Midwest Healthcare News Jan 28, 2015

Midwest Healthcare News

  • KanCare Contractors Say Most Problems Are Now Fixed

    Billing, Claims Glitches Addressed

    Jan 27, 2015 By Dave Ranney


    Chief executives with the managed care companies charged with running the state’s Medicaid program on Friday assured a legislative oversight committee that they’ve fixed most of the new system’s operational problems.

    “We feel very good about our performance,” said Tim Spilker, health plan chief executive officer with UnitedHealthcare. Testifying during a meeting of the Robert G. Bethell Joint Committee on Home and Community Based Services and KanCare Oversight, Spilker said consumer satisfaction surveys and claims and payment data show that the company is meeting national performance standards.

  • Indiana's Ortho Industry Unfazed By Medical Device Tax

    Growth And Hiring Still Booming

    Jan 27, 2015 By Julie Appleby


    Tom Till eyed the morning’s email to see who’s angling to hire his students: A local employer, which had already hired 23 people in less than a year, says it needs three more to help make the artificial hips, knees and other devices manufactured here in the self-proclaimed “Orthopedic Capital of the World.”

    “Everyone is going gangbusters,” said Till, who oversees an advanced manufacturing program at Ivy Tech Community College in this lake-dotted region two hours north of Indianapolis.

  • Cleveland Hospitals Struggle With Medicare Penalties

    Many Facilities Still Unable to Craft Appropriate Programs to Boost Quality

    Jan 27, 2015 By Sarah Jane Tribble


    At the Cleveland Clinic’s sprawling main campus, patient Morgan Clay is being discharged.

    Clay arrived a couple of weeks ago suffering from complications related to acute heart failure. He’s ready to go home. But before Clay can leave, pharmacist Katie Greenlee stops by the room.

  • Federal Informed Consent Proposal Stirs Controversy

    Healthcare Groups Think Overreach Would Stifle Medical Innovation

    Jan 20, 2015 By Shefali Luthra


    A patient plagued with difficult-to-control asthma is at the end of his rope, until his doctor suggests joining a clinical trial. He’s no longer just a patient but also a research subject, and he’ll be testing one existing treatment approach while others stay on a different therapy. These kinds of studies are the bedrock of medical science – they ensure that medicines and procedures are safe and effective.

    Before agreeing, he needs to know what he’s getting himself into – the potential benefits and harms, known as “informed consent.”

  • Iowa Insurance Co-Op Implodes

    CoOportunity Health Battered By Adverse Selection, Lack of Exchange Competiton

    Jan 20, 2015 By Clay Masters


    It was a heck of a Christmas for David Fairchild and his wife, Clara Peterson. They found out they were about to lose their new health insurance.

    “Clara was listening to the news on Iowa Public Radio and that’s how we found out,” Fairchild said. They went to their health plan’s website that night. “No information. We still haven’t gotten a letter about it from them.”

  • Kansas Tweaks Medicaid As Part of Budget

    Fees on Managed Care Companies Raised to Close Gap

    Jan 20, 2015 By Andy Marso


    Gov. Sam Brownback’s administration outlined a sweeping budget plan last week that includes changes to Medicaid and increases in the state’s tobacco and alcohol taxes.

    Budget Director Shawn Sullivan said closing a $650 million budget gap will require new tax revenue and slowed expenses in the state’s “three major cost drivers”: public schools, public employee pensions and Medicaid.

  • Medicaid Programs Straining To Meet Needs Of New Enrollees

    Many Have Untreated Chronic Diseases

    Jan 13, 2015 By Christine Vestal


    Under the Affordable Care Act, millions of low-income adults last year became eligible for Medicaid and subsidized health insurance for the first time. Now states face a huge challenge: how to deal with an onslaught of able-bodied, 18- to 64-year olds who haven’t seen a doctor in years.

    “It took a lot of time and effort to enroll everyone, particularly those who were new to the system,” said Matt Salo, director of the National Association of Medicaid Directors. “The next big step, and the biggest unknown, is finding out exactly how this newly insured population will use the health care system.”

  • Rural Doctor Launches Palliative Care Startup

    Focuses on House Calls, Personal Touch

    Jan 13, 2015 By April Dembosky


    Michael Fratkin, M.D., is getting a ride to work today from a friend.

    “It’s an old plane. Her name’s ‘Thumper,'” said pilot Mark Harris, as he revs the engine of the tiny 1957 Cessna 182.

  • Kansas, Missouri Still Debating Medicaid Expansion

    Stance Appears to Have Softened Little

    Jan 13, 2015 By Jim Mclean


    Several red-state governors have dropped their opposition to Medicaid expansion in recent months and are pursuing ways to use federal dollars to fund their own more conservative plans. Whether that occurs in Kansas and neighborhing Missouri remains to be seen.

    Governors in the solidly red states of Utah, Wyoming, Montana and Tennessee are pursuing expansion options that seek to use billions in additional federal Medicaid dollars to help low-income adults purchase private coverage or create health savings accounts. Many of the proposals, which require federal approval, also include incentives aimed at helping recipients get better jobs so that they can purchase their own coverage without government assistance.

  • HCA's Midwest Hospitals Get Big Medicare Penalties

    Dinged on Quality of Care Issues

    Jan 6, 2015 By Andy Marso


    A spokesperson for Kansas City's largest hospital system defended its record on patient safety following an announcement last month that more than half its facilities are among those to be penalized by the federal government for hospital acquired ailments.

    A total of 721 hospitals nationwide will lose 1% of their Medicare reimbursements in fiscal year 2015 because they scored poorly in federal metrics that measure the prevalence of conditions like urinary tract infections, central line infections and other complications patients acquire while in the hospital.

  • Jury Is Still Out On Innovations From The ACA

    Determining Impact of ACOs, Other Developments Could Take Years

    Jan 6, 2015 By Jay Hancock


    The health law’s ambitious lab for transforming how medicine is delivered and financed submitted its official report card to Congress late last month, boasting of a few early results but mostly showing many works in progress.

    If you’re covered by Medicare, Medicaid or even private insurance, there’s a decent chance you’re part of one of the Department of Health and Human Services’ tests to improve care and control costs.

  • Medicaid Cuts For Primary Care Doctors Take Effect

    Michigan Sees 50% Reduction

    Jan 6, 2015 By Phil Galewitz


    Andy Pasternak, M.D., a family doctor in Reno, Nev., has seen more than 100 new Medicaid patients this year after the state expanded the insurance program under the Affordable Care Act.

    But he won’t be taking any new ones after Dec. 31. That’s when the law’s two-year pay raise for primary care doctors like him who see Medicaid patients expires, resulting in fee reductions of 43% on average across the country, according to the nonpartisan Urban Institute.

  • Mixed Bag For State Mental Health Funding

    Much of it Tied To Medicaid Expansion

    Dec 16, 2014 By Michael Ollove


    Fewer states increased their spending on mental health programs this year compared to last year, when a spate of horrific shootings by assailants with histories of mental illness prompted a greater focus on the shortcomings of the country’s mental health system.

    Some states slashed their mental health budgets significantly this year. At the same time, however, a number of states adopted mental health measures in 2014 that won plaudits from behavioral health advocates.

  • Will Non-Profit Co-Ops Shake Up Health Insurance Exchanges?

    Their Low Premiums Are Attracting Growing Number of Enrollees

    Dec 16, 2014 By Phil Galewitz


    When Anna Duleep went shopping recently for 2015 health coverage on the Connecticut insurance exchange, she was pleasantly surprised to find a less expensive plan.

    To get the savings, the substitute math teacher had to change from for-profit giant Anthem Blue Cross and Blue Shield to a fledgling carrier she’d never heard of. Still, Duleep, 37, liked saving $10 on her monthly premium of about $400 and knowing that her new plan, HealthyCT, is a nonprofit governed by consumers. She also liked that all her doctors participate. “I just figured, ‘why not change?’” she said.

  • Missouri Lawmakers Move To Block ACA

    Proposal to Gut Subsidy Floated

    Dec 16, 2014 By Jordan Shapiro, St. Louis Post-Dispatch


    It’s been nearly five years since President Barack Obama’s healthcare overhaul was passed by Congress, but it remains a target of conservative state lawmakers intent on blocking the law.

    In Missouri, the most recent attempt was introduced last week by Republican Senator-elect Bob Onder, M.D., a physician from St. Charles. Onder’s bill would suspend a health insurance company’s license to sell policies in Missouri if it accepts federal subsidies for policies sold through the federally run marketplace.

  • Plan To Improve Kansas City's Healthiness Approved

    Will Provide More Green Space, Better Food Options

    Dec 9, 2014 By Jim Mclean


    A multimillion-dollar plan to transform Kansas City, Kan.'s downtown into a national model is one step closer to reality.

    The Unified Government Board of Commissioners last week unanimously approved a new master development plan designed to help improve the health of Kansas City and other Wyandotte County residents by providing a state-of-the-art community center, more green space in which to exercise and access to healthy foods at a 30,000- to 35,000-square-foot urban grocery store.

  • The ACA Is Creating A Federal Contracting Boom

    Defense Companies Among Those Cashing In

    Dec 9, 2014 By Jay Hancock


    Two years ago General Dynamics, one of the biggest federal contractors, reported a quarterly loss of $2 billion. An “eye-watering” result, one analyst called it.

    Diminishing wars and plunging defense spending had slashed the weapons maker’s revenue and left some subsidiaries worth far less than it had paid for them. But the company was already pushing in a new direction.

  • States Taking Steps Toward Cutting Medicaid Super-utilizers

    Missouri, Wisconsin, Ohio among the leaders

    Dec 9, 2014 By Michael Ollove


    In health policy circles, they are called “super-utilizers,” but the name isn’t meant to connote any special powers. Just the opposite.

    They are people whose complex medical problems make them disproportionately heavy users of expensive health care services, particularly emergency room treatment and in-patient hospitalizations. The cost of treating them is huge: Just 5% of Medicaid’s 68 million beneficiaries account for 60% of the overall spending on the program.

  • More Than 230,000 New Enrollees Reported

    Big Improvement Over First Week of 2013 Enrollment

    Dec 2, 2014 By Mary Agnes Carey


    Federal officials said today that during the first week of open enrollment for the health law’s online marketplaces, 462,125 people selected health plans, with just over half of those return customers.

  • Minnesota Using Health Disparities To Drive Other Policy Changes

    Wage And Environmental Issues Tied to Medical Quality of Life For State's Residents

    Dec 2, 2014 By Michael Ollove


    For years, proposals to raise the minimum wage in Minnesota bogged down over economic concerns: Would a raise impel businesses to leave the state? Would it decrease employment? Would it touch off inflation?

    The supporters’ main argument, that raising the minimum wage would put more money into the pockets of low-wage workers and their families, fell short.

  • Kansas Safety Net Organizations Seeking Federal Money To Open Clinics

    At Least Six Have Applied For HHS Funding

    Dec 2, 2014 By Bryan Thompson


    Even with the Affordable Care Act, millions of Americans still lack health insurance. For them, safety net clinics are a lifeline. These clinics provide primary care for anyone, regardless of their ability to pay. Today there are federally funded clinics in 21 Kansas counties, but there soon could be more.

    At least six organizations in Kansas are asking the U.S. Department of Health and Human Services for grants to open new clinics. GraceMed, in Wichita, is asking for $650,000 for a new clinic on the south side of the city. Chief Executive Officer David Sanford said that region of the state’s largest city is underserved.

  • Public Health Funding Cuts Strains Ebola Preparedness

    Fiscal Reality Clashes With Quarantine Orders

    Nov 18, 2014 By Christine Vestal


    Dwindling resources may make it difficult for public health departments across the country to carry out intensive airport screenings, patient monitoring, public education and other preparations for a potential Ebola outbreak in the U.S.

    Since 2008, diminishing federal funding for public health preparedness has meant the loss of 51,000 state and local public health jobs – more than one in five, according to a new survey by the Association of State and Territorial Health Officials.

  • Two KC-Area Firms Won't Have To Provide Contraceptive Coverage

    Companies Received Exemption Under Hobby Lobby Ruling

    Nov 18, 2014 By Dan Margoiles


    Two Kansas City-area companies that challenged the Affordable Care Act’s so-called contraception mandate won’t be required to cover birth control as part of their employees’ health care plans.

    Citing the U.S. Supreme Court’s Hobby Lobby decision, Senior U.S. District Judge Ortrie Smith on Wednesday barred federal officials from enforcing the requirement against Randy Reed Automotive Inc. and Sioux Chief Manufacturing Co.

  • New Enrollment Period Starts With Few Glitches

    9 Million Expected to Sign Up; Bad Weather in Midwest an Issue

    Nov 18, 2014 By Anna Gorman and Phil Galewitz


    A Los Angeles furniture store worker who had never had health insurance enrolled in a plan for $75 a month that will cover both him and his son.

    An unemployed accountant in Charlotte, N.C., who tried and failed to sign up last year found coverage for $11.75 a month.

  • Private Investment In Public Health Initiatives Taking Root

    Investors Get Paid A Return if Initiatives Succeed

    Nov 4, 2014 By Michael Ollove


    South Carolina is turning to an unusual source to finance a new program intended to reduce the state’s high rate of premature births: private investors.

    If the program succeeds in slicing that rate among Medicaid beneficiaries and reduces state spending as a result, South Carolina will repay the principal plus a healthy, yet-to-be determined rate of return. If the program doesn’t meet expectations, the state will owe the investors less or even nothing at all.

  • Home Care Workers Are Struggling To Get More Pay

    Organizing Has Been Sporadic At Best

    Nov 4, 2014 By Sarah Jane Tribble


    Holly Dawson believes her job is a calling.

    She is one of about 2 million home care workers in the country. The jobs come with long hours and low pay.

    Each workday, Dawson drives through the Cleveland suburbs to help people take their medicines, bathe and do the dishes. She also takes time to lend a sympathetic ear.

  • Obama Administration Plans To Close Hospitalization Loophole

    Large Group Plans Will Be Mandated to Provide Inpatient Coverage

    Nov 4, 2014 By Jay Hancock


    Moving to close what many see as a major loophole in Affordable Care Act rules, the Obama administration will ban large-employer medical plans from qualifying under the law if they don’t offer hospitalization coverage.

    The administration intends to disallow plans that “fail to provide substantial coverage for in-patient hospitalization services or for physician services,” the Treasury Department said in a notice Tuesday morning. It will issue final regulations banning such insurance next year, it said.


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