Midwest Healthcare News Feb 10, 2016

Midwest Healthcare News

  • Insurers Backing Away From ACA

    Many Cut Commissions to Brokers to Discourage Enrollment

    Feb 9, 2016 By Michelle Andrews


    Stung by losses under the federal health law, major insurers are seeking to sharply limit how policies are sold to individuals in ways that consumer advocates say seem to discriminate against the sickest and could hold down future enrollment.

    In recent days Anthem, Aetna and Cigna, all among the top five health insurers, told brokers they will stop paying them sales commissions to sign up most customers who qualify for new coverage outside the normal enrollment period, according to the companies and broker documents.

  • Midwest States Lead Fight On Obtaining Hep C Drugs

    Indiana, Minnesota File Lawsuits For Prisoners, Medicaid Enrollees

    Feb 9, 2016 By Michael Ollove


    A handful of federal lawsuits against states that have denied highly effective but costly hepatitis C drugs to Medicaid patients and prisoners could cost states hundreds of millions of dollars.

    The drugs boast cure rates of 95% or better, compared to 40% for previous treatments. But they cost between $83,000 and $95,000 for a single course of treatment.

  • Kansas Seeking Solutions To Medicaid Backlog

    Presumed Eligibility For Some Applicants Considered

    Feb 9, 2016 By Andy Marso


    Kansas Department of Health and Environment Secretary Susan Mosier said last week that she’s open to ideas to streamline the state's current backlog of Medicaid applicants, including presumed Medicaid eligibility for nursing home residents.

    When asked about a temporary lifeline for nursing homes drowning in uncompensated care while the department works through a computer system transition, Mosier said it was a “good concept” and that she liked the idea.

  • Minnesota Offers Low Cost Insurance Program

    Aimed at Individuals Who Earn Too Much For Medicaid

    Feb 2, 2016 By Michelle Andrews


    In January, more than 350,000 lower income New Yorkers began paying $20 a month or less for comprehensive health insurance with no deductibles and low copayments, under a federal health law program. Minnesota has similar coverage in place through the same program, with more than 125,000 enrollees.

  • Lack Of Weapons Against Chronic Conditions Killing Whites

    Compounded by Sinking Socioeconomic Status

    Feb 2, 2016 By Lisa Gillespie


    Don’t blame suicide and substance abuse entirely for rising death rates among middle-aged white Americans, asserts a new study out last week.

    They’re both factors, but the bigger culprit is almost two decades of stalled progress in fighting leading causes of death — such as heart disease, diabetes and respiratory disease — according to a Commonwealth Fund analysis of data from the federal Centers for Disease Control and Prevention. The fund studied actual and expected death rates, and causes of death, for working-age adults from 1968 through 2014.

  • Kansas Medicaid System Is Fouled Up

    New Computer System Kicks Many Out of Program Without Notice

    Feb 2, 2016 By Andy Marso


    Thousands of Kansans seeking Medicaid benefits are being forced to wait months because of continuing problems with a new computer system and a change in the state agency responsible for handling some eligibility determinations.

    The application backlog began to form in July when state officials moved Medicaid eligibility processing to the long-delayed Kansas Eligibility Enforcement System, or KEES. The software switch forced employees to use dozens of time-consuming workarounds to make the system function.

  • Feds Want To Standardize Plan Options On Exchange

    Could Cut Out-Of-Pocket Costs

    Jan 26, 2016 By Michelle Andrews


    Some consumers who buy coverage on the health insurance marketplaces in 2017 could see their out-of-pocket costs drop significantly under a federal proposal to create standardized plans, a recent analysis found.

  • Medicaid Expansion May Have Reached Tipping Point

    South Dakota among those considering takeup

    Jan 26, 2016 By Christine Vestal


    Louisiana this month became the first state in the Deep South to make the politically charged decision to expand Medicaid health insurance to low-income adults under the Affordable Care Act.

    At least one other state — South Dakota — is expected to extend Medicaid coverage this year. But in the lead up to the November presidential election, supporters of the ACA aren’t holding out much hope that more states will join in extending Medicaid coverage to more people — although the governors of Alabama, Virginia and Wyoming say they want to, as do key legislators in Maine and Nebraska.

  • Kansas Regulators Pushing To Allow For EPO Plans

    Option is Thought to Lower Premiums

    Jan 26, 2016 By Andy Marso


    Some Kansas health insurers are seeking legal permission to sell network-only plans — with the help of the state’s top insurance regulator.

    The office of Kansas Insurance Commissioner Ken Selzer supports a bill that would allow insurers to sell “exclusive provider organization,” or EPO, plans that provide no reimbursement for out-of-network health care except in the case of emergency.

  • Obama Tries To Entice States To Expand Medicaid

    Wants to Continue Offer Full Funding For Laggards

    Jan 19, 2016 By Phil Galewitz


    With full federal funding for expanding Medicaid set to expire at the end this year, President Barack Obama is proposing to indefinitely extend the health law provision for any of the 19 states that have not yet adopted the enhanced eligibility.

    But Obama would need the Republican-controlled Congress to approve the offer. That appears unlikely considering Congress voted last week to repeal the Affordable Care Act, though the GOP critics did not muster enough support to override the president’s veto.

  • Illinois May Yank Tax-Exemption For Non-Profit Hospitals

    State Appeals Court Throws Out 2012 Law

    Jan 19, 2016 By Associated Press


    An Illinois appeals court decision has reopened a statewide dispute over whether hospitals should be exempt from paying millions of dollars in income taxes and property taxes to local governments.

    The Illinois 4th District Appellate Court ruled earlier this month that part of a 2012 law that allows hospitals to avoid taxes is unconstitutional.

  • Instead Of Expanding Medicaid, Kansas To Examine Rural Care

    Brownback Creates All-GOP Working Group

    Jan 19, 2016 By Jim McLean


    A key member of Gov. Sam Brownback’s new rural health working group says he hopes the initiative is a serious effort to address problems facing rural providers, not an attempt to divert attention from a renewed push to expand the state’s Medicaid program.

    Republican Rep. Jim Kelly represents Independence, the southeast Kansas community that recently lost its only hospital due to budget problems exacerbated by federal reductions in Medicare reimbursement rates and the state’s rejection of Medicaid expansion.

  • Few Addicts Being Treated With Drugs

    Despite Hazelden Taking Lead, Aversion Remains Deep-Seated

    Jan 12, 2016 By Christine Vestal


    Marvin Seppala, M.D., wrote a book on conquering drug addiction with counseling and group therapy.

    The spiritual, abstinence-based strategy pioneered by Alcoholics Anonymous helped him overcome his own alcohol and cocaine addiction when he was 19. As medical director of Minnesota’s fabled Hazelden Clinic, he watched it work for patients.

    He believed in it — and then he changed his mind.

  • When Employers Rely On Medicaid To Cover Workers

    It is Often Cost-Effective For All Parties

    Jan 12, 2016 By Fred Mogul


    Butter-flavored popcorn oil is in high demand at Oasis Foods, a manufacturer of cooking oils, mayonnaise and other products that restaurants and distributors often purchase by the ton.

    “We get a rush this time of year with all the movie-going at the holidays,” said Duke Gillingham, president of Oasis, at his factory in Hillside, N.J., just west of Newark Liberty International Airport.

  • Psych Waiting Times At Kansas Hospitals Rise

    Cutbacks at Osawatomie Blamed

    Jan 12, 2016 By Jim McLean


    People experiencing a mental health crisis who are a danger to themselves or others sometimes are having to stay for days in emergency departments while waiting for a bed to open at Osawatomie State Hospital. That has prompted at least one Kansas hospital to increase staffing and security in its emergency department.

    Janice Early, vice president of marketing and communications at Lawrence Memorial Hospital, said the emergency department director confirmed to her that patients requiring an involuntary mental health commitment have waited an average of 17 hours for a placement in the last year, but recently those times at LMH have ranged from 24 hours to 140 hours, or just short of six days.

  • Cleveland's ERs Have Stopped Diverting Patients

    An Attempt to Improve Patient Safety

    Jan 5, 2016 By Sarah Jane Tribble


    When East Cleveland’s emergency medical squad gets called to treat a man with a severe nosebleed, it’s a pretty run-of-the-mill case.

    The patient walks woozily out to the ambulance from a tan house on a tree-lined street. Anthony Savoy, the head medic, calls ahead to University Hospitals, which has the closest emergency room. Savoy wants to make sure the ER has space for the patient.

  • Retail Clinics Grow With Little Regulation

    Minnesota is One Midwest Exception

    Jan 5, 2016 By Michael Ollove


    When walk-in health clinics started spreading rapidly in the mid-2000s, the nation’s biggest and most prestigious medical organizations voiced objections. They raised concerns about patient safety, gaps in patients’ medical records, conflicts of interest and disruptions of the relationship between patients and their doctors.

  • Kansas State Mental Hospital Loses Medicare Certification

    Despite Losing Millions In Reimbursement, State May Not Seek Reinstatement

    Jan 5, 2016 By Jim McLean


    State officials have not decided whether to seek federal recertification of the Osawatomie State Hospital for Kansans with mental illness.

    The Centers for Medicare & Medicaid Services decertified the hospital earlier this month because of the state’s failure to address security and safety issues cited by federal inspectors, who concluded the sexual assault of a hospital worker by a patient in October was due in part to lax security.

  • More States Considering Reciprocal Licensing For Doctors

    But Many Are Still Resisting Proposal

    Dec 15, 2015 By Michael Ollove


    When it comes to licensing, the nursing profession works almost exactly the way it does with driving a car — at least in half the states. A nurse with a license from one of those 25 states can practice in any other state that has signed on to a reciprocal licensing compact.

    Contrast that with doctors. A doctor licensed in one state who wants to practice in another still needs a license from the other state.

  • Obese Americans Tax Nursing Homes

    Many Don't Have Resources To Care For Such Patients

    Dec 15, 2015 By Sarah Varney


    At 72, her gray hair closely shorn, her days occupied by sewing and television, Wanda Chism seems every bit a typical nursing home patient — but for her size.

    Chism is severely obese, unable to leave her bed without a mechanical lift and a team of nurses. She has not walked in years. Her life is circumscribed by the walls of her room.

  • To Expand Medicaid, Kansas Could Follow Montana Model

    Conservative Lawmakers Were Swayed

    Dec 15, 2015 By Andy Marso


    Two leaders of Montana’s successful Medicaid expansion movement told Kansas expansion advocates Monday that persistence, organization and discretion were keys to getting it done in their state.

    Dozens of people who represent Kansas groups that favor Medicaid expansion gathered in Topeka to hear from Kim Abbott of the Montana Human Rights Network and Tara Jensen of the Montana Budget and Policy Center

  • Medicaid Program Frees Up Funding For Housing

    Considered a Proactive Way to Control Costs

    Dec 8, 2015 By Michael Ollove


    Communities with big homeless populations are increasingly turning to a strategy known as housing first. The idea: helping chronically homeless people to find a permanent home—and stay in it—is the best way to help them lead stable, healthy lives.

    The approach has been used in cities like Chicago and Cleveland, as well as in several states, such as Massachusetts, Minnesota and Washington, as local nonprofits have worked to provide both housing and health care to homeless people

  • More PPOs Do Not Cap Out-Of-Network Costs

    Could Leave Enrollees On Hook For Tens of Thousands of Dollars

    Dec 8, 2015 By Julie Appleby


    Citing the flexibility they offer, many consumers choose health plans that provide some coverage outside the insurer’s network. Traditionally, such plans not only paid a portion of the bill, but also set an annual cap on how much policy holders paid toward out-of-network care.

    Not anymore.

    An increasing number of preferred provider plans (PPOs) offered under the federal health law have no ceiling at all for out-of-network costs, leaving policyholders facing unlimited financial exposure, similar to what more restrictive and often less expensive types of coverage, such as health maintenance organizations (HMOs), offer.

  • Former Kansas Medicaid Director Suggests Changes For Streamlining Program

    Wants More Authority For State-Level Program Directors

    Dec 8, 2015 By Andy Marso


    A former Kansas Medicaid director has authored a paper proposing ways to streamline Medicaid programs that he says are too fragmented in many states.

    Andy Allison, who also previously ran the Arkansas Medicaid program, presented the paper last month at a conference of state Medicaid directors.

  • Kansas Pushes 2016 Enrollment Effort

    Outreach Program Includes Working With Social Agencies

    Dec 1, 2015 By Bryan Thompson


    Since enrollment opened Nov. 1 for 2016 health insurance in the federal marketplace, an effort called Cover Kansas has branched out across the state to help Kansans find a plan that best suits their needs.

    At a recent outreach event at the Dodge City Public Library, most of the chairs in the public meeting room were full as people waited for the consultations with marketplace navigators.

  • Bonus To Primary Care Physicians Ending Soon

    Concern it May Impact Access to Care

    Dec 1, 2015 By Michelle Andrews


    Many primary care practitioners will be a little poorer next year because of the expiration of a health law program that has been paying them a 10% bonus for caring for Medicare patients. Some say the loss may trickle down to the patients, who could have a harder time finding a doctor or have to wait longer for appointments. But others say the program has had little impact on their practices, if they were aware of it at all.

    The incentive program began in 2011 and was designed to address disparities in Medicare reimbursements between primary care physicians and specialists. It distributed $664 million in bonuses in 2012, the most recent year that figures are available, to roughly 170,000 primary care practitioners, awarding each an average of $3,938, according to a 2014 report by the Medicare Payment Advisory Commission.

  • In-Hospital Complications Stay The Same

    Leveled Off in 2014 After Years of Drops

    Dec 1, 2015 By Jordan Rau


    The rate of avoidable complications affecting patients in hospitals leveled off in 2014 after three years of declines, according to a federal report released Tuesday.

    Hospitals have averted many types of injuries where clear preventive steps have been identified, but they still struggle to avert complications with broader causes and less clear-cut solutions, government and hospital officials said.

  • Premiums On Illinois Exchange Up Sharply

    Blues Charging Nearly 18 Percent More

    Nov 17, 2015 By Ameet Sachdev


    Linda Sabor says Obamacare was a godsend. As the health care law enters its third year, her faith is starting to waver.

    Last month, her insurance company gave the 59-year-old Palatine resident some bad news. Blue Cross and Blue Shield of Illinois canceled the health plan that she and her husband have had the past two years. The company offered a plan for next year that has a similar network and benefits that would cost $1,142.24 a month, $325 more than their current monthly premium.

  • Brownback's Budget Shortchanges Children, Group Alleges

    Says Moves to Fill Budget Gap Hit Many Health Programs

    Nov 17, 2015 By Jim McLean


    A nonprofit advocacy group that frequently tangles with Gov. Sam Brownback on policy issues is charging that his latest plan to avert a budget shortfall will shortchange some of the state’s poorest and most vulnerable children.

    Shannon Cotsoradis, CEO of Kansas Action for Children, said the Brownback administration’s plan to sweep $9 million from a fund earmarked for early childhood programs will reduce their funding by about $1.3 million over the next 18 months.

  • When There's A Medical Error, It's Hazy Who Pays

    Fearing Litigation, Hospitals Are Often Elusive

    Nov 17, 2015 By Shefali Luthra


    When Charles Thompson checked into the hospital one July morning in 2011, he expected a standard colonoscopy.

    He never anticipated how wrong things would go.

    Partway through, the doctor emerged and said there were complications, remembered Ann, Charles’ wife. Charles’ colon may have been punctured. He needed emergency surgery to repair it.


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