Daily Health Policy Report

Friday, April 27, 2012

Last updated: Fri, Apr 27

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Administration News

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Wanted: Mavericks And Missionaries To Solve Mississippi's Doc Shortage

Mississippi Public Broadcasting's Jeffrey Hess, working in partnership with Kaiser Health News and NPR, reports: "When Janie Guice looks at the Mississippi Delta she sees a vast, flat flood plain, home to cotton fields and catfish farms, but she also sees desperate rural health problems and a deep shortage of doctors to deliver primary care to the region's residents" (Hess, 4/26). Read the story.

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Poor, Sick And Expensive: Colorado's Scaled-Down Medicaid Expansion

Colorado Public Radio's Eric Whitney, working in partnership with Kaiser Health News and NPR, reports: "The state's actually only paying for a small part of those bills. Colorado has an indigent care program that helps charity clinics and hospitals cover bills like Miller's -- but it only pays about ten cents on the dollar. That's starting to change as Colorado is adding people to its rolls for Medicaid, the state and federal health program for the poor and disabled" (Whitney, 4/26). Read the story

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Capsules: Respite Programs For Family Caregivers Face Cuts Despite Growing Need

Now on Kaiser Health News' blog, Jessica Marcy writes: "Family caregivers provide 80 percent of long-term care needs in the U.S., but many need time away from that job so they can continue to care for their loved ones. Respite can provide short-term relief through several options, including a paid home care worker or providing temporary stays for patients at a residential care facility or adult day care center. Some families pick up the cost of such care out-of-pocket, but many must rely on state and community programs" (4/26). Check out what else is on the blog.

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Political Cartoon: 'Supersize It?'

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

Meanwhile, here's today's health policy haiku:


Debt collectors stand
at patients' bedsides... It's a
new take on health care.

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

Rumors, Politics Swirl Around Supreme Court's Much-Anticipated Health Law Decision

The Supreme Court this week completed the current term's last oral arguments, and now begins a waiting game for what might be its most anticipated decision in years -- the constitutionality of the health law.

Reuters: As Supreme Court Mulls Healthcare, Rumors Fly
This week the U.S. Supreme Court wrapped up the last oral arguments of its current term. Now comes the nationwide angst of waiting - as long as two months - for decisions, particularly the one that will resolve the most high-stakes and closely watched case of the year: the challenge to the Obama-sponsored healthcare law. The collective impatience is fueling a mini-industry of rumors, wagers and speculation not seen since the Bush v. Gore case of 2000, when a presidential election hung in the balance. And perhaps not even then, because the court quickly put an end to the guessing game by issuing a ruling the day after the case was argued (Biskupic, 4/26).

The Associated Press: Supreme Court Moves To Center Of Presidential Race
The Supreme Court, suddenly at the heart of presidential politics, is preparing what could be blockbuster rulings on health care and immigration shortly before the fall election. The court, sometimes an afterthought in presidential elections, is throwing a new element of uncertainty into the campaign taking shape between President Barack Obama and presumptive Republican nominee Mitt Romney (Babington, 4/27).

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Rebates For Those Who Bought Their Own Insurance To Average $127 Per Person

Millions of consumers and small businesses will receive an estimated $1.3 billion in rebates from their health plans this summer under a provision of the health care law that requires insurance companies to pay refunds if they don't spend a high enough percentage of premium dollars on health care costs, according to a study by the Kaiser Family Foundation.

Los Angeles Times: Obama Healthcare Reforms Lead To $1.3 Billion In Insurance Rebates
U.S. consumers and businesses will receive an estimated $1.3 billion in rebates from insurance companies this year, according to a new study quantifying a key early benefit of the healthcare law that President Obama signed in 2010 (Levey, 4/26).

The Wall Street Journal: Health Insurers To Pay Rebates
Health insurers are expected to give rebates of more than $1 billion to consumers and employers this year, under a provision of the federal health overhaul that forces them to offer refunds if they don't spend enough of the premium dollars they take in on health care (Mathews, 4/26).

The Associated Press: Report: Rebates From Health Care Law Will Top $1B
More than 3 million health insurance policyholders and thousands of employers will share $1.3 billion in rebates this year, thanks to President Barack Obama's health care law, a nonpartisan research group said Thursday. The rebates should average $127 for the people who get them, and Democrats are hoping they'll send an election-year message that Obama's much-criticized health care overhaul is starting to pay dividends for consumers. Critics of the law call that wishful thinking (Alonso-Zaldivar, 4/26).

The New York Times: Rebates For Some Who Buy Own Health Insurance
Almost a third of people who bought their own health insurance last year will get rebates averaging $127 because of a requirement in the federal health care law, according to a new report from the Kaiser Family Foundation (Carrns, 4/26).

Market Watch: Health Insurers Could Rebate $1.3 Bln
This summer, your health-insurance costs could go down for a change. A provision in the federal health-reform law stands to return big bucks to customers whose health plans have exceeded the limits of a formula meant to ensure that most premium dollars go to pay for medical care instead of overhead and profit. Under rules set in the Affordable Care Act that Congress passed and President Obama signed in 2010, individuals and employers will begin receiving a total of $1.3 billion in rebates by Aug. 1, according to an analysis by the Kaiser Family Foundation, a nonpartisan research group (Gerencher, 4/26).

Kaiser Health News: Checks In The Mail: Millions Expected To Receive Insurance Rebates Totaling $1.3 Billion
The percentage of consumers and businesses in line for rebates varies widely by state. In Texas, for example, 92 percent of consumers who purchased individual policies are expected to get rebates because insurers spent too little of their premium dollars on medical care. But in Vermont, Rhode Island, Iowa and Hawaii, insurers are likely to owe less than 1 percent of consumers who bought policies on the individual market (Appleby, 4/26).

CQ HealthBeat: Kaiser Study Projects $1.4 Billion In Medical Loss Ratio Rebates
Some consumers will be getting a happy surprise when later this year health insurers ship out rebates mandated by new medical payout requirements in the health care law, according to a new study issued on Thursday by the Kaiser Family Foundation (Norman, 4/26).

National Journal: $1 Billion Refund Coming From Insurers
Health insurers will have to pay more than $1 billion in refunds to customers this summer because they have exceeded overhead and profit limits imposed by the 2010 health reform law, a new report finds. The report, from the Kaiser Family Foundation, examined data submitted to state insurance commissioners and estimates that the rebates will total $1.3 billion for the 49 states it analyzed. (Data were not available from California) (Sanger-Katz and McCarthy, 4/26).

Marketplace: Health Insurers Make Premium Paybacks
Part of the health care reform law says only a certain percentage of what we pay in premiums can go to things like insurance company profits and administrative costs. Everything else has to be spent on actual health care or we get it back. And in the first year of the program, we're getting back more than a billion dollars (Warner, 4/26).

Bloomberg: Health Insurers' Customer Rebates May Reach $1.3 Billion
UnitedHealth Group Inc. (UNH), WellPoint Inc. (WLP) and other health insurers may have to forfeit to consumers $1.2 billion to $1.3 billion in profits from last year because of changes to U.S. law that limit revenue from premiums. Rebates for exceeding the limits, called medical loss ratio, will amount to about 6 percent of the industry’s $21 billion in profits from 2011, said Matthew Borsch, a Goldman Sachs Group Inc. (GS) analyst. For consumers, that translates into rebates of as much as $517 a person, according to the Kaiser Family Foundation (Wayne, 4/26).

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Texas Tops MLR Rebate List: What About Other Locations?

Media outlets from Texas, Minnesota, Florida, Connecticut and Georgia offer insights into what these rebates will mean on a more local level. 

The Texas Tribune: Study: Texas Tops Health Insurance Rebate List
Texas consumers and businesses are poised to receive an estimated $186 million in rebates from health insurers under a requirement of the Affordable Care Act ... In July 2011, the Texas Department of Insurance requested that the state be able to phase in the new provision’s requirements over the course of three years, instead of implementing them immediately, but that request was denied. ... The estimated figures of rebate amounts and percentage of citizens who will receive rebates were high for Texas in all three categories [of insurance markets] (Jacob, 4/26). 

(St. Paul) Pioneer Press: HealthPartners, UnitedHealth Among Insurers To Pay Rebates
Some health care consumers in Minnesota and across the country might get a cut later this year of the record profits being posted by health insurers.  But the per-person take could be underwhelming.  The rebates are mandated by the 2010 federal overhaul of the nation's health care system, which set a limit on the share of premium revenue that health insurers could keep for administration, marketing, taxes and profit (Snowbeck, 4/26).

Georgia Health News: Georgians Due $30 Million In Insurance Rebates
Georgia consumers will qualify for an estimated $30 million in health insurance rebates this year due to a newly implemented provision in the federal health reform law, according to an analysis released Thursday. Nationwide, health insurers will have to pay an estimated $1.3 billion in rebates, said the report by the Kaiser Family Foundation (Miller, 4/27).

The Connecticut Mirror:  Insurers Could Pay $14.6 Million In Rebates To State Consumers
Insurance companies could be required to issue nearly $14.6 million in rebates for health plans covering more than 212,000 Connecticut enrollees later this year as part of the federal health reform law, according to an analysis released Thursday by the Kaiser Family Foundation. … In Connecticut, the analysis found, three plans each in the individual, small group and large group markets would be required to issue rebates, covering 212,106 members (Levin Becker, 4/26).

The Miami Herald: Floridians To Get $148.5 Million In Refunds, Study Says
Thanks to the healthcare reform law, 325,000 Florida purchasers of healthcare insurance are likely to get rebates of $152 each later this year, according to a study released Thursday by the Washington-based Kaiser Family Foundation. That’s part of a total refund of $148.5 million due to Florida individuals and businesses, the report said.The refunds are triggered by a provision in the legislation requiring that health insurers use at least 80 percent of premiums in the individual and small business markets for healthcare, with no more than 20 percent going for administrative and sales costs and profits. For large businesses, the threshold is 85 percent that should be spent on healthcare costs (Dorschner, 4/26).

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Capitol Hill Watch

Public Health Prevention Fund At Center Of Partisan Clash On Student Loans

House Republicans are eyeing the fund as a means to offset the costs of extending the current interest rates for student loans, but Democrats have other plans.

The Associated Press/Washington Post: Boehner Berates Obama's College Visits As Dems, GOP Fight Intensifies Over Student Loans
Their chief remaining dispute is how to pay for the $5.9 billion cost of keeping those rates low. When it comes to that, each side has in effect taken a political hostage: House Republicans would cut spending from Obama's prized health care overhaul law, Senate Democrats would boost payroll taxes on owners of some private corporations and House Democrats would erase federal subsidies to oil and gas companies (4/26).

Los Angeles Times: Pelosi Calls Plan To Gut Public Health Fund Another Assault On Women
As the battle intensifies over keeping student loan interest rates low, House Minority Leader Nancy Pelosi called the Republican plan to gut a public health fund to pay for it "another assault on women's health" (Mascaro, 4/26).

Politico Pro: Clash Over Prevention Funding Escalates
Democrats on Capitol Hill say they'll block a Republican proposal to take billions out of the health care reform law’s Prevention and Public Health Fund to prevent a student loan interest rate hike this summer. Picking up on the campaign season "war on women" theme, House Democratic Leader Nancy Pelosi accused Republicans of robbing women of cancer screenings and immunization for their children with their plan to cut $11.9 billion from the fund in the next 10 years (Haberkorn, 4/26).

CQ HealthBeat: Sebelius Cautions as House Readies Student Loan Bill
Health and Human Services Secretary Kathleen Sebelius warned lawmakers Thursday against repealing a health care overhaul fund that congressional Republicans have targeted to pay for maintaining the current federal student loan interest rate (Attias, 4/26).

National Journal: Health Group Rally For Public Health Fund
Public health groups are rallying the troops to try to help preserve the public health fund created under the 2010 health reform law, which Republicans now say they’ll raid to help pay for a student loan program. Republicans call it a slush fund, while public health experts who called for the fund say it protects vital programs from the vagaries of year-to-year Congressional funding fights – fights like this one (Fox, 4/27).

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Members Of Congress Urge Investigation Of Accretive Health

Accretive Health, which is one of the nation's largest medical debt collectors and which has been the subject of an inquiry by Minnesota's attorney general, is also drawing attention from lawmakers in Washington.  

The New York Times: In Congress, A Move To Look Into A Medical Debt Collector
A California representative is calling for an investigation into Accretive Health, one of the nation's largest collectors of medical debt, for potentially violating a federal law that requires hospitals to provide emergency care regardless of citizenship, legal status or the ability to pay (Silver-Greenberg, 4/26).

Modern Healthcare: Stark Urges Federal Probe Of Accretive
Rep. Pete Stark (D-Calif.) called for federal health officials to launch an investigation of Accretive Health, the healthcare billing and collection company that faced an inquiry by Minnesota's attorney general for aggressive practices. In letters to acting CMS Administrator Marilyn Tavenner and HHS Inspector General Daniel Levinson, Stark also asked for a report on enforcement measures should an investigation uncover illegal activity. In the event that Accretive's practices are found to violate law, he urged federal officials to warn hospitals that accept Medicare patients of possible enforcement for such behavior (Evans, 4/26).

The Hill: Dem: Alleged Medical Debt Shakedowns 'Corporate Greed At Its Worst'
A prominent House Democrat called for federal health regulators to investigate collectors of medical debt who allegedly imbed themselves in hospital staffs to more easily put pressure on patients.  Rep. Pete Stark (D-Calif.) called the alleged practices, described in a recent news report, "abominable" and "abusive" (Viebeck, 4/26).

Minnesota Public Radio: Franken Vows To Investigate Accretive Health
A debt collection company accused of gathering too much sensitive patient information from Minnesota hospitals will be investigated by U.S. Sen. Al Franken (Neely, 4/26).

In related news -

Minnesota Public Radio: Health Care Union: Debt Collector's Work Affects Contract Negotiations
About 1,500 Service Employees International Union members work at North Memorial Medical Center in Robbinsdale and Fairview Health Services in the Twin Cities. Both hospital systems had hired Chicago-based Accretive Health ... Tee McClenty, executive vice president for the SEIU's health care unit ... said workers are concerned about how their information is being used. (Dunbar, 4/26).

Detroit Free Press: Collection Agency Used By Three Metro Health Systems Under Investigation
A Chicago debt collection company with contracts at three large metro Detroit hospital systems is the focus of mounting investigations. Accretive Health was sued Thursday by Minnesota Attorney General Lori Swanson. The lawsuit charges that the company violated state and federal health-privacy laws and state debt-collection and consumer protection laws. Minnesota is in discussion with state and federal regulators about coordinating investigations, according to Swanson's office. Documents released by the state allege that unlicensed bill collectors from the company represented themselves as bill collectors and financial counselors (Anstett, 4/27).

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GOP Report: Obama's Corporate Advisers Say Health Law Will Increase Costs

The report by Republican staff of the House Energy and Commerce Committee also contends consultants have advised large employers to drop employee coverage after the exchanges come online in 2014.  Democrats say the report takes comments out of context, calling it "misleading, inaccurate, contradictory."

The Wall Street Journal: Employers Are Advised On Dropping Health Insurance
Consultants have told some large employers they can save money by dropping health insurance in 2014 and funneling employees into insurance exchanges under the new health-care law, according to a report by congressional Republicans (Radnofsky, 4/26).

Reuters: Republican Report Blasts Obama's Healthcare Law
Republicans on Thursday issued a politically charged report that quoted President Barack Obama's corporate advisers as predicting his 2010 healthcare overhaul would raise - not lower - the cost of care. The report, released as the Supreme Court weighs the fate of Obama's healthcare law, was compiled by the Republican staff of the House of Representatives Energy and Commerce Committee with input from major corporations including General Electric, Southwest Airlines and American Express (Morgan, 4/26).

CQ HealthBeat: Energy And Commerce Committee GOP Report Sparks Protests From Democrats
Companies on the Obama administration’s President’s Council on Jobs and Competitiveness say that the health care law will increase their health care costs and lead some firms to stop offering health insurance to workers, according to House Energy and Commerce Republicans in a new report. But Democrats say that the Republicans are twisting statements out of context and using incorrect information. The report by the Subcommittee on Oversight and Investigations that was released Thursday continues a fight between the parties over the impact of the 2010 health care law (Adams, 4/27).

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Administration News

GAO Report: Millions Of Adults Have Pre-Existing Conditions

A report issued by the Government Accountability Office estimated that between 36 million and 112 million American adults have some form of pre-existing condition that could result in health coverage denials or restrictions.

The Hill: GAO: As Many As 112 Million Adults Have Pre-Existing Conditions
Somewhere between 36 million and 112 million adults have pre-existing conditions, the Government Accountability Office says in a new report. President Obama's healthcare law requires insurance companies to cover people with pre-existing conditions. Insurers have historically been able to deny coverage to sick people or offer policies that don’t cover their pre-existing conditions (Baker, 4/26).

Modern Healthcare: Many Have Pre-Existing Conditions That May Prevent Coverage: GAO
Hypertension, mental health disorders and diabetes are the most commonly found medical conditions among adults that could lead to a health insurer denying coverage, the Government Accountability Office concluded in a new report about pre-existing conditions. GAO analysts found that between 36 million and 122 million adults—representing a range between 20% and 66% of the U.S. adult population—reported having medical conditions that could result in health insurance coverage restrictions. The midpoint of that spectrum is estimated to be about 32% (Zigmond, 4/26).

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Health Care Marketplace

McKesson To Settle Medicaid Billing Lawsuit

The Justice Department says the prescription drug distributor overcharged Medicaid.

MarketWatch: McKesson To Pay $190 Million In Drug-Price Pact
McKesson Corp. will pay $190 million to settle government allegations that the drug distribution giant improperly inflated drug prices that led to overbilling the Medicaid system. The Justice Department had charged the San Francisco-based company inflated the prices reported to the publisher used by Medicaid systems throughout the country to gauge prescription reimbursements (Britt, 4/26).

The Wall Street Journal: McKesson To Settle Drug Markup Claims For $190 Million
The government alleges that McKesson, a drug distributor, reported inflated pricing data on a wide variety of brand-name drugs to First DataBank, a publisher of drug prices that are used by most state Medicaid programs to set payment rates for pharmaceuticals. The actions may have violated the False Claims Act, the department said (Rubin, 4/26).

The Associated Press: McKesson Settles Federal False-Claim Allegations
New Jersey U.S. Attorney Paul Fishman and other officials said Thursday that McKesson marked up the average drug prices it reported to publisher First DataBank by 25 percent between 2001 and 2005 (4/26).

Meanwhile, federal prosecutors investigate insider trading allegations -

Los Angeles Times: Insider Trading Inquiry Focuses On Medical Devices Deal
Prosecutors probing insider trading in the medical devices industry are investigating a senior Goldman Sachs banker and a former employee of the notorious hedge fund Galleon Group. The investigation, according to a person briefed on the matter, is focused on the 2009 takeover of Advanced Medical Optics ... The investigation of Abbott Laboratories' takeover of Advanced Medical Optics is part of a broader inquiry of mergers and acquisitions in the medical devices industry (Reckard, 4/27).

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After Losing Two State Contracts, Molina Healthcare Pushes On

Los Angeles Times: Molina Healthcare Fights To Keep Growing
Healthcare companies are tripping over themselves to profit from a flood of government contracts for treating the poor and disabled, and a family-run company in Long Beach with nearly $5 billion in revenue is trying to stay ahead of the pack. Amid the growing competition, Molina Healthcare Inc.is facing new hurdles. It has lost two key state contracts in Ohio and Missouri and its shares have tumbled 23% in recent weeks (Terhune, 4/27).

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State Watch

Minn. Gov. Vetoes Anti-Abortion Bill; Calif. Bill Stalls

The Minnesota bill would have mandated licenses for clinics performing 10 or more abortions a month. The California measure would let nurse practitioners, nurse midwives and physician assistants perform specific types of abortions.

Minneapolis Star Tribune: Dayton Vetoes Abortion Bill
Gov. Mark Dayton vetoed a bill Thursday that would have required licensing of abortion clinics. He's also expected to veto another bill that would require a doctor to be present whenever an abortion pill is prescribed or swallowed. The abortion pill measure won final approval from the Republican-led Minnesota House on Thursday, just hours before Dayton rejected the licensure bill. Dayton said in a statement that the proposed law would have forced "inappropriate and unworkable" new requirements on the few facilities that offer abortions (Brooks, 4/26).

(St. Paul) Pioneer Press: Dayton Vetoes Abortion Clinic Restrictions
The Republican-backed proposal also would have forced clinics to pay a $3,712 annual license fee. Proponents argue it's an important issue to the health and safety of women. Opponents contend that state health officials already have ample oversight of abortion providers and that the proposed regulation is more about restricting access to abortions than protecting women (Boldt, 4/26). 

San Francisco Chronicle: Bill Expanding Abortion Access Stalls In Capitol
A bill to allow non-physicians to perform abortions stalled in a Senate committee at the Capitol Thursday, as key lawmakers questioned the scientific findings of UCSF researchers who conducted a study that led to the proposal. The bill, SB1338, would allow nurse practitioners, nurse midwives and physician assistants to perform what is known as an aspiration abortion, which is the most common abortion procedure and takes place in the first trimester (Buchanan, 4/27).

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State News: Cuomo's Plan For Out-Of-Network Charges Runs Into Trouble

Today's news on local health policy issues comes from New York, Connecticut, Mississippi, Colorado, Iowa, Texas, North Carolina and Kansas.

The Wall Street Journal: Cuomo Aims To Salvage Health Pact
Amid an intense lobbying battle between physicians and health insurers, Gov. Andrew Cuomo is trying to salvage his landmark overhaul of out-of-network medical charges. The outcome of the policy battle has large implications for health-care consumers who have been hit with unexpected spikes in their medical bills despite assurances from the governor that he had brought "fairness to a broken consumer reimbursement system" (Gershman, 4/26).

The Connecticut Mirror: Caring, Long Term: A Way Of Life For 1 In 8 Connecticut Residents
[Mimi] Galusha is one of an estimated 42 million Americans who act as unpaid caregivers, forming what experts call the backbone of the long-term care system. They far outnumber the home care workforce, providing services that one report estimated would cost $450 billion if performed by paid workers. In Connecticut, 486,000 people -- more than one in eight state residents -- were providing care to an adult with limitations in his or her activities at any given point in 2009, according to the report by AARP Public Policy Institute (Levin Becker, 4/27).

Kaiser Health News: Wanted: Mavericks And Missionaries To Solve Mississippi's Doc Shortage
When Janie Guice looks at the Mississippi Delta she sees a vast, flat flood plain, home to cotton fields and catfish farms, but she also sees desperate rural health problems and a deep shortage of doctors to deliver primary care to the region's residents (Hess, 4/26). 

Kaiser Health News: Poor, Sick And Expensive: Colorado's Scaled-Down Medicaid Expansion
Starting in mid-May, Colorado will begin offering Medicaid to adults like [Dale] Miller who make less than $1,080 per year (that's 10 percent of the federal poverty line, or $90 per month) – but there’s a catch. Though the state estimates that there are 50,000 people who meet the income bar, Colorado will only be able to offer the health coverage to 10,000 people. Those people will be chosen by a lottery method in each county, designed to distribute the benefits fairly across the state (Whitney, 4/26).  

Modern Healthcare: Iowa Health, Wellmark Announce ACO Plans
Wellmark Blue Cross and Blue Shield of Iowa and Iowa Health System, both of Des Moines, announced they will form an accountable care organization. ... IHS includes more than 200 physician clinics and employ more than 24,000, the release said. Wellmark covers 1.8 million customers in Iowa and employs 1,707 in the state, according to the company's website (Selvam, 4/26).

Houston Chronicle: Feds Seize Mental Health Clinic Records In Medicare Fraud Probe
Federal agents with search warrants seized hundreds of patient records from a Houston psychiatric hospital and its two mental health clinics Thursday, part of an escalating Medicare fraud investigation into financial exploitation and care of the mentally ill as detailed last year by the Houston Chronicle. The files, belonging to patients who attend counseling sessions at Westbury Community Hospital and its clinics in southwest Houston and Baytown, were boxed up and loaded into trucks in a pre-dawn swoop by the FBI and investigators from the Texas Attorney General's office (Langford, 4/26).

North Carolina Health News: NC Lawmakers Punt On Drugmaker Liability Bill
A bill that would significantly raise the bar for people suing pharmaceutical companies when they're injured by a drug was sent back to the senate judiciary committee yesterday after several months of meetings and, at times, emotional testimony from opponents. Senators on the judiciary Subcommittee on Pharmaceutical Liability did not make any changes to the proposed legislation and said there were still 'questions' about the bill (Hoban, 4/26).

Kansas Health Institute News: Governor Proposes Additional $1.9 Million For Larned State Hosptial
The funding, administration officials said, was needed to address staffing shortages cited during a recent accreditation survey. ... About half of the $1.9 million, he said, would be used to increase nurses' wages; the other half would allow the hospital to hire 23 additional direct-care workers. ... Larned State Hospital is one of the state's three hospitals for the mentally ill (Ranney, 4/26). 

KQED’s State of Health blog: Humboldt County – Amid Stunning Beauty, Sad Health Profile
[The] California Department of Public Health] recently released its County Health Status Profiles 2012 ... In its overall death rate from all causes, Humboldt ranked next to last, 57th, with 865 deaths per 100,000 people. ... Perhaps the mix of poverty and rural character is a factor, creating a physical and socio-cultural isolation that could be affecting health (Kipling, 4/26).

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Health Policy Research

Research Roundup: Practice Guidelines May Not Stop Defensive Medicine

KHN reporter Christian Torres compiled this selection of recently-released health policy studies and briefs.

Urban Institute/Robert Wood Johnson Foundation: The Value of Clinical Practice Guidelines As Malpractice "Safe Harbors" -- Overspending on health care has frequently been attributed to doctors practicing defensive medicine -- ordering extra tests, for example -- so that they avoid malpractice lawsuits. The authors of this brief write that while some have said clinical guidelines "should give caregivers a liability 'safe harbor,' shielding them from any malpractice claim for failing to provide services not included in the guideline." The brief "suggests that quality-promoting guidelines hold some promise for cutting wasteful defensiveness, but that practical feasibility limits their reach," as does patients’ lack of understanding about appropriate care (Bovbjerg and Berenson, 4/25).

Journal of General Internal Medicine: Professional Language Interpretation And Inpatient Length Of Stay And Readmission Rates -- This three-year study at one hospital found that providing a professional interpreter at both admission and discharge correlated with a shorter stay and decreased likelihood of readmission for patients with limited English proficiency. Patients who didn’t have an interpreter at either time stayed 1.5 days longer, on average, and were more likely to be readmitted within 30 days than those who did have an interpreter. Those results could help develop “a business case,” authors write, for providing interpretation (Lindholm, Hargraves, Ferguson and Reed, 4/18).

The Kaiser Family Foundation/Urban Institute: The Diversity of Dual Eligible Beneficiaries: An Examination of Services and Spending for People Eligible for Both Medicaid and Medicare -- The authors of this brief write: "As a group, dual eligibles are costly—with per capita Medicare and Medicaid spending over four times Medicare spending for other beneficiaries. However, a small share of dual eligibles account for most of the group's spending, and dual eligibles who are high cost to the Medicare program are generally not the same individuals who are high cost to the Medicaid program." They suggest that "decision-makers should adopt a multi-pronged approach" (Coughlin et al., 4/18).

SCAN Foundation: Bridging Medical Care and Long-Term Services and Supports: Model Successes and Opportunities For Risk Bearing Entities -- Acute medical care is largely separate from long-term care, often leading to poor quality and higher costs. This brief suggests that managed care plans, accountable care organizations and other organizations have an opportunity to bridge the gap, particularly under the health law and its incentives. Several model health systems are described to showcase how coordinated care can "provide a more cost-effective and humane service" (4/24).

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

Reuters: Wealthy Pick Colonoscopy Over At-Home Cancer Test
Colonoscopy has become an increasingly popular method of screening for colon cancer while the rate of at-home stool testing has dropped off, according to a new study. The findings, published in the journal Cancer, are primarily driven by a trend among people above the poverty line preferring colonoscopy; poor people still choose at-home testing as frequently as they did a decade ago (Grens, 4/23).

Reuters/Chicago Tribune: Prescription Drug Abuse Abetted By Family, Friends: Study
More than 70 percent of people who abuse prescription pain relievers obtain the drugs from friends or relatives, usually with permission and for free, according to a government study to be released on Wednesday. The study, based on data from the National Survey on Drug Use and Health, underscores the public education challenge that law enforcement officials face in persuading legitimate prescription drug users to dispose of their medications properly before they fall into the wrong hands (Morgan, 4/24). 

Medscape: Uneven State Progress in Reducing Central-Line Infections 
Although central line–associated bloodstream infections (CLABSIs) in hospitals fell significantly nationwide in 2010, uneven state-by-state progress points to considerable room for improvement, according to a report released today by the Centers for Disease Control and Prevention (CDC). ... In 2009, HHS set a goal of reducing them by 50% by 2013 compared with the baseline period of January 2006 to December 2008. ... Today's CDC report also goes deeper into the subject of surgical-site infections (SSIs). Last year the CDC revealed that hospitals had lowered SSIs by roughly 10% in 2010 compared with baseline (Lowes, 4/19).

MedPage Today: Healthcare Market Unique
A review of hospital costs for a common medical procedure casts doubt on the theory that the healthcare marketplace is similar to that for other goods and services, researchers found. In a retrospective review of charges for appendectomies, researchers found that in 2009 one California hospital charged $1,529 for the procedure while another hospital in a different county charged $182,955. ... The fact that the cost of an appendectomy can vary by $181,000 depending on which hospital it's performed at makes healthcare a unique good -- namely one whose cost cannot be accurately predicted, Renee Hsia, MD, of University of California San Francisco, and colleagues wrote in a letter published online in the Archives of Internal Medicine (Walker, 4/23).

Modern Healthcare: New Health Programs Need A Managed Approach: Report
The federal government needs a plan for managing the various programs and projects that resulted and will result from recent healthcare legislation, argues a new report from the Commonwealth Fund Commission on a High Performance Health System, which offered its own take on how that plan could look. The 24-page commission report, "Performance Improvement Imperative: Utilizing a Coordinated, Community-Based Approach to Enhance Care and Lower Costs for Chronically Ill Patients," suggests that the plan be first implemented among chronically ill patients with multiple conditions, a segment that represents a large chunk of healthcare spending (Barr, 4/26).

Medscape: Cost-Effectiveness of Lung Cancer Screening Questioned
Optimistic assumptions about the effects of low-dose computed tomography (CT) lung screening on cancer staging have cast doubts about a published actuarial analysis showing that its targeted use will be as cost-effective as mammography, colonoscopy, and Papanicolaou (Pap) smears. Bruce S. Pyenson and colleagues at the New York office of Milliman, an actuarial and consulting firm ... predicted that annual screening for the 18 million high-risk Americans could prevent 130,000 deaths during the first 15 years of its application (Brice, 4/26). 

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Editorials and Opinions

Viewpoints: Minn. Missteps With Medicaid Are Object Lesson; 'Defensive' Medicine: Red Herring Or Key To Health Costs?

Minneapolis Star Tribune: State Hit Hard Over Medicaid Missteps
It was painful to watch Minnesota's stellar health care reputation and its Human Services commissioner, Lucinda Jesson, get pummeled on Wednesday at a congressional hearing on Medicaid oversight. The sharp, high-profile criticism of Minnesota's medical program for the poor sent a strong message to officials in all states: They are financial stewards of federal tax dollars, not just state funds. That responsibility is too often overlooked in a flawed Medicaid system that doesn't reward states for spending wisely on this critical safety-net program but instead gives them incentives to try to milk as many federal dollars as possible (4/26).

The Atlanta Journal-Constitution: 'Defensive Medicine' Can Come With Price
As a former professor of emergency medicine, I can tell you that medical schools teach defensive medicine so physicians can protect themselves against patients who might sue for a missed diagnosis…. Ordering a battery of exams is often just a way to alleviate a physician's fears about potential litigation from frivolous lawsuits. The trade-off in society is that all of us have to endure more testing and medical procedures until we have fixed our broken medical tort system (Dr. Sam Kini, 4/26).

The Atlanta Journal-Constitution: Alleged Overtesting Just A Red Herring
"Defensive medicine" provides a convenient distraction from the real issues that plague our health care system…. In my experience, the drivers of medical treatment decisions are more complex. Doctors who put patients through uncalled-for tests are not practicing defensive medicine — they are practicing bad medicine. Most often, doctors conduct the tests and procedures they believe necessary based on their judgment and the needs of individual patients — not due to liability concerns (Dr. Kelly B. Thrasher, 4/26). 

MinnPost: Has Your Doctor Disappeared?
I have excellent, relatively inexpensive, employer-sponsored health insurance, for which I am immensely grateful. Even so, I'm having a hard time getting decent primary health care. In fact, it's been nearly two years since I saw a doctor who knows me. And I think I may be seeing a trend (Ann Bauer, 4/27).

Forbes: Customer-Driven Health Care Comes Of Age
U.S. health care reform is on the Supreme Court's operating table. It's going to be a long, painful procedure, multiple amputations are likely, and the patient's survival is uncertain. Whatever the outcome, however, the economic pressure that health care costs put on employers and individuals will continue to mount, and they will seek better value aggressively. This drives us towards an era of "customer-driven" healthcare (Todd Hixon, 4/26).

Baltimore Sun: Obama And Romney Surprisingly Similar On Health Care
When examined closely, both health care visions, past and present, are strikingly similar. Mr. Romney's biggest fundamental differences from President Obama are: 1) the dismantling of state and federal health insurance mandates, and 2) the restructuring of Medicaid and Medicare from open-ended entitlements to predictable contributions from the federal government (Dr. Cedric Dark, 4/26).

Washington Times: Undeniable: Entitlements Are Unsustainable
Medicare is on a steady downward course to financial ruin and everyone should care. Its trustees admit that Medicare's main trust fund could run out of money as early as 2017. Since the U.S. Treasury is under no obligation to make good the shortfalls, the checks to doctors, hospitals and pharmacies will be even less than they are today, covering a fraction of the actual cost of care, potentially shutting off access to health care for millions of seniors (Rep. John Fleming, R-La., 4/26).

Denver Post: The All Payer Claims Database Will Help Coloradans
In today's wired world, consumers have nearly instantaneous access to detailed information on the cost, quality and performance of nearly any major item they purchase. The glaring exception is health care. ...  The non-profit Center for Improving Value in Health Care (CIVHC) is launching an All Payer Claims Database (APCD) containing claims information (cost, diagnosis, payer, provider, and location) that will identify variations in cost and quality across Colorado and eventually provide the comparative information Coloradans need to make informed decisions about their health care (Lalit Bajaj and Nathan Wilkes, 4/27).

WBUR Common Health Blog: Mass. Taxpayers Foundation Responds To Critics On Health Reform Spending
A new Massachusetts Taxpayers Foundation (MTF) study finds ... when you look at the first five years of state spending for health reform, the annual increase, year-to-year, averaged about $91 million. In short, health reform hasn't been a "budget-buster" as some critics have claimed. Pretty good news, right? Well, the Pioneer Institute's Josh Archambault and Amy Lischko aren't so sure (Michael Widmer, 4/26). 

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Stephanie Stapleton

Andrew Villegas

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.