Kaiser Health News - Health Disparities

Medical Bills Higher For African Americans

Mon, 10 Jun 2013 13:07:27 GMT

NPR: African Americans Remain Hardest Hit By Medical Bills
For many years, high medical bills have been a leading cause of financial distress and bankruptcy in America. That pressure may be easing ever so slightly, according to a survey released earlier this week by the Centers for Disease Control and Prevention. But one in five Americans still face hardships due to medical costs — and African Americans continue to be the hardest hit (Neighmond, 7/10).

Viewpoints: Will 'Rate Shock' Grow?; Krugman Says GOP Spite Is Driving Opposition To Medicaid Expansion; Determining Who Owns Genes

Fri, 07 Jun 2013 13:27:40 GMT

The New York Times: Why Rate Shock Might Matter
Any plausible health care reform, the various conservative alternatives to Obamacare included, would necessarily have losers as well as winners, and as far as potential losers go single young men with above-average incomes are not precisely the country's most disadvantaged demographic. If you think the current system is flawless, then I suppose any rate increase anywhere is a strike against health care reform. But conservative and libertarian wonks don’t think the system is flawless. ... The unanswered question, though, is whether that "a little more" will actually be — or gradually become — a lot. And that's what's getting left out of some of the liberal brush-offs ... of the "rate shock" issue (Ross Douthat, 6/6).

The New York Times: The Spite Club
Sure enough, a number of Republican-dominated states seem set to reject Medicaid expansion, at least at first. And why would they do this? They won't save money. On the contrary, they will hurt their own budgets and damage their own economies. Nor will Medicaid rejectionism serve any clear political purpose. As I'll explain later, it will probably hurt Republicans for years to come. No, the only way to understand the refusal to expand Medicaid is as an act of sheer spite. And the cost of that spite won't just come in the form of lost dollars; it will also come in the form of gratuitous hardship for some of our most vulnerable citizens (Paul Krugman, 6/6).

The Wall Street Journal: Michigan's Medicaid Maelstrom
The Wolverine State is one of several still sitting on the fence when it comes to the ObamaCare expansion of Medicaid. Michael Reitz of the Mackinac Center, a conservative think tank, tells us that he is increasingly worried that "Republicans may be on the brink of caving on Medicaid." ... An idea gaining traction is to accept the Medicaid dollars but place a four-year lifetime cap on eligibility for able-bodied adults. After four years on the program, Michigan residents would be cut off from any further benefits. Another Republican reform would allow health savings accounts for Medicaid patients as a way to save money. Some Republicans are also demanding a "cancellation" policy that would allow the state to take the money now but opt out of the Medicaid expansion later if costs escalate out of control. Until 2017, the federal government covers 100 percent of the costs (Stephen Moore, 6/6).

Bangor Daily News: Medicaid Expansion In Hands Of Seven GOP Lawmakers
We have tried to present reasonable arguments to Maine's Republican lawmakers to urge them to accept federal funding to expand Medicaid. We have emphasized the good financial deal Maine is projected to get, according to independent, outside analyses. We have highlighted the obvious, practical health reasons why tens of thousands more Mainers should have access to care. We criticized lawmakers when they blocked a previous Medicaid expansion proposal. ... There is still a little time, however, for a few Republicans to stand up for their communities' poorest — on whose doors they've knocked and asked for votes. It will take only 12 Republicans in the House and Senate for the bill to be veto-proof; five are already on board (6/5).

USA Today: Retiree Benefits And ObamaCare Collide
Oct. 1, 2013 is a focus of increasing anxiety in this country. That's the date when enrollments begin for the federally run health insurance exchanges, created under the Affordable Care Act (ACA). No one really knows what to expect, but it could be far worse than advertised — and for a reason that has more to do with the federal deficit than health care. ... Amid all these concerns and speculations, almost no attention is being paid to the opportunity that the ACA's insurance exchanges could represent for state and local governments' retiree health care programs. It's time to think about it because the consequences could be far-reaching (David Walker, 6/6).

Fox News: Is America Prepared For The Coming ObamaCare Disaster?
For years I have been writing about the failures of the UK's National Health Service (NHS) as a warning for what the Affordable Care Act (aka ObamaCare) will do to health care here in the U.S. London's Daily Mail has chronicled the growing problems with the NHS, which include declining quality of care and availability of services coupled with increased costs. This is what is in store for us, if Congress does not repeal ObamaCare (Cal Thomas, 6/6).

National Journal: Separate And Unequal Access To Health Care?
Segregation is still real. Although black-white segregation has, overall, declined steadily since the 1970s, major American metros remain split into black and white areas. … One of those consequences is the disparity when it comes to health care between blacks and whites. The fact that black patients have poorer outcomes in surgery has been well documented. ... Recently, researchers at the University of Michigan sought a more-rounded answer to the problem. Their results, published in the journal Health Affairs, highlights a frustrating contradiction. While black patients live closer to high-quality facilities, they are still more likely to get care in low-quality facilities (Brian Resnick, 6/5).

The New York Times Room For Debate: Can The Human Blueprint Have Owners?
The Supreme Court is expected to decide soon whether human genes can be patented. The case involves patents by Myriad Genetics on the BRCA1 and BRCA2 genes, which, when mutated, heighten a woman's risk of getting cancer. Because of the patents on these genes, which Myriad isolated, the company controls all testing for the mutations. ... Should companies be allowed to patent genes? Read the discussion (6/6).

Tampa Bay Times: Paying Too Much For Too Little Health Care
Exotic prescription drugs and extraordinary end-of-life efforts are not the only factors driving up the cost of health care. It turns out that routine procedures such as colonoscopies cost far more in the United States than in other countries, and vary widely in price. In Tampa, for example, patients pay from $980 to $3,496 in out-of-pocket and insurance costs for a colonoscopy. There is no legitimate reason for such wide differences, and bringing health care costs under control will require increased efforts by consumers and government to demand more openness about pricing and to comparative shop (6/6).

JAMA: Eliminating Wasteful, Unnecessary Care Is The Best Way To Preserve Medicare
The release this past week of the Medicare Trustees' report was met with widespread enthusiasm among health economists and supporters of the federal health reforms in the Affordable Care Act (ACA). … Reduced Medicare spending might be a small silver lining of the recession, but it is not a strategy anyone would pursue to preserve the program (Andrew Bindman, 6/6).

Roll Call: Message To Congress: Immigrants Pay More Than Their 'Fair Share' Of Medicare
Immigrants don't just pick our fruit, deliver our take-out food and design our computers — they pay for our medical care. As Congress debates immigration reform, some would have us believe that immigrants are draining the Treasury. But it turns out that closing the borders would deplete Medicare's trust fund (Steffie Woolhander and David U. Himmelstein, 6/6).

State Highlights: Mo. Gov. Worried Tax Cut Bill Raises Prescription Drug Sales Tax

Fri, 31 May 2013 13:24:00 GMT

St. Louis Beacon: Nixon Says Tax Cut Bill Removes Missouri’s Sales Tax Break For Prescription Drugs
Gov. Jay Nixon has upped the ante in his criticism of a broad-based tax cut bill awaiting his decision, saying Thursday that it removes a sales tax exemption for prescription drugs that will raise taxes for millions of Missourians. One sponsor of the bill says there's plenty of time for the legislature to correct what he deemed a drafting error (Rosenbaum, 5/30).

Health News Florida: It's Deadline Day For Doctors' Bonus
Primary-care physicians who treat Florida Medicaid patients are eligible for a big fat retroactive bonus thanks to the Affordable Care Act -- as long as they file for it by Friday, May 31 (Gentry, 5/30).

The Washington Post: Man Accused Of Diverting Nearly $17 Million From D.C. Tax-Funded Health Plan
Businessman Jeffrey E. Thompson illicitly siphoned nearly $17 million from his taxpayer-funded health plan serving low-income District residents, the plan's city-appointed receiver asserted in a lawsuit filed Thursday. The court action is the latest development in the collapse of D.C. Chartered Health Plan, which served more than 100,000 people receiving Medicaid and other government assistance before ending its business with the city this month. It is estimated that Chartered owes city health providers more than $60 million, and its current assets are likely to cover only a fraction of that (DeBonis, 5/30).

Stateline: Cigarette Smuggling Cuts States' Per-Pack Tax Revenues
Over the past decade, almost every state has raised cigarette taxes, sometimes multiple times. The health benefits are undeniable, but the benefits to states’ revenues are not as clear-cut. In 2010, states with high tobacco taxes lost about $5 billion in revenue because of cigarette smuggling, according to the Bureau of Alcohol Tobacco Firearms and Explosives. Experts say the number is climbing. Most of the black market in cigarettes is between low-tax states and high-tax states: Smugglers purchase cigarettes in a low-tax state and transport them to a high-tax state. Then they sell them at a discount to smokers while still pocketing a healthy profit. Because there is such a wide disparity among states' cigarette taxes, the price differential is well worth the risk of smuggling, according to law enforcement officials (Povich, 5/31).

The Washington Post: Binge Drinking, Depression Among Health Issues In Northern Virginia, Study Finds
As one of the most affluent areas in the country, Northern Virginia can also boast that its 2.3 million residents are, by many accounts, in good health. But a report to be released Friday reveals a host of underlying health issues, including binge drinking among adults, delayed dental care, and a risk of depression in one out of four youths in the region (Sun, 5/31).

Georgia Health News: Community Health Chief Takes Capitol Job
David Cook is departing as head of Georgia's largest health agency to become secretary of the state Senate. Cook has served as commissioner of the Department of Community Health since January 2011. Before then, he had been executive director of the Medical Association of Georgia. He will be replaced by attorney Clyde Reese, who is currently commissioner of the Department of Human Services. This will be Reese’s second time as Community Health commissioner, because he was Cook’s predecessor in the office (Miller, 5/30).

The Associated Press: Pa. Union Officials Sue Over Health Fund Deal
Leaders of the union for Pennsylvania's state prison guards filed a lawsuit Thursday that challenges a 2009 deal struck by then-Gov. Ed Rendell to divert a large surplus from the trust fund that pays health benefits for state employees. Four executive committee members of the Pennsylvania State Corrections Officers Association sued in county court in Harrisburg, seeking to recover $226 million and remove several trustees from the Pennsylvania Employee Benefits Trust Fund (5/30).

California Healthline: Plan Proposed To Cover Autistic Children
A Senate subcommittee last week proposed a $50 million solution to temporarily address the lack of coverage of a type of autism treatment under Medi-Cal -- a gap in care that recently affected hundreds of Healthy Families children when the state moved them to Medi-Cal managed care plans. The new proposal would appropriate $50 million to make sure Medi-Cal children with autism are able to receive applied behavioral analysis treatment -- known as ABA therapy -- through the end of 2013. The assumption is that ABA therapy will be available as an essential health benefit under the Affordable Care Act starting in 2014 (Gorn, 5/30).

Lund Report: Ore. House Health Committee Bolsters Insurance Rate Review Bill Over Senator's Objection
The House Health Committee passed a bill on a 6-3 vote Wednesday that will provide new tools for the Insurance Division in the health insurance rate review process, while increasing the ability of consumers to contribute to the approval discussion. Rep. Mitch Greenlick, D-Portland, was able to marshal all three amendments that were proposed at a public hearing earlier this month to Senate Bill 413. Two of the amendments passed the committee on party-line votes while Rep. Jim Thompson, R-Dallas, supported one amendment, which directs the Insurance Division to devise an annual medical inflation rate that will serve as a baseline for insurance companies seeking to raise rates (Gray, 5/30).

Viewpoints: Scalia's 'Boost' To Obamacare; California Small Biz And Insurance Exchange

Fri, 31 May 2013 13:11:00 GMT

Bloomberg: Scalia Gives Obamacare A Big Boost
[L]ast week, a divided court decided Arlington v. FCC, an important victory for Barack Obama’s administration that will long define the relationship between federal agencies and federal courts. ... In a powerful and convincing opinion by Justice Antonin Scalia, the court’s majority ruled that even when the agency is deciding on the scope of its own authority, it has the power to interpret ambiguities in the law. ... The court’s ruling, which involved the Federal Communications Commission’s defense of its rules governing siting applications for wireless facilities, is an important win for all future presidents, ... It also strengthens the hand of agencies carrying out Obama’s health care law and financial reform (Cass R. Sunstein, 5/29).

Los Angeles Times: A Hidden Tax In Obamacare
The central provisions of the Affordable Care Act require younger and healthier Americans to buy insurance policies that will, in essence, subsidize the healthcare of older and sicker Americans. But one of Obamacare's hidden taxes — a new limit on contributions to health flexible spending accounts, or FSAs — will hit older and chronically ill individuals hardest. Starting this year, the health care law imposes a $2,500 annual cap on an individual's contribution to an FSA that is part of an employer's "cafeteria" benefits plan (Tom Miller, 5/31).

Bloomberg: To Reduce Health Care’s Costs, Destroy Its Jobs
Is health care America's economic savior or scourge? The answer, strangely, might be both. In the short term, growth within the health care sector provides a boost to a weak economy. But the same rise will eventually be more trouble than help (Evan Soltas, 5/30).

Tampa Bay Times: Vindictive Health Care Bill Targets Consumers
The federal health care reform law has withstood a court challenge and a presidential election, but the Republican-controlled Florida Legislature is still battling it. A bill that would allow health insurers to charge whatever they want, no matter how unreasonable, and blame the Affordable Care Act is on Gov. Rick Scott's desk. Its transparent intent is to infuriate Floridians over increases in health insurance costs and misdirect their anger toward the federal law. Scott should veto this vindictive and partisan bill (5/29).

Sacramento Bee: Rollout Of State Health Exchanges Tops Expectations
Californians can breathe a sigh of relief over a crucial first step in implementing health care reform. State officials last week unveiled the health plans and premium rates that will be available under the California health exchange. ... Where the exchange should really have a positive impact is for those who are self-employed, who are early in their careers and move from job to job or who want to start a business but have been stuck in "job-lock" to retain health benefits. The coverage seems well worth peace of mind – and is the responsible thing to do instead of shifting costs to others. Now the big task is getting the word out (5/31).

California Healthline: How Do California Small Business Owners Feel About ACA?
How about in California, where the state's new health insurance exchange -- Covered California -- is scheduled next month to announce insurers and premium prices in the Small Business Health Options Program (SHOP) exchange? We asked stakeholders to assess the mood of small business owners In California. We got responses from: [Michael Lujan, Betsy Imholz, David Chase, Ken Jacobs, Micah Weinberg, Bob Graboyes] (5/30).

Health Policy Solutions (a Colo. news service): Questioning The Role Of Medicine In Good Health
We are approaching a decision between one approach that leads to a mass, socialized system administered by the state and corporate oligarchs. The other way lives in the microcosm and is the path of the self-actualized individual assuming personal responsibility for his health and its costs. ... at an intuitive level most of us realize the institutional pill is addictive and leads to learned helplessness. When it comes to health care, we really do pay for it with our lives (Francis Miller, 5/30).

Bloomberg: U.S. Doctors Shouldn't Have To Beg For TB Drugs
I am a tuberculosis doctor. My patients and I inhabit a world of TB medications, diagnostic technology and public-health investigations. Together we have celebrated many triumphs over this deadly, but curable, disease. The problem we are now facing, however, is so threatening that it will take a concerted national effort to prevail. I am talking about the shortage of tuberculosis drugs. Last December, the Centers for Disease Control and Prevention reported that U.S. supplies of isoniazid, the most important drug in the treatment of TB, were critically low (Dr. Charity Thoman, 5/31).

Viewpoints: We Need More 'Socialism'; The IRS's 'Unwelcome Role'; 'Fog Of Obamacare'

Fri, 24 May 2013 13:11:20 GMT

Los Angeles Times: If This Health Plan Is 'Socialism,' We Need More Of It
So this is what socialism looks like: Private companies competing for people's business in an open marketplace. Californians got their first glimpse Thursday of what insurers plan to charge for coverage to be offered next year to about 5 million state residents who don't receive health insurance from employers (David Lazarus, 5/23).

The Washington Post: The Unwelcome Role Of The IRS In Obamacare
Thousands of new IRS agents will implement 40-odd provisions of the Patient Protection and Affordable Care Act — the exact number is a matter of dispute since the law itself is so confusing. The largest tax law and social policy change in a generation will be imposed on a skeptical public by a government agency whose credibility is in ruins. But the IRS is not merely implementing Obamacare. It engaged in a regulatory power grab to ensure that it could implement Obamacare (Michael Gerson, 5/23).

The Washington Post: The Fog Of Obamacare
You’ve heard of the "fog of war." Well, now we've got the fog of Obamacare. The controversial Affordable Care Act (ACA) has so many moving parts that it's hard to know how its implementation is proceeding. In 2014, many uninsured are supposed to get coverage either through insurance exchanges, where they can buy subsidized policies if their incomes are less than four times the federal poverty line, or through an expanded Medicaid. The trouble is that 20 or more states may reject the Medicaid expansion, and the exchanges aren’t yet finished. Much is unknown (Robert J. Sameulson, 5/23).

The New York Times' Economix: Debating Doctors' Compensation
Two themes run through the comments on previous blog posts that touched on the payment of the providers of health care. The first is that American doctors are paid too much. The second is that they are paid too little. Could both propositions be right? Let us explore the issue by looking at some numbers (Uwe E. Reinhardt, 5/24).

New England Journal Of Medicine: The Gross Domestic Product And Health Care Spending
How much will the United States spend on health care during the next decade or two? The answer matters greatly to physicians, federal and state governments, businesses, and the general public. The answer will determine the type and extent of care that physicians can provide to their patients, as well as the amount of physicians' take-home pay. It will also determine how much everyone else can consume or invest in other goods and services. Unfortunately, forecasting health care spending is extremely difficult. Future spending depends in part on developments within the health care sector and in part on developments in the economy as a whole (Victor Fuchs, 5/22).

Boston Globe: Do I Miss My Breasts?
I had voluptuous breasts. I miss them, when I think about them. But I rarely think about them because I’m busy not missing my family’s milestones and ordinary moments. The kind of moments that I suspect Angelina Jolie does not want to miss. Jolie and I have more in common than being mothers and having sexy husbands. I, too, carry the BRCA1 gene alteration, a mutation that raises a woman’s lifetime risk of ovarian cancer to 40-60 percent and breast cancer to 50-80 percent (Ellen Roth, 5/22).

WBUR: Cognoscenti: The Power Of Knowing: A Daughter Who Chose BRCA Gene Testing, Against Her Mother's Will
When Angelina Jolie explained in The New York Times her decision to take action after discovering she carried the BRCA-1 mutation, I saw on social media so many women asking each other, Would you undergo genetic testing? Many expressed anger at Myriad (the company that owns the patent), at insurance companies (several do not cover the cost of the test), and at doctors they believe hold assumptions about organ removal. While some cited how removing one's organs could shorten or alter their lives, as could cancer itself, others judged individual preferences as "right" or "wrong" (Tracy Strauss, 5/24).

The New York Times' Doctor And Patient: Disability And Discrimination At The Doctor's Office
It's been nearly 23 years since the Americans With Disabilities Act, a federal law prohibiting discrimination against people with disabilities, went into effect. Despite its unequivocal language, studies in recent years have revealed that disabled patients tend not only to be in poorer health, but also to receive inadequate preventive care and to experience worse outcomes (Pauline W. Chen, MD, 5/23).

USA Today: Mental Illness Manual No 'Bible': Column
Unlike many other physical ailments, there are no acceptable scientific tests that can pinpoint mental disorders. A blood test won't tell doctors which of my son's diagnoses, if any, are accurate. Instead, psychiatrists must rely on a patient or family members to describe symptoms of the illness to make a diagnosis. The doctor then consults psychiatry's "bible" — the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) — to determine which diagnosis best fits the patient's symptoms. This process can be ripe for error, especially if a patient doesn't believe there is anything wrong, a common reaction during a psychotic break (Pete Earley, 5/23).

The New York Times' Taking Note: Abortion After 20 Weeks
On the list of treasured Republican pastimes, trying to outlaw abortion and imposing a right-wing agenda on the District of Columbia (which is heavily Democratic and lacks any representation in Congress) both rank high. So it must have given Rep. Trent Franks of Arizona special pleasure to combine those hobbies by introducing a bill to ban abortion in D.C. after 20 weeks. But why stop there? (Andrew Rosenthal, 5/23).

New England Journal Of Medicine: Under The Medical Tent At The Boston Marathon
Bright sunlight filtered through the awnings of the medical tent pitched in Copley Square, where I joined the many medical professionals caring for people who'd fallen ill from their 26.2-mile run. Some volunteers had been staffing the medical tent for years — one nurse had worked at the Boston Marathon more than 25 times. Sickened and stressed runners poured into our makeshift hospital. A runner stumbled in and vomited into a bag. We helped him onto a cot, where he sat shivering. "You're OK," a nurse said gently, wiping his face. But his core temperature had dropped to 96 degrees, and he began having violent rigors. We brought him Mylar blankets and hot bouillon (Sushrut Jangi, 5/23).

Health Care Issues Become Hurdle For Immigration Reform Measure

Fri, 24 May 2013 13:10:00 GMT

The key question that seems to have stalled progress for House lawmakers is how to handle immigrants who do not have health insurance.

Los Angeles Times: Immigrant Health Care Bills Stump House Group
Differences over whether immigrants should be deported for failing to have health insurance or pay their health care bills have stalled a bipartisan group of House lawmakers, who blew past a self-imposed Thursday deadline as they pressed forward on a sweeping immigration overhaul (Mascaro, 5/23).

The Wall Street Journal: House Immigration Effort Hits Bump In The Road
Last week, a bipartisan group of House lawmakers thought they had a broad deal on how to overhaul the immigration system. This week, they don't. The eight House lawmakers were forced to backtrack from the "agreement in principle" reached last Thursday after House Democratic leaders objected to a provision dealing with health care coverage for illegal immigrants living in the U.S., according to aides from both parties. The group continued to meet this week, and its members remained hopeful they would be able to strike a deal that passes muster among all involved (Peterson, 5/23).

Modern Healthcare: Taxpayers Won't Pay Health Care Costs For Undocumented Immigrants
Two days after the Senate Judiciary Committee passed a comprehensive immigration reform bill, House Minority Leader Nancy Pelosi (D-Calif.) promised that U.S. taxpayers would not bear the cost of health care coverage for undocumented immigrants who are on the path to citizenship. Earlier reports had hinted that the coverage provisions under the Patient Protection and Affordable Care Act might be a sticking point as House members draft their own immigration-reform legislation (Zigmond, 5/23).

State Roundup: Miss. Gov. Says Medicaid Can Go On Without Reauthorization

Thu, 09 May 2013 13:30:00 GMT

A selection of health policy news from Mississippi, Kansas, California, Georgia, Minnesota, Wisconsin, Massachusetts and Colorado.

The Associated Press: Miss. Governor Says He Could Run Medicaid Program
Mississippi Gov. Phil Bryant says he thinks he can run Medicaid even if lawmakers don't reauthorize the program or set its budget by the time the state's new fiscal year starts July 1. The Northeast Mississippi Daily Journal reported Bryant's remarks and said he spoke about Medicaid after taking part in a tourism event at the state Capitol (5/9).

Kansas Health Institute: More Than 1,000 Rally At Statehouse For DD Carve-Out
A Statehouse rally today that coincided with the start of the Legislature's wrap-up session drew about 1,100 people from across the state to protest Gov. Sam Brownback's plan to include long-term supports for the developmentally disabled in KanCare. ... [Protestors] at the rally did not believe that the insurance companies hired by the state to manage its Medicaid program had the experience to handle long-term services for the developmentally disabled (Shields, 5/8).

Los Angeles Times: California Ranks 11th In Hospitals With A Grades For Safety
Ronald Reagan UCLA Medical Center improved slightly from an F to a D in a national hospital safety report released Wednesday, while Cedars-Sinai Medical Center stayed at a C grade. Leapfrog Group, a nonprofit health care quality organization, based the scores on an analysis of infections, injuries, medication errors and other problems that cause patient harm or death. The organization publicizes the scores in an effort to inform patients and reduce safety problems, said Leah Binder, its president and chief executive (Gorman, 5/8).

The Associated Press: SF Eateries Pay $845K To Settle Health Care Claims
San Francisco's city attorney says his office has recovered nearly $845,000 from 19 restaurants that allegedly charged customers for the cost of complying with the city's universal health care law but did not use most of the money for that purpose. City Attorney Dennis Herrera said Wednesday that the money had come from eateries that took advantage of a one-time amnesty program his office announced in January (5/8).

Georgia Health News: A Prescription To A Fun Place Could Be A Lifesaver
Overweight patients are being encouraged to take a walk, if not a hike. A unique collaboration between the Georgia Association of Physician Assistants (GAPA) and Georgia State Parks seeks to promote physical fitness in a fresh-air way. For a day trip to one of Georgia’s state parks, there’s normally a $5 parking fee. But nowadays, physician assistants in the state can hand out "Rx For Fitness" prescriptions that allow that charge to be waived (Kanne, 5/8).

MPR News: Growth Continues At Mayo Clinic's Three Campuses
In his pitch to state legislators for $500 million to help Mayo Clinic with its $5 billion expansion, Mayo Clinic President and CEO Dr. John Noseworthy has repeatedly said if Minnesota does not provide a taxpayer subsidy, other states would be eager for Mayo Clinic to expand. Two of the most logical places would be Florida and Arizona, where existing Mayo Clinic campuses are growing steadily. Mayo Clinic is investing hundreds of millions of dollars at all three of its campuses to strengthen each as a major regional medical hub (Baier, 5/8).

HealthyCal: Ballot-Mandated Drug Treatment Cut, Despite Success
In 2000, California voters overwhelmingly approved Prop 36, a ballot measure that offers non-violent drug offenders treatment instead of jail. But now the Substance Abuse and Crime Prevention Act is on life support, if not altogether dead, despite data that shows it has saved taxpayers money and tamped down recidivism among its participants (Urevich, 5/9).

Milwaukee Journal Sentinel: Wisconsin Assembly Passes Measure That Changes What Doctors Must Tell Patients For Diagnoses
The Assembly approved a bill Wednesday changing the standard for what doctors must tell patients when they diagnose them, which Republicans said was necessary in light of a state Supreme Court decision that they see as creating too many problems. Also, the Assembly passed a bill that would delay trials in cases where people are exposed to asbestos. Both measures now go to the Senate, which like the Assembly is controlled by Republicans (Marley, 5/8).

Boston Globe: Massachusetts To Require Labs To Test Marijuana For Medicinal Use
Massachusetts is the first state that will require independent labs to test the safety and quality of marijuana sold for medical use, under final rules that regulators unanimously approved Wednesday. The tests will screen for contaminants such as heavy metals, pesticides, and mold. They will also identify and measure the active chemical compounds in the marijuana (Lazar, 5/9).

Health Policy Solutions (a Colo. news service): Pedaling For Health
In an ambitious new health agenda, Gov. John Hickenlooper is pledging to cut the number of uninsured people in Colorado by 520,000, prevent 150,000 Coloradans from becoming obese and reduce Medicaid costs by $280 million. Hickenlooper this week released a report called The State of Health as part of his commitment to make Colorado the healthiest state in the nation. … The report centers on four key areas of focus: wellness and prevention, expanding health access and coverage, improving health systems and boosting value while cutting costs (Kerwin McCrimmon, 5/8).

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).

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: 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).

State Roundup: Calif. Lawmakers Push For Health Plan For Immigrants In U.S. Illegally

Mon, 22 Apr 2013 13:15:00 GMT

A selection of health policy stories from Massachusetts, California, Michigan, Texas, the District of Columbia, Pennsylvania, South Carolina and Tennessee.

Los Angeles Times: Boston Bombing Amputees Face Tough, Costly Recovery
For many of the injured, even those who have health insurance, the process may also be costly. Health insurance plans often restrict coverage for therapy and prosthetics. But a decade of wars has helped fuel breakthroughs that could help many Boston victims -- including those with amputated limbs -- live full, active lives (Levey, 4/21).

Sacramento Bee: Some California Leaders Want Low-Cost Health Care For Undocumented Immigrants
About a million of California's poorest undocumented immigrants would have access to basic low-cost health care under a plan being pushed at the Capitol. President Barack Obama's federal health care overhaul excludes undocumented immigrants, but some California leaders want to fill that gap by offering a safety net of primary and preventive care that does not consider immigration status. The county-run program would give undocumented immigrants – and legal residents who can't afford health insurance but don't qualify for Medi-Cal – the ongoing opportunity to see a doctor, get tested and receive treatment before minor health problems become severe (Sanders, 4/19).

The Associated Press: Bill Allows Refusal Of Health Care On Moral Basis
For 35 years, Michigan law has protected health care providers who refuse to perform an abortion on moral or religious grounds. … Legislation that could be voted on as early as this week in the Republican-led Legislature would extend the same legal protections for any medical service such as providing contraception or medical marijuana, or taking someone off life support. Employers and health insurers -- not just medical providers -- also could opt out of paying for services as a matter of conscience (Eggert, 4/21).

The Texas Tribune/New York Times: Optometrists Seek Negotiating Power With Insurers
A group of Texas optometrists is lobbying the State Legislature for more power to negotiate contracts with health insurance companies, and the measure they are supporting could hit consumers' wallets, some business advocates say (Aaronson, 4/20).

The New York Times: California Tries To Regain Fuller Control Of Prisons
In 1995, a federal court appointed a special master to carry out reforms in mental health care [at California's prison system], which it found inadequate at the time and in violation of the Constitution. The court ruled this month that the federal overseer was necessary to remedy continuing constitutional violations behind problems like the high suicide rate. The state is arguing that mental health care meets or exceeds constitutional standards. It is spending $400 million a year on mental health care in its prisons, and a dozen new facilities valued at a total of $1.2 billion have been built in the past three years or are under construction (Onishi, 4/20).

The Washington Post: Chartered Could Owe D.C. Health Providers $85 Million
The city's doctors, clinics and hospitals could be owed a combined $85 million from the soon-to-be-defunct D.C. Chartered Health Plan, and it remains unclear how the once-dominant city health contractor will be able to pay the vast majority of those claims. ... The $85 million figure, which is about double previous estimates of Chartered's potential liabilities to providers, represents about $60 million in Medicaid claims that have been incurred but have yet to be paid. An additional $25 million could be owed to providers due to litigation -- likely related to a pending battle between Chartered and the MedStar hospital chain (DeBonis, 4/19).

The Washington Post: Problems At Pa. Abortion Clinic Point To Lack Of Facilities Oversight
There was no shortage of red flags about what was allegedly going on in the three-story brick building on a bustling stretch of Lancaster Avenue in West Philadelphia. A routine inspection of Kermit Gosnell's abortion clinic had turned up problems as early as 1989, according to official reports. ... The case has captivated and repulsed a nation where back-alley abortion clinics have become a rarity since 1973, when the Supreme Court legalized abortion. The catalogue of horrors delineated by prosecutors has raised questions about whether there is adequate inspection and regulation of the 1,800 facilities nationwide that provide abortions (Dennis and Somashekhar, 4/20).

Boston Globe: New Spaulding Hospital Is Rehab Rethought
David Estrada, paralyzed from the chest down in a motorcycle accident 18 years ago, remembers well his miserable three months in a rehabilitation hospital room he shared with three other patients. That experience inspired him to help others with disabilities, which is why Estrada stopped short as he rolled his wheelchair through the new Spaulding Rehabilitation Hospital in Charlestown during its construction last winter. He'd heard there was a panoramic water view from the hospital's third-floor gymnasium, but he was not seeing it. The sills blocked the view of anyone in a wheelchair. ... Estrada's observation prompted the lowering of the sills. Price tag for the redo: $300,000 (Lazar, 4/22).

Modern Healthcare: HCA To Grow Presence In Behavioral Health, Official Says
HCA, the Nashville-based hospital giant, is building its presence in the behavioral health space at a time when the field is poised to grow. The publicly traded company has been a "re-start-up" in the sector since late 2009, said Terry Bridges, president of behavioral health care services, who spoke at an Avondale Partners' behavioral health conference this week in Nashville. Bridges joined HCA that year from Psychiatric Solutions, where he was co-chief operating officer. Universal Health Solutions bought Psychiatric Solutions in 2010, and Bridges' arrival at HCA was seen as sign that it planned to boost its own mental health services (Kutscher, 4/19).

California Healthline: Attorney: Decision Overdue In Suit Challenging Medi-Cal Disabled Cuts
A federal judge is "about to decide" a case with large ramifications for the developmentally disabled community. William McLaughlin, an attorney representing The Arc of California, a national disabled-rights group, said a final ruling from U.S. District Court judge Morrison England is coming "any time now." In a Jan. 24 hearing, McLaughlin argued for a preliminary injunction to halt the rate reductions. He contends a decision is overdue (Gorn, 4/19).

Research Roundup: Community Benefits and Hospitals' Tax-Exempt Status

Fri, 19 Apr 2013 13:10:00 GMT

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

The New England Journal Of Medicine: Provision Of Community Benefits By Tax-Exempt U.S. Hospitals –The federal health law requires tax-exempt hospitals to assess and address the needs of the community in which they serve by the end of 2013. These hospitals are exempted from federal and local taxes because to help finance their charitable efforts but the question as of these hospitals provide appropriate levels of community benefits remains unclear and controversial. In this study, researchers analyzed 2009 tax reports of more 1,800 tax-exempt hospitals to assess the level and pattern of community benefits they provide. "We found that hospitals devoted, on average, 7.5% of their operating expenditures to community benefits," the authors reported. "However, the level of benefits provided varied widely among the hospitals." They also add that most of those expenditures go to charity care and other patient benefits and compared to other expenditures, hospitals spent little on community health improvement (Young et al., 4/18).

JAMA Internal Medicine: Impact Of Providing Fee Data On Laboratory Test Ordering – Between 2000 and 2009, the number of imaging and diagnostic tests increased by 85 percent – but according to the study authors, empirical evidence suggests that not all tests are needed for provide high quality care. The researchers presented fees of 61 procedures and examinations to physicians and non-physicians at the Johns Hopkins Hospital and compared the number of tests they ordered to a control group of physicians who did not see the cost information. Their study showed a 9.1 percent reduction in the number of tests ordered among participants exposed to the fees. "Displaying the Medicare allowable fees of diagnostic tests at the time of offering can modestly affect provider ordering behavior," the authors concluded (Feldman et al., 4/15).

The Kaiser Family Foundation: Impact Of The Medicaid Expansion For Low-Income Communities Of Color Across States –Some states are wrestling with the question of whether to expand their Medicaid programs under the provisions of the federal health law. "While the Medicaid expansion will increase coverage options for all low-income Americans, it will disproportionately impact low-income people of color," the authors of this brief write. "Overall, people of color are more likely than whites to be uninsured and low-income, since they are more likely to work in low-wage jobs that do not offer employer-sponsored insurance and often have difficulty affording coverage when it is offered." This brief provides data on the uninsured by race and ethnicity across states based on analysis of the 2011 American Community Survey (Artiga and Stephens, 4/16).

The American Enterprise Institute/Robert Wood Johnson Foundation: Preserving The Future of Medicare: Three New Papers -- These research papers, released together, examine some of the key issues currently surround Medicare and its role in the federal budget. "The authors explain why reform matters, how to properly implement premium support, how to fix traditional Medicare, and how to structure a system of competitive bidding," AEI and RWJF said in announcing the publication of the papers. They include:

--The Role Of Medicare Fee-for-Service In Inefficient Health Care Delivery
This report looks at the fee-for-service system within Medicare, which comprises the third largest category of federal spending, and its effects on health care across the country and its cost. "At the heart of the crisis is rapid growth of entitlement spending driven by health care cost inflation. And at the heart of the health cost problem is Medicare. Put simply, America cannot solve its budget problems without slowing the pace of rising costs, and it cannot slow the pace of rising health costs without fundamental Medicare reform. ... In the end, real change will almost certainly require a more fundamental reform than has been enacted to date, such as using market forces to encourage the kind of far-reaching changes in how services are delivered to Medicare patients that are needed to bring costs under control," the author concludes (Capretta, 4/16).

--Plan Competition And Consumer Choice In Medicare: The Case For Premium Support
This brief reviews the difficulties Congress has had in reducing costs in the program and examines the plan by Republicans to offer premium supports to Medicare beneficiaries. "There is broad agreement," the author writes, "that our future depends on slowing the growth of Medicare spending while ensuring seniors’ access to appropriate care. Premium support is the core of a marketbased reform of Medicare financing. By shifting from defined benefits to defined contributions, premium support dramatically alters the economic incentives that drive program spending rather than program value, and it makes consumers an active part of the solution. The political and technical challenges of instituting marketbased reforms cannot be overstated, but the alternative approach of centralized decision making and cost control is less appealing" (Antos, 4/16).

--A Competitive Bidding Approach To Medicare Reform
This paper looks at the proposals to use competitive bidding among insurance plans to provide Medicare coverage, its potential to save money and improve the program and the challenges to such a system. "The most promising option for addressing Medicare reform is competitive bidding—using health plans’ bids to determine the government’s contribution to a basic set of benefits in every market area" (Feldman, Dowd and Coulam, 4/16).

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

Reuters: Hospital Program Improves Antibiotic Prescribing
A quality improvement program at a single children's hospital succeeded in cutting back inappropriate antibiotic prescribing, in a new study. Researchers found within six months of introducing new electronic and educational tools, doctors were meeting national guidelines for treatment of childhood pneumonia in 100 percent of patients (Grens, 4/17).

MinnPost: Pharmaceutical Reps Rarely Tell Doctors About Drugs' Potential Harms, Study Finds
U.S., French and Canadian doctors receive little or no safety information about drugs when visited in their offices by pharmaceutical sales reps for the drugs, a new study has found. That failure to include information on harm occurred even though the United States, France and Canada all have national laws that require drug sales reps to discuss safety information about their products with doctors (Perry, 4/12).

Reuters: People, Networks May Sway Parents' Vaccine Choices
The people and information sources parents surround themselves with may influence their choice to vaccinate their children or not, according to a survey from one county in Washington state. Of almost 200 parents who took the survey, almost all said they had groups of people offering advice on vaccination, but those who chose not to fully vaccinate their children were more likely to have larger social groups and to turn to other sources, such as books, pamphlets and the Internet, for guidance (Seaman, 4/15).

State Roundup: Immigration Proposal Could Mean Big State Health Care Costs

Wed, 17 Apr 2013 13:15:00 GMT

A selection of health policy stories from California, Oregon, Georgia, Texas, North Carolina, Kansas and Massachusetts.

Los Angeles Times: Immigration Proposal Could Affect California Health Safety Net
Making immigrants ineligible for public health benefits -- at least initially -- under proposed immigration law changes would push the costs of health care from the federal government to states and counties, said Sonal Ambegaokar, a health policy attorney at the National Immigration Law Center. And those costs could be sizable in a state like California, where there are an estimated 2.5 million illegal immigrants (Gorman, 4/16).

The Lund Report: Greenlick Wants Public Comment Period, But Ore. CCOs Resist
Rep. Mitch Greenlick, D-Portland, has put forth a compromise bill that would ensure greater public scrutiny of coordinated care organizations without putting them under Oregon’s public meetings law. House Bill 2960 would require that each monthly board meeting have a public comment period where people would have the right to address each CCO's board of directors. It would also require community advisory councils to meet in public (Gray, 4/16).

The Wall Street Journal: Kickbacks Alleged At Spine Hospital
The U.S. attorney for the Central District of California is investigating allegations that a hospital executive paid kickbacks to physicians so they would refer their patients for spine surgery at his facility, according to people familiar with the probe. Over the past 15 years, Michael D. Drobot built a Southern California business empire centered on treating people with back problems, many of them workers' compensation patients. At the heart of the operation is Pacific Hospital of Long Beach, a 184-bed facility that Mr. Drobot bought in 1997 and turned into a spine-surgery center (Carreyou, 4/16).

Georgia Health News: Child Obesity Dips; Need For Healthy Food Remains
Georgia has recorded a 5 percent drop in its childhood obesity figures, according to state officials, citing new federal statistics. The decrease helped move Georgia's ranking as having the second most obese child population in the nation, which came from 2007 data, to No. 17 in the new figures, from 2011, Public Health officials say. … Recommendations in the report include governments aggressively marketing economic development programs and public incentives to the grocery industry for supermarket and other healthy food retail projects in underserved areas (Miller, 4/16).

The Texas Tribune: Cancer-Fighting Charity Hired Tobacco Lobbyist
A beleaguered cancer-fighting charity paid a tobacco lobbyist $5,000 a month to represent its interests in the Texas Legislature, even as it was winding down its operations and facing the wrath of lawmakers (Root, 4/17).

The Texas Tribune: Interactive: Health Care Lobbying
Ahead of the 83rd legislative session, the state's 10 leading health care associations gave more than $4.6 million to Texas candidates. This interactive shows how much -- and to whom -- health care associations donated in 2011 and 2012 (Aaronson, 4/17).

North Carolina Health News: NC Medicaid Has Strengths, Weaknesses, But Broken?
Medicaid in North Carolina has some profound strengths and also some glaring weaknesses. In the second of a two-part story, we examine the question, how broken is Medicaid? (Hoban, 4/16).

Kansas Health Institute: Drug Screening Bill Signed Into Law
A bill authorizing state officials to order drug tests of people receiving or applying for unemployment or some welfare benefits was signed into law today by Gov. Sam Brownback. Senate Bill 149, which passed the House and Senate by large majorities, would allow officials to order the screening if they have a "reasonable suspicion" that an applicant or recipient of the benefits is using a "controlled substance” (Shields, 4/16).

Boston Globe: At Hospitals, Training For Disasters Gets Put To Test
Dr. Stephanie Kayden had just returned to the emergency room, after grabbing a slice of quiche in the hospital cafeteria. A resident pulled aside the senior doctor to discuss a pregnant woman who was vomiting. It was strangely serene for Marathon Monday. Suddenly, a dispatcher's voice crackled over a speakerphone at the nurses’ station. All Kayden caught was "Bombings" and "Copley Square." … Hospitals put in place long-rehearsed emergency plans, summoning help from across their campuses, and paging off-duty staff. Dozens of caregivers, including some unable to finish running the Marathon, simply showed up. (Kowalczyk, Lazar, Conaboy, 4/17).

California Healthline: Pre-Existing Conditions Bill Up For Final Vote
The Senate Committee on Appropriations yesterday unanimously approved ABX1-2 by Assembly member Richard Pan (D-Sacramento), the bill to ban pre-existing conditions as a means of denial for health coverage. It now heads to the Senate floor for a final confirmation vote. The bill already passed the Assembly, so Senate confirmation would be its ticket to the governor's desk. Brown Administration officials have said they support the bill (Gorn, 4/16).

Research Roundup: Lesson For Insurance Exchanges From Europe

Fri, 12 Apr 2013 13:26:00 GMT

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

Health Affairs: Health Insurance Exchanges In Switzerland And The Netherlands Offer Five Key Lessons For Operations Of US Exchanges – As states and the federal government begin creating insurance exchanges under the health law, researchers highlight several lessons from Switzerland and the Netherlands. Those countries have private insurance markets with five aspects of success: "risk-adjustment mechanisms—which provide premium adjustments intended to compensate health plans for enrolling people expected to have high medical costs" are "sophisticated and continually updated;" the importance of identifying barriers to enrollment among those eligible; a simple application process for subsidies; clear negotiating power for insurers on prices and quality of service; easy availability of reliable data regarding providers’ costs and quality of care for insurers and consumers. "American policy makers will need to conduct ongoing analyses of the different ... [exchanges] to learn what works best to create incentives for efficiency," the authors concluded (van Ginneken, Swartz, and Van der Wees, 4/8).

Health Affairs/Robert Wood Johnson Foundation: Health Policy Brief: The Multi-State Plan Program - The insurance markets for individuals and small businesses are highly concentrated in some states, meaning a single insurer could dominate the market. To spur competition and increase the number of options for individuals, the federal health law created the Multi-State Plan Program and put it under the direction of the Office of Personal Management (OPM). "OPM must certify at least two issuers to be able to sell coverage in the exchanges in time for open enrollment on October 1, 2013," the author writes. "Also, under the law, insurers participating in the multistate program must offer at least two plans through each exchange." This brief delves into the program's background and explores the OPM's role and potential challenges as its administrator (Goodell, 4/3).

JAMA Pediatrics: Association Between State Laws Governing School Meal Nutrition Content And Student Weight Status – By studying 4,800 eighth-graders from 40 states, researchers aimed to determine if school meal nutrition standards that exceeded the Department of Agriculture’s school meal standards improved the weight status of adolescents. "The results of this study suggest that in states with laws that encouraged or required a specific number of fruits/vegetables, reductions in trans fats, 1% skim milk, and/or a minimum proportion of whole grains, students who obtained school lunches had a more favorable weight status, particularly among participants eligible for a free/reduced-price lunch," the authors wrote. "The evidence supporting stringent school meal standards is far from conclusive, but this study provides promising signs of the potential for the USDA updated standards to improve student weight status" (Taber, Chriqui, Powell and Chaloupka, 4/8).

The Kaiser Commission on Medicaid and the Uninsured/Kaiser Family Foundation: Health Coverage For The Hispanic Population Today And Under The Affordable Care Act –The authors of this brief write: "The more than 50 million Hispanics living in the United States make up 17 percent of the total population and are the nation's fastest growing racial or ethnic group. Many Hispanics continue to face disparities in health coverage and care, and they have the highest uninsured rate among racial/ethnic groups, with nearly one in three lacking coverage. The Affordable Care Act (ACA) could help many uninsured Hispanics through the law's expansion of Medicaid and the creation of new health insurance exchange marketplaces with tax credits to help moderate-income people purchase coverage" (4/9).

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

NPR' SHOTS blog: Seniors In The South Are More Apt To Be Prescribed Risky Drugs
Health care types have spent years trying to make the point that seniors are being prescribed medications are unnecessary and dangerous. But the message hasn't really sunk in. More than 20 percent of people with Medicare Advantage coverage are taking at least one high-risk medication, a new study finds (Shute, 4/11).

Medscape: Adverse Drug Events Found By Mining Clinical Notes In EHR
Mining unstructured clinical notes written in electronic health records (EHRs) can be used as a strategy to identify early signs of adverse drug events, according to the findings of a new study by Paea LePendu, PhD, and colleagues from Stanford University in California. The authors published their findings online April 10 in Clinical Pharmacology and Therapeutics (Barber, 4/10).

Medscape: Drug Reps Provide Little Information On Harmful Effects
Pharmaceutical sales representatives (PSRs) rarely present serious adverse events during their sales calls. France has stricter standards than the United States and Canada, and therefore presentation of "minimally adequate safety information" is slightly higher in France than in these North American countries. Barbara Mintzes, PhD, from the School of Population and Public Health, University of British Columbia in Vancouver, Canada, and colleagues published the results of their prospective cohort study online April 10 in the Journal of General Internal Medicine (Pullen, 4/10).

State Roundup: Texas Hospitals Spar Over Indigent Care Payments

Thu, 04 Apr 2013 13:23:00 GMT

A selection of health policy stories from California, Texas, Kansas, Tennessee, Ohio, Oregon and Massachusetts.

Los Angeles Times: Closure Of Three Southland Hospitals May Be Part Of A Trend
Hospital owner Pacific Health Corp. said it will close its three remaining Southern California hospitals, citing the fallout from a federal fraud case last year in which the company admitted paying to recruit homeless people off skid row in Los Angeles and billing the government for unnecessary care (Terhune, 4/3).

The Texas Tribune: Public, Private Hospitals At Odds Over Budget Rider
Private and public hospitals are at odds over how they should be reimbursed for uncompensated care -- and at the crux of the fight is a budget provision hitting the House floor on Thursday. The budget rider, backed by private hospitals, calls for the state to fully maintain the Disproportionate Share Hospital program, or DSH, under which the state's large public hospital systems use local taxpayer dollars to draw down federal matching money to cover indigent care at both public and private hospitals (Ramshaw, 4/4).

Kansas Health Institute: Controversial Infectious Disease Bill Appears Headed For Passage
House and Senate negotiators appear headed toward approval of a controversial bill that critics fear would make possible quarantining people infected with or exposed to HIV. After the committee debated for a half-hour adding language to the bill that would have explicitly excluded the possibility of HIV quarantine, negotiators asked Kansas State Epidemiologist Charlie Hunt whether further changes to the bill were necessary (Cauthon, 4/3).

USA Today/The Tennessean: Many Meningitis Victims Owe Tens Of Thousands In Bills
Deol is one of dozens of Tennessee residents who face continuing health problems and mounting expenses from a fungal meningitis outbreak more than six months after it began. ... More than a dozen have filed lawsuits, but most have been put on hold because the supplier of the tainted drugs filed for bankruptcy late last year. Billing statements reviewed by The Tennessean for three patients show the amounts charged for treatment and hospitalization ranged from Deol's $66,000 partial bill to nearly $200,000 (Roche, 4/3).

NPR: Lawyers Join Doctors To Ease Patients' Legal Anxieties
Two professions that have traditionally had a rocky relationship -- doctors and lawyers -- are finding some common ground in clinics and hospitals across the country. In Akron, Ohio, for instance, doctors are studying how adding a lawyer to the health care team can help improve a patient's health (St. Clair, 4/4).

Lund Report: Oregon House Votes To Include Insurers In Consumer Fraud Act
Seven years ago, Regence BlueCross BlueShield blithely declared that Azusa Suzuki was dead and refused to honor a supplemental insurance claim after she was injured in a car accident. But on Tuesday, Rep. Brian Clem, D-Salem, was able to bring his mother-in-law to the State Capitol, and like Lazarus, she witnessed the passage of House Bill 3160, which would roll Regence and other insurers under the state's chief consumer fraud protection act (Gray, 4/3).

Boston Globe: Cambridge Health Alliance Latest To Cut Beds For Children With Mental Illness
Cambridge Health Alliance said Wednesday it will eliminate 11 of its 27 beds for treating children and teens with acute mental illness and will end inpatient care for its youngest children as it grapples with financial losses. The hospital system has two highly regarded inpatient units -- one serving adolescents ages 12 to 19 and another for children as young as 3. The two units will be combined into one smaller unit serving patients ages 8 to 18, said Dr. Jay Burke, chief of psychiatry, and the hospital will focus more on providing community-based services (Conaboy, 4/3).

State Roundup: Calif. Hires Consumer Group To Help Review Coverage Rates

Wed, 03 Apr 2013 13:16:00 GMT

A selection of health policy stories from California, Connecticut, Louisiana, New Jersey, Florida and Pennsylvania.

Los Angeles Times: State Hires Consumer Group To Help It Review Health Care Rates
California Insurance Commissioner Dave Jones lashed out Tuesday at another double-digit rate hike for thousands of small businesses getting their health insurance from industry giant Anthem Blue Cross (Terhune, 4/3).

CT Mirror: In Gun Bill, Boosts In Coverage For Mental Health, Substance Abuse
They're not as eye-catching as the expanded assault weapons ban or a new restriction on large-capacity magazines. But the bipartisan agreement legislative leaders crafted in response to the massacre at Sandy Hook Elementary School also includes changes to insurance laws agreed to by both health plans and patient advocates. And they say the provisions will reduce barriers to treatment for people with private coverage. The changes include requiring insurers to make faster decisions about whether certain urgent mental health and substance-abuse services will be covered, and making it easier for consumers to see what criteria carriers use in determining if care is covered (Becker, 4/2).

The Associated Press/Washington Post: Medicaid Contractor Objects To Cancellation, Says Nothing Improper Done to Get La. Contract
The company whose nearly $200 million Medicaid contract with the state has been cancelled says it didn't do anything improper to get the work, despite an ongoing federal investigation into the contract award (4/2).

Kaiser Health News: In South Jersey, New Options For Primary Care Are Slow To Take Hold
Camden, N.J., has serious health problems, with too many people going to local emergency rooms unnecessarily. But progress is being made, albeit slowly (English, 4/3).

Health News Florida: 'Bold' Plan Would Replace Lawsuits
Imagine a medical-malpractice system that resolves patients' complaints of harm quickly, without rancor or legal fees. Imagine a system that would encourage the injured patient and doctors to discuss the event to reduce the risk of future mistakes (Gentry, 4/2).

Pittsburgh Post-Gazette: SEIU Sues Pa. To Block Merging Rural Health Centers
A state plan to close and consolidate rural health centers will hurt public health and leave under-served, uninsured or immigrant Pennsylvanians with fewer health care options, the union representing nurses at those centers alleges. … A lawsuit filed Monday in Commonwealth Court by SEIU Healthcare Pennsylvania asks the court to halt the cuts. Several Democratic state legislators, including Sen. Tim Solobay, D-Canonsburg; Rep. Pam Snyder, D-Jefferson; and Rep. Ted Harhai, D-Westmoreland, also are plaintiffs in the suit (Giammarize, 4/3).

California Healthline: Spring Recess Gives Way To Spring Work
The California Legislature yesterday returned to work after a 10-day spring recess. A small mountain of bills is in front of lawmakers who have until May 31 to pass bills off the floor. Health care legislation up for discussion includes: Medi-Cal simplification. … Scope of practice expansion. … More [medical] interpreters. … Tax on soda. … Race evaluation (Gorn, 4/2).

Roundup: Feds Cut N.Y. Medicaid Payments $1.2B; 93,000 Fewer Kids Enroll In CHIP In Pa.

Tue, 02 Apr 2013 13:28:00 GMT

Reuters: Federal Government Slashes New York's Medicaid Payments
Federal authorities have dramatically lowered the amount that New York state can claim from the federal government for certain medical services, costing the state an estimated $1.2 billion. The Center for Medicaid Services (CMS), the federal agency that administers the nation's medical insurance system for people on low incomes, cut the per-patient reimbursement rate for patients in developmental centers to $1,200 from $5,100 from April 1, according to CMS documents seen by Reuters (Krudy, 4/1).

Philadelphia Inquirer: 93,000 Fewer Kids Enrolled In CHIP Under Corbett
For years, the Philadelphia region has been among the best places for a child to get sick. Pennsylvania's Children's Health Insurance Program, dating to 1992, was a model for what Congress expanded to all the states five years later. New Jersey set one of the easiest income thresholds for SCHIP and has aggressively enrolled children into Medicaid as well. New Jersey still has a top reputation, with more than 25,000 children added to the public insurance rolls since July 1, 2011. It has won more than $50 million in federal "bonus" grants for its performance.There have been no bonuses for Pennsylvania. Since Gov. Corbett's first budget took effect in mid-2011, enrollment has dropped by 93,000 (Sapatkin, 4/2).

The Wall Street Journal: Lawmakers Back Fight to Maintain Miners' Benefits
West Virginia's top lawmakers pledged at a rally Monday to ramp up pressure on Patriot Coal Corp. to continue providing health benefits to 23,000 retired coal miners and their dependents who could lose much of their coverage in bankruptcy court. U.S. Sens. Joe Manchin and Jay Rockefeller, and Rep. Nick Rahall, all Democrats, told several thousand gathered in the Charleston Civic Center that the retirees were entitled to keep receiving benefits, and that the company is breaking a contractual promise negotiated with the United Mine Workers of America to maintain benefits for life (Maher, 4/1).

Asbury Park (N.J.) Press/USA Today: Health Care Costs For Older Inmates Skyrocket
Older prisoners are also the fastest growing segment of the U.S. prison population. There were an estimated 246,000 people over 50 behind bars last year, according to a 2012 American Civil Liberties Union report. The growing number of older prisoners like (Stephen) Thomas represents a potential fiscal time bomb for the state and nation: Elderly prisoners cost more because almost all expenses related to their health care must be borne by state tax dollars (Mikle, 3/30).

Georgia Health News: Coverage Switch Affects Many Georgia Seniors
More than 7,000 Medicare beneficiaries in Georgia are switching health plans after a Florida-based insurer was ordered to liquidate. All policies of Universal Health Care have been canceled. Last week, federal agents raided the St. Petersburg headquarters of Universal Health Care, after a bankruptcy court trustee alleged a "pattern of dishonesty or gross mismanagement" at the company, including "side deals" that benefited insiders, according to a Tampa Bay Times article. A judge placed the insolvent Medicare insurer into receivership a week prior to the FBI raid. About 800 Universal employees lost their jobs last week after the company shut down (Miller, 4/1).

MPR News: Legislators Balk At $500M Request From Mayo To Aid Expansion
When Minnesota lawmakers return to the state Capitol on Tuesday to focus on a two-year budget, they will also weigh whether to approve the Mayo Clinic's request for $500 million to support its $3 billion expansion plan. Supporters of the project say state financing for roads, bridges, parking garages and other improvements would ensure that the hospital and clinic system cements its future in the Rochester area (Scheck, 4/2).

MPR News: 2012 Health Care Spending Per Person Up 5%
Health care spending per person rose 5 percent in Minnesota last year, reports the Minnesota Council of Health Plans, the trade group representing the state's health insurers. HMOs are required to annually report their financial reports to the state. The Minnesota health plans reported total revenue of nearly $21 billion; with an operating profit of $120 million. That's a margin of about six-tenths of a percent. Part of the rise in total spending per person is due to increased costs for chemical dependency and mental health services; chiropractors and social workers -- all were up 15 percent, said Julie Brunner, the council's executive director (Stawicki, 4/1).

Kansas City Star: Prime Healthcare Completes Hospital Purchases In Kansas City Area
A few hours after gaining Kansas regulatory clearance, Prime Healthcare Services on Monday said it completed its purchase of hospitals in Kansas City, Kan., and Leavenworth. The 400-bed Providence Medical Center and 80-bed St. John Hospital join 23 acute-care hospitals in the California-based Prime chain (4/1).

CT Mirror: Attorneys Press For Change In Medical Malpractice Procedure
Medical malpractice laws are getting an airing at the Capitol today as the Judiciary Committee hears testimony on a proposed change to how cases against physicians come to court. Since 2005, a patient wanting to claim damages from a doctor for alleged negligence must have his or her case reviewed by a similar health care provider, who will certify whether the claim has merit. If the patient can't get what's known as a good faith certificate, the courts will dismiss the case before it gets to trial. Attorneys say the statute has a chilling effect on cases (Jones, 4/1).

Baltimore Sun: Bill To Increase Oversight Of Cosmetic Surgery Centers Making Late Push In Assembly
A bill to give health regulators more oversight of facilities like the now-closed Monarch Medspa in Timonium is making a late surge in the General Assembly after weeks of discussions among state and industry officials. The House of Delegates unanimously passed the legislation Monday afternoon. It needs to clear the Senate, including an extra procedural step, within the next week (Dance, 4/1).

The Lund Report: Ore. House Bill 3000 Requires Children To Have Eyes Checked For School
Sen. Richard Devlin, D-Tualatin, as the co-chairman of the Joint Ways & Means Committee, presides over much of the budget and has to be well-versed on statistics and figures. But to show his support for House Bill 3000 -- which would require all Oregon children entering public schools to have a vision screening -- Devlin told the House Education Committee last week he didn't want to focus on statistics and reports, but wanted to tell a story (Gray, 4/1).

Modern Healthcare: Bill Would Offer Meaningful-Use Exemptions
A Republican congresswoman from Tennessee has introduced legislation that would exempt solo practitioners and physicians nearing retirement from the upcoming Medicare reimbursement cuts for physicians who do not meet meaningful-use requirements for electronic health-record systems under the American Recovery and Reinvestment Act. Rep. Diane Lynn Black, a former nurse and member of the House Budget and Ways and Means committees, re-introduced her Electronic Health Records Improvement Act last month (Conn, 4/1).

California Healthline: Mobile App Highlights Patient Advocate Site
Ratings of health plans' performance put together by the state Office of the Patient Advocate and newly displayed on its website are now accessible by mobile application. "This is the first app of this type nationally," said OPA director Amy Krause. "We hope this makes quality an important part of every doctor visit." At the heart of what makes the mobile app worthwhile, Krause said, is the rating system itself, which is based on information provided by the Department of Insurance. Patients can compare performance and quality factors among HMOs, PPOs and medical groups in California, both overall and within specific categories, such as how plans' providers handle diabetes prevention and treatment (Gorn, 4/1).

California Healthline: Changes Set Stage For 'Shakeout' Of Medical Suppliers, Services
Shifts in contracting practices -- part of the trickle-down effects of health care reform -- are going to change the landscape of medical equipment and service suppliers in California, stakeholders predict. ... Bob Achermann, executive director of the California Association of Medical Product Suppliers ... predicted the number of California businesses providing medical supplies and services may be cut in half over the next few years. Two changes are at the heart of the "thinning of the herd," as Achermann calls it. One is state-driven: California is shifting beneficiaries of Medi-Cal -- California's Medicaid program -- from fee-for-service to managed care. The second is a federally mandated change in the way Medicare contracts with suppliers (Lauer, 4/1).