Apr 22, 2014 By Payers & Providers Staff
Pressures of Reform Make Many Rush Through Patient Encounters
Apr 22, 2014 By Roni Caryn Rabin
Joan Eisenstodt didn’t have a stopwatch when she went to see an ear-nose-and-throat specialist recently, but she is certain the physician was not in the exam room with her for more than three or four minutes.
“He looked up my nose, said it was inflamed, told me to see the nurse for a prescription and was gone,” said the 66-year-old Washington, D.C., consultant, who was suffering from an acute sinus infection.
Providers are expanding patient hours, residency slots
Apr 22, 2014 By Rene Wisely
Michigan’s medical schools, doctors offices and health care networks are tackling a shortage of primary care doctors that is expected to worsen under the Affordable Care Act.
The state and nation have reported a shortage of primary care physicians for a decade, and the millions of newly insured patients are expected to add more pressure. In addition, health care reform is encouraging consumers to seek primary care more regularly to stay healthy and to keep on top of chronic conditions that can drive up costs.
Focusing on Low-Income Populations
Apr 22, 2014 By Michael Ollove
In a valley wedged between the Mississippi and Missouri rivers, St. Louis often finds itself beset by a stationary air mass that only a severe storm of some kind can dislodge. St. Louis is also an industrial city with high humidity, so it’s no wonder it usually makes the list of worst places for asthmatics to live.
But the state has also pioneered advances in addressing asthma treatment and costs. Two years ago, the Missouri Legislature became the first to allow schools to stock quick-relief asthma medications for emergencies. Missouri also became the first state to permit school nurses and other trained staff to administer that medication to any child suffering an asthmatic attack while at school, whether or not the child has an asthma diagnosis or a prescription at the school.
But Numbers Differ From State to State
Apr 15, 2014 By Lisa Gillespie
The Obama administration is touting the success of the health law’s open enrollment, which signed up at least 7.5 million Americans for health coverage through the online insurance marketplaces. But the experience varied according to states and Families USA brought together five state exchange directors Thursday to talk about what they’ve seen so far. These states – Kentucky, New York, Washington, California and Connecticut — all had functioning exchanges and pursued that health law’s Medicaid expansion.
Website Woes Contributed to Rocky Tenure
Apr 14, 2014 By Mary Agnes Cary
President Barack Obama Friday officially announced the resignation of Department of Health and Human Services Secretary Kathleen Sebelius, praising her efforts to implement the federal health overhaul and predicting that it would "benefit our families and our country for decades to come."
In a White House ceremony, the president also announced that he plans to nominate Sylvia Mathews Burwell, the director of the Office of Management and Budget, to replace Sebelius. News of the transition had leaked Thursday night.
Campaigns to Reduce Overused Procedures Tend to Avoid Physician Pocketbooks
Apr 15, 2014 By Jordan Rau
When America’s joint surgeons were challenged to come up with a list of unnecessary procedures in their field, their selections shared one thing: none significantly impacted their incomes.
The American Academy of Orthopaedic Surgeons discouraged patients with joint pain from taking two types of dietary supplements, wearing custom shoe inserts or overusing wrist splints after carpal tunnel surgery. The surgeons also condemned an infrequently performed procedure where doctors wash a pained knee joint with saline.
Many Are Trying to Fix Exchange Glitches
Apr 8, 2014 By Christine Vestal
Like other states that opted to run their own exchange, Colorado spent several years and hundreds of millions in federal dollars to create an insurance marketplace specifically tailored for Coloradans.
Complex legislation, multiple studies, numerous vendor contracts, dozens of public hearings and behind-the-scenes preparations led up to the launch of Colorado’s site in October.
Report Says Incarceration Often Subs For Care
Apr 8, 2014 By Jenny Gold
In 44 states and the District of Columbia, at least one prison or jail holds more people with serious mental illnesses than the largest state psychiatric hospital, according to a report released Tuesday by the Treatment Advocacy Center and the National Sheriffs’ Association.
Across the country, an estimated 356,268 people with mental illnesses including bipolar disorder and schizophrenia are in prisons and jails, compared to just 35,000 in state hospitals — a tenfold difference.
Bond -- Kit Bond -- is Working The Halls of The Capitol
Apr 8, 2014 By Virginia Young, St. Louis Post Dispatch/Kaiser Health News
Christopher "Kit" Bond is back.
The two-term governor (1973-76 and 1981-84) has been walking the Missouri Capitol's hallways and meeting with legislators, some of whom weren't born when he first came to Jefferson City as state auditor in 1970.
They Represent Nearly a Third of U.S. Population With Disease
Apr 1, 2014 By Michael Ollove
If used widely, a new generation of antiviral drugs has the potential to wipe out the deadly hepatitis C virus in the United States. But the high price of the drugs might prevent their use in prisons, which house as many as one-third of those who are infected.
Things to Watch Out For The Rest of 2014
Apr 1, 2014 By Julie Appleby, Phil Galewitz and Mary Agnes Cary
Just because open enrollment for people who buy their own health insurance formally closed March 31 doesn't mean debate over the health law will take a hiatus. After more than four years of strident rhetoric, evidence about how the law is actually working is starting to trickle in. Here are seven things to watch before the next enrollment period begins in November:
Delays, Frustrations Encountered
Apr 1, 2014 By Kaiser Health News
Last minute health insurance shoppers nationwide turned up in record numbers online Monday, and they also showed up in person at clinics, county health departments and libraries to sign up for Obamacare on the last official day of open enrollment. Here are dispatches from public radio reporters in Ohio, Pennsylvania and Houston — three of the 36 states that are using healthcare.gov — and Minnesota, which has one of the most troubled state-run marketplaces.
Long Grace Period For Premium Payments Cause For Concern
Mar 25, 2014 By Roni Caryn Rabin
Doctors groups fear their members won’t get paid because of an unusual 90-day grace period for government-subsidized health plans and are urging physicians to check patients' insurance status before every visit.
“This puts the physician and their patients in a very difficult situation,” said Ardis Dee Hoven, M.D., president of the American Medical Association, which advised physicians Wednesday about how to minimize their risk.
Ohio, Nine Others Responsible For Good Chunk of Enrollment
Mar 25, 2014 By Phil Galewitz
Ten states — seven of them controlled by Republicans —hold the key to whether the Obama administration succeeds at signing up 6 million people by the deadline of March 31.
Those large states account for nearly 30 million uninsured — almost two-thirds of the nation’s 47 million uninsured.
Would Address Insurer Cuts to Networks
Mar 25, 2014 By Susan Jaffe
Federal officials are considering new Medicare Advantage rules to help protect seniors when insurers make significant reductions to their networks of doctors and other healthcare providers.
The proposals follow UnitedHealthcare's decision to drop thousands of doctors from its Medicare Advantage plans in at least 10 states last fall.
Up Significantly From Prior Year
Mar 18, 2014 By Payers & Providers Staff
Minnesota's hospitals contributed $3.9 billion in community benefits to the state's 5.4 million residents in 2011, according to data provided by the Minnesota Hospital Association.
A large bulk of that figure consisted of uncompensated care and shortfalls from government payers, which totaled $2.2 billion. The payment shortfalls totaled $1.7 billion and were connected primarily to the Medicaid and Medicare programs.
Fewer Than 10% of Residents Have Signed Up On Health Exchange
Mar 18, 2014 By Sarah Jane Tribble
At a health center in Cleveland late last week, Health and Human Services secretary Kathleen Sebelius said Ohio is off to a “decent start” on health insurance enrollment.
With two weeks left before open enrollment ends under the Affordable Care Act, 79,000 Ohioans have selected a plan on the federally run insurance exchange.
Illinois is getting far more signups than GOP-dominated Missouri
Mar 11, 2014 By Tara Kulash
Free food and music are notorious for attracting young people; at least that’s the hope of Missouri insurance enrollment counselors.
Before the March 31 deadline under the Affordable Care Act, groups are beefing up their campaigns to bring last-minute customers to the federal health insurance marketplace—especially young people.
Denver Firm Acts as Clearinghouse on How 2015 Premiums, Costs Are Trending
Mar 11, 2014 By Jay Hancock
Now that medical insurers must accept all applicants no matter how sick, what will these new customers cost health plans? How will they affect coverage prices for 2015 and beyond? Few questions about the Affordable Care Act are more important. How it all plays out will affect consumer pocketbooks, insurance company profits and perhaps the political fortunes of those backing the health law.
A few Denver actuaries, bound to confidentiality, will be the first to glimpse the answers.
Manufacturers Are Churning Out Products At An Increasing Clip
Mar 11, 2014 By Daniela Hernandez
Eric Topol, M.D., a cardiologist at the Scripps Clinic in San Diego, knows when his patients’ hearts are racing or their blood pressure is on the rise, even if they’re sitting at home.
With high-risk patients hooked up to “personal data trackers” — a portable electrocardiogram built into a smartphone case, for instance — he and his researchers can track the ups and downs of patients’ conditions as they go about their lives. “It’s the real deal of what’s going on in their world from a medical standpoint,” said Topol, whose work is part of a clinical trial. “The integration of that with the classical medical record is vital.”
Allegedly Bilked Four Insurers Out of Millions
Mar 4, 2014 By Payers & Providers Staff
A Chicago-area chiropractor and physician are facing federal healthcare fraud charges after being accused of bilking four large insurance companies out of millions of dollars.
The physician, Eguert Nagaj, M.D., and the chiropractor, Igor Sher, operated three separate medical and chiropractic practices in the town of Buffalo Grove. They were among six people involved in the alleged scheme named in indictments that were unsealed in federal court earlier this week. Both are facing 16 counts of mail fraud, with an additional obstruction of justice charge against Sher.
Backers Say They Receive Care Legal Residents Can't Obtain
Mar 4, 2014 By Julie Appleby and Patricia Borns
Florida lawmakers backing expansion of the state’s Medicaid program plan to mount a new argument this legislative session: That voting against extending the program would deprive low-income U.S. citizens of access to insurance that’s available to some legal immigrants.
At issue is a little-noticed provision of the federal health law that allows some low-income immigrants who are living here legally to qualify for subsidies to help them buy private insurance through online marketplaces.
A Single Treatment Costs $84,000
Mar 4, 2014 By Julie Appleby
There's a new drug regimen being touted as a potential cure for a dangerous liver virus that causes hepatitis C. But it costs $84,000 -- or $1,000 a pill. And that price tag is prompting outrage from some consumers and a scramble by insurers to figure out which patients should get the drug —and who pays for it.
Called Sovaldi, the drug is made by California-based Gilead Sciences Inc. and is the latest in handful of new treatments for hepatitis C, a chronic infection that afflicts at least 3 million Americans and is a leading cause of liver failure. It was approved by the U.S. Food & Drug Administration in December.
Insurers Claim Reductions Are Far Deeper Than Thought
Feb 25, 2014 By Mary Agnes Cary
An Obama administration announcement about payment rates for Medicare Advantage plans in 2015 has set off a dispute about how large – or small – the changes really are.
Late Friday, the Centers for Medicare & Medicaid Services announced proposed rates that officials said could mean payment reductions of 1.9 percent for the private plans in the program.
Wide Price Variations Among Providers
Feb 25, 2014 By Eric Whitney
Coffee is important to many of us, but let’s say your coffee maker breaks. Finding a new one is as easy as typing “shop coffee maker” into your browser. Voila – you’ve got models, prices and customer reviews at your fingertips.
But say you need something less fun than a coffee maker, like a colonoscopy. Shopping for one of those is a lot harder. Actual prices for the procedure are almost impossible to find, and Bob Kershner said there's huge variation in cost from one clinic to the next.
Chronic Conditions Tackled With Varying Rates of Success
Feb 25, 2014 By Jordan Rau
Networks of doctors and hospitals set up under the Affordable Care Act to improve patients’ health and save money for Medicare are having varying rates of success in addressing their patients’ diabetes and heart disease, according to government data released Friday.
The release is the first public numbers from Medicare of how patient care is being affected by specific networks. These accountable care organizations, or ACOs, are among the most prominent of Medicare’s experiments in changing the ways physicians and health care facilities work together and are paid. The ACOs will be able to keep some of the money they save, but they also take on some of the financial risk if their patients end up being costly.
Technology Helping to Bridge The Gap
Feb 17, 2014 By Karen Bouffard
A new study shows more Michigan residents are depressed than those in other states, and mental health care workers are using telephone and video conferencing to reach out to patients in areas without psychiatric services.
Already overburdened with high case loads, mental health professionals statewide are expecting increased demand under the federal Affordable Care Act, which requires insurance companies to provide mental health coverage that is equal to what’s provided for physical-health conditions. Health advocates worry that the load will keep some patients from getting mental health care, despite their new benefits.
Many More Are Taking on Clinical Roles
Feb 17, 2014 By Anna Gorman
Jill Freedman felt like her heart was jumping out of her chest. She knew her blood pressure was too high and feared having a heart attack or a stroke.
"I was freaking out," said Freedman, 55. "You get very emotional when you think you could drop dead at any moment."
Numbers Topped 3 Million Through January
Feb 16, 2014 By Phil Galewitz
Nearly 3.3 million Americans have signed up for private health insurance plans since October through the online marketplaces created by the health law, with enrollment continuing to surge through January, an Obama administration report said last week.
But the number of young adults signing up continues to lag expectations, which could impact insurance premiums next year. Insurance industry officials have been closely watching the mix of customers to make sure they get enough healthy people to balance the cost of covering older Americans who generally require more medical care.
Some Midwesterners Price Out of Affordable Coverage
Feb 11, 2014 By Julie Appleby
The lure used to get uninsured Americans to sign up for health law coverage was the promise of generous premium subsidies.
But the promise comes with a catch for almost 3 million people earning between three and foutimes the federal poverty rate: They may have to pay up to 9.5 percent of their income toward that premium before the subsidy kicks in.
Many Offering Supplemental Plans
Feb 11, 2014 By Jay Hancock
Out-of-pocket medical costs grow for many Americans, the insurance industry is offering a way to help and, at the same time, expand its business: by selling supplemental policies that may fill the gaps for consumers.
Insurers are increasingly marketing these limited policies that pay cash after a hospital stay or specific disease diagnosis, such as cancer.
Lawmakers Could Take a Variety of Approaches
Feb 11, 2014 By Mary Agnes Cary
Now comes the hard part.
After negotiating for months over how to overhaul Medicare’s troubled payment system for physicians, the bipartisan leadership of three Senate and House committees has reached a deal on the policy. Their next task could be even harder – finding a way to finance repeal of the “doc fix,” the shorthand for the 1997 formula used to set physician payments, the sustainable growth rate (SGR).
Most Are Delineated by Race And Income
Feb 4, 2014 By Payers & Providers Staff
Despite having some of the best health indicators in the country, there remain some troubling gaps in outcomes in Minnesota, with most clearly delineated by race and income.
That's the conclusion of a new report by the Minnesota Department of Health submitted to the Legislature earlier this week. Lawmakers had requested the report to obtain more data about health inequities in the state. Department officials conducted interviews with more than 1,000 individuals at 180 different healthcare organizations statewide.
Variety of Market Factors Drive Up The Price
Feb 4, 2014 By Jordan Rau
If Lee Mullins lived in Pittsburgh, he could buy mid-level health coverage for his family for $940 a month. If he lived in Beverly Hills, he would pay $1,405.
But Mullins, who builds custom swimming pools, lives in Southwest Georgia. Here, a similar health plan for his family of four costs $2,654 a month.
They Only Want To Change Law Now, Not Eliminate It
Feb 4, 2014 By Eric Whitney
Some influential conservatives are now saying the healthcare law is too entrenched to repeal.
Take the U.S. Chamber of Commerce, the powerful business lobbying group. When the Affordable Care Act Passed in 2010, the Chamber got behind a major business lawsuit to fight it at the U.S. Supreme Court. And in January, 2011 during his annual State of American Business address, Chamber President Tom Donohue said, "It's time, in my opinion, to go back to the drawing board...and thus we support legislation in the House to repeal it."
More Than 350,000 Cases Are on Backlog
Jan 28, 2014 By Susan Jaffe
Medicare beneficiaries who have been waiting months and even years for a hearing on their appeals for coverage may soon get a break as their cases take top priority in an effort to remedy a massive backlog.
Nancy Griswold, the chief judge of the Office of Medicare Hearings and Appeals (OMHA), announced in a memo sent last month to more than 900 appellants and health care associations that her office has a backlog of nearly 357,000 claims. In response, she said, the agency has suspended acting on new requests for hearings filed by hospitals, doctors, nursing homes and other health care providers, which make up nearly 90 percent of the cases. She said that she expected the suspension would last about two years.
Billings Ballooned to Nearly $1 Million a Month
Jan 28, 2014 By Payers & Providers Staff
An Illinois attorney and part-owner of a hospice is facing criminal allegations that he overbilled the Medicare and Medicaid programs by as more than $20 million.
Prosecutors announced a single federal healthcare fraud charge against 46-year-old Seth Gillman, as well as a charge of obstructing a federal audit.
Exchange's Operation is Widely Dysfunctional
Jan 28, 2014 By Ron Shinkman
A new report has criticized the utility of Minnesota's health insurance exchange, saying it will fall short of enrollment goals and satisfying consumers trying to purchase coverage.
The MNSure exchange was built with $155 million in federal funds dispersed under the Affordable Care Act. It is one of 16 exchanges operated at the state level.