (Crosby, 4/15).

Pioneer Press: MNsure Extension Deadline For Private Insurance Buyers April 22
MNsure has told about 8,200 people who couldn't get health insurance by the end of last month that some of them might now face a sign-up deadline of April 22. In late March, the state's health insurance exchange created an online form for people to signify that they were trying to obtain coverage before the federal health law's March 31 deadline, but couldn't do so for technical reasons (Snowbeck, 4/14).

The Denver Post:  Colorado’s Private Health Insurance Enrollment Stands At 124,000
Final figures for Colorado's open-enrollment in private health insurance under the Affordable Care Act stand at about 124,000, according to state officials.That number kept climbing after the March 31 deadline, when it topped 118,000, as those who started enrollment but were unable to complete it by month's end were allowed to finish (Draper, 4/14).

Kaiser Health News: Focus On Marketplace Enrollment Overlooks Millions Who Bought Private Insurance
Want to know how many people have signed up for private insurance under Obamacare? Like the health care law itself, the answer is complicated. ... Often overlooked is that enrollment in private health plans outside the marketplaces is also booming. The federal government hasn’t been counting the number of people who buy new plans directly from insurance carriers -- and that number could be substantial (Feidt, 4/15).

And on the Medicaid expansion front -

The Associated Press: Anti-Tax Group Praises Va. House Speaker
An anti-tax group Americans for Tax Reform is applauding House Speaker William J. Howell for his opposition to Medicaid expansion, praise that comes a year after the group advocated for new leadership in the House of Delegates (4/14). 

Categories: Health Care

Burwell Steps Into Hot Seat

Kaiser Health News - Tue, 04/15/2014 - 9:31am

Sylvia Mathews Burwell, the president's nominee to head the Health and Human Services Department, may have some goodwill, but she will still have to navigate plenty of challenges -- starting with her confirmation hearing.

Politico: Sylvia Mathews Burwell: Do’s And Don’ts
Sylvia Mathews Burwell will start her new gig with a lot of goodwill. Everyone knows she’s not the Health and Human Services secretary who fumbled the launch of Obamacare, but the competent head of the wonky Office of Management and Budget. And then, something else will break. And then, Burwell could end up the one up on Capitol Hill, taking one for the team at the next round of Obamacare hearings, just like Kathleen Sebelius used to (Nather, 4/15).

St. Louis Post-Dispatch:  Sebelius Is Gone, But The Health Care Fight Endures 
Now that Kathleen Sebelius has left her stormy post as the head of Health and Human Services, what will happen to the sweeping health care reform law that is hers and President Barack Obama’s biggest legacy? Although Sebelius’ resignation removes a symbolic target for opponents of the Affordable Care Act, and although Obama’s 2012 re-election is seen by its supporters as a final validation, the law awaits yet another voter verdict in November’s House and Senate elections (Raasch, 4/15).

Meanwhile, ABC reports on another challenge to the law in federal appeals court -

ABC News: Little-Known Legal Challenge That Could Torpedo Obamacare
While the Supreme Court considers one challenge to a provision of the Affordable Care Act (ACA), a federal appeals court located just blocks away is contemplating a separate challenge that could have much more dire consequences for the future of the law. “What you’re asking for is to destroy the individual mandate, which guts the statute,” Judge Harry T. Edwards of the U.S. Court of Appeals for the District of Columbia said to an attorney representing the challengers during a hearing on March 25. .. The conflict at the center of the Halbig case (and three other challenges across the country) has to do with tax subsidies granted to those who seek to obtain insurance from the exchanges (de Vogue, 4/14).

Categories: Health Care


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