Daily Health Policy Report

Friday, December 21, 2012

Last updated: Fri, Dec 21

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Public Health & Education


Health Care Marketplace

Capitol Hill Watch

Health Reform

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Medicare Discloses Hospitals' Bonuses, Penalties Based On Quality

Kaiser Health News staff writer Jordan Rau reports: "Medicare on Thursday disclosed bonuses and penalties for nearly 3,000 hospitals as it ties almost $1 billion in payments to the quality of care provided to patients. The revised payments, which will begin in January, mark the federal government’s most extensive effort yet to hold hospitals financially accountable for what happens to patients. In what amounts to a nationwide competition, Medicare compared hospitals on how faithfully they followed rudimentary standards of care and how patients rated their experiences" (Rau, 12/20). Read the story and a sidebar on the methodology behind the analysis. KHN also has an interactive chart showing the effect of the program on individual hospitals and a state-by-state comparison.

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Health Law Seen Boosting Xerox, HP

Kaiser Health News staff writer Phil Galewitz, working in collaboration with USA Today, reports: "When Tennessee Medicaid Director Darin Gordon walks around his department in an office park north of downtown Nashville, he sees dozens of workers from technology giant Hewlett-Packard. HP's employees help to operate the massive computer systems that run Tennessee Medicaid. ... Growth in the program for the poor has created boom times for data management companies like HP and Xerox. ... Now, with Medicaid poised for broad expansion under the law and with online insurance markets being built in most states, those companies are well-positioned to profit" (Galewitz, 12/19). Read the story.


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Political Cartoon: 'Pole Position?' By Jimmy Margulies

Kaiser Health News provides a fresh take on health policy developments with "Pole Position?" By Jimmy Margulies.

Meanwhile, here is today's health policy haiku:


Fix the SGR:
That's what docs want for Christmas.
Can their wish come true?
- Anonymous

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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Fiscal Cliff

Boehner Fails To Rally GOP, Pulls His Tax Plan Back

The House speaker was under pressure from conservatives who wanted bigger cuts in entitlement spending.

The New York Times: Boehner Cancels Tax Vote In Face Of G.O.P. Revolt
Speaker John A. Boehner's effort to pass fallback legislation to avert a fiscal crisis in less than two weeks collapsed Thursday night in an embarrassing defeat after conservative Republicans refused to support legislation that would allow taxes to rise on the most affluent households in the country. ... The stunning turn of events in the House left the status of negotiations to head off a combination of automatic tax increases and significant federal spending cuts in disarray with little time before the start of the new year (Weisman, 12/20).

The Wall Street Journal: Boehner's Budget 'Plan B' Collapses
House Speaker John Boehner, facing a rebellion in his party's conservative ranks, abandoned his own plan to avert tax increases for most Americans Thursday night, throwing Washington's high-stakes budget negotiations into disarray and bringing the prospect of tumbling over the fiscal cliff into sudden focus. ... Mr. Boehner was already under pressure from party conservatives for concessions he had made in earlier talks with Mr. Obama, including a weekend offer to raise tax rates on millionaires and allow a one-year increase in the debt limit, in exchange for Mr. Obama proposing cuts in Medicare and other fast-growing entitlement programs. Administration officials now say they doubt whether Mr. Boehner would have been able to pass that proposal (Hook, Bendavid and Lee, 12/21).

The Washington Post: Boehner Abandons Plan To Avoid 'Fiscal Cliff'
House Speaker John A. Boehner threw efforts to avoid the year-end "fiscal cliff" into chaos late Thursday, as he abruptly shuttered the House for the holidays after failing to win support from his fellow Republicans for a plan to let tax rates rise for millionaires. ... Emboldened liberals quickly argued that Democrats should demand additional concessions from Republicans, either upping the demand for fresh tax revenue or withdrawing Obama's offer to seek savings through cuts in federal health and retirement programs (Montgomery and Helderman, 12/20).

Los Angeles Times: Boehner's 'Fiscal Cliff' Plan Fails
Now, Obama faces a crucial test of his leadership, with little time left to craft a deal. Obama's most recent offer is likely to be the starting point. He made a substantial concession: raising taxes only on household income above $400,000, rather than the $250,000 threshold he campaigned on for reelection. As he pursues votes in Congress, the president will need to face down Democrats, particularly the liberal wing that may feel emboldened to demand that a deal be tilted toward their views — perhaps with additional spending on infrastructure or unemployment benefits (Mascaro, Memoli and Parsons, 12/21).

Politico: Cliff Chaos: Boehner Pulls GOP Bill
Earlier on Thursday, Boehner, using his harshest tone of the fiscal cliff debate, said the White House has "done nothing" since he relented on letting low tax rates lapse on wealthy Americans. "For weeks the White House said if I moved on rates, that they would make substantial concessions on spending cuts and entitlement reform," Boehner said in an afternoon news conference. "I did my part, they've done nothing" (Sherman, Budoff Brown and Bresnahan, 12/20).

Politico: President Obama's Dilemma
Thursday’s revolt was a grim reminder of how closely Obama's future is tethered to that of his political rivals. If House Speaker John Boehner can't muscle his own bill through the House, his power to persuade his colleagues to accept a deal with the White House appears greatly diminished. And that means it might be tough for Obama to forge any agreement with House Republicans to avert the fiscal cliff this year — or to push through his second-term agenda in the years to come (Budoff Brown, 12/21).

Modern Healthcare: Fiscal Cliff Appears Closer As Sequester Bill Clears House And 'Plan B' Vote Is Dropped
Fiscal-cliff negotiations hit a new roadblock Thursday when House leaders—short of enough votes—pulled their "Plan B" tax bill from the floor shortly after the House narrowly passed veto-threatened legislation to replace part of the mandatory federal spending reductions scheduled for 2013 while keeping in place payment cuts to Medicare. Introduced by House Majority Leader Eric Cantor (R-Va.) as part of the ongoing debt discussions, the Spending Reduction Act of 2012 passed 215-209, with one member—Rep. Rob Bishop (R-Utah)—voting "present" and six members not voting (Zigmond, 12/20).

CQ HealthBeat: Obama Offer Likely Would Spare NIH, CDC From Budget Blade In January
What will happen to funding for such agencies as the National Institutes of Health and the Centers for Disease Control and Prevention if deficit negotiators are able to head off the automatic 8 percent cuts they face Jan. 2 under the sequester provisions of the budget control law? The answer to that depends on whether any final deal includes the discretionary spending provisions of President Barack Obama's most recent fiscal cliff or the Republican provisions (Reichard, 12/20).

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'Doc Fix' Unlikely Without Fiscal Deal

Lawmakers have assumed that whatever deal is negotiated by President Barack Obama and House Speaker John Boehner would include a patch to avoid the 26.5 percent cut to physicians who treat Medicare patients, which takes effect next month. Without a deal, however, providers face a double whammy, since they would also see a 2 percent pay cut under sequestration.

Politico Pro: Doc Fix Not Likely Before Fiscal Cliff
With just days to go before the nation could go over the fiscal cliff, key House members still haven’t heard a solid plan for stopping doctors’ payments from plunging after New Year’s Day. All month long, they’ve banked on the prospect that House Speaker John Boehner and President Barack Obama will include at least a one-year “doc fix” in whatever year-end agreement they carve out. And that’s what they’re still hoping for, with 10 days left to avoid the scheduled 27 percent plunge in Medicare doctors’ payments (Cunningham and Cheney, 12/20)

Politico: Double Hit Looms For Doctors, Hospitals
Going over the fiscal cliff would result in a 2 percent cut in payments to Medicare providers and private Medicare Advantage plans under sequestration. And if a “doc fix” isn’t passed along with a fiscal cliff deal, physicians and hospitals would face a 26.5 percent cut in pay for treating Medicare patients. Other smaller segments of the health industry, such as ambulatory services and rehabilitation therapies, would face cuts, too. ... The Centers for Medicare & Medicaid Services has already told health providers of the impending cut but indicated that payments would not immediately be processed with the cut in effect. In the past, CMS has held payments while Congress sorted out a patch to prevent the cut (Haberkorn and Norman, 12/20).

Modern Healthcare: Providers Oppose House Sequester Measure
As part of the ongoing fiscal-cliff negotiations, House Majority Leader Eric Cantor (R-Va.) introduced the Spending Reduction Act of 2012 (PDF), which would supplant one year of the sequester—the across-the-board spending cuts to defense and nondefense programs outlined in last year's Budget Control Act—with other spending cuts and an additional $200 billion in savings over 10 years. Payment cuts to Medicare, which the Budget Control Act capped at 2%, are scheduled to take place in early February, and Cantor's bill keeps those reductions in place (Zigmond, 12/20).

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Taxing Health Coverage Would Lead Some To Drop It, Survey Finds

Proposals to tax health benefits, sometimes touted as a way to help reduce the deficit, could have unintended consequences, according to a survey by the Employee Benefit Research Institute.

Kansas City Star: Possible Health Tax Is A Concern
More than half of American workers indicated they would look for a cheaper health insurance plan or even drop coverage if Congress decides to tax workers' health benefits. The proposal, a possible means to pare the federal deficit by raising revenue, was tested by the Employee Benefit Research Institute in its 2012 Health Confidence Survey. If the value of employment-based health benefits became taxable, 26 percent surveyed said they would switch to a less costly plan, 21 percent said they would want to shop for coverage directly from insurers, and 9 percent said they would want to drop coverage. Thirty-nine percent said they would continue with their current level of coverage (Stafford, 12/20).

CQ HealthBeat: Taxing Health Benefits Would Lead To Less Coverage, Study Says
More than half of American workers whom the Employee Benefit Research Institute surveyed would switch to a less costly health benefits plan, shop for others or drop coverage altogether if the government began taxing health benefits. The nonpartisan group’s poll found that 26 percent of workers getting employment-based insurance would find a cheaper plan, 21 percent would shop for coverage directly from insurers and 9 percent would drop coverage if health benefits were taxed. Four in 10 of the respondents said they would stick with their current plans. Lawmakers have considered a number of proposals over the past few years that would tax health benefits to help pay for the health care overhaul or fill revenue gaps (McGlade, 12/20).

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Public Health & Education

Post-Newtown: Parents, Politicians, Health Officials Press For More Mental Health Funding

Los Angeles Times: Connecticut Shooter's Problems All Too Familiar To Many Parents
For parents around the U.S., the mass school shooting in Connecticut fueled fears about how to ensure the safety of their own children. But for parents like [Elizabeth] Guzman, the tragedy affected them in a different and terrifying way, as they saw signs of their children in the shooter. ... Guzman and other parents say getting the right help for their mentally ill children is a constant and emotionally exhausting challenge. Schools are often unprepared to cope with their illnesses ... And years of state and local budget cuts have led to fewer mental health services nationwide (Gorman, 12/20).

The New York Times: Gaps In F.B.I. Data Undercut Background Checks For Guns
Nearly two decades after lawmakers began requiring background checks for gun buyers, significant gaps in the F.B.I.’s database of criminal and mental health records allow thousands of people to buy firearms every year who should be barred from doing so. The database is incomplete because many states have not provided federal authorities with comprehensive records of people involuntarily committed or otherwise ruled mentally ill (Schmidt and Savage, 12/20).

The Wall Street Journal: Lack Of Data Slows Studies Of Gun Control And Crime
There is no shortage of opinions about whether gun-control laws accomplish what they are designed to do—reduce violent crime. What is lacking are data. ... Researchers say the CDC hasn't funded primary research in gun control since the mid-1990s, in part because of pressure from the National Rifle Association. Congress has barred the agency from funding research that promotes a position on gun control, and the CDC has limited its efforts in the area to compiling data on firearm injuries (Palazzolo and Bialek, 12/21).

The Hill: Sen. Blunt: Reauthorize US Mental Health Agency
Sen. Roy Blunt (R-Mo.) called for a full reauthorization of the federal mental health agency, known as SAMHSA, in the wake of the Newtown, Conn. shooting massacre. In an op-ed Thursday, Blunt noted that the the Substance Abuse and Mental Health Services Administration has not seen a comprehensive reauthorization since 2000. ... SAMHSA is a branch of the federal Health department. Established in 1992, the agency studies mental health issues and provides grants for behavioral healthcare delivery (Viebeck, 12/20).

The Hill: Health Advocates Applaud Obama For Gun Comments
The American Public Health Association (APHA) wrote to Obama Thursday urging a comprehensive plan to reducing gun deaths. “Gun violence is one of the leading causes of preventable death in our country and we must take a comprehensive public health approach to addressing this growing crisis,” wrote APHA Executive Director Georges Benjamin, M.D. ... The APHA is the latest in a series of health groups to endorse new policy solutions in the wake of last Friday's shooting massacre in Newtown, Conn (Viebeck, 12/20

WBUR: A Pediatrician's Advice On Gun Safety At Home
The American Academy of Pediatrics has long recommended that pediatricians inform parents about gun safety, and in some cases, even provide them with gun locks and cables. The co-author of the AAP’s firearm guidelines [Dr. Robert Sege] joins Radio Boston to explain the importance of precaution (12/20).

Los Angeles Times: California Senate Leader Asks Feds For More Mental Health Funding
[T]he leader of the California state Senate proposed Thursday that the federal government step up and begin fully matching state spending to help the mentally ill. In California, for every dollar spent on mental health programs, the federal government provides only 32 cents, which Senate President Pro Tem Darrell Steinberg (D-Sacramento) said is inadequate given the need for mental healthcare in the state (McGreevy, 12/20).

The Associated Press: California Offered As National Mental Health Model
[T]he federal government should consider California's strategy for dealing with mental illness, experts and lawmakers said Thursday. The Mental Health Services Act passed by voters in 2004 levied a special tax on high-income residents to pay for housing, medication, therapy and other services. The tax has helped more than 60,000 Californians. A fifth of the money is dedicated to prevention and early intervention, though The Associated Press reported in August that tens of millions of dollars had gone to general wellness programs for people who had not been diagnosed with any mental illness (Thompson, 12/20).

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Medicare Rolls Out Quality Bonuses And Penalties

Under a new program created by the health law, hospitals can get larger payments -- or payment cuts -- based on the quality of care they provide.

Kaiser Health News: Medicare Discloses Hospitals' Bonuses, Penalties Based On Quality
Medicare on Thursday disclosed bonuses and penalties for nearly 3,000 hospitals as it ties almost $1 billion in payments to the quality of care provided to patients. The revised payments, which will begin in January, mark the federal government’s most extensive effort yet to hold hospitals financially accountable for what happens to patients. In what amounts to a nationwide competition, Medicare compared hospitals on how faithfully they followed rudimentary standards of care and how patients rated their experiences (Rau, 12/20).

Also read a sidebar on the methodology behind the analysis. KHN has an interactive chart showing the effect of the program on individual hospitals and a state-by-state comparison.

Meanwhile, New York cracks down on sepsis in hospitals --

The New York Times: One Boy's Death Moves State To Action To Prevent Others
Prompted by the death of a 12-year-old Queens boy in April, New York health officials are poised to make their state the first in the nation to require that hospitals aggressively look for sepsis in patients so treatment can begin sooner. Under the regulations, which are now being drafted, the hospitals will also have to publicly report the results of their efforts (Dwyer, 12/20).

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Health Care Marketplace

Shifting Health Care Landscape Changes How Doctors Practice, And For Whom

News from the health care marketplace includes changes in how doctors practice -- they are increasingly seeing patients via webcam and working for insurers in insurer-run doctor offices.

The Wall Street Journal: Doctors Move To Webcams
Virtual doctor visit services -- which connect patients from their homes with physicians whom they meet via online video or phone -- are moving into the mainstream, as insurers and employers are increasingly willing to pay for them (Wilde Mathews, 12/20).

NPR: When The Doctor Works For The Insurance Company
Some insurance companies are taking a page out of their own history books: running their own doctors' offices and clinics. Though the strategy previously had mixed results, insurers think that by providing primary care for patients, they might reduce costly diseases and hospital stays in the long run (Samuelson, 12/21).

The health law is also a boon for some technology companies --

Kaiser Health News: Health Law Seen Boosting Xerox, HP
When Tennessee Medicaid Director Darin Gordon walks around his department in an office park north of downtown Nashville, he sees dozens of workers from technology giant Hewlett-Packard. HP's employees help to operate the massive computer systems that run Tennessee Medicaid. ... Growth in the program for the poor has created boom times for data management companies like HP and Xerox. ... Now, with Medicaid poised for broad expansion under the law and with online insurance markets being built in most states, those companies are well-positioned to profit (Galewitz, 12/19).

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Capitol Hill Watch

Republicans Press Obama Administration For Information On Exchange Contractors

GOP members of the Senate Finance Committee say they want more information from the Department of Health and Human Services, even as House and Senate GOP lawmakers pressed for details about the contractors who will set up insurance markets in states that don't do it themselves.

Politico Pro: Finance Presses Schultz On HHS
Senate Finance Committee members grilled the nominee for HHS general counsel Thursday about the responsiveness and transparency of the agency, saying it has a long way to go. William Schultz, who currently serves as acting general counsel at HHS and has formerly worked at the Department of Justice and FDA, repeatedly promised that he'd take back to HHS the lawmakers’ message that the agency needs to deliver more information, more quickly. Ranking member Orrin Hatch (R-Utah) said he supported the confirmation of both Schultz and Christopher Meade, who also appeared before the committee as the nominee for general counsel of Treasury. But Hatch warned that both departments’ responsiveness to congressional inquiries had to improve (Smith, 12/20).

CQ HealthBeat: Senators Grill Nominees For General Counsel At HHS And Treasury
Senate Finance Committee members from both parties expressed frustration about a lack of responsiveness from the Obama administration during a confirmation hearing on the nominees for general counsel at the Departments of Treasury and Health and Human Services (Adams, 12/20)

CQ HealthBeat: Republicans Seek HHS Contracts For Federal Exchanges
House and Senate Republicans pressed Thursday for information about contractors the Department of Health and Human Services will hire to run federal health insurance exchanges in the states. Oversight and Government Reform Committee Chairman Darrell Issa of California and Senate Finance ranking member Orrin G. Hatch of Utah wrote to Secretary of Health and Human Services Kathleen Sebelius saying they want more information about the design, management and implementation of federal exchanges and federal-state exchange partnerships (12/20).

Meanwhile, a senator tries to get his bill to increase medical residencies moving.

CQ HealthBeat: Medical Training Bill Still Stalled In Senate
A Democratic senator's effort to amend a reauthorization of a medical-training program at children's hospitals is being held up by at least one Republican, more than a year after the legislation stalled in the Senate. Sheldon Whitehouse said he requested on Tuesday that the cloakroom "hotline" the Senate measure with his amendment, which would expand the Children’s Hospitals Graduate Medical Education Payment Program to certain children's psychiatric hospitals. Under the hotline process, legislation and nominations are approved for Senate action by unanimous consent (Attias, 12/20).

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Health Reform

GAO Raises Concerns About Spending On New Medicare Programs

The government may be duplicating efforts under several programs and paying for the same services to test new payment and treatment delivery models, a study finds.

Medscape: CMS Duplicating Efforts To Test New Programs, GAO Study Says
The U.S. Centers for Medicare & Medicaid Services (CMS) may be duplicating efforts and paying for the same services under multiple programs to test new payment and treatment delivery models, the US Government Accountability Office (GAO) said in a recent report. Better coordination among the programs is needed to prevent the inefficient use of federal resources, GAO said. The CMS Innovation Center became operational in November 2010, 8 months after the Patient Protection and Affordable Care Act was signed into law. The agency received 10 times the federal funding ($10 billion through 2019) for research, demonstrations, and evaluations than had been appropriated in the previous decade. It also hired 184 new employees (Crane, 12/20.

Also in news on the health law, a federal court denied a request from a religious employer for an injunction to stop administration rules requiring contraception coverage --

The Hill: Hobby Lobby Denied Relief From Obama Birth Control Rules
A federal appeals court denied Hobby Lobby's request for a preliminary injunction against President Obama's birth control coverage rules. The Tenth Circuit Court of Appeals ruled Thursday that the Christian-run arts-and-crafts chain must comply with the policy as its case proceeds. The decision is the latest setback in Hobby Lobby's case against the Obama administration (Viebeck, 12/20)

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State Watch

Feds OK Health Insurance Exchange Plans For Three More States

The Obama administration gave conditional approvals to Delaware, Minnesota and Rhode Island, saying they will be ready to open new insurance markets in 2014, as required under the health care law. Meanwhile, Colorado Gov. John Hickenlooper indicates he's likely to push for a Medicaid expansion.

CQ HealthBeat: HHS Gives Conditional Approval To Three States For Exchanges
The Department of Health and Human Services officials said Thursday that they believe three more states have demonstrated that they will be ready to open exchanges in 2014, including one that will operate through a partnership with the federal government. HHS issued conditional approvals to Delaware, Minnesota and Rhode Island. Delaware is the first partnership exchange to win a conditional approval. Last week, HHS officials said they have deemed that Colorado, Connecticut, the District of Columbia, Kentucky, Massachusetts, Maryland, New York, Oregon and Washington will be ready to operate state-based exchanges in time for open enrollment in October (Adams, 12/20).

Minneapolis Star Tribune: Minnesota’s Insurance Exchange Wins Approval
The federal government on Thursday approved Minnesota's plan for an insurance exchange under the new health care law. The conditional approval was a necessary step in Minnesota's effort to build and operate its own exchange, a key part of the Affordable Care Act, by a 2014 deadline. States that decline or are unable to establish exchanges will use one designed by the federal government (Crosby and Shaffer, 12/20).

MPR: Feds Approve Minn. Exchange, Insurers Scramble To Develop Health Plans
Without knowing what the new plans will be required to cover, insurers say they are scrambling to develop new health plans in a matter of months when the process would normally take at least a year. Insurance exchanges are online marketplaces where individuals and small groups will begin comparison shopping for health insurance. Those health plans have to be ready to accept enrollment Oct. 1, 2013. While that may seem like a long way off, the deadline insurers must meet to even be considered for the exchange is months sooner. They must submit their plans to the state for approval by May 17 (Stawicki, 12/20).

The Seattle Times: Shift In Senate May Affect How Olympia Handles Health Care
While a state Senate leadership coup backed by Republicans would impact budget and education debates, another issue could get caught in the crossfire: how to implement President Obama's health care law. A Senate health care committee under state Sen. Randi Becker, R-Eatonville, whom the new majority coalition has tapped as chairwoman, would likely focus more on controlling health care costs, reducing regulations and increasing competition (Ostrom and Rosenthal, 12/20).

Health Policy Solutions (a Colo. news service): Colorado Likely To Opt For Medicaid Expansion
Gov. John Hickenlooper has tipped his hand that he’s likely to push for Medicaid expansion. In documents presented Wednesday to the Legislature’s Joint Budget Committee, the governor’s staff wrote: “we are likely to opt in to the expansion.” The governor insisted that the decision to expand rests solely with his office, a contention that lawmakers challenged. … Colorado Medicaid managers at the Department of Health Care Policy and Financing have not yet released long-awaited cost estimates. In response to questions from JBC analysts, Hickenlooper’s office said that cost estimates will be final by Feb. 15, 2013 (Kerwin McCrimmon, 12/20).

Kansas Health Institute: Brownback Compiling Own Estimate Of Medicaid Expansion Cost
The Brownback administration has not ruled out implementing the Medicaid expansion called for in the federal health reform law. But a spokesman today told members of the Legislature’s Joint Committee on Health Policy Oversight that prior to making a decision administration officials want to develop their own estimate of how many Kansans are likely to sign up for the health care program and how much the expansion would cost the state (McLean, 12/20).

The Associated Press: Brown: Medi-Cal Expansion Could Hit Calif. Budget
Expanding the state's Medi-Cal program to meet new federal guidelines could increase costs by up to $4 billion a year at the same time California is implementing federal health reform, potentially putting its budget "right out of whack" if negotiations over the so-called fiscal cliff aren't favorable, Gov. Jerry Brown said Thursday. In a telephone interview with The Associated Press, Brown said his administration is seeking federal waivers for some of the proposed expansions to California's health care program for the poor (Williams, 12/20).

The Associated Press: Fla. Agency Says Health Care To Cost Billions More
[Fla. Gov Rick] Scott's health care agency has drawn up dramatic new estimates that now prices the cost of implementing the overhaul -- including expanding the state's safety net health care program to thousands of Floridians currently ineligible -- at nearly $26 billion over a 10 year period. ... Greg Mellowe, policy director for the health care advocacy group Florida CHAIN, blasted the new numbers as fantasy that rely on indefensible and unreasonable assumptions (Fineout, 12/21).

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Roundup: Calif. Hospitals Fined Over Serious Errors; Mass. Pharmacy Waiting Period Continues

Los Angeles Times: 10 California Hospitals Fined For Serious Errors
Ten California hospitals received fines Thursday for errors that resulted in either serious injury or death to a patient. The California Department of Public Health issued a total of $785,000 in penalties for errors that include removing the wrong kidney, leaving surgical objects behind and failing to call for assistance when a patient began bleeding excessively (Gorman, 12/21).

The Boston Globe: State Regulators Say Controversial 21-Day Waiting Period For Closed Pharmacies Will Remain
State regulators said Thursday they will keep the most controversial aspect of emergency regulations tightening oversight of Massachusetts compounding pharmacies, despite protests from several pharmacy groups. At issue is a new rule, adopted by the Board of Registration in Pharmacy on Nov. 1, that ­allows the state to shut down a pharmacy for 21 days without a hearing to "protect the public health, safety or welfare" (Lazar, 12/20).

Modern Healthcare: Idaho System Moves Ahead With Deal To Acquire State's Largest Doc Practice
St. Luke's Health System in Idaho intends to close on its embattled acquisition of the state's largest physician practice, Saltzer Medical Group, now that a judge has issued a favorable ruling in a lawsuit challenging the sale. ... Winmill's ruling noted that his decision not to grant an injunction stopping the sale was based on an assumption that Saltzer doctors would not stop referring patients to St. Alphonsus once they start working for its competitor (Carlson, 12/20).

Modern Healthcare: Capella Leaves Alabama's 'Tough Reimbursement Climate'
Capella Healthcare, Franklin, Tenn., has sold its remaining facility in Alabama, citing a "tough reimbursement climate" that makes the state one of the most challenging in which to operate. ... It was almost exactly a year ago when Capella, which has 15 acute-care and specialty hospitals in seven states, first started its exit from its Southern neighbor (Kutscher, 12/20).

The Associated Press: Official: Abortion Rights Not Behind Voided Pact
An attorney for Planned Parenthood who asked a federal judge Thursday to block the state from cutting the agency from a nutritional program argues that the organization's support of abortion rights played a role in the decision, but Oklahoma's health commissioner says that was not the case. ... Effective Dec. 31, the state plans to end agreements it has had with Planned Parenthood for the last 18 years due to the uncertainty of federal funds and a higher cost-per-participant rate at clinics in west Tulsa, midtown Tulsa and Broken Arrow (Talley, 12/20).

Georgia Health News: State Says 'No' To Standalone Emergency Facility
A proposal to build Georgia's first freestanding emergency department has been rejected by state regulators. But this week’s decision by Department of Community Health reviewers may not close the door to other proposals to build standalone emergency departments -- which unlike traditional emergency rooms are not physically located at hospitals. ... The reviewers ruled that the Loganville area’s emergency needs were already being met (Miller, 12/20).

The Sacramento Bee: Davis City Unions Agree To Retiree Health Care Changes
Davis [Calif.] officials say the city will save $4.9 million over the run of a new three-year deal with managers, support staff and the city's police force brokered this week after coaxing employee concessions on retiree medical and other health benefits. Davis reached the accord this week with its police officers union and two other bargaining groups (Smith, 12/21).

Minneapolis Star Tribune: Twin Cities Nurses Approve Contract With 4.5% Raise
Twin Cities nurses on Thursday approved a contract that will give them a 4.5 percent wage increase over the next three years. The contract covers 12,000 nurses working in 13 facilities ... Negotiations between the Minnesota Nurses Association and the hospitals focused only on wages, keeping intact in the new contract current language related to important nursing practice standards (Smith, 12/20).

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Medical Marijuana Lawsuit In Calif. Hinges On Federal Inaction, Science

The fight over marijuana -- for medical purposes or not -- simmers in California, where the drug is treated casually and a large medical marijuana dispensary is challenging the federal government's closure of its business.

The New York Times: Marijuana, Not Yet Legal For Californians, Might As Well Be
Let Colorado and Washington be the marijuana trailblazers. Let them struggle with the messy details of what it means to actually legalize the drug. Marijuana is, as a practical matter, already legal in much of California. No matter that its recreational use remains technically against the law. Marijuana has, in many parts of this state, become the equivalent of a beer in a paper bag on the streets of Greenwich Village (Nagourney, 12/20).

Reuters: Oakland, Calif. Spars In Court With Washington Over Medical Pot
The city of Oakland, engaged in a heated battle with federal authorities over the fate of a large medical marijuana dispensary, argued in court on Thursday that Washington was ignoring science by cracking down on medical pot. The city, in a novel lawsuit seeking to block U.S. officials from forcing the dispensary to close, says the federal government's own scientists have found medical benefits for pot and have secured a U.S. patent for use of the drug, even as prosecutors have targeted medical cannabis dispensaries (Cohen, 12/20).

San Jose Mercury News: Nation's Largest Medical Marijuana Dispensary Fights In Federal Court To Stay Open In Oakland And San Jose
For more than six years, the federal government watched quietly as Harborside Health Center grew to become the nation's largest medical marijuana dispensary despite knowing that its operations were illegal under federal law. Those years of inaction could now become a central issue in a federal court action in which the federal government is seeking to seize properties in Oakland and San Jose from which Harborside sells marijuana to patients. In a drastic change of policy last summer, U.S. Attorney Melinda Haag began federal civil forfeiture proceedings against two landlords who lease property to Harborside arguing the government has the right to take the properties because they house illegal drug businesses (Rosynsky, 12/20).

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Health Policy Research

Research Roundup: Health Law's Under-26 Coverage 'Significantly Increased' Access To Care; Thousands Of Surgical 'Never Events' Occur Each Year

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: The Affordable Care Act Has Led To Significant Gains In Health Insurance And Access To Care For Young Adults
The health law allows young adults to remain under their parents’ health insurance plans until age 26, raising questions about the law’s overall impact on access to care. Researchers used data from two nationally representative surveys to compare young adults who’ve gained access to dependent coverage to a control group of individuals (ages 26-34) unaffected by the new policy. "We found that the policy significantly increased private health insurance for people ages 19-25 and also resulted in a significant improvement in access to care," the authors write, adding that the policy "was particularly beneficial for young men, unmarried people, and nonstudents." They conclude that there were "significant reductions in the number of young adults who delayed getting care and in those who did not receive needed care because of cost" (Sommers, Buchmueller, Decker, Carey and Kronick (12/19). 

Archives Of Surgery: The Employed Surgeon
"[S]urgeons are increasingly choosing hospital or large group employment as their practice environment,” the authors write. They analyzed data (2001-2009) from the American Medical Association, and found that the number of self-employed surgeons decreased from 48 percent in 2001 to 33 percent in 2009: "During this period, there was a corresponding increase in the number of surgeon employees. ... 67.9 percent of all surgeons and 66.1 percent of general surgeons can be described as employed as of 2009.” They conclude: "General surgeons and surgical subspecialists are choosing hospital employment instead of independent practice. The trend is especially notable among younger surgeons and among female surgeons. The trend denotes a professional paradigm shift of major importance" (Charles et al., 12/17).  

Urban Institute/Kaiser Commission On Medicaid and the Uninsured: How Much Will Medicaid Physician Fees for Primary Care Rise in 2013? Evidence from a 2012 Survey of Medicaid Physician Fees
This issue paper "estimates that average Medicaid fees to qualified physicians for Affordable Care Act primary care services will rise by 73 percent [on average] when the primary care fee increase takes effect on January 1, 2013." The other key findings are: "Medicaid physician fees vary widely by state....  Medicaid pays 66% of Medicare fees on average. ... The Medicaid-to-Medicare fee gap has widened." The authors conclude: "This 2012 data on primary care fees provides a baseline for assessing the impact of the Medicaid primary care fee increase" (12/17).  

Related: Kaiser Family Foundation brief: Increasing Medicaid Payments for Certain Primary Care Physicians in 2013 and 2014: A Primer on the Health Reform Provision and Final Rule (12/17).  

Academic Medicine: Can Medical Students Afford To Choose Primary Care? An Economic Analysis Of Physician Education Debt Repayment
Researchers write: "Among medical school graduates in 2011, 86 percent had education debt at graduation, averaging $161,290 -- the highest total to date." Researchers created economic models to examine loan repayment for a fictional physician's household and found that: "Our economic modeling of a physician’s household income and expenses across a range of medical school borrowing levels in high- and moderate-cost living areas shows that physicians in all specialties, including primary care, can repay the current median level of education debt," though "Graduates pursuing primary care with higher debt levels need to consider additional strategies to support repayment such as extended repayment terms, use of a federal loan forgiveness/repayment program, or not living in the highest-cost areas" (Youngclaus, Koehler, Kotlikoff, and Wiecha, 1/2012).

Surgery: Surgical Never Events In The United States
Using the National Practitioner Data Bank, a federal database of medical malpractice claims, researchers identified a total of 9,744 paid malpractice settlement and judgments for surgical "never events," which include "retained foreign bodies, wrong-site, wrong-patient, and wrong-procedure surgery. They write: "Based on literature rates of surgical adverse events resulting in paid malpractice claims, we estimated that 4,082 surgical never event claims occur each year in the United States. Increased payments were associated with severe patient outcomes and claims involving a physician with multiple malpractice reports. ... Surgical never events are costly to the health care system and are associated with serious harm to patients. Patient and provider characteristics may help to guide prevention strategies" (Mehtsun et al., 12/22).

Here is a selection of news coverage of other recent research:

Medscape: Surgical Interns On Home Call Do Not Decrease Patient Safety
Having interns on call at home rather than at the hospital was not linked to postoperative morbidity or mortality among patients who underwent general, vascular, urologic, or cardiac surgery, according to a new report presented by Zachary J. Kastenberg, MD, from the Stanford University School of Medicine in California, and colleagues in an article published online December 17 in the Archives of Surgery (Hitt, 12/18).

Reuters: Shorter Hospital Stays Don’t Mean Worse Care: Study
U.S. Veterans Affairs hospitals were able to reduce their patients' length of stay without increasing the number of people who needed to be readmitted later on, according to a new study. According to the researchers, who published their findings in the Annals of Internal Medicine, hospitals are under pressure to cut the amount of time their patients spend there (Seaman, 12/18).

Politico Pro: Study: Most Workers To Keep Employer Insurance
It’s a key worry when it comes to health reform: After health exchanges kick in, will businesses find that covering workers no longer makes economic sense and drop their insurance plans? A new study for the National Institute for Health Care Reform says there's no need to worry -- for the most part. It finds that businesses covering a big majority of workers with health insurance -- 81 percent -- will still find it financially advantageous to keep offering it after the health law is implemented in 2014. But the health law will hit small businesses harder when it comes to the economic benefits of offering insurance (Smith, 12/19).

CQ HealthBeat: GAO Finds Some Duplication In Innovation Center Testing
A new Government Accountability Office report found three examples of overlap in some Centers for Medicare and Medicaid Services programs and 17 models of health care delivery its innovation center is testing. "The efforts share similar goals, engage in similar activities or strategies to achieve these goals, or target similar populations," the study said. ... The areas of duplication involved programs for accountable care organizations, Medicaid pilot programs and existing demonstration programs, and the Partnership for Patients effort to reduce medical errors (Reichard, 12/18).

Reuters: Medical Abortions Are Safe: Study
Less than one percent of women getting a medication-induced abortion at Planned Parenthood had a serious side effect or a failed abortion, according to a new study. Researchers found the rate of abortion-related complications sending women to the emergency room or requiring a blood transfusion, for example, was one in 625 during 2009 and 2010 (Pittman, 12/20).

Reuters: Poor Children Have Highest In-Hospital Death Rate
Children from poorer neighborhoods who are hospitalized are more likely to die before discharge than kids from wealthier areas, according to a new study. These differences persisted even though the number of deaths for all kids at the hospitals studied was lower than expected (Grens, 12/20).

Reuters: HIV Cases Decline For Black Women, Increase For Gay Men: CDC
Fewer black women in the United States are being infected with HIV, but the number of young gay and bisexual men infected is rising, the Centers for Disease Control and Prevention said on Wednesday. Between 2008 and 2010, the number of newly infected black women dropped 21 percent, according to the CDC report (Beasley, 12/19).

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Editorials and Opinions

Viewpoints: Playing Chicken On Entitlements; 'Getting Serious' About Mental Illness

The New York Times: Playing Taxes Hold ’Em
This is no time for a Grand Bargain, because the Republican Party, as now constituted, is just not an entity with which the president can make a serious deal. If we’re going to get a grip on our nation’s problems — of which the budget deficit is a minor part — the power of the G.O.P.’s extremists, and their willingness to hold the economy hostage if they don’t get their way, needs to be broken. And somehow I don’t think that’s going to happen in the next few days (Paul Krugman, 12/20). 

The Wall Street Journal: Teetering On The Cliff
Speaker John Boehner defaulted to Plan B as a last resort after weeks of failed negotiations with the White House. ... When Mr. Boehner finally cracked on raising rates, at an income threshold of $1 million, Mr. Obama still said no. ... Flush with victory, [Obama] could have at least made a gesture on entitlements. Instead, he has treated the talks as an extension of the election campaign, traveling around the country at rally-style events at which he berates Republicans for not accepting his terms of surrender. Grant gave Lee more at Appomattox (12/20).

The New York Times: Strangers In The Night
But down the road, Obama does have a problem and, for Republicans, a vulnerability. Even if the cliff talks go his way, Obama will still face a money shortage. Entitlement costs are rising. Revenues can’t keep up. ... The Republican strategy should be obvious. Swallow hard and accept a deal. End the showdown era. ... Prepare a comprehensive tax and entitlement reform strategy for 2013. Call Obama’s bluff on health care reform. In case Obamacare doesn’t bend the cost curve, get Obama to agree to some automatic triggers — plans that will kick in and bring down health care spending (David Brooks, 12/20).

The Washington Post: Making A ‘B’ Line To The Cliff
Boehner gave on both revenue (now $1 trillion) and rates (now letting rates rise for those earning more than $1 million). The White House gave on revenue, rates and entitlements. It reduced its revenue demand to $1.2 trillion and raised the sock-it-to-me, rate-rising level to $400,000, from $250,000. It agreed — infuriating progressives — to an entirely sensible change in the inflation measurement for calculating tax brackets and cost-of-living adjustments for benefit programs. The two sides were so close it makes you want to cry, although, in a sign of the trying times, they can’t even agree on how close (Ruth Marcus, 12/20). 

The New York Times: Medicare Spending Isn't Out Of Control
Critics of Medicare — notably private health insurers — contend that the higher prices for health care paid by private insurers can be explained by a “cost shift” from government, notably Medicare, to private payers. This view reflects the idea that the providers of health care are to be “reimbursed” for whatever costs they incur in treating patients, rather than budgeting backward from whatever revenue they are “paid,” like other sellers (e.g., hotels or airlines), which can charge different prices to different customers for the same thing (Uwe E. Reinhardt, 12/21).

Los Angeles Times: Medicare: A Plan B For Part D
[The Part D prescription drug program] enables seniors and the disabled to buy taxpayer-subsidized coverage for many of the most widely prescribed medicines. When it created the costly benefit in 2003, though, Congress provided no way to pay for the subsidies, which have cost more than $300 billion so far. Worse, it barred the government from negotiating with drug makers for better prices — an extra gift to the pharmaceutical industry, which already stood to gain from the increased demand for its newly subsidized products. Now that policymakers are casting about for ways to save money on Medicare, they should allow it to take advantage of its market power (12/21). 
St. Louis Beacon: Don’t Weaken Medicare
Medicare gives [my mother] control over her own health-care decisions. Unlike my own "private" health insurance, Medicare lets her pick from virtually every doctor and hospital in the country. That’s the kind of choice she wants. ... When we all want the same thing, it just makes sense to provide it for everybody. That’s exactly why we should just fix the problems with Medicare (end the deductibles and co-pays; correct the inadequate physician reimbursement, etc.) and provide it to all Americans, regardless of their age. ... Instead, our precious Medicare is under attack (Dr. Ed Weisbart, 12/21).

Roll Call: Changes To Medicare Part B Pose Risk To Rural Minorities
Rural residents are more likely to be uninsured or underinsured, to develop chronic illnesses and to have trouble finding qualified doctors than residents of urban areas. Minorities in rural areas are at even greater risk. They’re more likely than their white neighbors to be obese and to have diabetes. ...  Several articles have reported that Part B cuts could be part of the fiscal cliff deal once lawmakers figure out what programs to trim. If that passes, rural Americans suffering from serious illnesses such as cancer, multiple sclerosis and rheumatoid arthritis may have to travel further or be unable to get the medical care they need (Gary Puckrein,12/20).

USA Today: Dealing With Guns And Mental Illness
According to a recent article published by Public Health Law Research, gun restrictions on people with a history of mental illness, such as background checks and waiting periods, had no significant effect on homicide rates. The restrictions, however, did reduce the suicide rate, suggesting that people with mental disorders, especially depression, are more likely to kill themselves than others. ... What troubles me is broadside finger-pointing that increases stigma against persons such as my son. He didn't ask to have a mental disorder anymore than I asked to have poor eyesight and asthma (Pete Early, 12/20). 

The Washington Post: The Roots Of Mass Murder
As a psychiatrist in Massachusetts in the 1970s, I committed people — often right out of the emergency room — as a danger to themselves or to others. I never did so lightly, but I labored under none of the crushing bureaucratic and legal constraints that make involuntary commitment infinitely more difficult today. Why do you think we have so many homeless? Destitution? Poverty has declined since the 1950s. The majority of those sleeping on grates are mentally ill. In the name of civil liberties, we let them die with their rights on (Charles Krauthammer, 12/20).

The Miami Herald: Let’s Get Serious About Mental Health
The sad truth is, in almost every tragedy like Sandy Hook, Aurora, and Virginia Tech, cries for help went unheeded or unfunded. Sometimes it’s the person with a serious mental illness (SMI) — schizophrenia, bipolar disorder, major depression — or a family member reaching out to help them. In either case, their pleas for help often fall on deaf ears or on a mental health system that is stressed with too much unmet need and too few resources. ... Due to the cost of providing treatment and shrinking government budgets, policy makers dismiss adequate mental healthcare funding as something less than a high priority (Paula Dockery, 12/20).

The New York Times: Labs, Washed Away 
When the hospitals were hit by Hurricane Sandy, hundreds of experiments were obliterated by the loss of power. Precious biological samples carefully frozen over years were destroyed. Temperature-sensitive reagents and equipment were ruined. Medications and records for patients in clinical trials were rendered inaccessible. ... For many patients, the thrum of research within a medical center is invisible. But it is an integral — and very human — part of a hospital. When a hurricane disrupts research, it is a loss that resonates well beyond the laboratories (Dr. Danielle Ofri, 12/20).

The New York Times: Where Have All the Primary Care Doctors Gone?
More and more, my family and friends are asking for my help in finding a primary care doctor. That they would be having trouble finding one doesn’t surprise me. We’ve all been reading warnings about an impending doctor shortage for several years now. What is alarming to me is that there are no sure-fire solutions in place that will bail us all out in time (Dr. Pauline Chen, 12/20).

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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.