Spends $103 Billion a year
May 5, 2015 By Jordan Rau
The federal government popped the cap off drug spending last week, detailing doctor-by-doctor and drug-by-drug how Medicare and its beneficiaries spent $103 billion on pharmaceuticals in 2013.
The data show that 14 drugs cost the federal government and Medicare beneficiaries more than $1 billion each, accounting for nearly a quarter of Medicare prescription drug spending in 2013. Most of those drugs are used to treat chronic conditions that plague the elderly, including diabetes, depression, high cholesterol and blood pressure, dementia and asthma.
Kansas Among States to be Impacted
May 5, 2015 By Christine Vestal
The federal government is quietly warning states that failure to expand Medicaid under the Affordable Care Act could imperil billions in federal subsidies for hospitals and doctors who care for the poor.
In an April 14 letter to Florida Medicaid director Justin Senior, Vikki Wachino, acting director of the Centers for Medicare & Medicaid Services (CMS) wrote: “Uncompensated care pool funding should not pay for costs that would be covered in a Medicaid expansion.”
Uniform Surveys Still Not Available
May 5, 2015 By Andy Marso
Andrea Duarte-Rambo, a short, dark-haired woman from Johnson County, walked to the podium and commanded the attention of a full legislative hearing room as she began talking about her son’s traumatic brain injury.
Her son’s brothers hid the injury for fear of getting in trouble, Duarte-Rambo said. His undiagnosed condition led to unexplained mood swings and violent behavior, multiple inconclusive MRIs, treatment with antipsychotic medications that actually worsened his symptoms and a couple of trips to jail.
Facilities in Kansas Hit Hard
Apr 28, 2015 By Bryan Thompson
There are a lot of small, rural hospitals in Kansas. Without them, many Kansans would have to travel long distances for care. What’s more, in many small towns, the hospital is one of the largest employers — making it vital to the local economy.
But declining populations, combined with changes in the way hospitals are paid for their services, are making it more difficult for many small hospitals to survive.
Feds Want to Ratchet Down on Hospital Funding For Indigent
Apr 28, 2015 By Phil Galewitz
Add Tennessee and Kansas to the list of states that have been warned by the Obama administration that failing to expand Medicaid under the Affordable Care Act could jeopardize special funding to pay hospitals and doctors for treating the poor.
The Centers for Medicare & Medicaid Services confirmed last week that it gave officials in those states the same message that had been delivered to Texas and Florida about the risk to funding for so-called “uncompensated care pools” — Medicaid money that helps pay the cost of care for the uninsured.
Drug is More Deadly Than Oxycodone
Apr 28, 2015 By Christine Vestal
As prescription drug overdose deaths soar nationwide, most states have failed to take a simple step that would make it harder for doctors to prescribe the deadliest of all narcotics.
Methadone overdoses kill about 5,000 people every year, six times as many as in the late 1990s, when it was prescribed almost exclusively for use in hospitals and addiction clinics where it is tightly controlled. It is four times as likely to cause an overdose death as oxycodone, and more than twice as likely as morphine. In addition, experts say it is the most addictive of all opiates.
But Serco Employees Also Reported Much Idle Time
Apr 21, 2015 By Chuck Raasch
The contractor who runs the Affordable Care Act application processing facility in Wentzville paid more than 13,000 hours of overtime to catch up with a backlog created by computer problems after the initial sign-up period, according to documents obtained under the Freedom of Information Act.
From May 1 through Aug. 15 last year, workers in the Wentzville facility logged 13,228.25 hours of overtime to process “backlogged inconsistency work,” according to a report by Serco Inc., the contractor running the facility for the federal Centers for Medicare & Medicaid Services, or CMS.
Causes Unrealistic Expectations Regarding Ability to Pay Bills
Apr 21, 2015 By Jordan Rau
Despite the government’s push to make health information more available, few people use concrete information about doctors or hospitals to obtain better care at lower prices, according to a poll released Tuesday.
Prices for the healthcare industry have historically been concealed and convoluted, unlike those for most other businesses.
Extra Money Helps Preserve Provider Network
Apr 21, 2015 By Michael Ollove
Fifteen states are betting they can convince more doctors to accept the growing number of patients covered by Medicaid with a simple incentive: more money.
The Affordable Care Act gave states federal dollars to raise Medicaid reimbursement rates for primary care services—but only temporarily. The federal spigot ran dry on Jan. 1. Fearing that lowering the rates would exacerbate the shortage of primary care doctors willing to accept patients on Medicaid, the 15 states are dipping into their own coffers to continue to pay the doctors more.
St. Elizabeth's in East St. Louis Among Those Wanting to Move
Apr 14, 2015 By Phil Galewitz
Nearly as old as the railroad that slices through this southern Illinois city just east of the Mississippi River, St. Elizabeth’s Hospital has been a downtown bedrock since 1875.
Started by three nuns from a Franciscan order in Germany, the Catholic hospital still seeks “to embody Christ’s healing love” to the sick, the aged and the poor, according to its mission statement. It is so tied to the city that when the local economy slumped in 2009, the nonprofit St. Elizabeth’s gave $20 to every employee to spend on Main Street, sending hundreds of shoppers out to the mostly mom- and pop-owned stores.
Could Wind Up Curtailing Services to Those in Need
Apr 14, 2015 By Wes Venteicher
In the years before he started receiving consistent treatment for bipolar disorder, Illinois Medicaid patient Rome Tucker says he often was homeless, riding buses through the night.
When he felt overwhelmed, Tucker often checked into Chicago-area hospitals for days at a time. The hospitals provided structure, support and medicine but at a high price: Tucker’s 16 hospital visits in 2012 cost about $50,000, according to IlliniCare Health, the Medicaid managed care organization that insures him.
Michigan Gained New Revenue
Apr 14, 2015 By Andy Marso
As a legislative session focused on the Kansas budget problems winds to a close with no decision on Medicaid expansion, a new study says some states that have expanded eligibility have seen their budget situations improve.
And Many May Not Be Financially Prepared to Compete
Apr 7, 2015 By Jordan Rau
Michael Kitchell, M.D., initially welcomed the federal government’s new quality incentives for doctors. His medical group in Iowa has always scored better than most in the quality reports that Medicare has provided doctors in recent years, he said.
But when the government launched a new payment system that will soon apply to all physicians who accept Medicare, Kitchell’s McFarland Clinic in Ames didn’t win a bonus. In fact, there are few winners: out of 1,010 large physician groups that the government evaluated, just 14 are getting payment increases this year, according to Medicare.
Many Hospitals In Region Focused on Oncology
Apr 7, 2015 By Mike Sherry
The 40-mile stretch of highway between Olathe and Liberty, Mo., is a key artery in the region’s healthcare system, bookended by community hospitals and passing a few more medical centers along the way.
Yet this part of Interstate 35 is quickly becoming something more: a cancer treatment corridor, dotted with expanding oncology programs and bordering even more in the urban core of Kansas City, Mo., and in the suburbs on both sides of the state line.
Result of Medicaid Expansion in Ohio
Apr 7, 2015 By Sarah Jane Tribble
The Cleveland Clinic, one of the largest hospitals in the country, has cut its charity care spending — or the cost of free care provided to patients who can’t afford to pay — to $101 million in 2014 compared with $171 million in 2013.
Hospital officials credited the federal health law for the improvement. “The decrease in charity care is primarily attributable to the increase in Medicaid patients due to the expansion of Medicaid eligibility in the State of Ohio and the resulting decrease in the number of charity patients,” the hospital’s year-end financial statement reported.
Impact on Some Plan Members Seeking ER, Specialty Care
Mar 31, 2015 By Jordan Shapiro
’s largest health insurer.
Minnetonka, Minn.-based UnitedHealthcare, which covers approximately one-fourth of Missourians, has changed the way it handles something known as “balance billing” — the difference between the provider’s charge and the amount allowed by the insurer.
Midwest Healthcare Systems Are Taking The Lead
Mar 31, 2015 By Shefali Luthra
Whether a patient is in the hospital for an organ transplant, an appendectomy or to have a baby, one complaint is common: the gown.
You know the one. It might as well have been stitched together with paper towels and duct tape, and it usually leaves the wearer’s behind hanging out.
Some in Danger of Closing
Mar 31, 2015 By Jim Mclean
Several factors, including the state’s rejection of Medicaid expansion, are conspiring to put some Kansas hospitals at risk.
Two southeast Kansas hospitals — one in Independence, the other in Fort Scott — are among several that might have to close their doors.
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.