Daily Health Policy Report

Thursday, April 10, 2014

Last updated: Thu, Apr 10

KHN Original Reporting & Guest Opinion

Medicare

Health Reform

Capitol Hill Watch

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Medicare Records Provide Tantalizing New Details Of Payments To Doctors

Kaiser Health News staff writer Jordan Rau reports: “Medicare’s release Wednesday of millions of records of payments made to the nation’s doctors comes as the government is looking to find more cost-efficient ways to pay physicians, particularly specialists” (Rau, 4/9). Read the story.

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Doctors' Billing System Stays Stuck In The 1970s For Now

Eric Whitney, reporting for Kaiser Health News in collaboration with NPR, reports: “For doctors, hospitals and insurance companies, all the complexities of medicine get boiled down into a system of codes. These codes are used to track and pay for every procedure – like an 813.02 for mending a broken forearm, or an 800.09 for treating a concussion. But this coding system is now four decades old, and it doesn't meet the needs of the medical system today. It was scheduled to be upgraded this October, but Congress delayed it last week. JaeLynn Williams, for one, is seriously bummed out” (Whitney, 4/10). Read the story.

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Barriers Remain Despite Health Law's Push To Expand Access To Substance Abuse Treatment

Kaiser Health News staff writer Anna Gorman, working in collaboration with USA Today, reports: “The nation’s health law has promised sweeping changes to help millions of people with drug or alcohol addiction get treatment. Many unable to afford services in the past now can receive them without first landing in jail or an emergency room, health officials say” (Gorman, 4/10). Read the story.

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Capsules: Alzheimer’s Disease Support Model Could Save Minn. Millions; What Consumers Can Learn From Medicare Payment Data

Now on Kaiser Health News' blog, Lisa Gillespie reports on an innovative model for Alzheimer's care: “As states eye strategies to control the costs of caring for Alzheimer’s patients, a New York model is drawing interest, and findings from a study of Minnesota’s effort to replicate it shows it could lead to significant savings and improved services” (Gillespie, 4/10).

Also on the Capsules, Kaiser Health News staff writer Jordan Rau, who reported on what can be learned from the newly-released data, discusses Medicare payments to providers with NPR’s Melissa Block on “All Things Considered” Wednesday night. Listen to the audio or read the transcript.

Check out what else is on the blog.

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Political Cartoon: 'Measly Outcome?'

Kaiser Health News provides a fresh take on health policy developments with "Measly Outcome?" by Nate Beeler.

And here's today's health policy haiku:

LIONS, ALLIGATORS AND MEDICAL CODES - OH MY!

Sebelius says no
ICD10 delay!
Oops she was so wrong!
-Beau Carter

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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Medicare

Details -- And Limits -- Of Medicare Billing Data Emerge

News outlets begin to analyze the wealth of information now available as a result of Wednesday's release by the Centers of Medicare & Medicaid Services of a trove of payment records. They also note the limits.  

Kaiser Health News: Medicare Records Provide Tantalizing New Details Of Payments To Doctors
Medicare’s release Wednesday of millions of records of payments made to the nation’s doctors comes as the government is looking to find more cost-efficient ways to pay physicians, particularly specialists (Rau, 4/9). 

The New York Times: The Medicare Data’s Pitfalls
The release on Wednesday of Medicare payment data is getting mixed reviews from doctors. Many say they favor sharing information but worry that the data presented by Medicare omits important details and may mislead the public and paint an unfairly negative picture of individual doctors (Grady and Fink, 4/9).

The Wall Street Journal: Doctor-Pay Trove Shows Limits Of Medicare Billing Data
The trove of Medicare data released Wednesday shows a wide cast of characters in the top ranks of the highest-reimbursed doctors, and reveals as much about the limits of the newly public billing records as it does about medical practice (Weaver, Beck and Winslow, 4/9).

PBS NewsHour: Medicare Data Raises Fresh Questions About Concentrated Payout For Few Doctors
Just 3 percent of doctors and medical providers received at least one-quarter of the $77 billion paid to providers by the government in 2012, according to an unprecedented and controversial release of data by Medicare. Judy Woodruff gets analysis from Dr. Ardis Hoven of the American Medical Association and Shannon Pettypiece of Bloomberg News (Woodruff, 4/9).

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Analysis Of Medicare Pay Shows Variations In Drugs Used And Earnings By Specialists

The Washington Post examines how drugs administered by doctors is different in various regions of the country. Other outlets look at other issues, including how eye doctors are among the highest paid specialty.

The Washington Post: Cost Of Drugs Used By Medicare Doctors Can Vary Greatly By Region, Analysis Finds
An analysis of government data released Wednesday shows that the cost of drugs administered by doctors accounts for a growing piece of Medicare’s spending and varies widely from region to region in the United States, raising questions about whether some physicians may be misusing the pharmaceuticals. Most of the 4,000 doctors who received at least $1 million from Medicare in 2012 billed mainly for giving patients injections, infusions and other drug treatments, those records show (Whoriskey, Keating and Sun, 4/9).

Los Angeles Times: Medicare Pay Data Shock And Anger Many Doctors Listed As High Earners
Like dozens of other doctors across the country, [Newport Beach oncologist Minh] Nguyen was unwittingly thrust into the spotlight as federal officials listed for the first time what the government pays individual doctors to treat elderly Americans. Some of those with the highest billings had already drawn public scrutiny as part of government investigations into healthcare fraud. But many more doctors were shocked to see where they ranked, since Medicare hadn't shared the data with physicians before publication (Terhune and Smith, 4/9).

The Washington Post: Doctors React To Release Of Medicare Billing Records
Doctors reacted swiftly and indignantly to Wednesday’s release of government records revealing unprecedented details about Medicare payments to physicians. Many resented being included on a list that showed some doctors billing Medicare for millions of dollars. The top 10 doctors alone received a combined $121.4 million for Medicare Part B payments in 2012 (Millman and Fallis, 4/9).

The New York Times: Eye Doctors Say Their Profits Are Smaller Than Data Makes Them Look
Although consumers and health experts will be poring over the newly released Medicare data for months, maybe years to come, one startling piece of information has already emerged, demonstrating some of the complexity inherent in the long-fought-over information on 880,000 health care providers across the country. More than any other specialists, ophthalmologists — not cardiologists, cancer doctors or orthopedic surgeons — were the biggest recipients of Medicare money in 2012 (Pollack and Abelson, 4/9).

The Wall Street Journal: Medicare Payment Data Throw Spotlight On Potential Abuses
Some doctors who received large sums from Medicare in 2012 have had run-ins with the law, signaling how the government's unprecedented move to make such payments public could throw up red flags for potential abuse. The physician paid the most by Medicare in 2012 is a high-profile south Florida ophthalmologist who has been fighting with the federal government for years over allegations of overbilling (Mathews, Carreyrou and Barry, 4/9).

The Wall Street Journal: Medicare Paid One Doctor More Than $20 Million In 2012
The doctor who was paid the most by Medicare in 2012 is a high-profile south Florida ophthalmologist who has been fighting with the federal government for years over allegations of overbilling. Salomon Melgen, whose practice was searched twice last year by the Federal Bureau of Investigation, got $20,827,340.74 from the Medicare program in 2012. With four offices and 30 employees, Dr. Melgen draws almost 70% of his patients from the program, according to court documents, and often performs injections of medications to treat macular degeneration, a condition that can cause blindness (Mathews and Schwartz, 4/9).

The New York Times: Political Ties Of Top Billers For Medicare
Two Florida doctors who received the nation's highest Medicare reimbursements in 2012 are both major contributors to Democratic Party causes, and they have turned to the political system in recent years to defend themselves against suspicions that they may have submitted fraudulent or excessive charges to the federal government (Robles and Lipton, 4/9).

The Washington Post’s Wonkblog: Want To See How Problematic Medicare Pricing Is? Look To Ophthamology
One particularly striking example in the new data: billing in ophthalmology. The data show that there were nearly 4,000 individual physicians who each billed Medicare for at least $1 million in 2012 alone. As The New York Times noted, ophthalmology was the specialty that billed the highest total (Ehrenfreund, 4/9).

The Associated Press: Top-Paid Medicare Doctors Say They Have Reasons
How is it that a few doctors take in millions of dollars from Medicare? Explanations for Wednesday’s eye-popping numbers from Medicare’s massive claims database ranged from straightforward to what the government considers suspicious, as the medical world confronted a new era of scrutiny (Alonso-Zaldivar and Tumgoren, 4/9).

Politico Pro: No Top Medicare Billers Among Docs In Congress
The doctors in Congress don't appear to be breaking Medicare’s bank, but the government's massive payment disclosure Wednesday shows that some of their family members have brought in sizable sums. Of the 24 House and Senate members who are physicians, just four collected Medicare reimbursements in 2012, according to the CMS database of 2012 billings. The two members who were in Congress at the time received relatively small sums. Rep. Bill Cassidy (R-La.) drew $588 as an associate professor at Louisiana State University who occasionally provides care as a gastroenterologist. Rep. Scott DesJarlais (R-Tenn.) brought in $2,422, but his office explained Wednesday that the payment was for a nurse practitioner running his general medical practice since he no longer sees patients (Cunningham, 4/9).

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Taking A Close-To-Home Look At The Medicare Billing Data

Other news outlets offer localized takes on the Medicare data, including the Miami Herald's coverage of a physician who emerged as the federal program's top-paid doctor, the Philadelphia Inquirer's look at an ambulance business' billing patterns and the Seattle Times' examination of ophthalmologists.

Miami Herald: South Florida Ophthalmologist Emerges As Medicare's Top-Paid
A South Florida doctor under criminal investigation for alleged excessive billing of Medicare emerged as the federal health program's top-paid physician in the nation Wednesday, according to the most detailed data on physician payments ever released in Medicare's nearly 50-year history (Weaver and Chang, 4/9).

Philadelphia Inquirer: Ambulances Among Biggest In Medicare Payments
It doesn't take many customers to build an ambulance business, according to Medicare payment data released Wednesday by federal regulators. For example, Red Cross Ambulance, which is based in Huntingdon Valley and operates two ambulances, state data show, collected $395,601 from Medicare for a dozen patients in 2012.That amounted to an annual average of nearly $33,000 per patient (Brubaker, 4/9).

Seattle Times: State's Ophthalmologists Top Medicare Payment List
In Silverdale, Kitsap County, Retina Center Northwest's three doctors were among the state's top 50 in total payments. One, Dr. David Spinak, topped the list with total payments of more than $3 million in 2012. But Dr. Todd Schneiderman, 50, who founded the clinic in 2001 and whose reimbursements came in over $2 million, said the reimbursements reflect in large part payments for the expensive and very effective drugs he and many ophthalmologists use to stop, and even reverse, serious age- or diabetes-related eye problems such as macular degeneration (Ostrom, 4/9).

The Arizona Republic: Feds Shed Light On Doctors' Charges, Payments
The federal government today took the unprecedented step of releasing Medicare billing records for about 880,000 doctors and medical providers nationwide, providing the public a rare glimpse into the murky world of health-care billing. The massive data release showed that Arizona doctors and medical providers collected a one-year average of $94,699 from Medicare, ranking the state No. 14 among 50 states by that measure. In Arizona, 16,779 doctors, nurse practitioners, labs and other providers billed Medicare a total of $4.9 billion in 2012 and collected nearly $1.6 billion, or about 32 cents for each dollar billed (Alltucker and Dempsey, 4/9).

The Star Tribune: Medicare Payments To Doctors Reveal Specialists As Big Winners
The federal government spent a lot of money in 2012 on specialty eye care at 7760 France Av. S., Suite 310 — $13 million to be exact. Seven ophthalmologists practicing at that location received more than $1 million apiece from Medicare — an amount matched by only five other Minnesota doctors — according to Wednesday's first-ever release of data showing payments from the traditional Medicare Part B program to the nation’s doctors. The reimbursement to VitreoRetinal Surgery in Edina is one of many surprising nuggets in Wednesday’s data release, which also paints a detailed picture of the medical care used by the nation’s 49 million Medicare patients and how the program pays doctors and other providers to deliver it (Olson and Howatt, 4/9).

The Baltimore Sun:  Medicare Pays Hundreds Of Millions To Maryland Providers
Eye specialists, ambulance service providers and clinical laboratories are the biggest recipients of Medicare payments around the country and in Maryland, taking in hundreds of millions of dollars from the federal health program for seniors, according to newly released data. Federal officials released the data Wednesday for the first time since 1979, offering transparency to the system but drawing criticism from some provider groups who fear that the data could be taken out of context (Cohn, 4/9).

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Health Reform

Oregon, Minnesota Exchanges Weigh Next Steps

Officials overseeing the troubled exchanges examine what went wrong this year and debate how to proceed. Meanwhile, a small business exchange in Georgia gets few enrollees and The Denver Post reports that more residents signed up for Medicaid than for private insurance.

The Oregonian: Decision To Scrap Or Salvage Cover Oregon Health Insurance Exchange Poses Risks Either Way
In January, Cover Oregon officials told lawmakers that efforts to fix the health insurance exchange had steadily cut the number of most serious programming bugs to just 13. Since then, that tally has grown to about 300. The disturbing trend underlines the uncertainty Cover Oregon and Gov. John Kitzhaber wrestle with as they decide whether to try to salvage the unfinished insurance exchange -- or scrap the whole thing and move to the federal exchange. The exchange board will hear an update on the process at its Thursday meeting (Budnick, 4/9).

Minnesota Public Radio: Legislative Auditor To Investigate MNsure
The bi-partisan Legislative Audit Commission has directed the state's internal government watchdog to perform a broad audit of MNsure, Minnesota's online health insurance marketplace. Legislative Auditor James Nobles' office already has two limited examinations of MNsure underway. One is a federally required review of how MNsure spent more than $150 million in federal grants. It also is reviewing the security of MNsure's website (Stawicki, 4/9).

Minnesota Public Radio: Health Exchange Enrollment Passes 181K
The operators of Minnesota's health insurance exchange say enrollment has risen to about 181,000 people as they continue to process applications that were started before the March 31 enrollment deadline. MNsure is working through a backlog of some 36,000 insurance applications from people who started but could not complete the process by the close of open enrollment. The agency says that, so far, 47,697 Minnesotans have enrolled in a commercial health plan; the rest are in MinnesotaCare (37,050) and Medical Assistance (96,610), government-sponsored coverage (Catlin, 4/9).

Pioneer Press: MNsure To Undergo Evaluation By Auditor, Analysis Of Its Coverage Effectiveness
As Minnesota's legislative auditor announced Wednesday a full evaluation of MNsure, state officials revealed plans to address a key question: Did the federal health law reduce the number of Minnesotans lacking coverage. MNsure has asked University of Minnesota researchers to work with insurance companies and the state Department of Human Services to provide a preliminary estimate for the impact of the federal Affordable Care Act on the uninsured rate in Minnesota (Snowbeck, 4/09).

Georgia Health News: Small Firms’ Exchange Has A Big Problem: It’s Off To A Very Slow Start
The health insurance marketplace for small businesses is now open. But Mom and Pop aren’t buying. Many small employers do not even appear interested in checking out this feature of the Affordable Care Act, which is different from the better-known individual exchange where people buy coverage for themselves (Empinado, 4/9).

Meanwhile, on the topic of Medicaid expansion --

ProPublica: Medicaid Programs Drowning in Backlog
Last week, federal health officials celebrated two milestones related to the Affordable Care Act. The first, which got considerable attention, was that more than 7 million people selected private health plans in state and federal health insurance exchanges. The second, which got less attention, was that some 3 million additional enrollees had signed up for Medicaid and the Children's Health Insurance Program (public health insurance programs for the poor), many as a result of Medicaid's expansion. But there are growing signs that Obamacare's Medicaid expansion is a victim of its own success, unable to keep up with demand. While about half the states have refused to expand their Medicaid programs' eligibility, among those that have, some can't process applications fast enough (Ornstein, 4/9).

The Denver Post: More In Denver Signed Up For Medicaid Than For Private Insurance
In Denver, 2 1/2 times as many people enrolled in the taxpayer-funded Medicaid program from October through the first quarter of 2014 as those who signed up for private insurance through the state exchange, state figures show. And in Colorado and nationwide, Medicaid enrollments outpace private insurance registrants. Colorado ranked 11th in the nation of states with the highest percentage of Medicaid enrollments compared with private insurance subscribers through marketplaces as of the end of February, a Denver Post analysis of federal numbers shows (Kane, 4/10).

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White House Admits 'Worrying About The Wrong Thing'

Top officials say they focused too much on whether enough insurance companies would participate and not enough on the smooth rollout of the exchange website, The New York Times reports. 

The New York Times: Health Goal Met, White House Reviews Missteps
In an hour-long interview they requested, the officials said one of their biggest mistakes in the disastrous health care rollout last fall was worrying about the wrong thing. They said they focused too much on their ultimately unfounded fear that not enough insurance companies would participate in the health marketplaces and that premium prices would be too high. In turn, they said, they ignored what became the real problem, a website that was virtually inaccessible in its opening days (Shear, 4/9).

Meanwhile, Kaiser Health News looks at how the health law is affecting access to substance abuse treatment -

Kaiser Health News: Barriers Remain Despite Health Law's Push To Expand Access To Substance Abuse Treatment
The nation’s health law has promised sweeping changes to help millions of people with drug or alcohol addiction get treatment. Many unable to afford services in the past now can receive them without first landing in jail or an emergency room, health officials say (Gorman, 4/10).

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Capitol Hill Watch

House Rejects Health Law Fix

The bill, which was surprisingly defeated, would have exempted expatriates' insurance plans from the health law.

Politico: House Rejects Expatriate Obamacare Bill
The House on Wednesday rejected a bipartisan bill that would have changed how expatriates and their insurance carriers comply with Obamacare, amid strong opposition from senior Democrats who said it created large loopholes in the health law. The bill, H.R. 4414, fell 257-159. Republican leaders brought the bill to the floor under suspension of the rules, a procedure that requires support from two-thirds of members voting. It’s usually used for noncontroversial legislation, but opposition to this bill mounted all day, leading to its surprise defeat (Haberkorn, 4/9).

The Hill: Bipartisan ObamaCare Fix Fails In House
The House on Wednesday rejected bipartisan legislation to exempt expatriates' insurance plans from the 2010 health care law. The House voted 257-159 in favor of the bill, a clear majority. But Republicans called it up under a suspension of House rules, which requires a two-thirds majority vote (Marcos, 4/9).

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N.H. Senate Hopeful Makes Anti-Health Law Motto Cornerstone Of Campaign

The former Massachusetts senator, running now for Senate in New Hampshire, says the health law forces people to "live free or log on," a variation of New Hampshire's "Live Free or Die" motto.

The Associated Press: Senate Hopeful Brown: Health Law Costs Liberty
Hoping to return to Washington by way of New Hampshire, former Massachusetts Sen. Scott Brown is using a variation of the state’s “Live Free or Die” motto to argue against President Barack Obama’s health care overhaul law. Brown planned to formally announce his Senate bid Thursday night. In excerpts of remarks provided by his campaign, he said the health care law forces people to “live free or log on” (4/10).

Fox News: Brown To Kick Off NH Senate Campaign By Slamming ObamaCare
Former Massachusetts Sen. Scott Brown will use a variation of New Hampshire's "Live Free or Die" motto to make the case against Obamacare when he kicks off his Senate campaign in the Granite State Thursday. In excerpts of planned remarks provided to the Associated Press by his campaign, Brown said the health care law forces people to "live free or log on." Brown, a former Fox News contributor who left the network last month after forming an exploratory committee, will formally announce his candidacy at an event in the coastal city of Portsmouth, where he lived as a baby and where he frequently visited his grandparents growing up (4/10).

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State Watch

State Highlights: Va. Mental Health Care Task Force; Pharmacist Duties In N.C.; Nurse Practitioners In Conn.

A selection of health policy stories from Virginia, North Carolina, New York, Connecticut, Minnesota, Florida, Iowa and Oregon.

The Associated Press: Lt. Gov To Lead Va. Mental Health Task Force
Lt. Gov. Ralph Northam will lead a state task force on mental health. Gov. Terry McAuliffe signed an executive order Wednesday extending a task force first created by former Gov. Bob McDonnell last year following the suicide of a state senator’s son (4/9).

North Carolina Health News: Pharmacists Get New Duties, Business With New Law
North Carolina is among the growing number of states to expand pharmacy practice laws, offering pharmacists a more visible, public role in helping manage patient care. A law enacted last year by the state legislature that went into effect in October increases the number and types of vaccines pharmacists’ can now administer in North Carolina. The law also opens the door a little wider to allow the number of in-store pharmacy clinic services to grow (Porter-Rockwell, 4/9).

The CT Mirror: Senate Votes To Allow Nurse Practitioners To Practice Independent Of Doctors
The Connecticut state Senate voted 25 to 11 Wednesday night to allow nurse practitioners to practice independent of physicians, a controversial concept that has gained traction amid growing concerns about the availability of primary care providers in the state. The proposal, which now goes to the House, originated in Gov. Dannel P. Malloy’s administration, which pitched it as a way to increase access to primary care at lower costs as thousands more state residents gain insurance as part of the federal health law. But critics have raised concerns about the effects the change could have on patient care and primary care physicians (Becker, 4/9).

The Associated Press: N.Y. Health Commissioner Steps Down For Calif. Job
New York Health Commissioner Dr. Nirav Shah will step down in June to take an executive position with Kaiser Foundation Health Plan in California, the health department said Wednesday. During Shah's tenure as state health commissioner, he became a lightning rod for critics of hydraulic fracturing for natural gas because of the Cuomo administration's plan for an extended review of the technology. The health department also established a state health insurance exchange under the federal Affordable Care Act (4/9).

Kaiser Health News: Capsules: Alzheimer’s Disease Support Model Could Save Minn. Millions
As states eye strategies to control the costs of caring for Alzheimer’s patients, a New York model is drawing interest, and findings from a study of Minnesota’s effort to replicate it shows it could lead to significant savings and improved services (Gillespie, 4/10).

The CT Mirror: CT Scales Back Medicaid Repayment Rules For Some Recipients
Connecticut officials are scaling back the circumstances under which the state can seek repayment from the estates of Medicaid recipients when they die. The move addresses what some state and federal officials believe is a barrier to getting Medicaid-eligible people to sign up for the program under the federal health law commonly known as Obamacare. But the change affects people in only one portion of the program and leaves adults who received Medicaid-funded services before this year subject to having their estates docked for repayment (Becker, 4/9).

Health News Florida: Health Care 'Train' Coming?
Leaders of the Florida House, hoping to protect their pet health issues from being picked apart in the Senate,  have bundled them into a package to be introduced Thursday morning. In legislative parlance, they're creating a "train." The idea of a train is that it's a bunch of railcars that are connected and it would be hard to remove one of them without causing them all to derail. As a practical matter, it means some lawmakers might have to accept a bill they don't like in order to get one that's a must-pass.The House Health & Human Services Committee is expected to take up the measure at its meeting at 9 a.m. If approved, it will be the new version of the bill  (HB 7113) (Gentry, 4/10).

The Associated Press: Telemedicine Bill Still in Play
A Senate bill that would increase the use of telemedicine and establish requirements for health providers who treat patients remotely remains in play in Florida’s Legislature. A companion bill is also making its way through the House, but that bill doesn't require doctors to have a Florida license -- only that they be licensed in their home state and registered in Florida (4/9).

Miami Herald: HCA Will Waive Trauma Fees For The Uninsured
Hospital Corporation of America, Florida’s largest provider of trauma care, announced this week it will stop charging uninsured patients a special trauma fee that can add $30,000 or more to their bills. The new policy, announced Tuesday to the News Service of Florida, comes one month after the Tampa Bay Times published the results of a yearlong investigation showing that hospitals across the state were charging huge fees to trauma patients even when they needed little more than first aid (Zayas and Mitchell, 4/10).

The Des Moines Register: Mental Care Advocates Rally At Iowa Statehouse 
Advocates for people with mental disabilities or brain injuries gathered at the Statehouse Wednesday to decry years-long waiting lists for support services. The advocates said 7,700 Iowans are waiting for “Medicaid waiver” services, partly because Gov. Terry Branstad last summer vetoed $8.7 million that legislators had approved to clear such waiting lists (Leys, 4/10).

The Lund Report: Health Transformation Via A Website
Community health assessments and community health improvement plans have become a required component of the health care transformation landscape, some communities are turning to technology to assist with the planning process. Healthier Central Oregon, a web-based source of population data and community health information is helping policymakers, planners and community members in Central Oregon make their community healthier. The website is being run by the Central Oregon Health Board (Crook, Jefferson, and Deschutes counties) and the Central Oregon Health Council and sponsored by St. Charles Health System and Pacific Source Health Plans (Scharer, 4/9).

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Weekend Reading

Longer Looks: Vermont's Single Payer System; Nevada's Cancer Cluster

Every week KHN reporter Marissa Evans selects interesting reading from around the Web.

Vox: Forget Obamacare Vermont Wants To Bring Single Payer To America
Skatchewan is a vast prairie province in the middle of Canada. It's home to hockey great Gordie Howe and the world's first curling museum. But Canadians know it for another reason: it's the birthplace of the country's single-payer health-care system. ... Saskatchewan showed that a single-payer health-care system can start small and scale big. And across the border, six decades later, Vermont wants to pull off something similar. The state is three years deep in the process of building a government-owned and -operated health insurance plan that, if it gets off the ground, will cover Vermont’s 620,000 residents — and maybe, eventually, all 300 million Americans (Sarah Kliff, 4/9). 

The Atlantic/High Country News: Looking For Answers In A Town Known For Leukemia
One night in May 2008, in a modest ranch house in central Nevada, Ryan Brune woke with a headache. ... his mother, April, drove him to the hospital in Fallon, a farming town of 8,200 where the family had lived for most of Ryan’s 10 years. He was an otherwise healthy boy, with fleshy cheeks and sandy blond hair, but a CT scan revealed a chestnut-sized mass in his brain. ... Ryan had glioblastoma multiforme, a brain cancer that rarely afflicts children. His likelihood of survival was 1 percent. ... From 1997 to 2002, Fallon had also suffered a high incidence of acute lymphoblastic leukemia among children; 16 cases were diagnosed, an alarming number for a small town. Health officials declared it the most significant childhood cancer cluster on national record and launched an investigation unprecedented in cost and scope. They never found the cause (Sierra Crane-Murdoch, 4/5).

Health Affairs: A Family Disease: Witnessing Firsthand The Toll That Dementia Takes On Caregivers
In the summer of 2012 my father-in-law, Ed, telephoned on a Sunday night with some surprising news. Sylvia, his wife of fifty-five years, suddenly did not recognize him. She had recently been diagnosed with very early-stage dementia, but her symptoms had not yet been this severe. ... As a geriatric psychiatrist, I had urged Sylvia to seek care early, which she had done; so she knew options for her treatment included activities to keep her socially engaged, medication to slow the illness course, and possibly experimental treatment. But on a personal level, I was worried. I worried about Ed, my wife, her siblings, and myself. We would be Sylvia's caregivers for the rest of her life. And I understood the devastating toll dementia could take on an entire family (Dr. Gary Epstein-Lubow, 4/7).

The Houston Chronicle: This Scientist Just Might Cure Cancer
Decked out in black tie, Jim Allison stood on the red carpet in Silicon Valley. It was unfamiliar territory for the small-town boy from South Texas who had become a scientist and spent his research career on what many considered a lost cause, the study of the immune system's cancer-fighting potential. … Whatever the source of his genius, Allison, chairman of immunology at the University of Texas M.D. Anderson Cancer Center, is credited today with one of the most important breakthroughs in cancer history, the discovery that finally frees the immune system to attack tumors -- a dramatic departure from the existing models of treating the disease. Allison did it -- made the discovery, then translated it into a drug -- in a climate that wasn't exactly welcoming (Todd Ackerman, 4/7). 

The Boston Globe: Women With Turner Syndrome Tell Their Stories
Most kids are thrown into puberty whether they like it or not. But Miriam Beit-Aharon, who has a rare genetic disorder, made a choice to enter womanhood. Beit-Aharon has Turner syndrome, a disorder that stunts sexual development and causes infertility in about one in every 2,500 female births. She didn’t start puberty until she began taking estrogen therapy in high school, a transition that the now 22-year-old wrote about in her application to the University of Massachusetts-Amherst, where she received her diploma last May. Her application essay is now part of a collection of coming-of-age stories written by 18 women with the syndrome (Alyssa Botelho, 4/7).

WBUR: Obesity: A Disease By Any Other Name
When the American Medical Association declared obesity a disease last year, most of us — advocates who work to help those with obesity — were thrilled. We saw the new definition's potential to change how medical professionals regard people with obesity, increase society's focus on obesity, push insurance companies to cover obesity treatments, reduce social stigma and moderate the anxiety and depression often afflicting those with obesity. ... But nothing is that simple or easy (Melinda J. Watman, 4/2).

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Editorials and Opinions

Viewpoints: Medicare's 'Doctor Payment Problem'; A 'Wasted Advantage'; 'Puzzling' Rand Numbers

Los Angeles Times: Medicare's Real Doctor Payment Problem
The news that a small percentage of the country's physicians collected billions of dollars from Medicare in a single year may or may not be a testament to individual greed; some of the top recipients are under investigation for allegedly bilking the system, while others work long hours delivering costly care. But it is a powerful reminder that the program needs to stop rewarding doctors for the quantity of care they deliver rather than the quality. Happily, there's a bipartisan plan to do just that; unhappily, lawmakers haven't been able to agree on how to cover its cost. If Congress needed any further incentive to settle its differences, the fact that 1,000 doctors raked in $3 billion from Medicare should provide it (4/10).

The New York Times' Public Editor: Times Should Have Nodded To Wall Street Journal In Medicare Story
The New York Times led its print edition today with an extensive treatment of an important story: that a small fraction of doctors get a huge share of the billions of dollars paid out under Medicare. What’s missing in that story is any reference to The Wall Street Journal, whose persistent legal efforts over several years helped result in a trove of Medicare data being made public, including much of the data that Wednesday’s news reports were based on (Margaret Sullivan, 4/9).

Bloomberg: Medicare's Wasted Advantage
Anyone worried about the cost of health care in the U.S. should view this week's capitulation on Medicare Advantage with concern. Faced with a lobbying campaign that health insurers have described as their "largest ever," the federal government backed down from next year's proposed cuts to the program, which pays private insurers to deliver Medicare benefits. If the government has this much trouble trimming a useless subsidy for the insurance industry, it will have a hard time being frugal when it comes to health spending that actually matters (4/9).

Bloomberg: How To Give Obamacare The Slip
Here's the scenario: You run a trade association, and your corner of the health-care sector gets stuck with part of the bill for Obamacare. Naturally, you'd rather not pay that bill, so you start a campaign against it. You assemble a coalition of lawmakers from both parties to support your argument. You pay for studies. You write letters. You meet with officials. What happens next? If you represent the insurance industry, and you've been fighting the law's reduction in Medicare Advantage payments, you rack up a series of modest wins. If you represent the medical device industry, and you've been fighting the law's excise tax on your products, you get bupkis (Christopher Flavelle, 4/9).

Los Angeles Times: Watch The Right Search Desperately For Bad News On Obamacare
The peculiar efforts by opponents of the Affordable Care Act to knock down the unquestionably good news about its effects have continued this week, fueled by an omnibus survey released Tuesday by the Rand Corp. We reviewed the report's findings here. The report, based on the latest poll of a group of respondents questioned by Rand every month, concluded that 9.3 million Americans gained health insurance between September 2013 and sometime in mid-March. It acknowledged that there's a built-in margin of error because of the survey size (roughly 2,400 individuals), and that its figure might change because sign-ups for 2014 were still continuing when polling ended, but it said that on the whole "the ACA has already led to a substantial increase in insurance coverage" (Michael Hiltzik, 4/9).

Bloomberg: More Puzzling Obamacare Numbers
Late last month, the Los Angeles Times got a lot of buzz when it used data from an unpublished RAND Corp. report to assess the state of Affordable Care Act enrollment. That report is now available, and a lot of folks have been poring over its findings. Actually, puzzling over its findings might be a better way to put it (Megan McArdle, 4/9).

The Wall Street Journal: The Obamacare Debate Is Far From Over
With the announcement earlier this month that 7.1 million Americans signed up for health insurance through Obamacare, Democrats think they are over the hump. House Leader Nancy Pelosi told CNN's Candy Crowley that congressional Democrats "are happy to not run away from what we have done. We're very proud of what we have accomplished." Democrats at risk in Republican states this November agree. Louisiana's Sen. Mary Landrieu says Obamacare "holds great promise and is getting stronger every day." Alaska's Sen. Mark Begich proclaims "seven million people have access to quality, affordable care and are in control of their own health-care choices." ... That's a wish, not a fact. Obamacare is and will remain a political problem for Democrats because there's a huge disconnect between the party's rhetoric and the reality that people affected by the law have experienced (Karl Rove, 4/9).

The Fiscal Times: Two Studies Raise Red Flags On Obamacare's First Round
The White House celebrated as it announced that 7.1 million consumers had signed up for health insurance through the federal and state exchanges, slightly exceeding their original goals and significantly outpacing expectations after the disastrous rollout of Obamacare last October. "The debate over repealing this law is over," President Obama told the press on April 1. "The Affordable Care Act is here to stay." Last week, that sounded like wishful thinking. Two new studies released this week prove it (Edward Morrissey, 4/10).

The Washington Post: 400,000 Ways For McAuliffe To Win On Medicaid
Gov. Terry McAuliffe needs to ditch the talking points about hospitals, jobs and investments that he's used to justify Medicaid expansion under the Affordable Care Act. They aren't going to change any minds. At the same time, he needs to stop worrying about Obamacare, the federal deficit, broken Washington promises and all the other bullet points used to justify opposition to Medicaid expansion. ... Medicaid expansion comes down to one point, or more precisely, 400,000 versions of the same point. This is the rough number of poor Virginians whom the Medicaid component of Obamacare was designed to help get health care they couldn’t otherwise afford. Due to bad genes, bad luck or bad choices, many of them have pressing health issues but no way to get insurance (Norman Leahy and Paul Goldman, 4/9). 

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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.