Kaiser Health News - Aging

Research Roundup: Surgical Residents Not Happy With New Schedules

Fri, 17 May 2013 13:26:00 GMT

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

JAMA Surgery: Surgical Residents' Perceptions of 2011 Accreditation Council For Graduate Medical Education Duty Hour Regulations – In 2011, the organization that oversees medical student training instituted a new regimen to replace the traditional 24-hour call schedule for medical residents, to improve patient safety and the residents' health. Under this new policy, residents in their first year of post-graduate training get increased supervision and are limited to 16-hour shifts. Researchers interviewed more than 1,000 surgical residents and found nearly 66 percent of them disapproved. "Residents believe that the intended improvements in patient safety, resident quality of life, and education have not been borne out after implementation of the changes," the researchers write. "Furthermore, a concerning majority of surgical residents report noncompliance and falsification of duty hours. It may be difficult for residents, particularly in surgical fields, to learn and care for patients under the current ACGME regulations" (Drolet et al., 5/15).

JAMA Surgery: Effects Of Duty Hour Restrictions On Core Competencies, Education, Quality Of Life, And Burnout Among General Surgery Interns – Researchers aimed to measure the implications of the new work regulations by assessing the views and experiences of 213 surgical interns from 11 general surgery residency programs in July 2011 and May 2012. They found that half of the participants believed the new regulations decreased the coordination of patient care and the time they spent in the operating room while 70 percent felt it reduced their ability to achieve continuity with patients. The majority did not believe that the regulations decreased their fatigue. "The high rate of burnout among US surgeons appear to begin during residency training, even under the … reduced work hours," they conclude (Antiel et al., 5/15).

American Journal Of Public Health: The Impact Of Cigarette Excise Tax Increases On Purchasing Behaviors Among New York City Smokers – While tax increases on cigarettes have been shown to be effective in preventing and reducing smoking, many people respond to the hikes by buying their cigarettes in other jurisdictions with lower taxes, over the Internet, on the street or from Native Americans selling untaxed products. Researchers found that "Following the 2008 tax increase [in New York City], 21% of smokers reported buying more cigarettes from another person on the street. ...Tax increases should be paired with enforcement strategies that limit the flow of untaxed, cheap cigarettes into jurisdictions with high cigarette pack prices," they conclude (Coady et al., 6/2013).

Academic Emergency Medicine: National Growth In Intensive Care Unit Admissions From Emergency Departments In The United States From 2002 To 2009 – Patient admissions to intensive care units (ICUs) have been increasing with an aging population, the authors write. The authors analyzed records from more than 4,000 patients admitted to the ICU from emergency departments from 2002 to 2009. "Over the study period, ICU admissions from EDs increased from 2.79 million in 2002/2003 to 4.14 million in 2008/2009," they write. The largest growth was among visits by patients 85 years or older. Nonwhite and Medicaid-covered patients were also major contributors to higher ICU admissions. They suggest that growth trends should be considered as decisions are made in regards to ICU capacity and add that "an increased emphasis" on the link between the emergency department and intensive care unit as well as "critical care training for emergency providers may be warranted, as many patients stay in EDs for prolonged periods of time" (Mullins, Goyal and Pines, 5/2013).

Kaiser Family Foundation/Health Management Associates: Profiles Of Medicaid Outreach And Enrollment Strategies: Helping Families Maintain Coverage In Michigan – Looking ahead to the 2014 implementation of the health law, the authors write: "This brief provides insight into lessons learned from Medicaid and CHIP outreach and enrollment strategies by profiling a successful initiative of the Michigan Primary Care Association to facilitate coverage renewals through a systematic, technology-based reminder system coupled with one-on-one assistance." The authors assert that a critical challenge will be to help people stay enrolled. "Losses in coverage at renewal interfere with individuals' access to and continuity of care and create unnecessary administrative costs associated with re-enrolling eligible individuals into coverage" (Edwards, Rodin and Artiga, 5/14).

Retiree Medical Expenses Fall, But They Still Exceed Most People's Expectations

Thu, 16 May 2013 13:43:00 GMT

A study released by Fidelity Investments estimated that a couple, who are enrolled in traditional Medicare and retiring in 2013, will need $220,000 to cover medical costs throughout their retirement.

The Associated Press/Washington Post: Expected Retiree Medical Expenses Fall In 2013, But Still Outpace Many Americans' Estimates
After years of increasing health care costs, the outlook is improving for seniors worried about paying their medical bills during retirement. For the second time in the last three years, estimated medical expenses for new retirees have fallen, according to a study released Wednesday by Fidelity Investments. A 65-year-old couple retiring this year would need $220,000 on average to cover medical expenses, an 8 percent decrease from last year's estimate of $240,000. The study assumes a life expectancy of 85 for women and 82 for men (5/15).

The Wall Street Journal’s Total Return: Retiree Health Costs Get Cheaper
Here’s a twist: Health-care expenses should cost 8% less for a 65-year-old couple retiring this year compared with last year, according to new research by Fidelity Investments. A 65-year-old couple retiring in 2013 is estimated to need $220,000 to cover medical expenses throughout retirement, assuming that they are enrolled in traditional Medicare coverage, Fidelity says (Greene, 5/15).

State Roundup: N.D. Abortion Clinic Sues To Stop New Law

Thu, 16 May 2013 13:42:00 GMT

A selection of health policy stories from North Dakota, Connecticut, California, Massachusetts, Texas, Oregon, Oklahoma and North Carolina.

The New York Times: North Dakota's Sole Abortion Clinic Sues To Block New Law
The running battle over the regulation of abortions entered a North Dakota courtroom on Wednesday, as the state’s sole abortion clinic sued to block a new law that it says could force it to shut down. The law, requiring doctors performing abortions to have admitting privileges at a nearby hospital, was promoted by anti-abortion legislators, who argued that it would mean better care for women who suffer medical emergencies (Eckholm, 5/15).

CT Mirror: Big Health Care Savings Help Counter Shrinking State Budget Revenues
State officials trying to close a last-minute hole in the next budget got some good news Wednesday in the form of major savings in health care costs for retired state employees. The Legislature’s nonpartisan Office of Fiscal Analysis issued a memo indicating it has reduced its projected cost of providing health care to retired state workers in the fiscal year that begins July 1 by $140.6 million, and in 2014-15 by $166.5 million. The nonpartisan office is boosting the projected health care costs for current employees by $46.7 million in the next budget and by $36.4 million in 2014-15, but the net savings over the next two years still totals $224 million (Phaneuf, 5/15).

HealthyCal: Counties Still Not Prepared To Offer Expanded Mental Health Care
More than one million people in California suffer from mental illness -- the largest number of any state. When the final phase of the new federal health care law starts in January of next year, more California residents than ever before will be able to seek help for problems ranging from depression, anxiety, and addiction to schizophrenia and bipolar disorder. But mental health providers in the state’s Central Valley are unprepared for an influx of thousands of patients (5/16).

Boston Globe: State Health Insurers Post Mixed Financial Results
The state’s biggest health insurers reported mixed first-quarter financial results Wednesday, with two notching income gains, one registering lower earnings, and one posting a loss. While all of the health insurance companies said they were working to hold down premiums as they rolled out new products and shifted doctors and hospitals to risk-sharing payments, each cited unique factors influencing financial performance in the three months ending March 31 (Weisman, 5/15).

Los Angeles Times: 13 Health Care Workers Arrested In Protest At UC Regents Meeting
Thirteen people were arrested Wednesday at the UC regents meeting during a sit-down protest by health care workers threatening to strike at the system's medical centers. The University of California regents left during the protest while UC police cleared the room, handcuffing the protesters and leading them out of the hall at the Sacramento Convention Center (Gordon, 5/15).

The Texas Tribune: Senate Backs Bill On Psychotropic Drugs For Foster Kids
Lawmakers in both chambers have now endorsed legislation that would require guardians of foster children to take greater caution before giving psychotropic drugs to the children. The Senate on Wednesday approved a version of the "informed consent" measure that is slightly different than the one approved by the House in April (Aaronson, 5/15).

Lund Report: Oregon House Passes Assessments For Hospitals And Nursing Facilities
The House passed assessment taxes on hospitals and long-term care facilities by a wide 54-5 margin Tuesday, ensuring Oregon’s health and human service budgets will raise over a billion dollars from providers in coming years and leverage $1.4 billion from the federal government next biennium for Medicaid. Hospitals are compensated for their assessments with higher reimbursements for the Oregon Health Plan while nursing homes are paid for the use of their beds by Medicaid patients. … House Bill 2216 extends an expanded hospital assessment of 5.32 percent for two years. A previous bill, House Bill 2056, was attached to that version, which extends the long-term care facility assessment for six years, while expanding it to include all nursing homes except the Oregon Veterans Home (Gray, 5/15).

Lund Report: Single-Payer Activists Keep Dream Of Universal Health Care Alive In Oregon
Wes Brain was uninsured last winter when a tonsillectomy showed signs of throat cancer. He qualified for the high-risk Oregon Medical Insurance Pool, which the state has administered through Regence BlueCross BlueShield. But gaining access to that insurance soon proved a big obstacle for the Ashland resident, when Regence erroneously told him he hadn't submitted his driver's license. … Eventually, his policy was approved. He paid $2400 -- three month’s premium. His doctor ordered a PET scan for March 1. But then Regence came back and told him no, he’d have to wait until March 1 to even begin authorization (Gray, 5/15).

Stateline: Oklahoma's "Life-Preserving" Law Raises Questions For Doctors
University of Tulsa law professor Marguerite Chapman has been studying end-of-life issues in Oklahoma for three decades and has come to a conclusion: "It's getting almost to the point that you need a government permit in order to die in this state." Certainly, dying has gotten a lot more complicated here, the result of a unique measure passed by the Oklahoma legislature and signed into law last month by Republican Gov. Mary Fallin. Modeled after legislation written by the National Right to Life Committee, the law says that patients who are disabled, elderly or terminally ill cannot be denied life-preserving treatments if they or their health proxies want it (Ollove, 5/16).

North Carolina Health News: Bill To Compel Insurers To Cover Autism Treatment Advances
For kids with autism in North Carolina, it’s possible to get insurance coverage for the process of diagnosing the developmental disorder. But for the bulk of those kids, getting an insurance company to cover treatment is another matter (Hoban, 5/15).

Oregonian: Mental Health Staff In Oregon Prison System Push For Big Raises
A group of unionized mental health workers in the Oregon state prison system wants a pay raise that even they acknowledge is big enough to cause a public relations problem. About 50 mental health specialists who handle inmates with addictions and other mental health problems want to be reclassified because their job descriptions have changed, including a requirement of a master's degree. Under their current proposal, they're seeking raises between 25 percent and 26 percent, which would result in a maximum salary of more than $80,000, according to a memo obtained by The Oregonian (Esteve, 5/15).

The Challenge Of Increasing Long-Term Care Costs

Wed, 15 May 2013 13:24:52 GMT

The New York Times: Covering The Rising Cost Of Long-Term Care
A 2013 report by Genworth Financial, an insurance provider based in Waltham, Mass., estimates the national median daily cost of a private room in a nursing home at $230 a day, an increase of 3.6 percent over 2012 — some $6,900 per month. Sharing that room is only $27 less a day, according to the report (Kelly, 5/14).

Older Americans Fare Well With Budget Impasse Regarding Medicare, Other Entitlements

Fri, 10 May 2013 13:18:00 GMT

The Associated Press/Washington Post: Entitlement Programs Thrive Amid Gridlock, Shifting Money From Younger Generations To Older
With Congress increasingly unable to resolve budget disputes, federal programs on automatic pilot are consuming ever larger amounts of government resources. The trend helps older Americans, who receive the bulk of Social Security and Medicare benefits, at the expense of younger people. This generational shift draws modest public debate. But it alarms some policy advocates, who say the United States is reducing vital investments in the future (5/10).

Research Roundup: Out-Of-Pocket Costs On Individual Market

Fri, 10 May 2013 13:15:00 GMT

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

Health Affairs: Some Families Who Purchased Health Coverage Through The Massachusetts Connector Wound Up With High Financial Burdens – Since many of the people who will gain insurance under the federal health law will likely get such individual plans through the state-based online marketplaces, or exchanges, researchers sought to identify the effects on vulnerable populations, some of whom with incomes above 400 percent of the poverty level and thus will not qualify for Medicaid or receive subsidies. After surveying families who participated in "unsubsidized plans offered in the Massachusetts Commonwealth Health Insurance Connector Authority" - the state's exchange - they found that those with lower incomes, increased health care needs and more children will be at greater risk for financial burden and higher-than-expected out-of-pocket costs. They concluded: "In implementing the Affordable Care Act, policy makers will need to develop strategies to mitigate financial burden and facilitate discussion between patients and providers about the value of health care choices" (Galbraith et al., 5/6).

Health Affairs: Federal Spending On Behavioral Health Accelerated During Recession As Individuals Lost Employer Insurance – In the recent recession, many Americans who became unemployed lost their health insurance coverage. Using data from the Substance Abuse and Mental Health Services Administration, researchers found that: "(The) average annual growth in spending for behavioral health treatment slowed during the recession, from 6.1 percent in 2004-07 to 4.3 percent during 2007-09." In contrast, the federal behavioral health spending growth went from 7.2 percent in 2004-07 to 11.1 percent during the recession, providing a "critical safety net," the authors write. "The Medicaid expansions in eligibility and health insurance marketplace subsidies made available through the Affordable Care Act will relieve some of the budget pressures faced by state mental health and substance abuse authorities in funding behavioral health treatment services," they conclude (Levit et al., 5/6).

JAMA Internal Medicine: Cognition And Take-Up Of Subsidized Drug Benefits By Medicare Beneficiaries –While many low-income beneficiaries are eligible for subsidies to help cover their out-of-pocket costs for prescription drugs in the Medicare Part D program, enrollment has been low. Researchers analyzed 2006, 2008, and 2010 survey data from the nationally representative Health and Retirement Study and found that "Older age, poorer cognition, and poorer numeracy strongly and consistently predicted these apparent failures to take up fully subsided drug benefits." They offer several options for policymakers to improve participation in the subsidies and suggest broader implications as federal officials consider structural changes to the Medicare program: "This evidence suggests that policies that rely on seniors' choices to support efficient competition among plans may be less effective when not coupled with government efforts to regulate choice sets and guide beneficiaries to the best available options" (Kuye, Frank, and McWilliams, 5/6).

Urban Institute/Robert Wood Johnson Foundation: Limiting The Tax Exclusion Of Employer-Sponsored Health Insurance Premiums: Revenue Potential And Distributional Consequences – As officials seek to stabilize the federal budget and lower the deficit, one proposal often mentioned is to tax employer-provided health insurance coverage. The authors write: "In this brief, we provide estimates of the revenue potential and distributional consequences of limiting the exclusion from income and payroll taxes at the 75th percentile of 2013 premiums, indexing by GDP. The policy would produce $264.0 billion in new tax revenues over the coming decade while preserving 93 percent of the tax subsidies available under the current policy." While that tax threshold "would affect public-sector employers to a greater extent," they conclude that "limiting the tax exclusion for employer-sponsored insurance could be an important component of a broad-based federal debt-reduction package, while having minimum impacts on those with lower incomes" (Clemans-Cope, Zuckerman and Resnick, 5/8).

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

MedPage Today: Hospitals Move to Shut Down Elective Deliveries
Nearly two-thirds of all U.S. hospitals have instituted policies to eliminate non-medically indicated deliveries prior to 39 weeks' gestation and those policies may be having a positive impact on fetal outcomes, according to a pair of studies presented here at the annual meeting of the American Congress of Obstetricians and Gynecologists (Laino, 5/9).

Reuters: Insurance Law Tied To More Breast Reconstruction
Many more breast cancer patients had breast reconstruction following a 1998 federal law mandating insurance coverage for the procedure, according to a new study. … As a percentage of all the women treated for breast cancer in a given year, the number who got reconstructions rose from roughly 13 percent in 2000 to 36 percent in 2009, the team reports in the medical journal Cancer (Grens, 5/3).

Medscape: Little Benefit in Routine Imaging After Benign Breast Biopsy
Routine imaging studies that are conducted less than a year after a benign breast biopsy are unnecessary, according to a new study. "Our data do not support the routine use of interval imaging following benign concordant breast biopsy," said study author Demitra Manjoros, MD, a breast fellow at Bryn Mawr Hospital in Pennsylvania, during a press briefing at the 14th Annual Meeting of the American Society of Breast Surgeons, held in Chicago, Illinois (Nelson, 5/3).

Medscape: Pediatricians: Fewer Malpractice Claims, Equivalent Payments
Pediatricians have much lower rates of malpractice claims and indemnity payments than other physicians, but similar rates of payments that exceed $1 million, according to an analysis of the malpractice claims of 40,916 physicians (1630 pediatricians) from 1991 to 2005. Anupam B. Jena, MD, PhD, an assistant professor of health care policy and medicine at Harvard Medical School and an assistant physician and professor in the Department of Medicine at Massachusetts General Hospital in Boston, and colleagues present their findings in an article published online May 6 in Pediatrics (Brown, 5/6).

Reuters: Religious Support Tied To Intensive End-Of-Life Care
People with advanced cancer tend to get more aggressive care at the end of life and spend more time in the intensive care unit if they receive spiritual support from their religious communities, according to a new study [in JAMA Internal Medicine]. The report's lead researcher said in that finding was "quite the opposite" of what her team was expecting -- in part because of evidence that spiritual support coming from within a patient's medical team leads to less aggressive care and more use of hospice (Pittman, 5/7).

Longer Looks: A Wife's Alzheimer's; Doctors and Drug Companies

Thu, 09 May 2013 13:28:00 GMT

Every week reporter Ankita Rao selects interesting reading from around the Web.

Los Angeles Times: A Wife's Alzheimer's, A Husband's Obsession
When his wife got Alzheimer's disease, lawyer Ken Chiate invested all his hopes in an unorthodox treatment. Nothing, it seems, could make him give up on it. ... Jeannette's difficulties seemed to emerge out of nowhere. She couldn't grasp the rules of a dice game. She kept asking questions her husband had just answered. ... in 2001, at age 58, she was diagnosed with mild cognitive impairment. As months and years passed, she fell into an angry haze that was determined to be Alzheimer's disease. ... [Chiate] hated being told by doctor after doctor that there was no way to stop her disintegration. "I'm a fix-it guy," he says. "That's what I do. I fix people's problems. This was just a problem that needed fixing" (Alan Zarembo, 5/5).

The Atlantic: Getting To The Right Relationship Between Doctors And Drug Companies
The pharmaceutical industry is held in remarkably low esteem right now. It's seen as a bunch of nefarious pushers who pay off vulnerable doctors to prescribe their latest expensive, mediocre product. Physicians who work with pharma companies are considered especially suspect, routinely described as "cozy," "in bed with industry," and "on the take." … I think they have it backwards, though. Drug companies -- at least every one that I've worked for or consulted with -- would like to develop important new medicines that improve health and save lives. That's what gets every industry researcher I know up in the morning, and what keeps them going through the many highs and lows that characterize the scientific process (Dr. David A. Shaywitz, 5/8).

The New York Times: The Changing Face Of Medical School Admissions
At an assembly during my first week of medical school, one of the institution's venerable deans took to the podium to announce that our class marked a turning point in the school's history: nearly half of us were female … two perspective pieces in The New England Journal of Medicine reveal that admissions policies have been quietly but radically changing in a handful of medical schools. And those changes have yielded surprisingly successful results. ... Since Boston University School of Medicine began incorporating holistic review in all phases of its admissions process five years ago, faculty members have noted that students appear to be more collegial, supportive of one another, open to new ideas and perspectives and engaged in community activities (Dr. Pauline W. Chen, 5/8).

The American Spectator: How Low Can Part-Timers' Hours Go?
Say you're an employer with an employee who works 30 hours a week. If you have 50 employees or more come next year, you'll be required either to provide her with health-care coverage, which the Affordable Care Act will by then mandate for all employees who work at least 30 hours a week, or you'll have to pay a $2,000 penalty for failing to cover her. Or, you could just cut her weekly hours to 29. That way, you won't have to pay a dime, in either insurance costs or penalties. ... President Obama has said that if he could devise a system from scratch, he'd prefer single-payer, but as events would have it, we have a trillion-dollar employer-based private health insurance industry already in place. The fact that employers in both the private- and public-sectors are now cutting their workers' hours to game that system is just further confirmation of how dysfunctional and cruel that system really is (Harold Myerson, 5/6).

American Spectator: President Obama And 'Uncaring' Pro-Lifers
In President Obama's view, pro-life politicians who wish to defund Planned Parenthood (PP) are working tirelessly to "shut women out" from health care. That's the president's argument at its core: pro-lifers want to abandon needy women. ... Pro-life people care to a tremendous degree for women, especially in a relative sense. Working often at the grassroots level, pro-lifers have created twice the number of care-oriented clinics as pro-choice advocates. ... [Some] will pound the podium, and raise the old falsehoods without factual basis, and tell the world that pro-lifers do not care for women. To this point, however, the data and the record is clear: the pro-life side has devoted itself to the needy (Owen Strachan, 5/2).

The New Republic: Plan B: The Political Football Obama Keeps Punting
The administration's Plan B actions epitomize the unfair double standards that govern women's health: They face barriers to reproductive care that aren't imposed elsewhere in medicine. This is true in the case of abortion clinics, which must work under strict regulations unheard of at other low-risk outpatient centers. And true, to a much lesser extent, of Obamacare, which has been forced to provide a workaround for birth control coverage to avoid the ire of religious groups. And it's true of the gross disparity between the laws surrounding Plan B and those that govern any other drug in the country (Nora Caplan-Bricker, 5/3).

Health Affairs: To Cover Their Child, One Couple Navigates A Health Insurance Maze In Pennsylvania
Our son, Erik, was born in Philadelphia in April 2012. Two days after his birth, we applied for coverage for him through the Pennsylvania Children’s Health Insurance Program (CHIP), which covers children whose families do not qualify for Medicaid but cannot afford to buy health insurance. Under CHIP rules in our state, he should have been covered within four to six weeks. In fact it would be six months before he was covered. Changes coming under the Affordable Care Act are designed to make it easier for parents like us to navigate the CHIP and Medicaid programs, but it remains to be seen whether they will have the intended effect (Ari B. Friedman and Tara Mendola, May 2013).

The New York Times: A Forgotten Pioneer Of Vaccines
We live in an epidemiological bubble and are for the most part blissfully unaware of it. Diseases that were routine hazards of childhood for many Americans living today now seem like ancient history. … The name Maurice Hilleman may not ring a bell. But today 95 percent of American children receive the M.M.R. — the vaccine for measles, mumps and rubella that Dr. Hilleman invented, starting with the mumps strain he collected that night from his daughter. It was by no means his only contribution (Richard Conniff, 5/8).

HHS Launches Probe Into Unusual Billing Patterns For Inpatient Hospice Care

Tue, 07 May 2013 13:22:19 GMT

Modern Healthcare: Unusual Billing Patterns Spur Probe Of Inpatient Hospice Care
HHS' inspector general's office is launching an in-depth investigation into cases where Medicare hospice beneficiaries get inpatient care, following unusual billing patterns that surfaced during recent research on the $1.1 billion industry. Medicare hospice is designed to provide comfort to patients with six months to live, not life-saving treatments. However, in some cases, Medicare hospice patients do qualify for palliative inpatient care—and a new OIG study found that a high proportion of those lucrative services go to patients who stay in a certain type of provider, raising questions about the bills in those settings (Carlson, 5/6).

Caregivers Juggle Medical Tasks

Mon, 06 May 2013 13:42:24 GMT

Boston Globe: Caregivers Taking On More Complex Medical Tasks
Just listening to Irene Ingemi describe the patchwork system of friends, family, and part-time day-care services she’s stitched together to help her care for her frail mother-in-law is exhausting. The 90-year-old broke her hip last fall and has since become incontinent, needs a walker to get around, takes seven pills daily, and is having increasing memory problems. As Ingemi, a 60-year-old nursery school teacher, dashes from work back to her Norwood home each day, she mentally juggles a list of appointments for her mother-in-law with chores that need to get done (Lazar, 5/6).

Research Roundup: Surgical Care At Critical Access Hospitals

Fri, 03 May 2013 13:28:00 GMT

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

JAMA Surgery: Utilization And Outcomes Of Inpatient Surgical Care At Critical Access Hospitals In The United States – During the past 15 years, the number of critical access hospitals (CAHs) – those with fewer than 25 acute care beds that receive higher reimbursements and other considerations from Medicare to help sustain them – has increased substantially, representing a quarter of all U.S. acute care hospitals in 2011. But there is also growing interest in the quality of care and the costs. Using surgical data from 2005 to 2009, researchers found that "compared with non-CAH facilities, CAHs are less likely to provide inpatient surgical care in specialty fields" and that "in-hospital mortality for common low-risk procedures is indistinguishable between CAHs and non-CAHs." Although patients at CAHs were less likely to have a prolonged stay, the costs at CAHs were 9.9% to 30.1% higher than at non-CAHs. They conclude: "The higher costs associated with surgical care at CAHs identify potential opportunities for cost savings" but worry that "changes in payment policy for CAHs could diminish access to essential surgical care for rural populations" (Gadzinski et al., 5/1).

Annals Of Emergency Medicine: Owning The Cost Of Emergency Medicine: Beyond 2% – Emergency room care is often cited as overused and one of the drivers of the increasing health spending. However, emergency room physicians have countered that argument, estimating that ER costs make up just 2 percent of the nation's health care spending. But: "We have presented calculations demonstrating that aggregate ED expenditures are higher than previously published," the authors write. "A conservative estimate is approximately 5% of national health expenditures, although it could be as high as 10%. These results may invite further criticism that the expense of emergency care represents unnecessary, inefficient care. However, we offer a more sanguine interpretation: the high share of spending affirms the importance of emergency medicine." They suggest current estimates are based on outdated models and suggest instead that researchers use activity-based cost accounting, which involves mapping patients' entire clinical, administrative and diagnostic encounters. "Rather than minimizing the issue of cost, we should recognize the economic and strategic importance of the ED within the health care system and demonstrate that costs are commensurate with value," the authors conclude (Lee, Schuur and Zink, 4/26).

Rand Corp.: Oral Health In The District Of Columbia: Parental And Provider Perspectives – Many areas in the District of Columbia suffer from a shortage of dentists and other barriers to oral health care, especially those with a large low-income population, according to this study. Researchers interviewed parents, dentists, pediatricians, and school health nurses to assess the barriers to better oral health in the city. Health providers said they felt parents did not view their children's oral health as a priority. Parents, on the other hand, told researchers they felt the care provided by clinics serving Medicaid patients was lower in quality and they had trouble getting access to that care. The researchers recommended providing incentives to encourage dentists to accept Medicaid patients to expand their clinic hours. They add that there is "a need to expand health promotion in schools and in the greater District metropolitan area to better educate parents about the importance of preventive care" and that "such promotion should include community-based and culturally and linguistically appropriate media campaigns" (Blanchard, Towe, and Donald, 4/26).

Dartmouth Atlas Project/California HealthCare Foundation: End-Of-Life Care In California: You Don't Always Get What You Want -- The report presents research findings from 2003 to 2010 which show that end-of-life care for Medicare patients varied widely across California. "Most striking is the increase in intensity of care in some regions and hospitals but not others," the author notes. She writes that on some measures, care more closely matches patient preferences than it did in 2003: dying patients spend less time in the hospital and were more likely to receive hospice care. However, the findings also show an increase in the percentage of patients seeing more than 10 physicians during the last six months of life and the days spent in the intensive care unit during that time. Compared to the rest of the country, the state of California had a higher percentage of patients dying in the hospitals, patients with more days spent in the ICU, and patient deaths that involved an ICU stay. "The disparate findings point to the important role of the local delivery system in determining the care patients receive," she concludes (Brownlee, 4/2013).

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

CBS News: Lying To Doctors Could Be Harmful For Patients
Telling a white lie to a friend is not always the best idea. Telling one to your doctor could lead to serious health problems, but many still seem to do it. CBS News medical contributor Dr. Holly Phillips told "CBS This Morning: Saturday" that people go into their doctor's office with a problem and do not always tell the whole truth simply because they do not want to feel criticized. "Research shows that, again, people don't want to feel judged. It is a reflex," she said. "When you're in an interview setting, you want to make a good impression, but ultimately it's not about that." According to a study conducted with the Cleveland Clinic, 28 percent of patients say they "lie or omit facts" when visiting their health care providers (Davis, 4/27).

Reuters: MedEvac Cost Effective With Modest Use Improvements
Emergency helicopter transport is expensive, but could become cost effective if it's used mainly for cases where it will make a measurable difference in trauma patients' survival or long-term disabilities, according to a new analysis. "For the routine use of helicopter emergency medical services to be considered good value for our health care dollars, there needs to be a modest reduction in mortality or some reduction in disability among patients who are flown out with serious injuries," said study author Dr. Kit Delgado, an instructor of emergency medicine at Stanford University Medical School (Stokes, 5/2).

MedPage Today: Doc Pay: More $$$ For Primary Care
The pay disparity between primary care physicians and their specialty counterparts -- which is often cited as a reason for the shortage of primary care providers -- is lessening, according to a survey. Primary care physicians reported a first-year guaranteed compensation of $180,000 in 2012, up from $175,000 in 2011. Meanwhile, the average first-year compensation of all specialists combined dropped over that same time from $255,000 to $247,437, according to the MGMA Physician Placement Starting Salary Survey: 2013 Report Based on 2012 Data (Pittman, 5/2).

Reuters: Healthcare Costs To Negate State, Local Budget Improvements: Outlook
State and local governments can expect ever-widening budget gaps through 2060, as rising healthcare costs for both citizens and public employees surpass recent improvements in their revenue, the Government Accountability Office said on Monday. Closing the gap may require drastic action (Lambert, 4/29).

Reuter: Task Force Calls For Routine HIV Testing For All Adults
An influential U.S. panel is calling for HIV screening for all Americans aged 15 to 65, regardless of whether they are considered to be at high risk, a change that may help lift some of the stigma associated with HIV testing. The new guidelines from the U.S. Preventive Services Task Force (USPSTF), a government-backed panel of doctors and scientists, now align with longstanding recommendations by the U.S. Centers for Disease Control and Prevention (Steenhuysen, 4/29).

State Roundup: Calif. Regulator Says Insurer's Proposed Rate Hikes Are 'Unreasonable'

Thu, 02 May 2013 13:35:00 GMT

A selection of health policy stories from California, Iowa, Maryland, Georgia, Oregon and North Carolina.

Los Angeles Times: California Deems UnitedHealth Rate Hikes Unreasonable
California Insurance Commissioner Dave Jones said the nation's largest health insurer, UnitedHealth Group Inc., is imposing unreasonable rate hikes on about 5,000 small businesses. Jones said Wednesday that UnitedHealth couldn't justify the average annual increase of nearly 8 percent, which reflects both higher premiums and a reduction in benefits (Terhune, 5/1).

The Associated Press: House GOP Seeks To Bar Medicaid-Funded Abortions
Iowa's Medicaid program would no longer pay for any abortions under a massive budget bill for state health departments that the state House approved Wednesday. In a 52-46 vote, the House approved the roughly $1.7 billion state Health and Human Services budget, which includes funding for the Medicaid program. The plan approved by the Republican-controlled House offers less money for health programs than the version approved by the Democratic-majority Senate (Lucey, 5/1).

Los Angeles Times: Coalition Working On Ballot Measure To Limit Prescription Drug Abuse
Fearing lawmakers may fail to pass a package of medical reform bills, a coalition of consumer groups and trial lawyers is mounting a campaign to put before voters an even more ambitious slate of initiatives aimed at curbing prescription drug abuse and holding doctors more accountable for misconduct (Glover and Girion, 5/1).

The Associated Press/Washington Post: Fort Detrick Critics Hail Md. Law Requiring State Scrutiny Of Cancer Cluster Investigations
Critics of Fort Detrick in Frederick are hailing a bill requiring closer scrutiny of cancer cluster investigations. Gov. Martin O'Malley is set to sign the measure Thursday in Annapolis. It requires an appointed workgroup to examine the state's process for investigating suspected cancer clusters (5/2).

Georgia Health News: Phoebe Subpoenas Other Hospitals In FTC Fight
Hospital executives across Georgia have been receiving a surprise delivery in the past week: a subpoena requesting loads of financial information. The subpoenas were sent by attorneys representing Phoebe Putney Health System, which is locked in a long-running, contentious fight with the Federal Trade Commission over the 2011 Albany hospital merger. A spokesman for Phoebe Putney told GHN on Wednesday that every Georgia hospital has been sent the requests, and so have some facilities in neighboring states if they treat Georgia patients. There are two forms of requests (Miller, 5/1).

The Lund Report: Oregon Pioneered Home Care Workers, Who’ve Waited Six Years For Raise
Oregon has pioneered home care workers for the indigent elderly, helping them to live with greater dignity and freedom in their old age. Many of Oregon's 10,000 homecare workers are family members who often take on the full-time work of assisting elderly Medicaid clients with long-term care needs. Others are hired from a registry of homecare workers that’s managed by the Oregon Home Care Commission (Gray, 5/1).

North Carolina Health News: Sex-Selection Abortion Ban Heads To House Of Representatives
A new bill that seeks to restrict the practice of abortions based on the gender of the fetus. It could make doctors liable to being sued by a woman or her family members if they feel the physician should have realized that gender bias played a part in the decision to terminate the pregnancy (Hoban, 5/2).

California Healthline: Home Services Workers Balk At Regulation
The Assembly Committee on Human Services yesterday voted to approve a bill designed to register and regulate home health care workers. "An unknown number of independents operate without any oversight or regulation in California," said Gary Passmore, who sits on the board of directors at the California Congress of Seniors. "AB 1217 requires both the owners and aides of the organization to pass a background check and meet basic licensure standards. … And it requires all home care aides … to be certified." The bill also would publish the names of workers and their occupational data on a public website (Gorn, 5/1).

NY Health Care Advocates: Medicaid Managed Care Shuns The Most Disabled Users

Wed, 01 May 2013 13:37:00 GMT

Medicaid programs in North Carolina and Washington, D.C., also make news.

The New York Times: Advocates Say Managed-Care Plans Shun The Most Disabled Medicaid Users
Managed-care companies in New York have come under fire for signing up vigorous older adults referred to them by social day care centers, customers whose health needs are relatively small. But on Tuesday, legal advocates for the disabled told the state's Medicaid director that the most seriously impaired people were getting the opposite treatment (Bernstein, 4/30).

North Carolina Health News: Bill Would Untie Medicaid Benefits From Recipients' Home Counties
Years ago, North Carolina counties paid part of a recipient's Medicaid tab, but that practice was phased out in the past decade. Yet, recipients' benefits are tied to their counties of origin, even if they now live across the state (Hoban, 5/1).

The Washington Post: Thrive Health Plan Approved As Medicaid Contractor
A brand-new health-care firm won the D.C. Council's approval Tuesday to do $542 million in Medicaid business with the city, but not before a legislator accused one of the company's owners of committing perjury by not making required disclosures to insurance regulators (DeBonis, 4/30).

What's On Tap In The Senate?

Tue, 30 Apr 2013 13:18:53 GMT

In addition to consideration of the stalled nomination of Marilyn Tavenner to head the Centers of Medicare & Medicaid Services, one senator appeared optimistic about repealing the health law's tax on medical devices.

Kaiser Health News: Health On The Hill: What's Next In The Senate: In The Coming Weeks And After 2014 (Video)
Kaiser Health News staff writer Mary Agnes Carey talks with Jackie Judd about what's next for the stalled confirmation of Marilyn Tavenner, and who will fill the void in health policy when three senior Senate Democrats retire in 2014 (4/29).

MPR News: Klobuchar Hopeful On Repeal Of Med-Tech Tax
U.S. Sen. Amy Klobuchar on Monday said she's optimistic a tax on medical devices will be overturned. The senator told executives at a Minneapolis medical device industry conference she's not only confident Congress will repeal the 2.3 percent tax, she expects the measure can be linked to tax reform or other legislation likely to avoid a presidential veto. One such bill could be soon-to-be-retiring Sen. Max Baucus' tax reform effort, Klobuchar said (Moylan, 4/29).

CQ HealthBeat: End-of-Life Planning Must Be Addressed, Some Members Say
Few issues are tougher to tackle than death and dying, as evidenced by the huge flap over mythical "death panels" during the debate over the health care law. Yet some members of Congress remain willing to advocate for better end-of-life planning, just as millions of aging baby boomers enter their later years (Norman, 4/29).

CMS Plans To Increase Medicare Hospital Payments By 0.8%

Mon, 29 Apr 2013 13:12:00 GMT

The Centers for Medicare & Medicaid Services announced the proposed increase Friday, which will raise payments for services that elderly and disabled patients receive after being admitted to hospitals.

Bloomberg: Medicare Plans To Boost Pay To U.S. Hospitals By 0.8%
Hospitals will get a pay raise from the U.S. government for treating patients in the nation’s Medicare program. The U.S. Centers for Medicare and Medicaid Services plans to raise payments 0.8 percent beginning Oct. 1 for services that elderly and disabled patients receive after being admitted to hospitals, according to a regulatory proposal today (Wayne, 4/29).

CQ HealthBeat: Hospital Payment Increase Totals $27 Million Nationwide In Proposed CMS Rule
Hospitals would get a fairly skimpy net rate increase of 0.8 percent in fiscal 2014, under a rule that the Centers for Medicare and Medicaid Services posted late Friday. In addition, that large of an increase would go only to hospitals that successfully participate in a quality reporting program developed by CMS, according to documents released by the agency (Norman and Reichard, 4/26).

Medpage Today: Medicare Offers Pay Boost To Hospitals
The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule late Friday that would increase payments to the nation's 3,400 acute care hospitals by nearly $27 million in fiscal 2014. Under its proposed Inpatient Prospective Payment System (IPPS) rule, payments for inpatient stays at hospitals that participate in CMS' Inpatient Quality Reporting Program would increase by 0.8 percent. Hospitals not successfully participating would see their payments cut by 2.0 percent, CMS said in its proposed rule. The $27 million increase takes into account both an increase for inflation as well as an 0.8 percent cut that CMS took in order to recover part of $11 billion in overpayments from prior years as required by the American Taxpayer Relief Act of 2012 (Pittman, 4/26).

Additionally, The Washington Post reports on a care-management system that has not experienced great success --

The Washington Post: The Solution Medicare Is Shutting Down
Health Quality Partners is all about going there. The program enrolls Medicare patients with at least one chronic illness and one hospitalization in the past year. It then sends a trained nurse to see them every week, or every month, whether they’re healthy or sick. It sounds simple and, in a way, it is. But simple things can be revolutionary. Most care-management systems rely on nurses sitting in call centers, checking up on patients over the phone. That model has mostly been a failure. And while many health systems send a nurse regularly in the weeks or months after a serious hospitalization, few send one regularly to even seemingly healthy patients. This a radical redefinition of the health-care system's role in the lives of the elderly. It redefines being old and chronically ill as a condition requiring professional medical management (Klein, 4/27).

Research Roundup: Young Women And Delays In Breast Cancer Diagnosis

Mon, 29 Apr 2013 13:11:00 GMT

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

JAMA Surgery: Delay In Surgical Treatment And Survival After Breast Cancer Diagnosis In Young Women By Race/Ethnicity –Adolescents and young adults (ages 15-39) make up 5 and 6 percent of all breast cancer cases in the United States and have the lowest five-year survival rates. Using 1997-2006 data from the California Cancer Registry, researchers found "that young women with a delay in surgical treatment (>6 weeks) have shorter survival compared with those who had surgery closer to their diagnosis." The impact on survival rate was greater for African Americans, publicly insured or uninsured individuals, and those with low socioeconomic status. "It is crucial to prevent further physician-related delays before and after the diagnosis of breast cancer is established to maximize the survival of these young women who are in the most productive time of their life," they concluded (Smith, Ziogas, Anton-Culver, 4/24).

American Journal Of Public Health: Change In Health Insurance Coverage In Massachusetts And Other New England States By Perceived Health Status: Potential Impact Of Health Reform – The 2010 federal health law is modeled on Massachusetts' 2006 revamping of its system. Using population-based survey data, the researchers found that coverage increased more in in Massachusetts than in other New England states. "This increase was strong and statistically significant for those most in need of health care such as individuals reporting poor mental health, poor physical health, and more limitations in their activities because of poor physical or mental health," the authors write. People with medical problems "were more likely to purchase insurance than those with better perceived health" after the new law, likely because they had been denied coverage before or it was priced too high based on their conditions. The authors conclude: "This study indicates that if the health care coverage trends observed in the natural experiment in Massachusetts foreshadow what will occur in the United States following full implementation of the ACA, the rate of decrease in health insurance coverage will be slowed and an increase in health insurance coverage is predicted" (Dhingra et al., 4/18).

Health Affairs: Per Capita Caps In Medicaid – Some analysts have suggested that calculating per capita spending and setting an allowable annual rate of growth could slow the growth of federal spending on Medicaid, the federal-state health care program for the poor. Supporters of this proposed change, the author of this brief adds, "describe the approach as a middle ground between the program as it currently operates and other proposals such as block grants, which would more dramatically change the way federal Medicaid funding is calculated.' Others are concerned that a per capita cap approach would shift costs to the states. "Whether a Medicaid per capita cap will emerge as part of negotiations on the federal budget, or entitlement reform efforts, isn't known," the author notes, adding that "several approaches are being discussed" by policymakers looking for ways to cut federal spending (Cassidy, 4/18).

U.S. Department Of Health And Human Services (HHS): National Culturally And Linguistically Appropriate Services (CLAS) Standards In Health And Health Care – In 2000, the HHS Office of Minority Health published its first National CLAS Standards in order to provide a framework aimed at helping all health care organizations in better serving the increasingly diverse communities. Last week, the office released its most updated framework, consisting of 15 measures, that aims to "advance health equity, improve quality, and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services" (4/24).

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

MedPage Today: Senior-Centered Hospital Care Boosts Outcomes
Older patients, who are making up more of the U.S. population, are at increased vulnerability for adverse events during a hospital stay. As a result, the development of older-patient-centered hospital care practices may help improve patient outcomes, the research teams wrote online in the April 22 issue of JAMA Internal Medicine (Petrochko, 4/22).

Reuters: Aging U.S. To Drive Up Heart-Related Health Costs: Study
The costs linked to heart failure in the United States are expected to more than double within the next two decades as the population ages and treatments help patients with the disease live longer, a study released on Wednesday found. The American Heart Association predicted that the number of Americans with the fatal condition will grow to 8 million in 2030 from about 5 million in 2012 (Heavey, 4/24).

Reuters: Psychiatric Insurance Approval Takes Time In ERs
Doctors spend about 40 minutes getting approvals from insurance companies to get a psychiatric patient from the emergency room to a hospital bed, according to a new study. In some cases, the researchers found the approval process took more than an hour, which the study's senior author said results in patients being kept in ERs longer and doctors taken away from other duties. ... [Dr. J. Wesley Boyd and his colleagues] published their findings in a letter to the Annals of Emergency Medicine (Seaman, 4/23).

State Roundup: Md. Panel Says Hospitals Should Absorb Sequester Cuts

Fri, 26 Apr 2013 13:48:00 GMT

A selection of health policy stories from Maryland, Iowa, California, Oregon, Pennsylvania and the District of Columbia.

The Associated Press/Washington Post: Md. Hospital Association Asks State Panel To Spare Hospitals From A Medicare Cut
The Maryland Hospital Association urged a state commission on Thursday to spare hospitals from a 2 percent Medicare cut that is part of federal budget reductions. In response to the recommendation by staff members of the Health Service Cost Review Commission to have hospitals absorb the cuts for the rest of the fiscal year, the group issued a report warning the panel about deteriorating financial health of hospitals in the state (4/25).

Baltimore Sun: Rate-Setting Commission Recommends No Increase In Hospital Charges
The state's hospitals would absorb all of the 2 percent Medicare cuts required by federal sequestration under a proposal released Thursday by the state panel that sets hospital rates. The recommendation by the staff of the Health Services Cost Review Commission would mean that state hospitals would not get rate increases for the last three months of fiscal year 2013, a decision that prompted intense criticism from medical institutions that say they already operate on slim margins. Hospitals sought a rate increase to help offset the cost of the federal budget cuts and said they will have to cut services and jobs without one (Walker, 4/25).

Los Angeles Times: Medical Board Of California Could Lose Investigative Powers
The Medical Board of California would be stripped of its power to investigate physician misconduct under a sweeping reform plan by legislators who say the agency has struggled to hold problem doctors accountable. The medical board has come under fire for failing to discipline doctors accused of harming patients, particularly those suspected of recklessly prescribing drugs (Glover and Girion, 4/25).

Des Moines Register: Senators File Fetal 'Personhood' Resolution
Twenty-one members of the Iowa Senate filed a resolution Thursday proposing a fetal "personhood" amendment to the Iowa Constitution that would give human embryos a right to life beginning at conception. ... The resolution has little chance of winning approval in the 50-member Senate, where Democrats who support legal abortion would be expected to block the initiative. Senators opposed to abortion tried last week to amend a $1.9 billion state health and human services spending bill to prohibit use of taxpayer money for certain abortions. But it failed with 23 senators in support and 24 against (Petroski, 4/26).

Los Angeles Times: Labor Groups Renew Push For Paid Sick Leave
Following recent legislative victories in New York and Portland, Ore. -- and one of the worst flu seasons in years -- advocates for paid sick leave are hoping to ride that momentum to win victories locally. Previous failures to get the Legislature to mandate paid sick leave have taught labor groups a few lessons. Among them: Focusing on passing legislation on a city-by-city basis appears to be more fruitful (Lopez, 4/26).

The Lund Report: Oregon Senate Votes To Give Nurse Anesthetists Prescriptive Powers
The Senate passed Senate Bill 136 on a 26-3 vote, which will allow certified registered nurse anesthetists to write prescriptions for up to 10 days. Sen. Laurie Monnes Anderson, D-Gresham, the chief sponsor of Senate Bill 136, said nurse anesthetists already administer medications to patients within a care setting, but cannot ensure that patients will be able to have the medication they need to combat nausea or anxiety related to surgery or anesthesia as they recover at home (Gray, 4/25).

The Lund Report: Periodontal Hygienists, Kaiser Likely To Face Arbitration Over Union Contract
Jackie Farlinger-King has worked for Kaiser Permanente as a periodontal hygienist -- treating only patients with gum disease -- since the mid-1980s, and has been a hygienist with Kaiser for 32 years. But last September, she learned that her position may be phased out. Jeffrey Carr, an organizer with the Oregon Federation of Nurses and Health Professionals, which represents hygienists at Kaiser, said that's when the union learned that Kaiser Permanente Northwest intended to sunset the periodontal hygienist classification in its next contract (McCurdy, 4/26).

Philadelphia Inquirer: Urgent-Care Centers Drawing Investor Attention
Three private equity firms have contacted Children's Hospital of Philadelphia during the last six months about partnering to open urgent-care centers, Steven Altschuler, the hospital's chief executive, said Thursday. Urgent-care centers are increasingly common, staffed by doctors and touted as a way to keep people out of emergency rooms for relatively minor ailments. … Children's turned down the invitations and is trying to get more out of its existing primary-care network while pursuing other experiments, Altschuler said (Brubaker, 4/26).

The Associated Press: Judge Rules Same-Sex Spouse Should Get Health Benefits
A federal appellate judge ruled this week the judiciary must grant health care benefits to the same-sex spouse of a federal public defender in Portland. Ninth U.S. Circuit Court of Appeals Judge Harry Pregerson said in a ruling Wednesday that the court's administrative office discriminated against Alison "Tex" Clark when it refused to add her spouse to Clark's benefit plan. Pregerson ruled that Oregon's same-sex marriage ban -- Measure 36, enacted by voters in 2004 -- and the federal Defense of Marriage Act are both unconstitutional (Cooper, 4/25).

California Healthline: No Diversion Of Mental Health Money
A Senate budget subcommittee last week rejected a plan to divert roughly $34 million a year for mental health services to a CalWORKs (California Work Opportunity and Responsibility to Kids) fund. The California Department of Finance wanted to redistribute realignment money so half the funds currently going to mental health services would instead be shared equally between mental health and CalWORKs starting in 2015-16 (Gorn, 4/25).

The Washington Post: Plan Coming For Unpaid Chartered Health Claims, Gray Says
Not quite a week after it was announced that D.C. Chartered Health Plan could owe tens of millions more than previously anticipated to city health-care providers, Mayor Vincent C. Gray said Thursday his administration is "developing a plan to provide relief." Chartered Health Plan is currently the city's largest Medicaid contractor, handling the care of more than 104,000 District residents (DeBonis, 4/25).

California Healthline: Autism, Dental, Mental Health Focus Of Transition Concerns
Under the first phase of the transition, 600,000 Healthy Families children were moved into Medi-Cal managed care plans. In the next transition phase, set to begin May 1, the remaining 260,000 children will be moved into managed care plans by the end of the year, according to the state's timeline. … Of the first set of beneficiaries who have transitioned, 207 families will not be able to receive autism services known as applied behavioral analysis -- or ABA therapy -- through Medi-Cal managed care plans. … The loss of coverage for ABA therapy is the first indication that services have changed because of the transition. Some state officials and children's advocates are concerned about coverage for other services, particularly mental health services and dental care (Gorn, 4/25).

State Roundup: Mass. AG Warns On Hospital Sale Market Impact

Thu, 25 Apr 2013 13:37:00 GMT

A selection of health policy stories from California, Minnesota, Massachusetts, Oregon, Texas and Colorado.

Los Angeles Times: Employer Health Premiums Rose 170% In California In Last Decade
Premiums for employer health insurance in California jumped 170 percent over the last decade, more than five times the 32 percent increase in the state's inflation rate. That escalation in premiums has taken a toll on employers' willingness to offer health benefits, according to an annual survey by the California HealthCare Foundation (Terhune, 4/24).

MPR News: Blue Cross Blue Shield Cut Payments, Hospital Organization Alleges
Blue Cross and Blue Shield of Minnesota is accused of slashing payments to hospitals by the Minnesota Hospital Association. The organization represents most of Minnesota's hospitals. Lawrence Massa, President and CEO of the association, says Blue Cross will change its payment system for at least a dozen hospitals by May 1 from a negotiated discount to a rate unilaterally set by Blue Cross (Stawicki, 4/24).

Boston Globe: Coakley: State Should Monitor Hospital Sales For Market Impact
The pace at which hospitals and doctors are consolidating or forming new affiliations could enable some health systems to gain significant market power, a factor that already contributes to high prices for medical care in Massachusetts, according to the latest report on health costs released Wednesday by Attorney General Martha Coakley. Coakley highlighted market clout as a driver of health care costs in a 2010 report. The latest findings point to the rate at which hospitals are consolidating or expanding their contracted physician networks, in the name of better care coordination for patients or management of risk-based insurance contracts under which providers could lose money if patient care is too expensive (Conaboy, 4/24).

The Associated Press: Care Worker Raises In Minn. House Health Budget
The Minnesota House passed a health and social programs budget late Monday with a small salary increase for nursing home and long-term care workers, but some lawmakers questioned whether they were enough for struggling homes in rural areas. The Democratic-sponsored, $7 billion health and human services bill passed on a mostly party-line vote of 70-64 (Condon, 4/24).

Los Angeles Times: Federal Judge Renews Order For California Prison Mental Health Plan
Even as California makes preparations to appeal federal court rulings on the quality of care and crowding of conditions in state prisons, new orders are in the making. U.S. District Judge Lawrence Karlton on Tuesday dusted off a pending August 2012 order for the state to produce a plan to improve the quality of inmate mental health care, and gave it a new July 1 deadline. The judge's order notes that compliance was interrupted by the state's bid in January to end court oversight of prison mental health care (St. John, 4/24).

The Associated Press: Rural Oregon County Sees More Physician Assistants
The number of physician assistants has more than doubled in Malheur County over the past five years, helping to fill a gap in medical care for a rural county at the edge of Eastern Oregon that has trouble attracting doctors. The county has one primary care physician for every 1,958 residents, but, statewide, the number is one primary care physician per 1,134 residents, the Ontario Argus Observer reported (4/24).

The Texas Tribune: Legislators Seek Action On Medicaid Fraud Measures
After the discovery that the state was spending millions of dollars on fraudulent Medicaid dental and orthodontic care, state lawmakers held hearings ahead of the legislative session to identify what went wrong and how to prevent future fraud. And this session, lawmakers have filed a handful of bills to reform how Texas addresses Medicaid fraud. But the bills aren't progressing as fast as some would like (Aaronson, 4/25).

Health Policy Solutions (a Colo. news service): Hidden Gun Injuries ‘Routine’ Among Children
The horror of 20 children being shot to death at Sandy Hook Elementary School shocked the nation and the world. But Colorado researchers — who initially set out to study playground accidents — found that gun violence is harming children every day. Very few people know about these gun injuries because federal law has prohibited funding for research on gun accidents and fatalities. The Colorado researchers combed through every single injury over an eight-year period at Denver’s two primary trauma hospitals that serve children, Denver Health and Children’s Hospital Colorado. They expected to find information about playground injuries and were surprised to learn that violence was harming a significant number of children every year (Kerwin McCrimmon, 4/24).

California Healthline: Committee Oks 'Culture Change' Spending
A new bill aimed at changing the culture of long-term care in part by redirecting nursing home penalty fees passed a surprisingly controversial hearing yesterday before the Assembly Committee on Health. AB 973 by Assembly member Sharon Quirk-Silva (D-Fullerton) would direct roughly $150,000 a year in state penalty funds collected from long-term care facility violations to be used to "change the culture" at nursing homes, Quirk Silva said (Gorn, 4/24).

AP Poll: Americans Underestimate Their Chances Of Needing Long-Term Care As They Age

Wed, 24 Apr 2013 13:27:21 GMT

The Associated Press/Washington Post: Poll Finds People In Denial About The Need For Long-Term Care As They Get Older
We’re in denial: Americans underestimate their chances of needing long-term care as they get older — and are taking few steps to get ready. A new poll examined how people 40 and over are preparing for this difficult and often pricey reality of aging, and found two-thirds say they've done little to no planning (4/24).