Congress Mulling Proposals
Mar 24, 2015 By Mary Agnes Carey
It’s make-or-break time for a Medicare “doc fix” replacement.
The House is likely to vote this week on a proposal to scrap Medicare’s troubled physician payment formula, just days before a March 31 deadline when doctors who treat Medicare patients will see a 21% payment cut. Senate action could come this week as well, but probably not until the chamber completes a lengthy series of votes on the GOP’s fiscal 2016 budget package.
Legislature Seems Unwilling to Move Forward
Mar 24, 2015 By Jim Mclean
The recent legislative hearings on Medicaid expansion brought representatives from dozens of powerful groups to the Statehouse.
Lobbyists representing hospitals, doctors and some big businesses pleaded with members of the House Health and Human Services Committee to approve an expansion proposal one day. The next, representatives of conservative, anti-tax organizations urged committee members to continue to say ‘no’ to expansion, despite the billions of additional federal dollars it would inject into the Kansas economy.
Coverage Mostly Remained Unchanged Last Year
Mar 24, 2015 By Michelle Andrews
There has been much hand wringing over the health law requirement that large employers this year offer insurance to workers who put in 30 or more hours a week or face penalties for not doing so. The new rules would cost employers a bundle, some fretted, as part-timers clamored for company coverage previously unavailable to them. Others worried that employers would cut workers’ hours to get under the cap.
Agree to Grace Period Regarding Disputed Bills
Mar 17, 2015 By Michelle Andrews
Too many consumers have learned the hard way that their credit rating can be tarnished by medical bills they may not owe or when disputes delay insurer payment. That should change under a new policy agreed to this week by the three major credit reporting agencies.
Nixon Says Benefits Should Be Tied To Work
Mar 17, 2015 By Jordan Shapiro
Missouri Gov. Jay Nixon last week said he was willing to work with Republicans on a plan to expand the state’s Medicaid program and even offered endorsements for conservative ideas that have drawn reproach from some health advocates.
Speaking at a career center in Springfield, Mo., the Democratic governor said he would support a proposal to require Medicaid recipients to work or pay more for their government-funded health insurance if it meant more people could enroll in the program.
Missouri, Kansas Numbers Way Up
Mar 17, 2015 By Alex Smith
Twice as many Kansans and Missourians signed up for health insurance this year under the Affordable Care Act compared with the first enrollment period last year, new figures released last week show.
Scripps Mercy, Rady Join Forces on Community Benefit
Mar 12, 2015 By Payers & Providers Staff
Two San Diego hospitals have collaborated on creating an unusual community health benefit: Communal meals.
Scripps Mercy Hospital and Rady Children's Hospital have created what is known as the “Teaching Kitchen,” a program intended to educate low-income residents of the San Diego area regarding better food and lifestyle choices.
Missouri System Makes Great Strides, But Others At a Loss
Mar 10, 2015 By Jordan Rau
Lillie Robinson came to Rowan Medical Center in North Carolina for surgery on her left foot. She expected to be in and out in a day, returning weeks later for her surgeon to operate on the other foot.
But that’s not how things turned out. “When I got here I found out he was doing both,” she said. “We didn’t realize that until they started medicating me for the procedure.” Robinson signed a consent form and the operation went fine, but she was told she would be in the hospital far longer than she had expected.
“I wasn’t prepared for that,” she said.
Indiana, Missouri, Ohio Would Jumpstart Process if There's an Adverse Ruling From The Supreme Court
Mar 10, 2015 By Christine Vestal
The Obama administration says it does not have a contingency plan if the U.S. Supreme Court rules against federal tax subsidies in King v. Burwell. But lawmakers in at least nine states are proposing backstop measures that legal experts say could work.
At issue is whether residents of the 34 states where the federal government runs the health insurance exchange under the Affordable Care Act can receive premium tax subsidies. Affordable Care Act opponents argue that a strict interpretation of the language in the statute indicates people can only receive federal subsidies if they purchase policies on an “exchange established by the state.”
Tells Lawmakers He Would Sign Bill
Mar 10, 2015 By Jim Mclean
News that Gov. Sam Brownback has softened his position on Medicaid expansion wasn’t exactly racing through the Statehouse on Thursday. But it certainly had some legislators buzzing.
In remarks last week to conservative lawmakers in Missouri, Brownback said if the Kansas Legislature presented him with a budget-neutral expansion bill, he would likely sign it, according to a report in the Missouri Times.
Even if They Remain, Millions Would Be Ineligible For Coverage
Mar 3, 2015 By Tim Henderson
President Barack Obama’s controversial executive action on immigration has highlighted a thorny health care issue for states: Potentially millions of immigrants could legally stay here and work, but still lack health insurance.
Unauthorized immigrants have limited access to health care coverage, and the president’s action likely will make them ineligible for most Medicaid services and bar them from purchasing insurance on the federal and state exchanges created under the Affordable Care Act (ACA).
Claims Funds Were Misappropriated
Mar 3, 2015 By Phil Galewitz
In their latest attack on the Affordable Care Act, House Republicans question why the Obama administration transferred money last year from the National Institutes of Health and the Centers for Disease Control and Prevention to pay for the operation of the federal health insurance marketplace.
“Now it appears that we are robbing Peter to pay Paul in order to finance the disaster that is healthcare.gov,” said Rep. Jody Hice, a Republican congressman from suburban Atlanta.
As Argument is Heard This Week, Many Fear Losing Their Subsidies
Mar 3, 2015 By Sarah Varney
It’s been a bitterly cold winter in the Blue Ridge Mountains for Julia Raye and her 13-year-old son, Charles. But despite the punishing weather, 2015 has been looking good: Raye is finally able to afford insulin and the other medications she needs to keep her diabetes under control.
She’s a self-employed auditor who relies on a $400 per month government subsidy to afford the private health plan she bought on healthcare.gov, the online federal marketplace for health insurance.
Missouri, Kansas Hard Hit
Feb 24, 2015 By Dan Margoiles
More than 389,000 Kansans and nearly 2 million Missourians were affected by last month’s massive cyberattack on Anthem Inc., the nation’s second largest health insurer, figures released by the company show.
“This data breach is so far-reaching that it impacts nearly one-third of our state’s population,” Missouri Department of Insurance Director John M. Huff said in a statement Monday.
Study Suggests They Can See Through Superficial Efforts to Impress
Feb 24, 2015 By Jordan Rau
The sleek hospital tower that Johns Hopkins Medicine built in 2012 has the frills of a luxury hotel, including a meditation garden, 500 works of art, free wi-fi and a library of books, games and audio.
As Zishan Siddiqui, M.D., watched patients and some fellow physicians in Baltimore move from their decades-old building into the Sheikh Zayed Tower, the internist saw a rare opportunity to test a widespread assumption in the hospital industry: that patients rate their care more highly when it is given in a nicer place.
Some Midwest Providers Devise Other Strategies
Feb 24, 2015 By Michael Ollove
Nearly half the states use higher copayments to dissuade Medicaid recipients from unnecessary visits to emergency rooms, where care is more costly.
These states require patients to make the payments, which are as high as $30 per visit in Oklahoma, when it is later determined that they did not experience a true medical emergency.
CMS Said Changes Could Bump Down Many Facilities
Feb 17, 2015 By Julie Appleby
Starting immediately, the federal government is making it harder for nursing homes to get top grades on a public report card, in part by increasing scrutiny of their use of anti-psychotic drugs and raising the bar on an array of quality measures.
Those grades – in the form of one- to five-star ratings – are part of Nursing Home Compare, a government website to help consumers evaluate nursing homes.
Would Give Brownback Leeway to Pursue Options Without Legislature
Feb 17, 2015 By Jim Mclean
Now there are three.
Medicaid expansion bills, that is.
After months of behind-the-scenes negotiations with legislators and members of Gov. Sam Brownback’s administration, the Kansas Hospital Association has introduced its expansion bill.
Medicaid expenditures hit
Feb 17, 2015 By Maria Schiff
For the first time in several years, state and local government health care spending grew relatively slowly in 2013—increasing by 3.2%, according to the latest data from the Centers for Medicare & Medicaid Services (CMS), a unit of the U.S. Department of Health and Human Services. In 2011 and 2012, this spending grew by 9.3% and 6.3%, respectively.
Suggesting More Coverage Be Made More Palatable to Middle Class
Feb 10, 2015 By Julie Rovner
“Repeal and replace” has been the rallying cry for Republicans since the Affordable Care Act was signed into law in 2010. But now that most of the law’s provisions have taken effect, some health experts are pitching ways to improve it, rather than eliminate it.
An ideologically diverse panel at the National Health Policy Conference Monday presented somewhat different lists of ideas to make the law work better. But they all agreed on one thing: The Affordable Care Act is too complicated.
That Group Would Lost Most From an Adverse Supreme Court Decision
Feb 10, 2015 By Michael Ollove
If the U.S. Supreme Court strikes down tax credits for people buying health insurance on the federal exchange, about 8.2 million Americans in 34 states could lose their coverage under the Affordable Care Act. Most of the people likely to be affected are white, employed, and low- to middle-class. They also are concentrated in a single region of the country: the South.
Health insurance rates in those states are expected to rise by as much as 35%, which may make coverage unaffordable even for those who don’t qualify for tax credits. Some believe that if the tax credits are disallowed by the Supreme Court, the underpinnings of President Barack Obama’s signature health care law would collapse.
Would Pivot on Hospital Bed Tax
Feb 10, 2015 By Andy Marso
An alternative plan to expand Medicaid loaded with elements meant to woo Republicans has been introduced in Kansas. But it could face the same difficult political climate that killed similar bills in other states last week.
Rep. Tom Sloan said Monday that the proposal introduced by the Vision 2020 Committee he chairs represents a Kansas solution that can appeal even to those who campaigned on unwavering opposition to the federal health care reforms spearheaded by President Barack Obama.
Two Big Projects Have Not Yielded Great Results
Feb 3, 2015 By Jay Hancock
Medical homes are a simple, compelling idea: Give primary-care doctors resources to reduce preventable medical crises for diabetics, asthmatics and others with chronic illness — reducing hospital visits, improving lives and saving money.
But it’s not so easy in practice.
May Lead Rush of New States Toward Expansion
Feb 3, 2015 By Christine Vestal
The federal government has approved Indiana’s plan to expand Medicaid under the Affordable Care Act, increasing the number of expansion states to 28, plus the District of Columbia. With enrollment starting Feb. 1, Indiana’s plan could add an estimated 350,000 low-income adults to the nearly 5 million expected to enroll in the 27 states that expanded Medicaid last year.
In accepting Indiana’s plan, the Obama administration demonstrated its determination to increase the number of expansion states, even if it means waiving traditional Medicaid rules. For example, under Indiana’s plan, people with incomes above the federal poverty level ($11,670 for an individual) must contribute to a health savings account or be locked out of coverage for six months.
New Study Shows Issues From 1990s Still in Place
Feb 3, 2015 By Jenny Gold
It’s been more than 15 years since the Institute of Medicine released its seminal 1997 report detailing the suffering many Americans experience at the end of life and offering sweeping recommendations on how to improve care.
So has dying in America gotten any less painful?
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.
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.
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.
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.”
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.”
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.
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.”
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.
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.
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.
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.
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.