Daily Health Policy Report

Wednesday, January 23, 2013

Last updated: Wed, Jan 23

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Administration News

Medicare

Women's Health

Medicaid

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

HMO-Like Plans May Be Poised to Make Comeback In Online Insurance Markets

Kaiser Health News staff writer Julie Appleby, working in collaboration with USA Today, reports: "It's back to the future for insurers, which plan to sharply limit the choice of doctors and hospitals in some policies marketed to consumers under the health law, starting next fall" (Appleby, 1/22). Read the story.

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Cracks Appearing In GOP Opposition To Health Law

Kaiser Health News staff writer Phil Galewitz, working in collaboration with USA Today, reports: "Gov. Phil Bryant and Insurance Commissioner Mike Chaney have known each other for 30 years and call themselves friends. Now, though, a wedge has come between the two elected Republicans -- President Barack Obama's health law" (Galewitz, 1/22). Read the story or a related Q & A with Mississippi Gov. Phil Bryant.

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Despite Incentives, Doctors' Offices Lag On Digital Records

Colorado Public Radio's Eric Whitney, working in partnership with Kaiser Health News and  NPR, reports: "The good news: Colorado is working to help kids stay current with their immunizations and has a computerized registry where any provider who gives a child a vaccine can report that information. The bad news: The state's computer system is not compatible with most of the computer systems doctors use, so many practices don't update the central database because it's just too much extra work, according to Dr. Allison Kempe, a researcher at the University of Colorado" (Whitney, 1/22). Read the story.

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Capsules: CMS Community Initiatives Could Reduce Health Costs; Report: States Making It Easier To Apply For Medicaid

Now on Kaiser Health News' blog, Phil Galewitz reports on a study finding that states are making it easier to apply for Medicaid: "Despite the reluctance of some Republican governors to expand Medicaid next year under the 2010 health law, most governors are making it easier for people to apply for coverage in the state-federal program for the poor" (Galewitz, 1/23). 

Also on Capsules, Ankita Rao writes about a CMS pilot program: "A pilot program introduced by the U.S. Centers for Medicare and Medicaid Services to boost quality of care for seniors by developing community-wide approaches to health problems could play a key role in bringing down costs, according to a new report in the Journal of the American Medical Association" (Rao, 1/22). Check out what else is on the blog.

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Twitter Topics: We're Talking #HospiceAudits

What happens when a hospice patient lives longer than 6 months? Medicare may not pay. Recently, Kaiser Health News' Tweet sparked conversation about Medicare's audits of hospice care -- and one hospital that is being forced to make major changes because of it.

Join the conversation on Twitter using the hashtag #HospiceAudits and follow @KHNews for the latest.

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Political Cartoon: 'Last Call?'

Kaiser Health News provides a fresh take on health policy developments with "Last Call?" by RJ Matson.

Meanwhile, here is today's health policy haiku, with a hat tip to one of its authors who also penned the related study:

IT TAKES A VILLAGE

Community's key 
to cutting hospital use
so Medicare saves.
-Janice Lynch Schuster and Joanne Lynn  

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Capitol Hill Watch

Debt Limit Plan Draws Future Battle Lines On Entitlement Spending

House Republican leaders believe their leverage in forcing budget cuts to Medicare, Medicaid and other programs will be greater in the next battles.

The Washington Post: Obama 'Will Not Oppose' House GOP Plan To Suspend Debt Limit Until May
The measure -- set for a vote Wednesday in the House -- would not resolve the dispute over how to control the national debt. … Balancing the budget over the next decade, however, is likely to require extraordinarily deep cuts in spending that go even further than reductions in previous House budgets. In the past, Ryan has targeted spending on health care for the poor and other social safety net programs, such as food stamps and aid for college tuition. On Monday, Obama vowed in his Inauguration Day speech to defend those programs (Montgomery and Helderman, 1/22).

The New York Times: Obama Speech Leaves GOP Stark Choices
Their decision shows that even among some staunch conservatives, Mr. Obama's inauguration could be ushering in a more pragmatic tone -- if not necessarily a shift in beliefs. From the stimulus to the health care law to showdowns over taxes and spending, Republicans have often found that their uncompromising stands simply left them on the sidelines, unable to have an impact on legislation and unable to alter it much once it passed. Even in the budget impasses that forced spending cuts sought by conservatives, the Republicans' ultimate goals -- changes to entitlement programs and the tax code -- have been out of reach. Now, some in the party say, it is time to take a different tack (Weisman, 1/22).

The Wall Street Journal: Obama Would Accept Stopgap Debt Extension
But a debt-limit extension would defuse only one of the fiscal land mines scattered over the next several months. Both parties say the government needs to do more to reduce the deficit, but they remain far apart on how to do that. Republican leaders suggested Tuesday they will author a deficit-reduction plan that would balance the budget within 10 years. Last year's House budget plan, by contrast, wouldn't have led to a balanced budget until about 2040, according the Congressional Budget Office. White House officials remain opposed to many of the structural changes to Medicare and Social Security that Republicans have proposed, and President Barack Obama wants tax increases to be part of any agreement (Paletta and Hook, 1/22).

Los Angeles Times: House GOP Lines Up Debt Ceiling Vote; White House Will Not Oppose
Boehner and his leadership team emerged with the new strategy after a private retreat last week with lawmakers. They believe their leverage in forcing budget cuts to Medicare, Medicaid and other domestic programs will be greater on the next battles, and want to push the politically and economically risky debt ceiling debate off to pursue these next pressure points (Mascaro, 1/22).

The Associated Press/Washington Post: House Republicans Seek To Defuse Debt Crisis With Vote On 3-Month Increase In Borrowing Limit
But Republicans and Obama now appear on a collision course over how to replace the across-the-board cuts. … "The sequester is arbitrary, but the fact is that when the sequester goes into effect ... it will have a pretty dramatic effect of people's attitudes here in Washington, and they may get serious about cuts to the mandatory side of the spending equation," Boehner said, referring to benefit programs like Medicare and food stamps, whose budgets essentially run on autopilot (1/22).

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Sen. Harkin Prepares Sweeping Public Health Legislation To Combat Obesity

Senate HELP Committee Chairman Sen. Tom Harkin is -- for the sixth time -- introducing legislation to combat obesity in children and adults across America using a host of new programs.

Modern Healthcare: Harkin Offers Sweeping Public Health Bill Again
For the sixth time, the chairman of the Senate Health, Education, Labor and Pensions Committee introduced sweeping legislation to strengthen the nation's public health with provisions that aim to combat chronic disease and encourage healthier lifestyles in schools, businesses and communities. Sen. Tom Harkin's (D-Iowa) bill calls on several Cabinet departments and federal agencies to implement a host of recommendations, and, in some cases, work together to achieve those goals. The legislation would require HHS to issue and update physical activity guidelines for all ages every 10 years; provide tax credits to businesses that offer comprehensive workplace wellness programs; and mandate that the Federal Trade Commission, the Food and Drug Administration, the Centers for Disease Control and Prevention, and the Agriculture department release recommendations for standards in food marketing to children (Zigmond, 1/22).

The Hill: Harkin Health Bill Orders Stack Of Federal Prevention Efforts
A new bill from Sen. Tom Harkin (D-Iowa) would order more than 30 federal actions to encourage healthier living, from a penalty on certain tobacco manufacturers to targets for sodium reduction in U.S. foods. Harkin, who leads the Senate Health, Education, Labor and Pensions (HELP) Committee, described the bill as a comprehensive step forward for preventive health care in the United States (Viebeck, 1/22).

In the meantime, Republicans again take aim at the health law's individual mandate as well as repealing the "Sustainable Growth Rate" and ask the White House to issue regulations to expose financial relationships between doctors and the health care industry --

The Hill: GOP Bill Would Repeal Health Law's Individual Mandate
Republican senators introduced a bill Tuesday to repeal the unpopular individual mandate in President Obama's signature health care law. Sens. Orrin Hatch (R-Utah) and Lamar Alexander (R-Tenn.) introduced the measure, dubbing it the "American Liberty Restoration Act." They said the mandate is an assault on constitutionally protected freedoms -- despite the Supreme Court's ruling last year that upheld the mandate as constitutional (Baker, 1/22).

The Hill: Grassley Pushes White House On Sunshine Act Regs
Sen. Chuck Grassley (R-Iowa) urged the White House Tuesday to finalize long-overdue regulations that would expose financial relationships between doctors and industry. The letter to Jack Lew, President Obama's chief of staff, is Grassley's latest move to pressure the Obama administration to release final rules for the Physician Payments Sunshine Act (Viebeck, 1/22).

Medpage Today: SGR Repeal To Get Hard Look In New Congress
Repealing the sustainable growth rate (SGR) formula for physician reimbursement under Medicare will likely be a high priority for the new leader of a key congressional health subcommittee. Rep. Kevin Brady (R-Texas), who took over as chair of the House Ways and Means Health Subcommittee as the 113th Congress kicked off this week, wants to work with the House Energy and Commerce Committee to craft legislation to permanently repeal the SGR and replace it "with a reliable physician reimbursement formula that rewards quality," the congressman wrote in a news release. He said he hopes to "push structural reforms this session to preserve Medicare and reduce Medicare fraud" (Pittman, 1/22).

And a former Senate Democrat will lead a national insurance group --

Politico: Ex-Sen. Ben Nelson Leads Insurance Commissioners Group
Former Nebraska Sen. Ben Nelson, one of the key figures in passing the president's health care law, is being tapped to lead the National Association of Insurance Commissioners, the group announced Tuesday (Millman, 1/23).

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Administration News

Obama's Inaugural Speech, Medicare View Trigger Reaction, Analysis

President Barack Obama's inaugural address laid out very specific choices regarding the future of Medicare and other entitlement programs. Some Republicans, such as House Budget Committee Chairman Paul Ryan, R-Wis., took a dim view of Obama's take on these issues.

Politico: Paul Ryan Slams Obama 'Straw Man' Speech
The Wisconsin Republican told "The Laura Ingraham Show" that Obama's second inaugural address demonstrated the president does not understand the Republican position on entitlements such as Medicare and Social Security. Ryan responded to Obama's line that these programs "do not make us a nation of takers; they free us to take the risks that make this country great," telling guest host Raymond Arroyo that the president's take on the issue entirely missed the mark (Weinger, 1/22).

The Medicare NewsGroup: With Second Term Underway And Budget Battle Ahead, Obama's Medicare Legacy Is Not Yet Written
When President Obama came to power, he carried with him the promise to extend health care coverage to all, regardless of a person’s income or medical history. He also promised to improve Medicare by cutting costs, increasing quality and stemming fraud and abuse. The Patient Protection and Affordable Care Act (ACA), a controversial piece of health care reform legislation and the signature legislative victory of Obama's first term, was his solution. It extended the solvency of the Medicare Hospital Insurance (Part A) trust fund from 2016 to 2024 and created new programs to test new payment and delivery models in an effort to improve care and lower costs. Even with a major health care reform bill under his belt, Obama's legacy on health care, and Medicare in particular, isn't set (Sjoerdsma, 1/21).

The Medicare NewsGroup: Fact/Fiction: Raising The Medicare Eligibility Age Would Save The Program Money
Deficit hawks have long argued that raising the Medicare eligibility age is a good way to reduce entitlement spending. It has routinely been part of Republican, and sometimes bipartisan, proposals to reform the program. Rep. Paul Ryan’s (R-Wis.) fiscal year 2013 budget proposal would raise the eligibility age from 65 to 67 years by two months a year starting in 2022, until it reaches 67 in 2033; and the bipartisan Burr-Coburn deficit reduction plan would gradually raise the age to 67 by 2027. The Facts: This is fact. The federal government would spend less on the Medicare program because costs primarily would be shifted to individuals, employers and state government programs. They would, collectively, pay more for health care services than Medicare would pay to cover the same group of people (Sojerdsma, 1/22).

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Medicare

Supreme Court Dashes Hospitals' Hopes For Recovering Underpayments

The court's unanimous ruling rejected the arguments advanced by 18 hospitals that sought to reopen a set of Medicare claims that were more than 25 years old.

Modern Healthcare: High Court Quashes Hospitals' Hopes Of Recouping Underpayments
In a unanimous, decision the U.S. Supreme Court on Tuesday dismissed hospitals' and health systems' hopes of recouping millions in Medicare underpayments made between 1987 and 1994. Providers had asked the high court to give them the same extra time to find underpayments in Medicare reimbursement that the government gave its outside contractors to find overpayments. The ruling rejected the equity argument, noting the dozen or so private companies that manage Medicare claims have an extremely difficult job in looking for errors among claims from thousands of U.S. hospitals, while hospitals, in contrast, have only their own claims to worry about (Carlson, 1/22).

Reuters: U.S. Top Court Rejects Hospitals' Medicare Claims Suit
The U.S. Supreme Court rejected on Tuesday a bid by a group of 18 hospitals to reopen a specialized group of Medicare reimbursement claims that are up to 25 years old. The hospitals, which are entitled to extra compensation for treating a large number of low-income patients, claimed the Centers for Medicare & Medicaid Services miscalculated those payments between 1987 and 1994 (Baynes, 1/22).

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JAMA Studies Examine Hospital Readmissions, Effects Of New Penalties

Research shows that poor coordination among providers can lead to patients returning to the hospital. In addition, the new payment procedures are likely to affect academic medical centers and safety net hospitals.

The Wall Street Journal: Return Patients Vex Hospitals
Hospitals fearing new Medicare penalties are trying to reduce the number of patients who need to return soon after discharge, a problem that new research suggests is widespread and without an easy fix. Several studies published online Tuesday in JAMA, the Journal of the American Medical Association, suggest that poor coordination among different providers after patients leave the hospital is largely to blame for many readmissions, and the focus should be on improving that care. Hospitals may fail to identify patients at high risk for complications or new illnesses that may land them back in the hospital, and there is often insufficient help for patients to make the transition from hospital to home (Landro, 1/22).

Bloomberg: Medicare Cuts For Readmissions To Target Large Hospitals
Large U.S. teaching hospitals such as those affiliated with major universities are more likely to be penalized under a U.S. program linking Medicare pay cuts to higher rates of patient readmission, research suggests. About 67 percent of 3,282 hospitals studied will receive lower payments for providing care to patients in Medicare, the U.S. government's health program for the elderly and disabled, as a result of the policy that took effect on Oct. 1, according to a research letter published today in the Journal of the American Medical Association (Armour, 1/22).

Reuters: Poor U.S. Hospitals Likeliest To Pay Readmission Fine
Large teaching hospitals and hospitals that primarily provide care to poor and uninsured patients are most likely to lose federal money under the U.S. government's plan to improve quality by tying payments to readmissions, according to new research (Seaman, 1/22).

Medscape: Readmission Penalty Hits Safety Net, Teaching Hospitals Hard
Ninety-five-bed Falmouth (Massachusetts) Hospital on Cape Cod doesn't have the national reputation of Massachusetts General Hospital, 77 miles to the north in Boston. But the small hospital bests the big teaching hospital in the big city on this point -- it's not getting penalized by Medicare for excessive readmissions within 30 days of discharge. Massachusetts General, in contrast, will forego about 0.5 percent of its Medicare reimbursement in fiscal year 2013 because its readmission rate was higher than what the Centers for Medicare & Medicaid Services (CMS) projected based on the case mix, or medical complexity, of their patients (Lowes, 1/22).

Medpage Today: Big Hospitals To Be Biggest Losers Of Federal $$
Large, teaching, and safety-net hospitals are those most likely to be penalized for failing to reduce hospital readmissions, researchers found. In the federal Hospital Readmissions Reduction Program (HRRP), 40 percent of large hospitals will likely see big cuts in their fiscal 2013 Medicare reimbursements compared with 28 percent of small hospitals, according to Karen Joynt, MD, of Brigham and Women's Hospital in Boston, and Ashish Jha, MD, of the Harvard School of Public Health. In addition, major teaching hospitals are more likely to be highly penalized than nonteaching hospitals (44 percent versus 33 percent) as are safety-net hospitals compared with hospitals that do not have the safety net designation (44 percent versus 30 percent), they wrote in a research letter in the Journal of the American Medical Association online (Petrochko, 1/22).

In other news related to readmissions --

Medpage Today: Kids' Hospital Readmissions Vary Widely
Readmission rates vary widely across pediatric acute care hospitals, and multiple patient and disease factors contribute, a retrospective study suggested. The 30-day readmission rate for hospitals with high readmission rates was 7.2 percent compared with 5.6 percent for centers with low readmission rates, a difference of 28.6 percent, according to Jay G. Berry, MD, of Harvard Medical School, and colleagues. But rates rose significantly depending on the number of chronic conditions for individual patients (Walsh, 1/22).

Medpage Today: ER Visits Common After Hospital Stay
Nearly one-fifth of hospital patients returned for acute care within 30 days of discharge, with emergency room (ER) visits accounting for 40 percent of those encounters, a large multistate study found. Among some 5 million hospitalizations, involving about 4 million unique patients in California, Florida, and Nebraska over a 15-month period in 2008 and 2009, 17.9 percent of discharges were followed within 30 days by a "treat-and-release" ER visit or readmission, according to Anita Vashi, MD, MPH, of Yale University, and colleagues (Gever, 1/22).

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Medicare Community Care Initiative Helps Lower Readmissions, Study Finds

The pilot project in 14 communities looked at a variety of strategies, including patient coaches, medication-management and better hospital discharge plans.

Kaiser Health News: Capsules: CMS Community Initiatives Could Reduce Health Costs
A pilot program introduced by the U.S. Centers for Medicare and Medicaid Services to boost quality of care for seniors by developing community-wide approaches to health problems could play a key role in bringing down costs, according to a new report in the Journal of the American Medical Association (Rao, 1/22).

Modern Healthcare: State Quality Projects Curbed Readmissions: Study
A Medicare initiative aimed at smoothing transitions of care through community-based interventions successfully lowered 30-day readmission rates and all-cause hospitalization rates among beneficiaries, according to a study. Led by Medicare quality improvement organizations (QIOs), which contract with the CMS to lead statewide quality-related efforts, the 14-community project relied on patient coaches, medication-management strategies, home health tool kits, enhanced discharge planning and other interventions to keep patients out of the hospital. Communities that had multistakeholder care-transition programs in place had lower rates of 30-day all-cause readmissions and all-cause hospitalizations than did comparison communities with no such interventions, according to the study, which appeared in the Journal of the American Medical Association (McKinney, 1/22).

Politico: Medicare Eyes Hospital Readmissions
Now a major multicity Medicare quality initiative, highlighted this week in The Journal of the American Medical Association, has reduced readmissions by nearly 6 percent compared with similar communities over two years. The authors estimate that in an average community with 50,000 Medicare patients, spending $1 million on relatively simple steps to curb hospitalizations would save $4 million per year on hospital bills alone. That would add up fast if these programs were to spread nationwide (Kenen, 1/23).

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Women's Health

GOP-Led State Legislatures Ready Bills To Further Restrict Abortions

Republican legislatures around the nation are readying new legislation to further restrict abortion on the 40th anniversary of Roe v. Wade -- and looking back on how they've already significantly restricted the procedure in recent years.

The Associated Press/Washington Post: Republican Legislatures Across The Country Aim For New Abortion Limits As Roe V. Wade Turns 40
It has been rare for states to expand access to abortions since the 1973 Roe v. Wade ruling, but there have been numerous efforts to limit them -- including several proposals already introduced in statehouses this year. Here is a look at some of the abortion restrictions currently being considered in Republican-controlled states (1/22).

The Wall Street Journal's Law Blog: Abortion Foes Mark Gains By Targeting Clinics, Abortion Providers
Anti-abortion activists have made significant strides in recent years by targeting not abortions per se, but the clinics that provide them. In the last two years, several states, among them Kansas, Mississippi, Tennessee, Pennsylvania, Virginia and Michigan, have passed bills adding layers of regulations to clinics (Jones, 1/22).

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Medicaid

Medicaid Patients Could Face Higher Co-Payments, Other Charges

The New York Times: Many Medicaid Patients Could Face Higher Fees Under A Proposed Federal Policy
Millions of low-income people could be required to pay more for health care under a proposed federal policy that would give states more freedom to impose co-payments and other charges on Medicaid patients (Pear, 1/22).

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State Watch

Contention, Hearings Dominate State Health Law Implementation Efforts

Lawmakers in Mississippi, Missouri, Wyoming, Kansas, Florida and California are considering the effects of expanding Medicaid and establishing health insurance exchanges -- both major tenets of the health law for states.

Kaiser Health News: Cracks Appearing In GOP Opposition To Health Law
[Mississippi] Gov. Phil Bryant and Insurance Commissioner Mike Chaney have known each other for 30 years and call themselves friends. Now, though, a wedge has come between the two elected Republicans -- President Barack Obama's health law" (Galewitz, 1/22).

The Associated Press: Mo. Budget Panel Hears Support For Medicaid Growth
With Missouri's budget prospects improving, dozens of advocates for social services and education crowded a Senate committee room Tuesday asking for more money for things such as Medicaid and college scholarships. Medicaid expansion was the key topic during the Senate Appropriations Committee's first public hearing on Missouri's next operating budget, which begins July 1 (Shapiro, 1/22).

The Associated Press: Committee To Hear Bill On Medicaid Expansion
A Wyoming legislative committee is set to consider a bill to approve expansion of the federal Medicaid program. The Senate Labor Health and Social Services Committee is set to consider a bill Wednesday that would add nearly 30,000 people to the Medicaid rolls in the state (Neary, 1/23).

Kansas Health Institute: Medicaid Expansion Bill Introduced
A Wichita Democrat has introduced legislation that would expand eligibility for the Kansas Medicaid program to include people earning up to almost $15,000 a year. Currently, the Kansas program is among the most restrictive in the nation and generally covers only children, pregnant women or disabled persons who are poor (Shields, 1/22).

The Associated Press: Fla. Looks To Mass. For Health Care Advice
Florida lawmakers considering how to implement the federal health care overhaul sought information Tuesday from two economists on the Massachusetts initiative that served as the blueprint for the national plan. Massachusetts pioneered an approach emulated in the federal Affordable Care Act with its 2006 health care initiative and is currently the only state that requires individuals to have health insurance (Kennedy, 1/22).

California Healthline: Exchange Readies Its New Website
Covered California, the new brand name for the state's health benefit exchange, will unveil its new website next week, according to Oscar Hidalgo, director of communication and public affairs at the exchange. Hidalgo spoke at last week's exchange board meeting … Exchange officials plan to maintain the current website and update its design so it can be used for stakeholder information, Hidalgo said. The new site -- initially in two languages -- is designed to help consumers in 13 languages (Gorn, 1/23).

California Healthline: Report Shows Central Valley Behind In ACA Preparation
One of the poorest and most underinsured regions in the state trails other areas of California when it comes to health care reform readiness, according to a study examined in a public forum last week. The Fresno region, which includes Fresno, Madera, Mariposa, Kings and Tulare counties, needs to do more to prepare for the large increase in patients who will have health care coverage under the Affordable Care Act, according to the report. A team of researchers from the Center for Studying Health System Change conducted the study on behalf of the California HealthCare Foundation (Daniel, 1/22).

And states also prepare for fallout around initiatives to cut costs while improving patient care --

HealthyCal: Mixed Results For Hospital Pay-For-Performance Initiatives
Federal health care reforms are trying to cut costs and improve quality -- two objectives that are often at odds. Policy makers hope that strategies like changing how providers are paid can balance cost and quality. But studies of current programs like pay-for-performance initiatives show mixed results in cutting costs and improving quality. Providers say the incentive amounts are not enough to cover the cost of change. "It's an awful lot of sticks and not a lot of carrot," said G. Scott Smith, medical director of St. Joseph Heritage Medical Group in Orange County (Shanafelt, 1/23).

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State Roundup: Legislatures Tackle Health Budget Gaps, Worker Pay

Health policy news from New York, California, Oregon, Georgia, Maryland, Massachusetts, Minnesota, Florida and Kansas.

Stateline: States' Fragile Recovery At Risk
With the national economy picking up and the housing market improving, states are poised in 2013 to finally rebound from the recession’s lingering revenue crunch. But continued budget delays in Washington may dampen that prospect. For all the talk about the fiscal cliff, states already know what a free-fall in revenue feels like … Overall, though, Medicaid is still the biggest budget worry for most states in the coming year. That’s because Medicaid spending continues to be the largest component of total state spending at nearly 24 percent, easily surpassing K-12 education, which takes up less than 20 percent (Prah, 1/23).

The Miami Herald: South Florida Hospitals Face Huge Federal, State Cuts
With the federal government already slashing their funds in big and small ways, and major state cuts possible from the upcoming session of the Legislature, South Florida’s hospitals are concerned about looming financial problems. An analysis by the Florida Hospital Association shows that Miami-Dade hospitals stand to lose $1.9 billion in federal funding over the next decade to treat Medicare patients (Dorschner, 1/22).

Pioneer Press: Dayton’s Budget: Health Groups Praise Proposal
[Minn.] health care groups expressed cautious optimism for the budget proposal outlined Tuesday, Jan. 22, by Gov. Mark Dayton. Doctors and hospitals applauded Dayton's call to ... expand and reform the state's Medical Assistance and MinnesotaCare health insurance programs. ... The human services budget, which is a huge source of revenue for groups that operate nursing homes and assisted living facilities, has sustained budget cuts for several years (Snowbeck, 1/22).

The New York Times: Cuomo Builds Budget With Cuts, Gambling And Fees
Over all, the proposed $142.6 billion budget represents a 5.3 percent increase over the current one, but much of the increase will be covered by federal money provided for the recovery from Hurricane Sandy and the enactment of the health care law championed by President Obama (Hakim and Kaplan, 1/22).

The Associated Press: Okla. Budget Chair Eyes Pay Hikes For DHS Workers
State workers who deal daily with Oklahomans with developmental disabilities and abused and neglected children should be targeted for merit-based pay hikes, the head of a House budget panel said on Tuesday. ... Rep. Jason Nelson said pay increases for workers in the child welfare, developmental disabilities and family support divisions of the Department of Human Services will be among his top priorities for the largest state agency (Murphy, 1/22).

The Associated Press: Changes To Md. Medicare Waiver In Works
Maryland officials will submit a plan to the federal government aimed at allowing them to hang onto about $1 billion in Medicare reimbursements received under a unique agreement with Washington, the chairman of a panel that sets hospital billing rates told lawmakers Tuesday. ... [The agreement] allows Medicare and Medicaid payments to be based on rates set by the state commission, instead of national federal payment principals (Witte, 1/22).

The Wall Street Journal: Bidding Battle Over Bronx Hospital
Two competing bids to take over New York Westchester Square Medical Center, a struggling hospital in the Bronx, are bringing to light deeper tensions about health care in the borough. Montefiore Medical Center has made a play acquire the assets of Westchester Square—one of the last remaining independent hospitals in the borough—and turn it into an ambulatory surgery and primary-care facility with an emergency room (Kusisto, 1/22).

Boston Globe: Boston Medical Center Expects Profit For 2012
Boston Medical Center, the state’s largest safety net hospital, expects to post a modest financial gain for its 2012 fiscal year, reversing three consecutive years of losses. ... [chief executive Kate] Walsh attributed the turnaround to multiple factors, including an increase in federal funding for hospitals that serve large numbers of low-income patients, higher reimbursements from commercial insurers, new billing codes that let government insurers better measure BMC’s range of care, and moves to aggressively cut costs by, among other things, consolidating operations at its South End campus and closing a 12-bed inpatient rehabilitation unit (Weisman, 1/23).

Kansas City Star: Hospitals Join In Network To Share Patient Information
More than a dozen area hospitals and clinics announced Tuesday that they have joined together in one of the first regional computer networks in the Midwest that allows doctors and hospitals to share patients’ medical information to make care faster and more efficient. … Health information exchanges are intended to speed up care and reduce costs by eliminating the need to duplicate tests or to copy and fax medical records. Care may be improved by keeping more complete medical histories of patients, including previous treatments and medications (Bavley, 1/22).

Kansas Health Institute: Alternatives To Nursing Homes Lacking, Lawmakers Told
Efforts by Kansas officials to keep frail, elderly people out of nursing homes have been hampered by the shortage of community-based alternatives, representatives of the industry told lawmakers today. It’s not unusual, [Cindy Luxem, chief executive of the Kansas Health Care Association] said, for nursing home administrators to be told that one of their Medicaid residents could and should be living in a community setting. But when a nursing home tries to arrange the services needed to make that happen, she said, the services often are not available (Ranney, 1/22).

Georgia Health News: Report Questions Claim Of Dentist Shortage
A new report shows that although Georgia has a low number of dentists per capita, a large majority of them still have room in their practices to accept new patients. The report on Georgia’s dental workforce also found that only about 20 percent of dentists serve Medicaid and PeachCare patients (Miller, 1/23).

WBUR: Free Health Clinics For Uninsured Thrive In Mass.
Massachusetts has the highest rate of residents with health insurance in the country, but that still leaves about 277,000 men, women and children who aren’t sure where to turn when they get sick and often put off care because it costs too much. A loose-knit network of free clinics in churches, synagogues and vacant offices around the state — often run by retired doctors and nurses — is quietly caring for many of these patients (Bebinger, 1/22).

The Lund Report: Sen. Jeff Merkley Urges Physicians, Nurses To Raise Their Voices
According to public opinion polls, U.S. Senators are less well-liked and less well-respected than cockroaches, Sen. Jeff Merkley told a small crowd of physicians, nurses and community members last week. Doctors and nurses, on the other, consistently rank at the top of public opinion polls – so when it comes to public policy, their opinions often hold more sway (McCurdy, 1/22).

Sacramento Bee: Democratic Lawmakers Revive California Bill On Early-Abortion Providers
More medical professionals, including nurses and midwives, would be permitted to perform certain early abortions in California under a bill unveiled Tuesday. In a news conference at the Capitol, ... lawmakers and women's health advocates said the measure is necessary for women in communities without abortion providers. They said 52 percent of California counties do not contain a provider, other than hospitals, which often have only limited services (White, 1/23).  

Fox News: Pro-Life Groups Say Cuomo Bill Would Allow Late-Term Abortions ‘On Demand’
On the heels of passing sweeping gun control legislation, New York Gov. Andrew Cuomo is pushing the envelope once again -- this time with a call for an abortion bill that opponents say would effectively allow late-term abortion "on demand."  Pro-life organizations and religious groups are beginning to rally against the proposal, after Cuomo declared in his Jan. 9 State of the State address that he wanted to enact a so-called "Reproductive Health Act" as part of a 10-point plan to advance "women's equality" (Berger, 1/22).

Boston Globe: Bill Would Require Consent To Use Antipsychotics
Concern about overuse of anti­psychotic medications and similar drugs in nursing homes, hospitals, and other health care facilities has prompted a sweeping proposal that would require Massachusetts facilities to inform patients, or their legal representatives, in writing of the medications’ risks, benefits, and alternatives. This informed consent process would need to be repeated every three months if patients were taking these drugs long term (Lazar, 1/23).

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Editorials and Opinions

Viewpoints: A 'Gift' To Amgen; Obama Omits Talk Of Grand Bargain; Defending Physician Pay

The New York Times: Amgen Gets A Gift From Congress
For a disheartening example of how intense lobbying and financial contributions can distort the legislative process in Washington, consider what happened to the "fiscal cliff" bill approved three weeks ago by Congress. Senators who play a major role in federal health care financing were happy to help Amgen, the world’s largest biotechnology company, evade Medicare cost-cutting controls (1/22).

Los Angeles Times: Obama, A More Ardent Advocate
Obama reaffirmed his belief in a muscular federal government and the importance of "collective action" to enhance education and infrastructure. He rejected the belief that "America must choose between caring for the generation that built this country and investing in the generation that will build its future." We appreciate Obama's vigilance in protecting the social safety net, but we hope he isn't abandoning any effort to reach a "grand bargain" with Republicans that would put Social Security and Medicare on a path to long-term solvency (1/22). 

The Wall Street Journal: We The Government
On that theme, the speech was especially striking for including a specific defense of the federal entitlement programs that everyone knows must be reformed. Mr. Obama cited "Medicare, and Medicaid, and Social Security" by name as "the commitments we make to each other." Typically, such programmatic specificity is reserved for State of the Union speeches. Mr. Obama almost seemed to be elevating them to Constitutional rights (1/21).

The Washington Post: Obama: No Patsy Now
What does this mean, substantively? Ah: “The commitments we make to each other through Medicare, and Medicaid, and Social Security — these things do not sap our initiative; they strengthen us. They do not make us a nation of takers; they free us to take the risks that make this country great.” Loose translation: Entitlement reform will not be topping the president’s second-term agenda. What it means beyond this is any palm reader's guess. We understand that we're not a nation of takers (as Paul Ryan once regrettably put it), but how entitlement programs that far exceed our ability to pay for them "free us to take the risks that make this country great" is gobbledygook of the first order (Kathleen Parker, 1/22).

The Washington Post: Obama's Unapologetic Inaugural Address
Obama will be seen as combative in his direct refutation of certain conservative ideas, and it was especially good to see him argue — in a passage that rather pointedly alluded to Paul Ryan’s worldview — that social insurance programs encourage rather than discourage risk-taking and make us a more, not less, dynamic society. "The commitments we make to each other — through Medicare, and Medicaid, and Social Security — these things do not sap our initiative; they strengthen us," he said. "They do not make us a nation of takers; they free us to take the risks that make this country great." This is one of the most important arguments liberals have made since FDR’s time, and in the face of an aggressive attack now on the very idea of a social insurance state, it was important that Obama make it again (E.J. Dionne Jr., 1/21).

Los Angeles Times: Roe Vs. Wade Turns 40
Forty years ago Tuesday, the Supreme Court ruled that women had a constitutional right to an abortion. This one sweeping decision transformed abortion from what was often a secret, illicit and dangerous act, sometimes crudely self-inflicted, into a generally legal and safe procedure. But it also turned abortion, always an emotional issue, into one of society's most divisive (1/22). 

The Washington Post: Chipping Away At Roe V. Wade
Over the past 40 years, state legislatures across the country have managed to place a slew of impediments, inconveniences and indignities between women and their right to choose (Katrina vanden Heuvel, 1/22).

Bloomberg: Use Profit Motive To Improve Health Care
The fundamental problem with the U.S. health-care system, many people argue, is that medicine can’t operate well on the profit motive. It is a social good, and profit-driven behaviors undermine efforts to provide high-quality care. It's true that our private health-care system provides care that is extraordinarily expensive, excessive, wasteful, patient-unfriendly and often dangerously sloppy. But the problem with this argument is that for-profit and nonprofit providers alike produce the same bad result. The profit motive itself doesn't seem to be the differentiator (David Goldhill, 1/21).

Philadelphia Inquirer: Physicians Are Not Overpaid
Everyone likes to complain about how much money doctors make. Many people hear the word "physician" and equate it with a mansion, BMW, and lavish vacation. But physicians don’t make nearly as much as you think. After finishing high school, physicians spend a minimum of 11 years in training. Specialized physicians train even longer, sometimes for as long as 20 years. These are years spent making no money while in school, or making very little money during residency and fellowship. And by the time these individuals are "real" physicians, they are already in their mid-to-late thirties and have spent years struggling financially to support themselves and their families. … So, you think doctors are in it for the money? If they once were, they aren’t anymore. Nearly half of all physicians regret going into medicine. And when asked whether they feel they are adequately compensated, only 51% of physicians say yes (Erica Cohen, 1/23).

Medpage Today: Patient Safety And The Ethics Of EMR Implementation
We should acknowledge that there might be cause, ethically, to deploy a technology that truly benefits patients at some cost. After all, you have to break a few eggs to make a good omelet. If interoperability of (electronic medical record) systems between facilities were commonplace and clinical data were shared with ease while patient privacy was vigorously upheld flawlessly, the cost of these systems might be ethically justified. But the promise of improved efficiencies to our healthcare system, improved patient safety and (especially) reduced costs for our healthcare system remain elusive. More importantly, these goals remain unproven (Dr. Wes Fisher, 1/22).

Sacramento Bee: Save Programs That Help Create Healthy Communities
California Field Poll results released Tuesday from 12 California counties show that 94 percent of surveyed registered voters see obesity in the United States as a serious problem. And they think we need to do more to address it, along with other chronic diseases. They want more help – from local governments, civic leaders, our legislators and businesses. They want more investments in the infrastructure that supports health: in parks, safe streets, and smoke-free environments. Meanwhile, in Washington, lawmakers from across the country are set to slash public health funding that supports these kinds of efforts as part of the sequester (Mary Pittman, 1/23).

The Houston Chronicle: Texas Facing Mental Health Crisis
Here in Texas, we do a woeful job of serving our citizens with mental health problems. More than 4.3 million Texans, including 1.2 million children, live with some form of mental health disorder. Yet, according to the Kaiser Family Foundation, Texas has fallen to the 51st place in per capita funding for mental health services. That puts us behind even Washington, D.C. The national average for state spending on mental health services is $109 per capita. Texas shamelessly spends $36 (State Rep. Sylvester Turner, 1/22).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.