Families Unhappy About Changes In Funding
Oct 21, 2014 By Dave Ranney
Parents of adult children with developmental disabilities say state officials are breaking a provision in deliberations that led to legislators last year agreeing to include Medicaid-funded home- and community-based services for the developmentally disabled in the state’s KanCare program.
“I have one thing I want to say to the (Kansas) Department for Aging and Disability Services: ‘Liar, liar, pants on fire,’” said Susan Jarsulic, whose 35-year-old daughter, Jayne, has severe physical and developmental disabilities.
Rural Areas Are Leery of Law; Cities Embrace It
Oct 21, 2014 By Jordan Shapiro and Walter Moskop, St. Louis Post-Dispatch
Jasmin Maurer was among nearly 150,000 Missourians who signed up for insurance during the first open enrollment under President Barack Obama’s healthcare overhaul.
She hadn’t been insured since she graduated from college in 2008 and her mother lost her job — along with her employer-sponsored coverage. Now Maurer had insurance for about six months, and it’s completely changed how she thinks about her health.
More Insurers Capping What They Will Pay For Surgeries
Oct 21, 2014 By Michelle Andrews
Aiming to contain healthcare costs, a growing number of employers and insurers are adopting a strategy that limits how much they’ll pay for certain medical services such as knee replacements, lab tests and complex imaging. A recent study found that savings from such moves may be modest, however, and some experts question whether “reference pricing,” as it’s called, is good for consumers.
The California Public Employees’ Retirement System (CalPERS), which administers the health insurance benefits for 1.4 million state workers, retirees and their families, has one of the more established reference pricing systems.
Tied to Improving Fiscal Outlook
Oct 14, 2014 By Phil Galewitz
With an improving fiscal climate, many states are increasing benefits for Medicaid recipients and paying their providers more.
The trend is continuing into fiscal year 2015 for those who rely on Medicaid, the state and federal health insurance program for the poor, according to a survey of 50 state Medicaid programs released Tuesday by the Kaiser Family Foundation and the National Association of Medicaid Directors.
Kascich's Back-Door Plan Requires Reauthorization -- And Political Support
Oct 14, 2014 By Sarah Jane Tribble
A battle is brewing in Ohio.
University Hospitals Chief Executive Officer Tom Zenty warned a Cleveland audience that the state’s Medicaid expansion may not be permanent. “In July of next year, if there is no intervention, Medicaid expansion in the state of Ohio disappears,” Zenty said, during a recent panel discussion.
Would no Longer Contract With Private Companies to Serve Special Needs Patients
Oct 14, 2014 By Jim Mclean
Democratic gubernatorial candidate Paul Davis says if elected he will reverse Gov. Sam Brownback’s controversial decision to put the private companies managing the state’s Medicaid program in charge of delivering support services to Kansans with developmental disabilities.
Brownback, a conservative Republican seeking a second term, privatized the state’s $3 billion Medicaid program in 2013 and renamed it KanCare to achieve two – and some say conflicting – goals of improving care and reducing costs.
Cost of Hepatitis C Drug Renews Debate on America's Approach
Oct 7, 2014 By Michael Ollove
The new hepatitis C drug Sovaldi promises a cure rate of well over 90% compared to 45% (at best) for older drugs. But when Sovaldi went on the market earlier this year for as much as $84,000 for a single course of treatment, critics blasted the cost as “exorbitant” and “gouging.”
It is estimated that between 3.2 million and 5.2 million Americans have hepatitis C, an infectious illness that can eventually compromise the liver.
Medicare Increasing Penalties
Oct 7, 2014 By Jordan Rau
Medicare is fining a record number of hospitals – 2,610 – for having too many patients return within a month for additional treatments, federal records released Wednesday show. Even though the nation’s readmission rate is dropping, Medicare’s average fines will be higher, with 39 hospitals receiving the largest penalty allowed, including the nation’s oldest hospital, Pennsylvania Hospital in Philadelphia.
The federal government’s penalties, which begin their third year this month, are intended to jolt hospitals to pay attention to what happens to their patients after they leave. Around the country, many hospitals are replacing perfunctory discharge plans—such as giving patients paper instructions—with more active efforts, such as ensuring that outside doctors monitor their recoveries and giving supplies of medication to patients who may not be able to afford them. Others are still struggling to meet the new expectations. Before the program, some hospitals resisted such efforts because they weren’t paid for the services, and, in fact, benefited financially when a patient returned.
Will Monitor Rural Patients In Four Midwestern States
Oct 7, 2014 By Bryan Thompson
The University of Kansas Medical Center will receive $10 million in federal funding to compare the effectiveness of obesity treatment models in rural communities.
The money is from the Patient-Centered Outcomes Research Institute, which was created through the Affordable Care Act. Professor Christie Befort's study will track approximately 1,400 patients in rural Kansas, Nebraska, Iowa and Wisconsin.
Practice is Controversial in Other States
Sep 30, 2014 By Jenni Bergal
Over the years, Illinois Attorney General Lisa Madigan has consistently heard “horror stories” about the abuse or neglect of nursing home residents. Now she is trying to bring such cruelty out of the shadows and into clear view.
Madigan’s office is drafting legislation, likely to be introduced in 2015, which would allow Illinois nursing home residents and their families to place cameras in their rooms to help protect them.
ACA Credited With Dramatic Reduction
Sep 30, 2014 By Mary Agnes Carey
Hospitals are projected to save $5.7 billion this year as previously uninsured patients gain coverage through the 2010 healthcare law, the Department of Health and Human Services said last week.
States that have expanded their Medicaid programs will see about 74% of those savings, an HHS report said. While 27 states and Washington, D.C. have expanded the federal-state insurance program for the poor to date, the survey was done when 25 states and D.C. had done so.
Some Say it Was Intentional; Others Believe it Was an Error
Sep 30, 2014 By Jay Hancock
Lance Schnider is confident Obamacare regulators knew exactly what they were doing when they created an online calculator that gives a green light to new employer coverage without hospital benefits.
“There’s not a glitch in this system,” said Shnider, president of Voluntary Benefits Agency, an Ohio firm working with some 100 employers to implement such plans. “This is the way the calculator was designed.”
Studies Show Huge Variations in Utilization by Region
Sep 23, 2014 By Michael Ollove
Several years ago, a California study showed that a half-dozen elective surgeries were being performed far more often in Humboldt County than they were in the rest of the state. The procedures included hip and knee replacements, hysterectomies and carotid endarterectomies, a surgery to remove plaque buildup in the carotid arteries.
Geographical variation in the delivery of healthcare can harm patients and increase costs. That is especially true when it comes to surgery, which is usually more expensive and riskier than less invasive treatments. Medicaid makes up a huge portion of state budgets, so the issue of healthcare variation is a pressing one for states looking to hold down costs.
Rates Insurers Pay Providers Mostly Kept From Public
Sep 23, 2014 By Julie Appleby
When Anthem Blue Cross Blue Shield became embroiled in a contract dispute with Exeter Hospital in N.H. in 2010, its negotiators came to the table armed with a new weapon: public data showing the hospital was one of the most expensive in the state for some services.
Local media covering the dispute also spotlighted the hospital’s higher costs, using public data from a state website.
Wellmark's Refusal to Enter Exchange Depresses Enrollment
Sep 23, 2014 By Pauline Bartilone
Here’s a health law pop quiz: Which two states have the least successful Obamacare health insurance exchanges?
You may guess a state in the Deep South where political opposition to the law is fierce. Or maybe Missouri? It passed a state law saying consumer advisors funded by the Affordable Care Act aren’t allowed to advise consumers.
Rate Fell 10 Percent in a Year
Sep 16, 2014 By Jordan Rau
The federal government’s first survey of the nation’s insured rate since the health care law’s new marketplaces began found a decrease in the number of adults without coverage, particularly among young adults.
The National Health Interview Survey of people during the first three months of this year found that the number of adults under 65 without health insurance dropped to 18.4% from 20.4% in 2013.
Attempts to Sidestep Law May Mislead Consumers
Sep 16, 2014 By Michelle Andrews
For decades, states have set rules for health coverage through mandates, laws that require insurers to cover specific types of medical care or services. The health law contains provisions aimed at curbing this piecemeal approach to coverage. States, however, continue to pass new mandates, but with a twist: Now they’re adding language to sidestep the health law, making it tougher than ever for consumers to know whether they’re covered or not.
Avera Health Provides Low Cost Service For Emergency Care
Sep 16, 2014 By Jim Mclean
A new nurse was on duty a few weeks ago in the emergency room at the Phillips County Hospital when paramedics arrived with a critically injured patient.
She immediately pushed the red button on some newly installed equipment. Seconds later, a seasoned ER nurse and board-certified doctor sitting at a bank of monitors 380 miles away in Sioux Falls, S.D., were using a high-definition camera and other diagnostic equipment to monitor the patient, give advice and document everything the on-site nurse was doing to save the patient’s life.
Providers in Iowa, Kansas and Ohio Get Grants
Sep 9, 2014 By Phil Galewitz
Data From Kansas, Missouri Suggests Drug Companies May Be Gaming Medicare
Sep 9, 2014 By Mike Sherry
Spritzing perfume is how Judy Johnson realized her eyesight had gone bad.
At one point, diabetes had worsened her vision so much that the 69-year-old Lansing resident had to squirt out a puff of her favorite scent just to find the opening in the mister.
Created in Midwest, Its Patient-Centered Approach Dovetails With ACA
Sep 9, 2014 By Michael Ollove
Recent reforms in American healthcare weren’t designed with osteopathic medicine in mind. It only seems that way.
The emphasis on “patient-centered care”—the idea that physicians should follow the wishes and preferences of patients, and treat patients holistically, rather than just treating their symptoms—have been the hallmarks of osteopathic medicine since its founding in the 19th century by a frontier doctor.
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.