Kaiser Health News - Delivery of Care

Viewpoints: Health Law's Effect On Patient Safety; Angelina Jolie's Surgery Is The Ultimate 'Choice'

Fri, 17 May 2013 13:33:02 GMT

The New York Times: Learning From Litigation
Much of the discussion over the Affordable Care Act has focused on whether it will bring down health care costs. Less attention has been paid to another goal of the act: improving patient safety. Each year tens of thousands of people die, and hundreds of thousands more are injured, as a result of medical error (Joanna C. Schwartz, 5/16).

The New York Times: The Murky World Of Hospital Prices
Last week, the federal government made public a vast trove of information on the list prices charged by hospitals for a large array of procedures commonly performed on hospitalized patients. It was a good start toward providing greater transparency in hospital billing, which has long been shrouded in secrecy. But it fell short of providing full information that patients need to make informed decisions about which hospitals to use and which insurance to buy (5/16).

The Washington Post: Bill Gates: 'Death Is Something We Really Understand Extremely Well'
"I always use this chart of childhood death," Bill Gates says. "In 1960, 25 percent of kids died before the age of 5. And now we're down below 6 percent of kids dying before the age of 5." We're sitting in a bare conference room at his foundation’s D.C. headquarters. Gates is in town to talk to members of Congress about his top priority this year: Global health -- and, in particular, the total eradication of polio. He wants to drive that 6 percent even lower, and he believes he can. Wiping out a disease like polio sounds impossible. But it's actually, Gates tells me, completely achievable (Ezra Klein, 5/17).

Reuters: A Woman's Choice
We use that word so often: choice. It has become the code word for abortion, alas, and thus a lightening rod for activists on both sides of that continuing battle. But this week Angelina Jolie redeemed the word and the idea behind it -- that a woman has a right to choose what happens to her body, however tough that choice sometimes is (Anne Taylor Fleming, 5/16).

Philadelphia Inquirer: Angelina Jolie's Lesson For Obamacare
Angelina Jolie's announcement that she underwent a double mastectomy to protect against a genetic form of breast cancer inspired widespread surprise and admiration. With her op-ed revelation in the New York Times, she put herself forward as a role model for millions of women who face a similar dilemma. Such candor and forthrightness are rare among celebrities. Yet, she is extremely fortunate in one respect. She has the financial resources to afford both the testing that found her heightened risk and the consequent surgery. As she noted in her op-ed, many women do not (Robert Field, 5/17).

Tampa Bay Times: Politics And My Double Mastectomy
During the same week that Angelina Jolie announced that she had a preventive double mastectomy as a precaution against her genetic predisposition toward breast cancer, House Republicans are likely to vote for the 37th time to repeal or replace Obamacare. These two events have more in common than you think. That's because, for everyone except the mega-wealthy like a Hollywood star, having Jolie-like health care options depends on good, affordable health insurance. And having access to that kind of coverage depends on reasonable and caring leaders in Washington -- something the Republican caucus is missing, as proved by the anticipated vote (Robyn E. Blumner, 5/16).

Fox News/Washington Examiner: ObamaCare Is About Power
Members of the House of Representatives are scheduled to vote Thursday to repeal all of ObamaCare. Given that the House voted to repeal the law last year, some commentators and observers have questioned the need for another repeal vote. However, the scandals coming to light over the last week perfectly make the case for why Congress must eradicate the law from the statute books (Jim DeMint, 5/16).

New England Journal Of Medicine: Expanding The Role Of Advanced Nurse Practitioners – Risks And Rewards
As the 2014 expansion of coverage mandated by the Affordable Care Act (ACA) looms larger, one question with no ready answer is how health care providers, policymakers, and payers will cope with an expected surge in patient demand for services. A shortage of primary care physicians to treat newly insured persons is the most immediate health workforce issue, but when added to the nation's population growth and more aging patients who require treatment, finding a practitioner may become an even more daunting challenge (John Iglehart, 5/16).

Tampa Bay Times: Hypocrisy In The House
Republican state lawmakers on Tuesday didn't want to talk about 1 million of the state's poor who don't have health insurance. Or about how Floridians and their health care system inevitably absorb the cost when the uninsured are in crisis. They tried to change the subject when asked at a Suncoast Tiger Bay meeting in St. Petersburg about news reports that juxtaposed Republican House members' generous taxpayer-covered health insurance with their votes to reject federal Medicaid expansion dollars to cover 1 million uninsured -- and pump $51 billion into the state economy. Floridians shouldn't so easily dismiss the hypocrisy (5/14).

Orlando Sentinel: Costly Expansion Wouldn't Improve Floridians' Health
The state Legislature's decision this year to reject Medicaid expansion was the correct decision for Florida. There is little evidence that growing the health care program for the poor would improve the health of state residents. A recent study in the New England Journal of Medicine is all the proof that Sunshine State legislators needed to reject Medicaid expansion. Those lamenting the failed implementation of this part of the federal Affordable Care Act in Florida can look to Oregon to see that Floridians won't be missing out on much (Bob Williams, 5/17).

Orlando Sentinel: Misrepresentations Blocked Care For A Million Floridians
Despite the support of Gov. Rick Scott and the Florida Senate, the 2013 legislative session ended with the Florida House unilaterally blocking the extension of health coverage to more than a million low-income, uninsured Floridians. Approving "Medicaid expansion" (or a comparable Senate-backed alternative) would have provided low-wage workers, parents and patients priced out of coverage with desperately needed access to care and protection from financial ruin. It would have infused $51 billion of our tax dollars into the economy, created 120,000 private-sector jobs, saved the state more than it would cost, and enabled service-sector employers to avoid hundreds of millions in penalties. In short, a "win-win-win." The only remaining impediment was purely political (Greg Willowe, 5/17).

Cincinnati Enquirer: Kentucky Expands Medicaid, Why Not Ohio?
By virtue of Kentucky’s Medicaid laws, Gov. Steve Beshear was able to expand that state's program without going through the Kentucky General Assembly. Good for him and good for Kentucky. ... But in Ohio, the Republican-controlled General Assembly is taking a lifetime to ponder the issue (5/16).

State Highlights: State Medicaid Investigators Get More Money To Investigate Fraud

Fri, 17 May 2013 13:32:00 GMT

A selection of health policy stories from Texas, Kansas, Georgia, Wisconsin and California.

CQ HealthBeat: OIG Final Rule Allows Medicaid Investigators To Use Data Mining
State Medicaid fraud investigators will be able to get federal matching funds to electronically search for potential fraud, under a final rule to be published on Friday. The rule, which will be published by the Health and Human Services Office of Inspector General, is expected to save the federal government about $34.3 million from fiscal 2014 through fiscal 2023 in fraudulent claims that would have been paid (Adams, 5/16).

The Texas Tribune: End-Of-Life Bill Sparks Anger, Accusations
Political powerhouse Texas Right to Life is working overtime to try to defeat a compromise measure aimed at improving state laws governing "end of life" medical decisions. But with time running out to get Senate Bill 303 passed, the fight over the legislation has shifted from political to personal. Sen. Bob Deuell, R-Greenville, a family physician who has worked for years to craft legislation acceptable to faith-based groups, the disability community and medical professionals, said Texas Right to Life is acting like "the woman that went to Solomon and wanted the baby to be cut in two" (Aaronson, 5/17).

The Texas Tribune: House Backs Bill To Protect Medicaid Providers’ Rights
Medicaid providers would have clearer due process rights during fraud investigations under a measure the House gave tentative approval to on Wednesday. The bill would also codify the state's rules for withholding payments to providers during such investigations (Smith and Aaronson, 5/16).

Kansas Health Institute: Governor's Mental Health Initiative Panned At Manhattan Meeting
Karen McCulloh spent much of Wednesday afternoon listening to state officials explain how Gov. Sam Brownback's mental health initiative might work. She said she didn't hear much that she hadn't heard before. … Brownback has said his initiative, much of which remains undefined, is meant to "strengthen" the state's mental health system and better serve those most at-risk of hospitalization or incarceration (Ranney, 5/16).

Georgia Health News: Albany Hospital Merger Slowed By Latest Ruling
U.S. District Court Judge Louis Sands has issued a temporary restraining order against further moves by Phoebe Putney Health System to consolidate with the former Palmyra Medical Center in Albany. The ruling had been sought by the Federal Trade Commission. Phoebe Putney officials said in a statement that the judge's action won't alter day-to-day operations at the former Palmyra, which was purchased from HCA and has been renamed Phoebe North (Miller, 5/16).

Milwaukee Journal Sentinel: Uninsured, Low-Income Visits To Hospital
More than 1 million visits to Wisconsin's hospitals were by patients who were uninsured and low-income in 2011 -- an increase of more than 30 percent since 2006, according to the Wisconsin Hospital Association Information Center's annual Guide to Wisconsin Hospitals. The Wisconsin Hospital Association Information Center also reported that 70 percent of surgeries and procedures now done at the state's 148 hospitals don't require an overnight hospital stay and are done in outpatient departments. The figure shows that the traditional measure of inpatient stays no longer is a valid way to gauge a hospital's patient volume and size (Boulton, 5/16).

California Healthline: Increasing Medical Residencies Could Help Inland Empire
As the Inland Empire grapples with a shortage of primary care physicians, experts say the solution hinges on creating more medical residencies. New state legislation could help. AB 1176 proposes to increase the number of primary care medical residencies in underserved regions, such as the Inland Empire. The new slots would be funded by levying a fee on insurers (McSherry, 5/16).

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).

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).

HHS To Pay $1 Billion For Ideas To Drive Down Health Costs

Thu, 16 May 2013 13:41:55 GMT

The availability of a second round of grants -- funded by the health law -- was announced to support approaches to reduce costs and improve care. The initial round, announced last year, funded 107 organizations.

CBS News: Gov't To Pay $1 Billion For Innovative Health Care Ideas
The U.S. government will award up to $1 billion in grants for innovative health care ideas that drive down medical costs, the Department of Health and Human Services (HHS) in conjunction with the Centers for Medicare & Medicaid Services (CMS) announced Wednesday. On a conference call with reporters, HHS secretary Kathleen Sebelius said the country has made strides in reducing medical costs, and national health care spending has fallen to a 50-year low. However, she said there is still more to do (Jaslow, 5/15).

CQ HealthBeat: Innovation Center Plans Second Round Of Grants
The Center for Medicare and Medicaid Services Innovation Center is preparing to distribute $1 billion in grants for projects designed to improve care and lower costs for federal health programs, agency officials said Wednesday. The second round of grants follows an initial round that was announced last year. At that time, 107 organizations received funding from a total pot of $895 million (Adams, 5/15).

Meanwhile, Medpage Today reports on ACOs -

Medpage Today: Doc-Led ACOs Better Model For Saving $
Physician-led accountable care organizations (ACOs) could have more opportunities to create savings in patient care with a little help from health insurers, a leading health reform expert said Wednesday. Doctor-centric ACOs can do a better job at controlling costs than hospital-led organizations, Paul Ginsburg, PhD, president of the Center for Studying Health System Change here, said at an ACO summit hosted by America's Health Insurance Plans. … Unlike in hospital-led ACOs, doctor-led ACOs aren't compromised financially by reducing hospital admissions and emergency department visits, he pointed out (Pittman, 5/15).

Weekend Reading: Volunteers In The Battle With Heart Disease

Thu, 16 May 2013 13:39:00 GMT

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

The Atlantic: Lost In Medication
Psychiatrists who take time with their patients are not the norm. It's not because others don't care. Rather the system rewards efficiency, not empathy ... I treated a patient who had suffered from schizophrenia for years. He had finally achieved some stability on a cocktail of antipsychotic medications as he was passed along through the clinic, year after year ... One day, though, he showed up for his appointment looking completely different. His complaints had nearly disappeared; he was cheerful, optimistic. ... Inquiring about what had changed, I found out that with the assistance of the hospital work program, he had gotten a job for the first time in nearly 30 years. … In many places psychiatry has become a biological enterprise, with some psychiatrists even introducing themselves as "psychopharmacologists." In no other specialty does a physician define themselves by the medication that they use (Sarah Mourra, 5/10).

The New Republic: My Five Obamacare Anxieties
Conservatives are talking about the implementation of Obamacare in the same thoughtful way they talked about its enactment—that is, as an impending apocalypse. It won't be, as I've noted previously. Most Americans get insurance through employers, Medicare, and Medicaid, and that will still be the case on January 1, when Obamacare's big provisions take effect. But the minority who buy insurance on their own or have no insurance will see tremendous changes. And you don't have to be Rush Limbaugh to have real concerns about how those changes will play out (Jonathan Cohn, 5/13).

The Fiscal Times: Why The IRS Scandal Could Bring Down Obamacare
The Internal Revenue Service's scandalous targeting of Tea Party-themed and other conservative groups could severely damage President Obama – but it's not necessarily because anyone close to the White House sanctioned the allegedly independent actions by the tax collection agency. ... The real fallout could be that it will impede Obamacare, ... The IRS will largely administer this attempt at providing near-universal health insurance. It is responsible for overseeing the tax credits and tax increases in the law, and—most critically—ensuring that businesses and individuals comply with the individual mandate and other major provisions. Prominent Republicans are already connecting the unpopular insurance program to the questions swirling around the IRS (Josh Boak and Eric Pianin, 5/14).

The Weekly Standard: Eggs For Sale?
If you want to know what's going to go wrong in the culture, read the professional journals. A case in point: An article in the April 10 New England Journal of Medicine called for the creation of a commodities market for "made-to-order" human embryos. The authors, I. Glenn Cohen and Eli Y. Adashi—university professors, of course—treat embryos as the equivalent of a prize cattle herd. They note that sperm and eggs are already bought and sold for in vitro fertilization (IVF) and, further, that New York legalized buying eggs for use in biotechnological research a few years ago. Hence, "it is not clear" (an oft-used phrase in bioethical advocacy that frees the author from actually having to prove a point) why we should not also allow companies to make "made-to-order embryos" for profit, since that activity would be "more similar to the sale of gametes than the sale of children" (Wesley J. Smith, 5/14).

The New York Times: Seeking Clues To Heart Disease In DNA Of An Unlucky Family
Researchers have long known that a family history of early death from heart disease doubles a person's risk independently of any other factors. Family history is defined as having a father or a brother who were given a diagnosis of heart disease before age 55 or a mother or sister before age 65. Scientists are studying the genetic makeup of each member of the Del Sontro family, searching for telltale mutations or aberrations in the long sequence of three billion chemicals that make up human DNA. Until very recently, such a project almost certainly would have been futile. Picking through DNA for tiny aberrations was so costly and time-consuming that it was impractical to take on for an entire family (Gina Kolata, 5/12).

The New Yorker: Can We Patent Life?
On April 12, 1955, Jonas Salk, who had recently invented the polio vaccine, appeared on the television news show "See It Now" to discuss its impact on American society. Before the vaccine became available, dread of polio was almost as widespread as the disease itself. Hundreds of thousands fell ill, most of them children, many of whom died or were permanently disabled. The vaccine changed all that, and Edward R. Murrow, the show's host, asked Salk what seemed to be a reasonable question about such a valuable commodity: "Who owns the patent on this vaccine?" Salk was taken aback. "Well, the people," he said. "There is no patent. Could you patent the sun?" ... It took thousands of scientists and technicians more than a decade to complete the Human Genome Project, and cost well over a billion dollars. The same work can now be carried out in a day or two, in a single laboratory, for a thousand dollars—and the costs continue to plummet. As they do, we edge closer to one of modern science's central goals: an era of personalized medicine, in which an individual’s treatment for scores of illnesses could be tailored to his specific genetic composition. That, of course, assumes that we own our own genes (Michael Specter, 4/2).

The National Journal: How Much Big Insurance Paid A Small-Business Group To Fight A Premium Tax
The nation's leading health insurance industry group gave $850,000 to a top small-business trade association as part of a campaign to repeal a key provision of President Obama’s health care law, National Journal Daily has learned (Frates, 5/14).

Viewpoints: When A Doctor Should Keep Quiet; 2 Views Of Hospital Pricing; Stem Cell 'Snake Oil'

Thu, 16 May 2013 13:31:57 GMT

Los Angeles Times: For A Dying Patient, A Prescription Of Silence
In medical school, we were taught not to withhold information from our patients or to be "paternal" in making decisions for them. We internalized the idea that fully informed patients are better equipped to make treatment decisions. And with patients likely to die of their diseases, discussing the prognosis frankly would allow them to say goodbyes, get things in order and prepare advanced directives for what kind of interventions they did and didn't want. But Pedro's wife was adamant. "He will lose his will to live if he knows he has cancer. And he will then die even sooner" (Susan Partovi, 5/16).

USA Today: Hospital Pricing Gouges Patients: Our View
Shouldn't you be able to see the price of something before you buy it, so you can shop for value or simply figure out whether you can afford it? Before you roll your eyes and say, "Of course," think about the last time you bought medical care, especially in a hospital. See any price lists on the wall? Probably not. And, if you had, you might have fainted on the spot (5/15).

USA Today: Hospital Billing Too Complex: Another View
Many parts of America's health care delivery and financing systems urgently need updating, and the matter of "charges" ranks high on the list. Today's hospital bill is a symptom of a broken payment system. Hospitals deal with more than 1,300 insurers, each having different plans with multiple requirements for hospital bills. Decades of federal regulations have made a complex billing system even more complex and frustrating for everyone involved (Rich Umbdenstock, 5/15).

USA Today: Beware Of Stem Cell Therapy Claims
A stem cell transplant can help cure patients with acute myeloid leukemia, and research has shown incredible potential, from growing teeth to mending "unhealable" bone fractures. Still, stem cells are poorly understood. Despite this, as (Ferris) Jabr writes, many cosmeticians continue to claim that stem cells are a cure-all for "everything from wrinkles to joint pain to autism." Until we understand them better, stem cells are the new snake oil peddled by 21st century charlatans. Thankfully, the Food and Drug Administration is cracking down (Alex Berezow, 5/15).

JAMA: Accountable Care Organizations: Accountable For What?
Dr Robert Potenza and Dominica Potenza, partners in life and in work, are, respectively, a cardiologist and a registered nurse who have a cardiology/internal medicine practice in the Bronx. … In theory, continuity of care should be improving at Montefiore, one of 32 Pioneer Accountable Care Organizations (ACOs) that aim to become models for improving population health while lowering costs. Montefiore has been acquiring physicians' practices to expand its primary care capacity, but the Potenzas are reluctant to join, fearing they'll lose what control they have over the personalized care they give their patients (Diana Mason, 5/15).

Columbus Dispatch: Expanding Medicaid Would Help In Fight Against Breast Cancer
As a seven-year breast-cancer survivor, I know how important annual screening can be. I was diagnosed with Stage IIa breast cancer on a routine mammogram. ... I was lucky and had very adequate health insurance, yet my personal cost remained over $6,000. While expanding Medicaid in Ohio would seem counterintuitive as a cost-saving measure, we must sometimes view Medicaid dollars spent as a long-term investment in Ohio and enable Ohioans to realize the savings. Screening to capture cancer at the earliest possible stage reduces the costs of treatment and improves mortality (Tammy Weis, 5/16).

Bloomberg: U.S. Must Fight Harder Against TB
While USAID's TB budget is being slashed, public-health spending on tuberculosis in the U.S. is also being cut. On top of belt tightening from sequestration, the administration of Barack Obama has been pillaging money from the U.S. Department of Health and Human Services’ Prevention and Public Health Fund, which goes to efforts such as immunizations, health screenings and smoking prevention. ... Almost all TB specialists in the U.S. work in public clinics and hospitals. Many patients, being either uninsured or underinsured, have nowhere else to go for their treatment. Even after the Affordable Care Act is fully in place, public TB clinics will remain important safety nets for undocumented immigrants and legal immigrants who don’t yet qualify for public services. It's safe to assume that cuts in public health funding will have the same effect we saw in the early 1990s after earlier reductions: Many patients will be inadequately treated, allowing greater transmission of TB and the emergence of multidrug-resistant strains (Celine Gounder, 5/15).

Tampa Bay Times: Fight On Prescription Drug Abuse Not Over
Once local law enforcement and the Florida Legislature finally committed to addressing prescription drug abuse, it made a difference. The welcome news that prescription drug deaths in the Tampa Bay area are down 30 percent since 2010 is surely a result of a focus on unscrupulous pain clinics and easy access to pills. But there is more work to be done, and boosting the state's still-tepid commitment to a prescription drug database is the place to start (5/14).

New England Journal Of Medicine: The Role Of The NIH In Nurturing Clinician-Scientists
The awarding of the 2012 Nobel Prize in Chemistry to Robert Lefkowitz and Brian Kobilka, both M.D.s trained in cardiology, for their work on characterizing the structure and function of beta-adrenergic receptors, should remind us of the critical role that clinician-scientists have played in formulating the seminal concepts that govern modern biomedical science. Much has been written since the 1970s about the demise of the physician-scientist -- as evidenced by the declining share of RO1 grants that the National Institutes of Health (NIH) awards to physicians -- and the economic factors that have driven physicians away from the laboratory and research clinic into more remunerative clinical practice (Dr. Michael Gottesman, 5/15).

Viewpoints: Controversy Taints IRS Efforts On Health Law; Another Chance To 'Gut' The Overhaul In The Courts; Salt Wrongly Accused

Wed, 15 May 2013 13:26:29 GMT

The Wall Street Journal: Your Next IRS Political Audit
Even as the politicized tax enforcement scandal expands, the Internal Revenue Service continues to expand its political powers thanks to the Affordable Care Act. A larger government always creates more openings for abuse, as Americans will learn when the IRS starts auditing their health care in addition to their 1040 next year (5/14).

The Washington Post's The Plum Line: Why Washington Scandal-Mania May Save Medicare And Social Security
Liberals who are dreading the scandal-mania that is taking hold should note that it contains a potential upside: It could make a Grand Bargain that includes cuts to Medicare and Social Security benefits even less likely than it already is. That's because when scandal grips Washington, a president actually needs his core supporters more than ever to ward it off, making it harder to do anything that will alienate them (Greg Sargent, 5/14).

New Republic: The Supreme Court Is About To Get Another Chance To Gut Obamacare
(Michael) Carvin's legal argument, which originated with CATO Institute economist Michael Cannon and Western Reserve law professor Jonathan Adler, is that, due to a drafting glitch in the ACA, only state-run exchanges, not federal ones, can provide tax credits and subsidies to enable lower-income individuals to afford ACA-mandated health insurance. ... So, could rejectionists have any basis for hoping to overturn Treasury's rule? Yes, they could. All the Obama administration's arguments, however well-founded, could be shoved aside, if the case reaches the Supreme Court, and the Court's conservative bloc deploys a "methodology," long touted by Justice Antonin Scalia, for interpreting statutes. Scalia's approach, which he calls "textualism," holds that judges must tease out the meaning of individual statutory words or phrases in isolation, rather than giving weight to the statute's overall structure, design, purpose, or legislative history (Simon Lazarus, 5/13).

The New York Times' Economix: Patterns Of Changes In Health Insurance
A number of industries can expect big changes in employee health insurance in the next year or two, while others will continue with business as usual (Casey B. Mulligan, 5/15).

Arizona Republic: Fiscal Risks Of Not Expanding Medicaid
Opponents of Gov. Jan Brewer's Medicaid expansion proposal are recklessly minimizing the risk to the (state) of not participating. Arizona is in an unusual position regarding this issue. Most states offer very little Medicaid coverage to childless adults. So, for them, expanding coverage to 133 percent of the federal poverty level is a very big step. And even the 10 percent of that expansion they will end up having to pay under Obamacare is a big bill (Robert Robb, 5/14).

Politico: Fixing The VA-DOD Health System Fiasco
As health care plans nationwide enter the home stretch of implementing electronic records under the framework of the Obama administration’s Affordable Care Act, and military service disability claims backlogs grow in size and attention, the Department of Veterans Affairs and the Pentagon need a much more coherent approach to modernize and deploy their electronic health record systems (Peter Levin, 5/15).

Medpage Today: Hospitals In Crisis: The Effects Of Obamacare
Under the Affordable Care Act's Hospital Readmissions Reduction Program, hospitals that readmit certain patients within 30 days of discharge could face significant penalties. Under the Affordable Care Act's Hospital Readmissions Reduction Program, hospitals that readmit certain patients within 30 days of discharge could face significant penalties. The question is whether hospitals really have that much control over factors leading to readmission and whether they are really at fault (Dr. Sreedhar Potarazu, 5/14).

The New York Times: Doubts About Restricting Salt
After years of warnings to cut sodium consumption to reduce heart attacks and strokes, it is disturbing to learn how little evidence exists that such reductions would actually be beneficial to health. There is even emerging evidence that some groups in the population could suffer harm from levels that are too low (5/14).

Los Angeles Times: Doctoring In A Family Way
New policies proposed in April by the Residency Review Committee for Family Medicine, or RRC, the group that outlines requirements for physician training programs nationwide, threaten to interfere with that comprehensive care and to decrease reproductive health access for women like Jennifer. The proposed RRC changes would eliminate the current requirement that family medicine residents learn full-scope reproductive healthcare. Instead, the decision to teach these skills would be up to the discretion of individual residency programs. Family doctors would no longer be required to learn how to prescribe birth control, place intrauterine devices or contraceptive implants, provide options counseling for women with unintended pregnancies or diagnose and manage miscarriages (Alison Block, 5/15).

USA Today: Angelina Jolie, Breast Cancer Fighter: Our View
While her message was brave and important, it's equally important to note that Jolie is among an extremely small percentage of women with an unusually high risk of breast cancer due to her family history and her gene mutation. Only about 1 percent of women test positive for mutations to the BRCA1 or BRCA2 genes that signal elevated risk for breast and ovarian cancer, and most women who develop breast cancer can be successfully treated with less radical treatment if the cancer is caught early (5/14).

Health Policy Solutions (a Colo. news service): The Ethically Slippery Slope Of Assisted Suicide
While New Mexico and other states are grappling with the question of whether to allow doctors to write prescriptions for drugs that terminally ill patients can take to commit suicide, countries such as Belgium and The Netherlands are pushing the envelope in distressing ways. For those who claim there is no evidence of a slippery slope in abuse of physician-assisted suicide once implemented, I offer several problems presented by the Belgium and Netherlands experiments. In these countries, it is legal for physicians to directly euthanize patients (Dr. Anthony Vigil, 5/14).

Health Policy Solutions (a Colo. news service): Making Sense Of Variation In Health Care Pricing
Some have been outraged by the seemingly pointless variation in charges the Medicare data shows. However, some variation in the base charges for hospital services does make sense. Facilities and providers alike need to charge differently depending on how sick and complicated their patients are, whether they have additional overhead costs because they are a teaching facility, number of patients receiving charity care, etc. The more important task, though, is to figure out where variation is not adding value and to identify opportunities to get health care spending under control (Phil Kalin, 5/15).

Hospitals: Calif. Bidding War Intensifies; Va. System Eyes Children's Facility

Wed, 15 May 2013 13:25:00 GMT

The business of hospitals makes news in California -- where sides are engaged in a bidding war to buy a famed Santa Monica hospital; Virginia -- where pediatricians eye a new children's hospital; and Oregon, where lawmakers passed a new hospital tax.

Los Angeles Times: St. John's Bidding War Escalates
A high-stakes bidding war has erupted for St. John's Health Center, a storied Santa Monica hospital, with a local billionaire teaming up with the Roman Catholic Archdiocese of Los Angeles on an unsolicited offer. The latest bid, expected to be formally announced Wednesday, comes from former drug-company executive and health care entrepreneur Patrick Soon-Shiong, who said in a statement the bid has the support of the archdiocese (Terhune, 5/15).

Richmond Times-Dispatch: Pediatricians Work Toward Children’s Facility
In the past three years, Bon Secours Virginia Health System has boosted the number of pediatric specialists in its physician network to 77, probably double what it was before, as its builds its St. Mary’s for Kids brand. … The "hope" he refers to is the prospect that Richmond will one day have an independently operated, free-standing children’s hospital that would consolidate most pediatric care in the region under that facility’s umbrella. For such an entity to stand a chance of financial success in Richmond, the major hospital systems -- Bon Secours, VCU Health System and HCA -- would have to stop offering most pediatric services at their hospitals (Smith, 5/15).

Oregonian: Oregon House Passes Hospital Tax, But It’s Still Part Of Senate PERS Debate
The Oregon House approved a major piece of the Oregon Health Authority’s budget Tuesday, including provisions extending taxes on hospitals and long-term care facilities, but the bill appears destined to be held up by Senate Republicans. The two taxes were drawn into a larger debate over taxes and public pension spending last week after Republicans cast protest votes against House Bill 2216 in the Legislature’s budget committee (Gaston, 5/14).

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).

Vermont Lawmakers OK Doc-Assisted Suicide

Wed, 15 May 2013 13:23:38 GMT

The state will become the first to use a legislative vote to legalize physician-assisted suicide after the governor, who has expressed his support for the measure, signs the bill.

The Wall Street Journal: Lawmakers in Vermont Approve Assisted Suicide
Vermont is poised to become the third state in the nation to allow physicians to prescribe lethal drugs to terminally ill patients who want to die. State lawmakers on Monday night approved an assisted-suicide bill, which now awaits the signature of Gov. Peter Shumlin, a first-term Democrat who has said he would sign it, likely within a week. Once enacted, Vermont would be the first state to decriminalize assisted suicide through a legislative vote (Gershman, 5/14).

Politico: Vermont OKs Assisted Suicide Bill
The approval of an assisted suicide bill in Vermont brings to a close a 10-year battle in the state over the issue and delivers the third state-level victory for advocates seeking to advance the policy nationwide. But the national implications for the bill -- which won legislative approval Monday night and allows doctors to prescribe lethal doses of drugs to some terminally ill patients -- are tough to pinpoint (Cheney, 5/15).

Medpage Today: Vermont Passes Assisted Suicide Bill
Vermont will soon become the fourth state to allow physician-assisted suicide now that state lawmakers there have passed a bill allowing the practice. The bill, the Patient Choice and Control at End of Life Act, next heads to the desk of Gov. Peter Shumlin (D), who is expected to sign the bill into law, having previously expressed his support for it. Taking effect July 1, the law would absolve healthcare professionals licensed in the state of civil or criminal liability if a terminally ill patient self-administers a lethal dose of a drug meant to treat their condition. The physician is required to have examined the patient, who must be expected to live no more than 6 months (Pittman, 5/14).

Medicaid: Lawsuit Alleges Conn. Application Backlog Breaks Federal Law

Wed, 15 May 2013 13:23:00 GMT

Medicaid doctors continue to wait for their pay raise -- five months after they were supposed to get it. In Connecticut, some allege a backlog of applications for the program breaks federal law, and are suing to stop it.

Kaiser Health News: Capsules: Most Doctors Still Waiting On Medicaid Pay Raise
Five months after primary care doctors who treat Medicaid patients were supposed get a big pay raise, most physicians have yet to see it. Only three states have implemented the pay raise -- Nevada, Michigan and Massachusetts, according to the American Academy of Family Physicians (Galewitz, 5/14).

CT Mirror: Suit Hammers Huge Medicaid Backlog, Long Waits
Every month, thousands of poor state residents go without health care coverage while their applications for Medicaid linger, without being approved or denied, for longer than federal law allows. The numbers "tell the whole story," attorney Sheldon Toubman said Tuesday at the start of a trial in Hartford centered on allegations that the state Department of Social Services doesn't have enough workers to handle Medicaid applications within federally required time frames (Becker, 5/14).

State Roundup: Veto Of Medical Charity Tax Break Scrutinized In Ga.

Wed, 15 May 2013 13:23:00 GMT

A selection of health policy stories from California, Georgia, New York, Florida, California and Kansas.

Los Angeles Times: Gov. Jerry Brown Unveils Cautious Budget For Deficit-Free State
But Brown vowed to continue to resist pressure from fellow Democrats and interest groups to restore some money to adult dental care and to doctors who treat the poor. … Sacramento will oversee the expansion this year of Medi-Cal, California's health care program for the poor, to more than 1 million Californians who do not have health insurance now. Under Brown's plan, the newly insured would be offered the same benefits as those already covered by the public program, a shift from January. Then, the governor did not include stays in rehabilitation facilities and other long-term care for those who will become eligible for Medi-Cal for the first time next year (Megerian, 5/14).

Sacramento Bee: Gov. Jerry Brown Takes Cautious Approach On California Budget
Gov. Jerry Brown, dismissive of a surge in state tax revenue that stirred optimism at the Capitol, moved Tuesday to blunt appeals for increased spending, downgrading his budget proposal from January. The budget revision -- an annual exercise opening a month of negotiation with the Legislature -- threatened to strain Brown's relationship with Democratic lawmakers and with social service advocates who called Brown's estimates overly conservative and who are lobbying to restore programs cut during the recession (Siders, 5/14).

Georgia Health News: Veto Sidetracks Tax Break For Medical Charities
Among Gov. Nathan Deal’s five vetoes this year, probably the most surprising one targeted a bill that would have given sales tax breaks to charitable medical clinics, federally qualified health centers, food banks and other charities. The measure, House Bill 193, had overwhelming legislative support. It passed the House unanimously during the 2013 legislative session, and the Senate approved it 52-2. The legislation would have restored sales tax exemptions for community health centers and volunteer charity clinics – tax breaks that had sunset (expired automatically) in 2010 (Miller, 5/14).

The New York Times: Archbishop Presses Cuomo Over Abortion
Cardinal Timothy M. Dolan declined on Tuesday to say whether Gov. Andrew M. Cuomo was "a Catholic in good standing," as he ratcheted up his criticism of the governor's continued advocacy for abortion rights (McKinley, 5/14).

NPR: How A Florida Medical School Cares For Communities In Need
Brown helps direct FIU's Neighborhood HELP program. It's part of the school's curriculum that connects medical students with families in neighborhoods where medical care is scarce. Students visit families in their homes where they conduct examinations and provide basic care. But some things are better done in a clinic. So the medical school bought its own RV. "We're able to bring free basic primary care to our households relatively close to their community," Brown says (Allen, 5/15).

Health News Florida: Prescription Drug Deaths Drop In Tampa Bay
New data reveals the Tampa Bay area's prescription drug problem is on the decline. The number of accidental drug deaths in at least four local counties has dropped since 2010. Pinellas, Pasco, Hillsborough and Hernando counties have all seen a decline in drug overdoses over the last two years (Saleh, 5/15).

HealthyCal: Poor Health Care Moving From Prison To Jails
California’s sweeping criminal justice reform plan was meant to sharply reduce the state’s prison population. But the changes may have also had the unintended consequence of passing along to county jails the biggest problem associated with overcrowding -- poor health care. The reform, also known as prison realignment or AB 109, transferred authority for people convicted of certain non-violent felonies from the state to the counties in 2011 (Flynn, 5/15).

Kansas Health Institute: Kansas Drug Disposal Program Collects 6,000 Pounds Of Medications In First Year
Pharmacist Lori Murdock said she often heard the question even from people who weren’t her customers: How do we get rid of our old drugs? As the owner of Cedar Creek Pharmacy in this western Johnson County community, Murdock responded by signing up a couple months ago for the medication disposal program run by the Kansas Department of Health and Environment (Sherry, 5/14).

California Healthline: Stop-Loss Bill Heads For Senate Floor Vote
The Senate Committee on Appropriations yesterday approved a bill to ban a certain type of selection criteria when insurers issue stop-loss health care coverage to small employers. … The bill would end the practice of cherry-picking healthy employees from the pool of workers within small businesses by stop-loss insurers, said Beth Capell, legislative advocate for Health Access California (Gorn, 5/14).

Doctors Transform How They Practice Medicine

Wed, 15 May 2013 13:16:55 GMT

Kaiser Health News staff writer Ankita Rao reports: "The buzz, and anxiety, in the medical profession is palpable – trade magazines tout new coping strategies, doctor groups discuss the transformation of practices. Physicians are experimenting with business models and new practice techniques, hoping to find work that is both financially and personally rewarding" (Rao, 5/15). Read the story.

Administration Issues Proposed Rule On Medicaid DSH Payment Reductions

Tue, 14 May 2013 14:13:00 GMT

These payments, known as disproportionate share hospital payments, go to hospitals that treat a high number of uninsured patients.

Politico: W.H. Plans To Delay Medicaid DSH Payment Cuts
The Obama administration has proposed delaying a potentially painful decision on whether to penalize states that refuse to expand Medicaid coverage for low-income populations under Obamacare. The national health care law calls for a gradual reduction in special federal payments — known as Disproportionate Share Hospital or DSH payments — to hospitals that take care of large numbers of uninsured patients. The idea of reducing the DSH payments, which totaled $11.3 billion in 2011, was tied to the fact that the health law's coverage expansion would reduce the burden on hospitals. If more people get covered, the hospitals should have to provide less uncompensated care (Millman, 5/14).

Kaiser Health News: Capsules: CMS Won't Penalize Hospitals In States Slow To Expand Medicaid
That sigh of relief you heard Monday was from hospital administrators in nearly two dozen states, including Florida and Texas. That's because the Obama administration announced that for the next two years, it doesn't plan to penalize states that have yet to expand Medicaid coverage under the federal health law by targeting them for reduced Medicaid funding, according to a proposed rule unveiled Monday. That money goes to hospitals that treat large numbers of poor people (Galewitz, 5/14).

The Wall Street Journal: Health Officials Detail Payment Cuts For Uninsured
The Obama administration on Monday published a plan for cuts in payments for hospitals that treat many uninsured patients and said states that decline to expand their Medicaid programs under the 2010 health law won't get preferential treatment. The federal government currently sends about $11 billion a year to states to help cover the costs of uncompensated care. The health law called for cuts in those payments, assuming that most Americans would have insurance coverage after the law took effect (Radnofsky, 5/13).

Reuters: U.S. Proposes Rule On Medicaid Payment Cuts For Hospitals
The U.S. government on Monday issued a proposed rule for cutting payments to hospitals that treat a disproportionate share of the poor, including a $500 million reduction in fiscal 2014, as part of President Barack Obama's healthcare reform law. The Patient Protection and Affordable Care Act mandates annual reductions in Medicaid payments to hospitals through fiscal 2020 in exchange for increased insurance coverage options that are expected to reduce levels of uncompensated care (5/13).

Miami Herald: Jackson And Other Hospitals May Face Cuts In Pay For Uninsured, Under Healthcare Reform
Florida hospitals that treat many uninsured patients will lose millions of dollars in funding meant to offset those costs, according to a proposal unveiled Monday by federal health officials who had anticipated that more Americans would have access to insurance under the Affordable Care Act, reducing the amount of uncompensated care delivered by hospitals. In announcing the proposed cuts, federal health officials said they would not give preferential treatment, at least at first, to states that declined to expand Medicaid, such as Florida (Chang, 5/13).

Viewpoints: Angelina Jolie On Her Decision To Have a Double Mastectomy; Justice Ginsburg's 'Blind Spot' On Abortion

Tue, 14 May 2013 13:36:46 GMT

The New York Times: My Medical Choice
My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman. Only a fraction of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average. Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex (Angelina Jolie, 5/14).

Forbes: If You Want to Stop Hospital Harm, Don't Call a Capitalist
The Leapfrog Group has just released its latest report grading the safety of hundreds of individual hospitals, but the real news isn't the "incremental progress." It's how a group started by some of the most powerful corporations in America has quietly devolved into just one more organization hoping press releases produce change. Amid the current enthusiasm for "value-based purchasing" by employers and possible privatization of Medicare, it is worth examining why Leapfrog's initial notion that corporations would spearhead a crackdown on crummy care failed and what we can learn from that publicly unacknowledged failure (Michael Millenson, 5/12).

The New York Times' Taking Note: Ginsburg's Roe V. Wade Blind Spot
Instead, Justice Ginsburg contended, the court prevented the states from working out on their own how best to regulate abortion, short-circuiting the democratic process and provoking an angry "backlash" among conservatives and resistance to Roe that continues to this day. But as the Times editorial page summarized last month, "The real story, as explained by Linda Greenhouse, a former New York Times reporter who now teaches at Yale Law School, and Reva Siegel, a professor there, is that political conflict over abortion was escalating before the Roe decision, and that state progress on decriminalization had reached a standstill in the face of opposition from the Roman Catholic Church" (Lincoln Caplan, 5/13).

National Review: The Medicaid Deniers
For years, progressives have claimed that they are the party of science. ... But there is at least one area of public policy where the Left has abandoned its rhetorical allegiance to science: health care. For years, studies have shown that patients on Medicaid — America’s government-run insurance program for the poor — do no better, and sometimes do worse, than those with no insurance at all (Avik Roy, 5/14).

Health Policy Solutions (a Colo. news service): New Evidence Against Colorado Medicaid Expansion
The problem is that the latest research suggests that much of the additional Medicaid spending will be wasted. Results from the Oregon Health Study Group … show that enrolling the able-bodied poor in Medicaid increases annual health spending by $1,172 per person per year without improving blood pressure, cholesterol levels or blood sugar levels. Rates of outpatient surgery, emergency department visits and hospital admissions are also unaffected. … While it is clear that Medicaid benefits the sick and helpless for whom it was originally designed, in the current environment there is little evidence of benefit from expanding Medicaid to cover able-bodied adults. In fact, the opposite may be true (Linda Gorman, 5/13).

Bloomberg/Businessweek: Want to Improve Health Care? Spend Less on It
It’s shocking that, in one of the richest countries in the world, millions are still denied access to health care—and especially preventative services—because they can't afford coverage. And the pain and disruption associated with paying medical bills is immense. The U.S.'s move toward universal health coverage is a step in the right direction. But the U.S. also needs to get more serious about keeping people out of doctors' offices and hospitals in the first place. That's the most effective – and by far the cheapest — path to longer, healthier lives (Charles Kenny, 5/13).

JAMA: Patients' Responsibility To Participate In Decision Making And Research
It is time to reduce the artificial barriers between research on one side and patient care and practice on the other. The path to effective, sustainable patient-centered health care and decision making requires that patients let clinicians know their priorities, understand which strategies are most likely to achieve their priorities, and participate in the research that generates this evidence (Drs. Mary E. Tinetti and Ethan Basch, 5/13).

Boston Globe: Looking Past A Patient's Crimes A Difficult Challenge
It was the first day of a new rotation. I was getting to know my patients, trying to match faces and diagnoses with names on my list. A frail man with end-stage heart failure, Mr. T was too weak to walk and spent most of his time in a reclining chair. He had been in the hospital for weeks with pneumonia, kidney failure, and several other complications. I introduced myself and proceeded to examine him. … No one came to visit him. A few days into the rotation, I found myself reading through his medical record, trying to figure out what his life outside the hospital had been like, and whether there might be a friend or relative able to help care for him after discharge. I was not prepared for what I discovered (Kiran Gupta, 5/13).

WBUR: Cognoscenti: Mental Illness: The View From Within
Amid the search and subsequent capture of Boston Marathon bombing suspect Dzhokhar Tsarnaev, and in the weeks since, I was riddled with fear, dread, and curiosity. I think that range of emotions was fairly common. Perhaps slightly less common was the other emotion I felt: a vague sense of shame. As someone who struggles with mental illness, I was waiting for everyone to start speculating about depression, bipolar disorder or schizophrenia as a possible explanation (Susan Senator, 5/14).

First Edition: May 14, 2013

Tue, 14 May 2013 11:22:25 GMT

Today's headlines include reports about an Obama administration plan to delay Medicaid DSH payment reductions.

Kaiser Health News: Hospitals, Testing Companies Face Questions About Value Of Community Screenings
Kaiser Health News staff writer Julie Appleby, working in collaboration with The Washington Post, reports: "Hospitals hoping to attract patients and build their brands are teaming up with medical-screening companies to promote tests aimed at consumers worried about potentially deadly heart disease or strokes. What their promotions don't say is that an influential government panel recommends against using many of the tests on people without symptoms or risk factors" (Appleby, 5/13). Read the story.

Kaiser Health News: Insuring Your Health: Coverage Problems Could Still Remain For Young Adults
Kaiser Health News consumer columnist Michelle Andrews writes: "Supporters and critics of the Affordable Care Act seem to agree on at least one thing: Allowing young adults to stay on their parents' health plans until they reach age 26 is a smart move. The change, which took effect in the fall of 2010, has resulted in more than 3 million young people gaining health insurance" (Andrews, 5/14). Read the column.

Kaiser Health News: Capsules: CMS Won't Penalize Hospitals In States Slow To Expand Medicaid
Now on Kaiser Health News' blog, Phil Galewitz writes: "That sigh of relief you heard Monday was from hospital administrators in nearly two dozen states, including Florida and Texas. That's because the Obama administration announced that for the next two years, it doesn't plan to penalize states that have yet to expand Medicaid coverage under the federal health law by targeting them for reduced Medicaid funding, according to a proposed rule unveiled Monday. That money goes to hospitals that treat large numbers of poor people" (Galewitz, 5/14). Check out what else is on the blog.

Los Angeles Times: GOP Slams Fundraising, Other Efforts To Promote Obama Health Law
Congressional Republicans have opened a new line of attack on President Obama's healthcare law, charging that the administration has improperly sought help from the healthcare industry and other outside groups to implement the landmark statute. Health and Human Services Secretary Kathleen Sebelius for months has been asking foundations, consumer and business groups, insurance companies and others to help enroll uninsured Americans in health insurance this fall, a key goal of the Affordable Care Act. Administration officials say those actions were entirely appropriate (Levey, 4/13).

The Wall Street Journal: Doc-Owned Hospitals Prep To Fight
The Affordable Care Act aimed to end a boom in doctor-owned hospitals, a highly profitable niche known for its luxury facilities. Instead, many of the hospitals are wiggling around the federal health-care law's growth caps and even thriving. The law, passed in 2010, blocked building any new physician-owned hospitals and prevented existing ones from adding beds or operating rooms in order to qualify for Medicare payments. The drafters wanted to clamp down on a sector that some policy experts contend is prone to perform unnecessary procedures at high prices, driving up overall health spending (Mundy, 5/13).

The Associated Press/Washington Post: Hospitals Could Lose $500M In Federal Money To Pay For Uninsured In 2014
Hospitals nationwide could lose half a billion dollars in federal funding meant to offset the cost of covering the uninsured next year. The loss that will be especially felt in states where lawmakers have decided against expanding Medicaid coverage (5/13).

The Associated Press/Washington Post: Faith Leaders To Gather For Summit To Learn About New Health Options
Maryland faith leaders will be gathering for a summit to learn more about new health insurance options under the federal health care overhaul. Maryland Department of Health and Mental Hygiene Secretary Joshua Sharfstein is scheduled to speak at Tuesday's event in Baltimore (5/13).

The Washington Post: D.C. Nears Decision On Health Insurance Exchange
The D.C. Council could decide as soon as next week whether to require small-business owners to purchase their employee health insurance through a city-run exchange, highlighting a special implication of the federal health-care overhaul that has been strongly opposed by some business interests (DeBonis, 5/13).

Politico: DOJ Appeals For Stay Of Plan B One-Step Order
The federal government's legal fight over the availability of emergency contraception is heating up at the next level in the courts. The Department of Justice is seeking a delay in compliance with a district court order requiring the Food and Drug Administration to make emergency contraception available over the counter without age restrictions while it appeals that decision (Smith, 5/14).

The Wall Street Journal: Health-Policy Move Widely Shared
More people than previously thought predicted a major change in U.S. health-care policy that led to a federal insider-trading probe, according to new documents assembled by congressional investigators. Justin Simon, a policy analyst with Height Securities, said in a previously unreported email that was reviewed by The Wall Street Journal that he heard about the policy change before it was made official from "like 30 people." Mr. Simon sent an alert to Wall Street traders just before markets closed April 1, sending health-insurance stocks on a tear (Mullins and McGinty, 5/13).

The Associated Press/Washington Post: Subsidiary Of Indian Drug Maker Agrees To Pay Record $500 Million US Penalty For Impure Drugs
A subsidiary of India's largest pharmaceutical company has agreed to pay a record $500 million in fines and penalties for selling adulterated drugs and lying to federal regulators in a case that is part of an ongoing crackdown on the quality of generic drugs flowing into the U.S. Federal prosecutors say the guilty plea by Ranbaxy USA Inc. represents the largest financial penalty against a generic drug company for violations of the Federal Food, Drug and Cosmetic Act, which prohibits the sale of impure drugs (5/13).

The Wall Street Journal: Autism Center Is Set To Target Need
Children and adults with autism will begin arriving this month at a new autism center tucked into a 214-acre mental-health campus in Westchester County, which promises to help provide an answer to the piecemeal care currently available to many. The center, run by NewYork-Presbyterian Hospital and the medical schools at Cornell and Columbia universities, attempts to address what experts say is a significant challenge: autism rates are rising around the country but access to treatment lags well behind (Kusisto, 5/13).

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