Kansas Report Paints Troubling Picture
Aug 26, 2014 By Mike Shields
Experts say powerful antipsychotic drugs — sometimes given in combination — are used too much and often inappropriately as “chemical restraints” or sedatives to control the behavior of Kansas nursing home residents suffering from Alzheimer’s or other dementias, and that efforts to curb the practice so far are showing weak results compared with other states.
“Kansas is pretty far outside the norm, clearly, of what is happening in the rest of the nation,” said Mitzi McFatrich, executive director of Kansas Advocates for Better Care, a Lawrence-based group that champions improved conditions in nursing homes.
GOP Focuses on Impact to Economy
Aug 26, 2014 By Phil Galewitz
Beverly Hires, a former nurse running for Congress in South Florida in one of the nation’s rare competitive House races, ticks off her problems with the federal healthcare law: higher premiums, cancelled policies and employers cutting full-time jobs.
“The Affordable Care Act is not making insurance more affordable,” she said in an interview, citing many of the same criticisms as her five GOP opponents in the Aug. 26 primary, who are vying for the chance to oust first-term Democrat Rep. Patrick Murphy.
Nurse Practitioners Bill For Dermatology Procedures at High Rate
Aug 26, 2014 By Shefall Luthra
ne of the hopes embedded in the Affordable Care Act was to expand the role of nurse practitioners and physician assistants in addressing the nation’s shortage of primary care providers. But a new study questions whether that’s actually happening in doctors’ offices.
Of the more than 4 million procedures office-based nurse practitioners and physician assistants independently billed more than 5,000 times in a year to Medicare – a list including radiological exams, setting casts and injecting anesthetic agents – more than half were for dermatological surgeries.
Budget Cuts, Lack of Insurance Create Crisis
Aug 19, 2014 By Dave Ranney
One day last month, Osawatomie State Hospital had 254 patients in its care — almost 50 more than its optimal capacity.
The overcrowded conditions forced a few dozen patients, all of them coping with a serious mental illness and likely a danger to themselves or others, to be triple-bunked in rooms meant for two.
Show Me State Has Yet to Disclose 2015 Premiums
Aug 19, 2014 By Samantha Liss
Health insurance carriers all across the country are disclosing what they plan to charge customers for coverage in 2015 — almost everywhere, that is, except Missouri.
In Connecticut, for example, Anthem Health Plans Inc. submitted its rates to the state’s insurance department in May, requesting an average increase of 12.5%. The state denied the request on July 25. Anthem has until Aug. 31 to submit revised rates.
Some Want to Rescind Offers to Those Who Refuse to Get Coverage
Aug 19, 2014 By Julie Appleby
As more Americans gain insurance under the federal health law, hospitals are rethinking their charity programs, with some scaling back help for those who could have signed up for coverage but didn’t.
The move is prompted by concerns that offering free or discounted care to low-income uninsured patients might dissuade them from getting government-subsidized coverage.
It Cuts Costs, But Resistance Remains Strong
Aug 12, 2014 By Christine Vestal
Providing healthcare to an aging prison population is a large and growing cost for states. Not only do inmates develop debilitating conditions at a younger age than people who are not incarcerated, but caring for them in the harsh environment of prisons is far more expensive than it is on the outside.
Of the 2.3 million adults in state and federal prisons, about 246,000 are 50 or older, according to the National Institute of Corrections. The U.S. currently spends more than $16 billion annually caring for these aging inmates, and their numbers are projected to grow dramatically in the next 15 years.
Program Expansion Led to Drop in Patient Volumes
Aug 12, 2014 By Phil Galewitz
Without insurance, Pam Milliken relied for years on the free health clinic here to help manage her arthritis, high blood pressure and diabetes. When she needed to have her gallbladder removed, the clinic, located in a former State Farm Insurance building, found her a specialist and hospital willing to do the surgery at no cost.
This year, Milliken was among the 70% of patients at Wheeling Health Right Center who enrolled in Medicaid after the state expanded the program under the Affordable Care Act.
Urban Institute Report Outlines Potential Loses
Aug 12, 2014 By Jim McLean
A new study by the Urban Institute says that not expanding Medicaid will cost hospitals in Kansas and Missouri more than $9 billion over a 10-year period.
The analysis from the nonpartisan research organization pegs the loss to Kansas hospitals at $2.6 billion between 2013 and 2022. Missouri hospitals would forfeit $6.8 billion over the same period.
They Want to Solidify Control in Case Ruling on Subsidies Holds Up
Aug 5, 2014 By Christine Vestal
As states ready their health insurance exchanges for a second open enrollment season in November, many have more to worry about than the computer glitches that plagued them last year.
Last month’s federal appeals court ruling that said language in the Affordable Care Act allows only state-run exchanges to give consumers tax credits to help pay for policy premiums is spurring several states to solidify their state-based credentials.
IOM Recommends More Equitable Distribution of $15 Billion to Train Doctors
Aug 5, 2014 By Julie Rovner
A high-level report recommending sweeping changes in how the government distributes $15 billion annually to subsidize the training of doctors has brought out the sharp scalpels of those who would be most immediately affected.
The reaction also raises questions about the sensitive politics involved in redistributing a large pot of money that now goes disproportionately to teaching hospitals in the Northeast U.S. All of the changes recommended would have to be made by Congress.
They Could be Interpreted as Going in Either Direction
Aug 5, 2014 By Jay Hancock
Analysts who fear health spending is accelerating got plenty of evidence in Wall Street's second-quarter results to support their thesis. But so did folks who hope spending is still under control.
Now everybody's trying to sort out the mixed message.
They Wind up With Big Out-Of-Pocket Costs
Jul 29, 2014 By Julie Appleby
Nancy Pippenger and Marcia Perez live 2,000 miles apart but have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers.
“They said, ‘We take the old plan, but not the new one,’” said Perez, an attorney in Palo Alto, Calif.
But Disability Program is on Brink of Insolvency
Jul 29, 2014 By Julie Rovner
Medicare’s Hospital Insurance Trust Fund, which finances about half the health program for seniors and the disabled, won’t run out of money until 2030, the program’s trustees said Monday. That’s four years later than projected last year and 13 years later than projected the year before the passage of the Affordable Care Act.
Unlike Medicare, however, the part of Social Security that pays for people getting disability benefits is in far more immediate danger. The Disability Insurance Trust Fund is projected to run out of money in 2016, just two years from now, unless Congress intervenes, the trustees said.
No Estimates On Those Who Previously Lacked Coverage
Jul 29, 2014 By Phil Galewitz
About 10.3 million Americans gained health coverage this year, primarily as a result of the Affordable Care Act, according to a study by the federal government and Harvard University, published Wednesday in the New England Journal of Medicine.
The estimate of newly insured adults — the largest to date — is the first published in a major medical journal and authored by some federal health researchers.
Pro-ACA States Enjoy Economic Expansion
Jul 22, 2014 By Bryan Thompson
A study released earlier this month by the White House Council of Economic Advisers says the decision not to expand Medicaid is costing Kansas and other Midwest states billions of dollars and tens of thousands of jobs.
Wisconsin, Iowa First States to Obtain Medicaid Waivers
Jul 22, 2014 By Michael Ollove
By his own admission, for many years Cyrus Napolitano’s mental illness—bipolar disorder—did not make him an ideal employee. Perhaps the worst moment came when he walked into the Brooklyn McDonald’s he was managing to discover some now-forgotten worker infractions.
“Whatever it was,” he said, “it triggered an explosion where I was screaming at the top of my lungs and beating a path of destruction all the way to the back, knocking everything off shelves and kicking the back door with my boot.”
They Say Repeating The Arduous Process Doesn't Make Them Better Doctors
Jul 22, 2014 By Roni Caryn Rabin
Many specialist physicians are balking at what they say are onerous new rules to get recertified, warning the demands will force some physicians out of practice at a time when the nation faces a shortage.
Doctors say the new requirements have made maintaining specialty certifications a process that never ends. Younger doctors already retake the arduous certification exam every seven to 10 years to keep their credential, long considered the gold standard of expertise. But physicians of all ages must now complete a complex set of requirements every two to three years, or risk losing their certification.
CMS Wants Eligibility Delays Ironed Out
Jul 15, 2014 By Dave Ranney
Federal officials have asked six states, including Kansas and Michigan, to submit plans for resolving issues that appear to be delaying the processes to determine Medicaid eligibility, primarily for pregnant women, children and people with disabilities.
Letters were sent to each state’s Medicaid director on June 27.
Eight out of 10 are out of work
Jul 15, 2014 By Jenny Gold
Employment rates for people with a serious mental illness are dismally low and getting worse, according to a report from the National Alliance on Mental Illness. Just 17.8 percent of people receiving public mental health services were employed in 2012 – down from 23 percent in 2003.
That’s an unemployment rate of more than 80%.
Focusing On Keeping Patients at Home
Jul 8, 2014 By Michael Ollove
Three years after the demise of the long-term care piece of the Affordable Care Act, some states are retooling their Medicaid programs to maximize the number of people who can get care at home and minimize the number who have to become poor to receive help.
They also are trying to save state dollars. Medicaid is a joint state-federal program, and long-term care for the elderly is putting an ever greater burden on state budgets: Total Medicaid spending for long-term services rose from $113 billion in 2007 to nearly $140 billion in 2012.
Could Affect Nine Other States
Jul 8, 2014 By Jake Grovum
The U.S. Supreme Court’s recent ruling in a case brought by home healthcare aides in Illinois casts doubt on labor agreements between such workers and state governments in nine other states.
It also closes off—or at least complicates—one of labor’s clearest paths to reversing a decades-long trend of declining ranks and shrinking clout.
Liberals, Conservatives Have Different Interpretations
Jul 8, 2014 By Julie Rovner
The U.S. Supreme Court’s opinion last week holding that some for-profit firms do not have to provide women the contraceptive coverage required under the Affordable Care Act if they have religious objections addressed only half of the ongoing legal battle over the birth control mandate.
But those on both sides of the issue think the court’s majority may have telegraphed which way it could rule when one of those other cases reaches the justices.
Many Had Lacked Coverage For Years, According to Survey
Jun 24, 2014 By Julie Appleby
Nearly six in 10 Americans who bought insurance for this year through the health law’s online marketplaces were previously uninsured—most for at least two years, according to a new survey that looks at the experiences of those most affected by the law.
That finding is higher than some earlier estimates, and counters arguments made by critics of the law that most of those who purchased the new policies were previously insured.
Midwest Hospitals Defend Business Practices
Jun 24, 2014 By Mary Agnes Cary
A federal program designed to allow certain safety net hospitals and clinics to save money on drug purchases is under fire from critics who say the facilities are using that money to pad profits rather than help patients.
The 340B drug pricing program lets thousands of hospitals, community health centers and family planning clinics buy outpatient prescription medications from manufacturers at an estimated 25% to 50% discount. Participants can then charge higher rates to insured patients and keep the additional revenue.
Making Group Reconsider Vaccinations
Jun 24, 2014 By Sarah Jane Tribble
The Amish countryside in central Ohio looks like it has for a hundred years. There are picturesque pastures with cows and sheep, and big red barns dot the landscape. But something changed here when, on an April afternoon, an Amish woman walked to a communal call box. She called the Knox County Health Department and told a county worker that she and a family next door had the measles.
ACA is credited with enrollment boost
Jun 17, 2014 By Ron Shinkman
Although controversial in many parts of the country, the Affordable Care Act has been a boon in Minnesota, as the federal reform law helped reduce the number of uninsured by more than 40%.
A new study by State Health Access Data Assistance Center (SHADAC) at the University of Minnesota concluded that the number of uninsured statewide dropped by 40.6% between September of last year and the start of last month.
Requirements For Risk Assessments, Co-Pays Do Not Deter Enrollment
Jun 17, 2014 By Phil Galewitz
Delayed by state lawmakers, Michigan did not expand Medicaid until the day after the federal online insurance exchange closed March 31 – a move advocates feared would undermine signups.
Turns out, enrollment is exceeding expectations, which has pleased officials who seek to make the state among the first in the nation to add a heavy dose of “personal responsibility” to the federal-state entitlement program.
Result of Hospitals Buying Physician Practices
Jun 17, 2014 By Julie Appleby
Some cancer patients and their insurers are seeing their bills for chemotherapy jump sharply, reflecting increased drug prices and hospitals’ push to buy oncologists’ practices and then bill at higher rates.
Patients say, “‘I’ve been treated with Herceptin for breast cancer for several years and it was always $5,000 for the drug and suddenly it’s $16,000 -- and I was in the same room with the same doctor same nurse and the same length of time’,” said Donald Fischer, M.D., chief medical officer for Highmark, the largest health plan in Pennsylvania.
Most Costs Covered by State, Federal Funds
Jun 10, 2014 By Michelle Andrews
The effects of a sexual assault can be long-lasting, but the medical bills shouldn’t be. Yet a new study finds that despite federal efforts to lift that burden from rape victims, a hodgepodge of state rules means some victims may still be charged for medical services related to rape, including prevention and treatment of pregnancy or sexually transmitted infections.
"If you're exposed to HIV as a result of the attack, that’s something the state should be paying for, especially if we can give you prophylaxis to prevent infection," said Ilse Knecht, deputy director of public policy at the National Center for Victims of Crime.
Across America, Many Say Healthcare Costs Too Much
Jun 10, 2014 By Jenny Gold
Recently, I moved across the country, from Washington, D.C., to San Francisco. I drove the Southern route and decided to conduct an informal survey, asking folks I met along the way a question relevant to the health care reporting I've been doing for the past five years.
The question: What bugs you most about your medical care?
Application Backlogs Are Substantial
Jun 10, 2014 By Phil Galewitz
While an unprecedented 6 million people have gained Medicaid coverage since September, mostly as a result of the Affordable Care Act, more than 1.7 million more are still waiting for their applications to be processed—with some stuck in limbo for as long as eight months, according to officials in 15 large states.
The scope of the problem varies widely. California, the most populous state to implement the health law’s expansion of Medicaid, accounts for a lion’s share of the backlog with 900,000 applications still pending as of early June. The next biggest pileup is in Illinois, with 283,000 cases, while New York has no backlog at all.
Snyder Administration Looking to Save Money
Jun 3, 2014 By Karen Bouffard
The Affordable Care Act is expected to save Michigan hundreds of millions of dollars annually in mental health costs, but there’s a growing dispute over whether the money should be immediately reinvested in mental health programs, or banked.
As part of major changes associated with the healthcare overhaul, Michigan opened Medicaid to nearly 500,000 additional residents. That moves their healthcare costs — including mental health — off the state’s books and onto the federal government’s.
Second Only to Wyoming
Jun 3, 2014 By Virginia Young
Missouri is seeing a bigger decline in its Medicaid rolls than nearly any other state, a ranking that the administration of Gov. Jay Nixon attributes to an improving economy and critics blame on application snafus.
A new federal report compares Medicaid enrollment in March to the average for the three-month period of July through September 2013. Missouri’s caseload declined 3.9 percent, a drop second only to Wyoming, which declined by 5.6%.
Moving Past Stigma of Death Panels
Jun 3, 2014 By Michael Ollove
The federal government may reimburse doctors for talking to Medicare patients and their families about “advance care planning,” including living wills and end-of-life treatment options — potentially rekindling one of the fiercest storms in the Affordable Care Act debate.
A similar provision was in an early draft of the federal health care law, but in 2009, former Republican vice-presidential candidate Sarah Palin took to Facebook to accuse President Barack Obama of proposing “death panels” to determine who deserved life-sustaining medical care. Amid an outcry on the right, the provision was stripped from the legislation.