Daily Health Policy Report

Monday, April 22, 2013

Last updated: Mon, Apr 22

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Seniors Get Hung Up In Health Care Scams

Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "Law enforcement agencies are reporting an increase in these sorts of health insurance scams across the country. Many of the fraudsters seem to be preying on the public's confusion over the massive changes taking place in the nation’s health care system" (Gold, 4/22). Read the story.

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Capsules: Boston Couple Faces Amputation Rehab, Together

Now on Kaiser Health News' blog, WBUR's Martha Bebinger, working in partnership with KHN and NPR, reports: "Only the most seriously injured of the 188 marathon bombing patients remain hospitalized. Patrick Downes and Jessica Kensky Downes are among them. The couple was cheering runners near the finish line of the Boston Marathon when the explosions threw them apart. Patrick and Jessica each lost the lower part of their left legs" (Bebinger, 4/22). Check out what else is on the blog.

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Political Cartoon: 'Taste As Directed?'

Kaiser Health News provides a fresh take on health policy developments with "Taste As Directed?" By Dan Piraro.

Meanwhile, here is today's health policy haiku:


Health insurance scams...
The grifters spin confusion.
Their target: seniors.

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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Health Reform

Ahead Of Big Reforms, Health Care Marketplace Feels Slowdown

Reuters reports a softening in demand for hospital chains and device makers, among others. Meanwhile, law enforcement officials warn of insurance scams that play on confusion over the health care overhaul.

Reuters: Analysis: Ahead Of Reform, Medical Care Slowdown Hits Companies
As the clock ticks down to the start of a U.S. healthcare overhaul, companies from device makers to hospital chains have been surprised to see Americans make even fewer trips to the doctor's office. Use of non-emergency medical services has been weak for several years in the wake of a deep recession, high joblessness and the steadily rising cost of care (Berkrot, 4/22).

Kaiser Health News: Seniors Get Hung Up In Health Care Scams
Law enforcement agencies are reporting an increase in these sorts of health insurance scams across the country. Many of the fraudsters seem to be preying on the public's confusion over the massive changes taking place in the nation's health care system (Gold, 4/22).

Medscape: Push To Keep ACA Guidelines Out Of Malpractice Cases
The Affordable Care Act (ACA) is accelerating the switch from fee-for-service reimbursement to pay-for-performance, and organized medicine is worried about the medical liability implications. What if a physician scores poorly on ACA-driven performance measures regarding his or her care for patients with diabetes, for example? Do low grades give those patients sufficient grounds to sue the physician for malpractice? … Not in Georgia, at least, under a bill passed earlier this month by the state legislature and awaiting the signature of Governor Nathan Deal (Lowes, 4/19).

The Hill: Obama Administration Inks $8M PR Contract To Promote Health Law
The Obama administration has signed a new contract with a public relations firm to promote the central piece of ObamaCare. The agency charged with implementing most of the healthcare law has signed a new contract with the firm Weber Shandwick (Baker, 4/19).

Also, an examination of how the health law and immigration reform proposals could potentially interact -

The Wall Street Journal: Bill Bars Health-Care Cost Assistance For Immigrants
Immigrant advocates are upset with a health-care provision of the immigration-overhaul legislation that could force certain immigrants to pay a fee for lacking insurance coverage while excluding them from financial help to buy it. The wrinkle could create the first class of Americans who would face the 2010 Affordable Care Act's penalties without having access to its main benefit. If passed into law, the immigration changes would apply to many of the 11 million immigrants living in the U.S. illegally who would have "provisional" status for a decade before becoming eligible for green cards (Radnofsky, 4/19).

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For States, Rejecting The Health Law's Medicaid Expansion Comes With Consequences

The Associated Press reports on the wrinkles that state leaders will face as a result of opting against the sweeping expansion. Meanwhile, states and federal officials note possible points where flexibility will be in play. Also, news outlets report on the state-level action regarding this health law provision in Florida, Missouri, South Carolina and Montana.

The Associated Press/Washington Post: State Leaders Deal With Consequences Of Rejecting Medicaid Expansion In Obama Health Overhaul
Rejecting the Medicaid expansion in the federal health care law could have unexpected consequences for states where Republican lawmakers remain steadfastly opposed to what they scorn as "Obamacare." It could mean exposing businesses to Internal Revenue Service penalties and leaving low-income citizens unable to afford coverage even as legal immigrants get financial aid for their premiums. For the poorest people, it could virtually guarantee that they will remain uninsured and dependent on the emergency room at local hospitals that already face federal cutbacks (4/22).

CQ HealthBeat: State Medicaid Officials Consider Multi-Tiered Benefits, Cost Sharing Under Overhaul
The benefits for Medicaid recipients already are different from state to state. And in those states planning to expand the health program for the poor under the health care overhaul, people on Medicaid who live next door to each other could pay different amounts to see a doctor and be entitled to different levels of care (Adams, 4/19).

CQ HealthBeat: Sebelius Promises Flexibility
Health and Human Services Secretary Kathleen Sebelius said in a Jan. 14 letter that states also "may select different plans for different groups of individuals" within the expansion population. One difference between the benefits for the expansion and traditional groups is that the newly eligible are not entitled to nursing home care and other institutional long-term care (Adams, 4/19).

Tampa Bay Times: Moderate House Republicans Key To Any State Health Care Deal
After weeks of posturing and debate, the decision to expand Medicaid in Florida or accept $51 billion in federal health care money might rest with a moderate bloc of a dozen or so House Republicans. And they're not saying a lot, at least publicly. While Senate Republicans appear willing to join Democrats in supporting a massive health care expansion, many House Republicans serving in moderate districts have yet to vocally embrace or reject federal assistance (Mitchell, 4/20).

Health News Florida: House Panel Passes Alternative Health Plan, Rejects Federal Funds
The House Appropriations Committee today passed HB 7169, a measure that creates a program called Florida Health Choices Plus, that will cover about 115,000 people. The committee rejected a strike-all amendment from state Rep. Mia Jones, D-Jacksonville, that would have directed the state Agency for Healthcare Administration to accept federal funds and extend the state Medicaid program under the federal Patient Protection and Affordable Care Act (Watts, 4/19).

The Missoulian: Vote That Killed Medicaid Bill Was A Mistake, Lawmaker Says
A contentious Medicaid proposal to fund private health insurance for thousands of low-income Montanans appears dead at the 2013 Legislature, after House Republicans Friday successfully bottled up the bill in committee. A move by Democrats to bring the measure to the floor failed by a single vote, with one Democrat later admitting he voted the wrong way. A later effort to undo the first vote failed by three votes (Dennison, 4/20).

The Associated Press: Missouri Medicaid Expansion Unlikely In 2013
Proposals to expand Missouri's Medicaid health care program for the poor appear increasingly unlikely to pass during the legislative session that ends May 17. Money for the Medicaid expansion is not included in either the House or Senate version of the state budget. And a Republican alternative to the Medicaid expansion backed by Democratic Gov. Jay Nixon also has stalled. House member Jay Barnes, of Jefferson City, says he has asked the House Rules Committee not to vote on his legislation (4/21).

The Associated Press: Medicaid Agency Posts Hospital Data
Data posted online Thursday for South Carolina's 60 acute-care hospitals shows a wide disparity in their financial health, with the bottom lines of each ranging from a four-year loss of $96 million to a combined profit of $223 million. The state's Medicaid agency put the data on its website in an effort to encourage discussions about an industry at the center of the health care debate, director Tony Keck told The Associated Press before the material was posted. ... Keck said he wanted legislators, business groups and the public to have access to hospitals' financial numbers as the debate over whether to expand Medicaid eligibility under the federal health care law moves to the Senate (4/19).

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Minn. Gov. Seeks 'Diversity' On Health Exchange Board; Colorado Exchange Brings In Mediator To Smooth Process

Also in the news, reports about costs in the Massachusetts health exchanges.

MinnPost: Health-Exchange Board 'Diversity' Is Top Of Priority For Dayton
For Gov. Mark Dayton and the commissioners and staff advising him, "diversity" has been the key word when discussing appointments to the board of MNsure, the state's new health insurance exchange. By the end of April, Dayton must name six members to the board, which will oversee an online marketplace where one in five Minnesotans are expected to find health insurance (Nord, 4/19).

Health Policy Solutions (a Colo. news service): Mediator To Triage Health Exchange Problems
Sparring between Colorado's Medicaid managers and those building the state's new health exchange prompted an outside analyst to recommend a "third party to triage and manage the project." A mediator from the New Jersey-based Robert Wood Johnson Foundation now will come to Colorado to help managers get the giant multi-million dollar project off the ground on time by Oct. 1 when it's slated to open to consumers. Complicating tight launch deadlines is that Colorado lawmakers set up the state’s new online health insurance marketplace as an independent public entity, not a state agency (Kerwin McCrimmon, 4/19).

Medpage Today: High Costs Seen In Mass. Health Exchange Plans
Between a third and a half of Massachusetts families suffered financial burden and higher-than-expected out-of-pocket costs when purchasing health coverage through the state's insurance exchange, a study found. Furthermore, the Affordable Care Act's (ACA) insurance subsidies won't help all those needing financial assistance when shopping for coverage in a similar exchange under the national law, according to the report published online Wednesday in Health Affairs (Pittman, 4/19).

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Capitol Hill Watch

Senate Immigration Bill Could Boost Health Care Workforce

News outlets report that the plan could make it easier for foreign-born doctors to come to the United States while reducing the dependence of newly legal immigrants on emergency rooms.

Politico: Immigration Bill Could Import Foreign-Born Doctors
The immigration bill might have a partial solution to the doctor shortage in underserved areas: import them. Or more precisely, make it easier for foreign physicians who come to the U.S. for their medical residencies to stay on after their training — if they’ll then serve three years where they are most needed (Cunningham, 4/22).

Modern Healthcare: Boost To Healthcare Workforce Could Come From Immigration Bill
A bipartisan Senate immigration bill could boost the nation's healthcare workforce, in addition to expanding coverage to millions of newly legal residents. The 844-page Border Security, Economic Opportunity, and Immigration Modernization Act, which was introduced Thursday, would provide a legalization process for the approximately 11 million illegal immigrants. Although the bill bars access to public benefits during a transitional period, the newly legal residents could qualify for private insurance for the first time—possibly reducing their dependence on emergency rooms, according to health policy experts (Daly and Zigmond, 4/19).

Also in the health policy headlines from Capitol Hill -

Politico: Mental Health Advocacy Hits Reset
Mental health advocates hitched a ride on the gun control wagon. Now the wagon is stuck. After the Sandy Hook school killings, all sides of the gun control divide agreed that mass shootings — Tucson, Aurora and Newtown, among them — highlighted inadequacies in the U.S. mental health care system. Some opponents of any new gun restrictions framed the problem as primarily a mental health crisis. From their viewpoint, guns don't kill, mentally ill people do (Kenen and Cunningham, 4/21).

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Health Care Marketplace

Medical Researchers Race To Find Ways To Use Gene Sequencing To Fight Cancer

Technology is quickly revamping medical care. The New York Times looks at the possible use of gene sequencing, while other news outlets examine apps and online tools that are helping Alzheimer's and autism caregivers.

The New York Times: Cancer Centers Racing to Map Patients' Genes
Major academic medical centers in New York and around the country are spending and recruiting heavily in what has become an arms race within the war on cancer. The investments are based on the belief that the medical establishment is moving toward the routine sequencing of every patient's genome in the quest for "precision medicine," a course for prevention and treatment based on the special, even unique characteristics of the patient's genes. ... Sequencing an entire genome currently costs in the neighborhood of $5,000 to $10,000, not including the interpretation of the information. It is usually not reimbursed by insurance, which is more likely to cover tests for genetic mutations that are known to be responsive to drugs. The treatments themselves, which are sometimes covered, typically cost several times that (Hartocollis, 4/21).

The Associated Press/Washington Post: Apps And Online Tools Make Tough Life A Bit Easier For Alzheimer's, Autism Caregivers
From GPS devices and computer programs that help relatives track a wandering Alzheimer's patient to iPad apps that help an autistic child communicate, a growing number of tools for the smartphone, the tablet and the laptop are catering to beleaguered caregivers. With the baby boom generation getting older, the market for such technology is expected to increase (4/21).

Meanwhile, some people are exploring using Internet-based coupons to cut medical costs -

Philadelphia Inquirer: Could Groupons Sell Trouble For Doctors And Patients?
The saying "There is no such thing as a free lunch" has been popular for decades. But in the case of physicians using Groupons, there may be another applicable saying, "There is no such thing as a good deal." From both the patient and physician perspective, offering daily deals for medical procedures can be risky. Groupon and other daily deal sites became popular several years ago as buyers saw benefit in buying a coupon that would allow them to pay for services at typically half the retail cost. While most daily deals are offered for restaurants, haircuts, and vacations, some physicians, particularly plastic surgeons, have offered deals for noninvasive procedures (Cohen, 4/20).

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FDA Wants To Understand Physician Experiences With Direct-To-Consumer Ads

Medpage Today: FDA To Poll Docs On Impact Of DTC Ads
The FDA will survey healthcare providers about their experience with direct-to-consumer (DTC) advertising in order to assess its impact on their practice after receiving White House clearance for the program this week. The survey is a follow-up to a similar one the agency conducted in 2002 which found that one-third of physicians said they believed DTC advertising had a negative impact on their practice, while one-third said it had a positive influence, and the remaining third said it made no difference. … Researchers have long believed DTC advertising might cause adverse health outcomes when patients request prescriptions for drugs they saw on television, radio, or print ads. But DTC marketing also could impact clinicians' prescribing habits (Pittman, 4/19).

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State Watch

State Roundup: Calif. Lawmakers Push For Health Plan For Immigrants In U.S. Illegally

A selection of health policy stories from Massachusetts, California, Michigan, Texas, the District of Columbia, Pennsylvania, South Carolina and Tennessee.

Los Angeles Times: Boston Bombing Amputees Face Tough, Costly Recovery
For many of the injured, even those who have health insurance, the process may also be costly. Health insurance plans often restrict coverage for therapy and prosthetics. But a decade of wars has helped fuel breakthroughs that could help many Boston victims -- including those with amputated limbs -- live full, active lives (Levey, 4/21).

Sacramento Bee: Some California Leaders Want Low-Cost Health Care For Undocumented Immigrants
About a million of California's poorest undocumented immigrants would have access to basic low-cost health care under a plan being pushed at the Capitol. President Barack Obama's federal health care overhaul excludes undocumented immigrants, but some California leaders want to fill that gap by offering a safety net of primary and preventive care that does not consider immigration status. The county-run program would give undocumented immigrants – and legal residents who can't afford health insurance but don't qualify for Medi-Cal – the ongoing opportunity to see a doctor, get tested and receive treatment before minor health problems become severe (Sanders, 4/19).

The Associated Press: Bill Allows Refusal Of Health Care On Moral Basis
For 35 years, Michigan law has protected health care providers who refuse to perform an abortion on moral or religious grounds. … Legislation that could be voted on as early as this week in the Republican-led Legislature would extend the same legal protections for any medical service such as providing contraception or medical marijuana, or taking someone off life support. Employers and health insurers -- not just medical providers -- also could opt out of paying for services as a matter of conscience (Eggert, 4/21).

The Texas Tribune/New York Times: Optometrists Seek Negotiating Power With Insurers
A group of Texas optometrists is lobbying the State Legislature for more power to negotiate contracts with health insurance companies, and the measure they are supporting could hit consumers' wallets, some business advocates say (Aaronson, 4/20).

The New York Times: California Tries To Regain Fuller Control Of Prisons
In 1995, a federal court appointed a special master to carry out reforms in mental health care [at California's prison system], which it found inadequate at the time and in violation of the Constitution. The court ruled this month that the federal overseer was necessary to remedy continuing constitutional violations behind problems like the high suicide rate. The state is arguing that mental health care meets or exceeds constitutional standards. It is spending $400 million a year on mental health care in its prisons, and a dozen new facilities valued at a total of $1.2 billion have been built in the past three years or are under construction (Onishi, 4/20).

The Washington Post: Chartered Could Owe D.C. Health Providers $85 Million
The city's doctors, clinics and hospitals could be owed a combined $85 million from the soon-to-be-defunct D.C. Chartered Health Plan, and it remains unclear how the once-dominant city health contractor will be able to pay the vast majority of those claims. ... The $85 million figure, which is about double previous estimates of Chartered's potential liabilities to providers, represents about $60 million in Medicaid claims that have been incurred but have yet to be paid. An additional $25 million could be owed to providers due to litigation -- likely related to a pending battle between Chartered and the MedStar hospital chain (DeBonis, 4/19).

The Washington Post: Problems At Pa. Abortion Clinic Point To Lack Of Facilities Oversight
There was no shortage of red flags about what was allegedly going on in the three-story brick building on a bustling stretch of Lancaster Avenue in West Philadelphia. A routine inspection of Kermit Gosnell's abortion clinic had turned up problems as early as 1989, according to official reports. ... The case has captivated and repulsed a nation where back-alley abortion clinics have become a rarity since 1973, when the Supreme Court legalized abortion. The catalogue of horrors delineated by prosecutors has raised questions about whether there is adequate inspection and regulation of the 1,800 facilities nationwide that provide abortions (Dennis and Somashekhar, 4/20).

Boston Globe: New Spaulding Hospital Is Rehab Rethought
David Estrada, paralyzed from the chest down in a motorcycle accident 18 years ago, remembers well his miserable three months in a rehabilitation hospital room he shared with three other patients. That experience inspired him to help others with disabilities, which is why Estrada stopped short as he rolled his wheelchair through the new Spaulding Rehabilitation Hospital in Charlestown during its construction last winter. He'd heard there was a panoramic water view from the hospital's third-floor gymnasium, but he was not seeing it. The sills blocked the view of anyone in a wheelchair. ... Estrada's observation prompted the lowering of the sills. Price tag for the redo: $300,000 (Lazar, 4/22).

Modern Healthcare: HCA To Grow Presence In Behavioral Health, Official Says
HCA, the Nashville-based hospital giant, is building its presence in the behavioral health space at a time when the field is poised to grow. The publicly traded company has been a "re-start-up" in the sector since late 2009, said Terry Bridges, president of behavioral health care services, who spoke at an Avondale Partners' behavioral health conference this week in Nashville. Bridges joined HCA that year from Psychiatric Solutions, where he was co-chief operating officer. Universal Health Solutions bought Psychiatric Solutions in 2010, and Bridges' arrival at HCA was seen as sign that it planned to boost its own mental health services (Kutscher, 4/19).

California Healthline: Attorney: Decision Overdue In Suit Challenging Medi-Cal Disabled Cuts
A federal judge is "about to decide" a case with large ramifications for the developmentally disabled community. William McLaughlin, an attorney representing The Arc of California, a national disabled-rights group, said a final ruling from U.S. District Court judge Morrison England is coming "any time now." In a Jan. 24 hearing, McLaughlin argued for a preliminary injunction to halt the rate reductions. He contends a decision is overdue (Gorn, 4/19).

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Editorials and Opinions

Viewpoints: Solving The Doctor Shortage; Can Gov. Scott Convince Fla. Lawmakers To Accept Medicaid Expansion?

The Washington Post: We Still Have A Health Care Spending Problem
With every new report about the recent slowdown in health-care spending there is speculation in the media that the problem of rising health costs has somehow been solved or cut down to size. ... The idea that we have licked the problem of health-care cost increases is no more probable today than it was in the past. Our nation has made no fundamental change in how health care is paid for or delivered (Drew Altman and Larry Levitt, 4/21).

The New York Times: How to Put America Back Together Again
Rebuilding our strength has to start with healing our economy. ... We're trying to put America back on a sustainable growth track that will expand employment, strengthen our fiscal balance sheet to withstand future crises and generate resources to sustain the most needy and propel the next generation. That requires three things: We need to keep investing in the engines of our growth ... We need to reform Social Security and Medicare so they can support all the baby boomers about to retire. And we need to raise more revenues (Thomas Friedman, 4/20). 

Los Angeles Times: An Rx For The Doctor Shortage
New subsidies and insurance regulations in the 2010 healthcare law are expected to bring coverage to millions of uninsured Californians starting next year. The newly insured are likely to put a bigger strain on the healthcare system, particularly in their demand for primary-care doctors, of whom there are already too few in many parts of the country. That's why trained medical professionals who aren't physicians, such as nurse practitioners, want more freedom to deliver the care they're capable of giving than state rules allow. Lawmakers should give it to them (4/21).

St. Louis Post Dispatch: Missouri Medicaid Expansion Is Too Important To Die
The Medicaid expansion effort is too important to allow it to be blocked, particularly for the Senate’s specious reasons. Gov. Jay Nixon, a Democrat, has done his level best traveling the state, hand in hand with business leaders, most of whom have traditionally supported Republicans, to rally support for this important legislation. But it hasn't been enough. It's time for those business leaders to take a stand. Write some big checks for Democrats and see who comes running. Let Republicans like Mr. Lamping know that their careers are over if they don't get serious. ... Medicaid expansion isn't about Mr. Obama and it's not about some consultant-driven debate about future electoral success. The more people in Missouri who have health insurance, the fewer of them will die. This is literally a life-and-death issue (4/22).

Tampa Bay Times: Time For Scott To Get To Work On Legislature
Gov. Rick Scott has two weeks to demonstrate he can govern as well as he can issue press releases. It's great that the governor supports expanding Medicaid and accepting billions of federal dollars to provide health coverage to nearly a million residents. Now he has to persuade fellow conservative Republicans in the Legislature to agree or embrace a reasonable alternative. This is a defining moment for this state, and Scott should use all of the persuasive tools of his office to lead lawmakers to the right conclusion (4/19).

Forbes: Michigan's Legislature Resists Its Governor's Call To Approve Obamacare's Medicaid Expansion
Michigan's Republican governor, Rick Snyder, was among the many GOP state executives who made national headlines this winter by endorsing Obamacare's expansion of Medicaid, America's government-run health insurance program for the poor. But what isn't making headlines is that Michigan's legislature, like its counterparts in Florida, Ohio, and Arizona, is not going along (Avik Roy, 4/20).

Cleveland Plain Dealer: Still Hope For Ohio Medicaid Expansion
In a bipartisan move, the Republican-run Ohio House on Thursday kept alive Statehouse discussion of Medicaid expansion in Ohio. ... The amendment doesn't guarantee expansion, and in fact says that if no action is taken by Dec. 31 the subject is closed. But the House did, in effect, maintain Medicaid expansion as an open question. That represents a victory for Gov. John Kasich, who has proposed expanding Medicaid coverage in Ohio, and for the broad coalition of Ohioans who support expansion (4/20).

Bloomberg: Fix Immigration Bill To Reduce Health-Care Costs
Politicians have seldom talked about immigration reform and health-care costs in the same breath. With Congress debating legislation to remake the U.S. immigration system, perhaps it's time they did (Marta Tienda, 4/21).

Des Moines Register: Mentally Ill And Guns Are A Thorny Issue
After a week of madness and mayhem, explosions and poisoned letters, there was a moment of sanity last week in the U.S. Senate. Sadly, it was short-lived and quite possibly in vain. During debate on the ill-fated gun-control bill, senators passed an amendment 95-2 that was sponsored by Sens. Tom Harkin, D-Ia., and Lamar Alexander, R-Tenn. ... It expands federal programs related to mental health, including school programs aimed at early identification and intervention, suicide prevention, awareness training and substance abuse assistance. The idea is to spot warning signs and deal with problems long before anyone has to worry about whether a person can be trusted with a gun (Kathie Obradovich, 4/21).

Los Angeles Times: What California Should Learn From The 1-800-GET-THIN Saga
Today, 19 months after her death, we may finally have a good idea of what killed Paula Rojeski. According to a lawsuit and public autopsy records, the causes included her doing business with the 1-800-GET-THIN folks and the slicing of her aorta during weight-loss surgery at one of their affiliated surgical centers. There was also regulatory indifference on a truly majestic scale (Michael Hiltzik, 4/19). 

Forbes: Home Health Medicare Co-Pay: A Study In Unintended Consequences
The budget that President Obama submitted to Congress last week contains a call for, among other things, an increase of $1.4 billion in discretionary spending for the administrative expenses related to implementation of the Affordable Care Act (Obamacare). In a budget that claims to reduce the deficit, where is all this money coming from? Some of it -- $730 million -- is supposed to come from instituting $100 co-payments for Medicare patients who use home health care (Robert A. Book and Doug Holtz-Eakin, 4/19).

Boston Globe: Why Patients Don't Always Follow Doctor's Orders
Medicine, as physician and literary scholar Abraham Fuks has pointed out, often borrows language from the military. Patients "battle" cancer, which "invades" bodily tissues, hoping for a "magic bullet." Similarly, doctors, unlike lawyers, architects, and accountants, give "orders." The implication seems to be that while a person who rejects advice from any other sort of professional is a discriminating consumer, someone who fails to follow a doctor's orders is foolish, self-destructive, or even insubordinate. Yet, patients do ignore doctor's orders, and much more frequently than physicians would care to acknowledge (Suzanne Koven, 4/22).

Boston Globe: Chronic Care At Walgreens? Why Not.
Walgreens, the country's largest drugstore chain, announced last week that its 330-plus Take Care Clinics will be the first retail store clinics to both diagnose and manage chronic conditions like asthma, diabetes, high blood pressure, and high cholesterol. The Nurse Practitioners and Physician Assistants who staff these clinics will provide an entry point into treatment for some of these conditions. ... But the Walgreens announcement was met with skepticism by physician groups like the American Association of Family Physicians. And there are certainly causes for concern, at least based on what we know so far (Ishani Ganguli, 4/22).

MinnPost: How Surveillance Cameras Can Improve Medical Care
As the video released Thursday of the two suspects in the Boston Marathon bombings make clear, the surveillance video camera is now a ubiquitous part of our lives. … Still, I was surprised to read in an essay published online Thursday in the Journal of the American Medical Association (JAMA) of how hospitals are using surveillance cameras, sometimes surreptitiously, to get their medical staff to improve care. And the cameras seem to work remarkably well for this purpose (Susan Perry, 4/19).

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Stephanie Stapleton

Andrew Villegas

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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.