Daily Health Policy Report

Friday, May 17, 2013

Last updated: Fri, May 17

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform


Public Health & Education

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

My Insurer Says It Paid Too Much. Do I Have To Reimburse Them? (Video)

Kaiser Health News consumer columnist Michelle Andrews answers a reader question about having to repay an insurer that says it reimbursed too much after the patient received care from an out-of-network provider (5/17). Watch the video or read the transcript.

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Capsules: CDC Takes A Closer Look At Kids' Mental Health

Now on Kaiser Health News’ blog, Capsules, Jenny Gold reports: "Somewhere between 13 and 20 percent of kids in the United States experience some sort of mental illness, according to a new report from the Centers for Disease Control and Prevention. That adds up to millions of children suffering from disorders like ADHD, depression, autism and illicit drug use" (Gold, 5/16). Check out what else is on the blog.

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Political Cartoon: 'Cock-A-Doodle Don't?'

Kaiser Health News provides a fresh take on health policy developments with "Cock-A-Doodle Don't?" by Mike Luckovich.

Meanwhile, here is today's health policy haiku:


The new public face
for Affordable Care Act
is the IRS.

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

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Capitol Hill Watch

IRS Controversy Fuels Republican Health Law Opposition

Just as the House took its 37th vote to repeal the health law, largely along party lines, the Republicans held their first hearing on the IRS's tax-exempt and government-entities division. Several media outlets report that Sarah Hall Ingram, who led the division when the questioned operations began, is now in charge of the branch overseeing implementation of parts of the health law.

The New York Times: Congressional Hearings On IRS Scandal Set To Start
Joseph Grant, commissioner of the I.R.S.'s tax-exempt and government-entities division, announced Thursday that he, too, would be leaving in the next month. But Republicans jumped on news Thursday evening that Mr. Grant's predecessor, Sarah Hall Ingram, who led the division when the targeting operation began, is now in charge of the I.R.S. division overseeing implementation of parts of the president's health care law. Ms. Ingram's name did not appear anywhere in the inspector general's report of the program, nor had Republicans singled her out for criticism until now. But Republicans were eager to link the I.R.S. scandal with their opposition to the health care law (Weisman, 5/17).

Politico: Obamacare Repeal Now About The IRS
Republicans have hated Obamacare for years, and on their 37th repeal vote Thursday, they found a reason to hate it even more: the IRS. They've warned about its role in Obamacare before, but this time, they used its targeting of conservative groups as a fresh warning about how it might apply the law to the rest of the country. It’s the IRS, after all, that will enforce the individual mandate that most of the country already hates. And if the IRS can’t shake its image as a political tool of the White House, any conservatives who get hit with an Obamacare penalty are certain to cry foul (Samuelsohn and Cunningham, 5/16).

Fox News: IRS Official Who Oversaw Unit Targeting Tea Party Now Heads ObamaCare Office
The IRS official who led the tax-exempt organizations unit when Tea Party groups were targeted is now in charge of the IRS office responsible for ObamaCare, two Capitol Hill sources told Fox News. The acknowledgement comes after the administration announced that the official’s successor Joseph Grant -- who had only been on the job a few days -- would be retiring. And it fueled criticism of the agency, as the outgoing IRS commissioner prepared to face lawmakers’ questions at a hearing Friday morning (5/17).

The New York Times: House Votes Again To Repeal Health Law
For many Republicans, this was one of the major reasons for coming to Washington in the first place. And they were not going to miss their chance — whether it was their 37th time voting to repeal the 2010 health care overhaul, or their first (Peters, 5/16).

Los Angeles Times: House Republicans Repudiate Obama Healthcare Program - Again
House Republicans voted for the 37th time Thursday evening to repeal all or part of President Obama's healthcare law, underscoring once again the deep partisan divide over the landmark 2010 legislation. The bill to roll back the entire Affordable Care Act passed 229 to 195, with just two Democrats crossing the aisle to join the GOP. No Republicans voted against the legislation, which is assured of going nowhere in the Senate (Levey, 5/16).

The Hill: House Votes To Repeal ObamaCare
The House voted to repeal ObamaCare on Thursday for the third time since Republicans took over the chamber in 2011. Only two Democrats sided with Republicans in the party-line 229-195 vote — Jim Matheson (Utah) and Mike McIntyre (N.C.). All Republicans voted in favor of repeal (Kasperowicz, 5/16).

The Washington Post: House Votes To Repeal Obamacare For 37th Time
This vote does not put the Affordable Care Act in jeopardy. Thursday's repeal bill will probably meet the same fate as five others that would have eliminated the entire health-care law: It will die in the Democrat-led Senate. But for the GOP, the point was not to change the law. At least, not right away. Instead, the point was to refocus the House — and, hopefully, a swath of the American public — on a law that remains controversial three years after it was passed (Fahrenthold, 5/16).

The Wall Street Journal's Washington Wire: Freshman Republicans Get Chance To Vote Against Health Law
More than 70 freshmen Republicans had pushed House Speaker John Boehner to give them a chance to go on the record in opposing the 2010 law, and many of them made short speeches in the several hours of debate preceding the vote (Radnofsky, 5/16).

The Associated Press/Washington Post: House GOP Pushes Full Repeal Of Obama’s Health Care Law – 37th Vote To Scale Back Or Kill It
One more time, with feeling! The Republican-led House voted yet again Thursday to repeal President Barack Obama's health care law, knowing full well that won’t stop it. Only months away from the rollout of coverage for uninsured Americans, it was the 37th attempt in a little more than two years by House Republicans to eliminate, defund or partly scale back the Affordable Care Act. The Democratic-led Senate and the president will simply ignore the House action, which came on a virtual party line vote, 229-195 (5/16).

Reuters: U.S. House Votes To Repeal Obamacare In 37th Symbolic Act
The Republican-controlled U.S. House of Representatives voted to repeal President Barack Obama's healthcare reform law on Thursday in a symbolic move aimed as much at healing internal Republican rifts as demonstrating dogged party opposition to "Obamacare." The 229-195 vote occurred largely along party lines and marked the 37th time the House has voted to repeal or defund the 2010 Patient Protection and Affordable Care Act, which is now in the final months before full implementation on January 1 (Morgan, 5/16).

USA Today: Obamacare: 3 Years In, It Faces Steep Challenges
The Affordable Care Act is sure to survive the latest vote by the House of Representatives Thursday to repeal it — since the Senate doesn't plan to take it up and President Obama would veto a repeal bill if it somehow reached his desk — but the administration's signature legislative achievement still faces serious perils ahead (Page, 5/16).

The Washington Post's Wonk Blog: Yes, The 37th Obamacare Repeal Vote Matters
It's easy to write off these votes as pure political spectacle with no substantial meeting. Members of Congress can tell their constituents that they voted to repeal Obamacare and move on to other issues. But there's actually a compelling case on the other side, that these actions do really matter in a substantive way. This slew of three dozen repeal votes have changed both how the Affordable Care Act works and how the public perceives it (Kliff, 5/16).

Politico: John Boehner: No Timetable For Obamacare Replacement
House Speaker John Boehner was noncommittal on when — or even if — Republicans would put a bill on the floor to replace President Barack Obama’s health care law…Republicans offered replacements to the Affordable Care Act when they were in the minority. And the Pledge to America — their promises to voters when they took the majority in 2011 — clearly stated that they would “repeal and replace the government takeover of health care.” They’ve passed some bills that would do that (Sherman, 5/16).

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Conservative Lawmakers Seek To Capitalize On Link Between Current 'Scandals' And Health Law

Rep. Michele Bachmann, R-Minn., was among the members of Congress linking the I.R.S. scandal to the repeal vote and even talk of impeachment. 

Politico: Conservatives Link IRS Mess To Obamacare
Conservative lawmakers and tea party advocates Thursday sought to link the IRS scandal to efforts to repeal Obamacare, even acknowledging the potential of impeachment. Rep. Michele Bachmann (R-Minn.) made the leap from Benghazi to the IRS scandal to Obamacare, a progression she said was all related. At a packed press conference, she argued that the IRS will now be able to access individuals' health records because they are tasked with overseeing compliance with the new law (Gibson, 5/16).

The Associated Press: Bachmann Sprints To TV With Health Care Ad
Minnesota Rep. Michele Bachmann quickly launched a campaign-style television ad Thursday in hopes of capitalizing on the latest U.S. House vote to undo President Barack Obama's health care law. The Republican critic of the Affordable Care Act -- dubbed Obamacare by foes -- was to begin airing the ad Thursday night in Twin Cities market. She spent about $85,000 for the TV spot (Bakst, 5/16).

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Health Reform

Republicans Ask GAO To Probe Sebelius' Fundraising

GOP lawmakers seek an investigation of the Health and Human Services secretary's efforts to secure more funding for a private group that will help with the implementation of the health law. At the same time, an HHS spokesman offered more detail regarding whom she contacted.

Politico: GOP: GAO Should Investigate Kathleen Sebelius
A group of Republican lawmakers called on the Government Accountability Office to investigate Health and Human Services Secretary Kathleen Sebelius over her fundraising for a nonprofit supporting Obamacare. Republicans are criticizing news that Sebelius sought donations from health care companies for a group working to encourage more people to enroll in Obamacare programs (Gibson, 5/16).

Modern Healthcare: GOP Lawmakers Seek GAO Probe Of Sebelius’ Fundraising Efforts
Pressure continued to mount on the Obama administration Thursday as Republican leaders in the House and Senate asked the Government Accountability Office to investigate HHS Secretary Kathleen Sebelius' fundraising efforts for a private organization to help implement the healthcare reform law. House Ways and Means Committee Chairman Dave Camp (R-Mich.), Energy and Commerce Committee Chairman Fred Upton (R-Mich.), and Appropriations Subcommittee on Labor, HHS and Education Chairman Jack Kingston (R-Ga.), along with Sens. Lamar Alexander (R-Tenn.) and Orrin Hatch (R-Utah), the ranking members on the Senate Health, Education, Labor and Pensions and Senate Finance committees, respectively, sent a letter to Comptroller Gene Dodaro at the GAO asking Dodaro's office to examine Sebelius' efforts to solicit funds for Enroll America, a not-for-profit organization whose purpose is to help Americans learn about, enroll in and retain healthcare coverage (Zigmond, 5/16).

Bloomberg: Sebelius Limited Fundraising For Health Law To Two Calls
The U.S. health secretary's solicitation of money from companies to promote the Affordable Care Act ended after two phone calls, to H&R Block Inc. (HRB) and the Robert Wood Johnson Foundation, according to her spokesman. Enroll America, a nonprofit promoting the 2010 health law had asked Health and Human Services Secretary Kathleen Sebelius to help raise money from a longer list of companies. Sebelius solicited two for money, and only asked the others for technical advice and nonfinancial support because they were regulated by her department, said Jason Young a spokesman for the agency (Wayne, 5/16).

Meanwhile -

The Hill: CRS: Sebelius Can Take Place Of Controversial Medicare Board
If congressional Republicans succeed in blocking a controversial new Medicare board created in the Affordable Care Act, Health and Human Services Secretary Kathleen Sebelius can step in instead. GOP leaders have resisted the Independent Payment Advisory Board (IPAB), a 15-member panel tasked with slowing the growth in Medicare spending. The IPAB would make targeted cuts in Medicare's payments to doctors and other providers. ... But if Republican efforts to block the panel are effective, they could further empower Sebelius, the Congressional Research Service (CRS) said. CRS said in a memo to Sen. Tom Coburn (R-Okla.) that the law directs the HHS secretary to propose Medicare cuts if the IPAB doesn't (Baker, 5/16).

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CMS Examines Interaction Between Medicaid And Health Insurance Exchanges

Also in the news, developments on Medicaid expansion from Arizona, Ohio and Iowa.

CQ HealthBeat: At MACPAC, Discussion Of Interaction Between Medicaid And Exchanges
The Centers for Medicare and Medicaid Services has put out most of the rules to implement coverage changes under the health care law, but a top official said Thursday that the public should expect more guidance on such issues as outreach and the enrollment of lawmakers and their staffs into the new marketplaces that will start accepting people in October. Chiquita Brooks-LaSure, the deputy director for policy and regulations at the CMS Center for Consumer Information and Insurance Oversight, offered few new details in her wide-ranging remarks to the Medicaid and CHIP Payment and Access Commission (Adams, 5/16).

The Associated Press: Arizona Senate Passes Budget With Medicaid
The Republican-controlled Arizona Senate on Thursday passed an $8.8 billion state budget that embraces a signature part of President Barack Obama's health care overhaul, with a handful of Republican members teaming up with Democrats to push through Gov. Jan Brewer's top priority of the session. The Medicaid expansion proposal will add 300,000 Arizonans earning between 100 percent and 138 percent of the federal poverty level to the current 1.2 million people now on the state's insurance plan for the poor (Christie, 5/16).

Arizona Republic: Arizona Senate Backs Medicaid Expansion
The Arizona Senate on Thursday approved expanding the state’s Medicaid program, capping a rancorous debate that had split the Republican Party and had been building since January, when Gov. Jan Brewer issued a surprise call to increase Arizona’s health care program for the poor. A handful of Senate Republicans teamed with Democrats to approve the fiscal 2014 budget plan and overcome a flood of amendments intended to scuttle Medicaid expansion, pushing through the governor’s top legislative priority on a 19-11 vote after three hours of debate (Pitzl and Reinhardt, 5/16).

Columbus Dispatch: Legislators Mull Medicaid Changes Rather Than Expansion 
Ohio Medicaid recipients could face time limits and work requirements under alternatives being discussed in the legislature to Gov. John Kasich’s proposed expansion of tax-funded health care for the poor and disabled. Republican leaders also are considering taking thousands of pregnant women, disabled workers and children off the Medicaid rolls and putting them into yet-to-be-established health exchanges (Candisky and Siegel, 5/17).

Des Moines Register: Medicaid Proposal Too Bitter A Pill For 27 States
Iowa Gov. Terry Branstad isn’t alone in scorning the Obama administration’s prescription for government health coverage for those who can’t afford private insurance, and he’s not alone in seeking another way to cover some of them. Iowa is one of the last states to decide, for this year, what to do about the hefty sums of federal money at stake for enlarging the pool of poor people eligible for Medicaid. More than half of the states have decided against a deal that the White House had thought they couldn’t refuse (Jacobs, 5/17).

Meanwhile, here's the latest on on the health exchange front in Colorado and California -

Health Policy Solutions (a Colo. news service): New Health Insurance Era Dawns With 19 Companies Competing
Coloradans hunting for health insurance will have 19 companies competing for their business with up to 1,000 different plans that could be offered through the state’s new health exchange and on the open market. Starting in 2014, for the first time, insurance companies selling to individuals won’t be able to exclude people with pre-existing health conditions. That’s one of the reasons consumers and competitors are eagerly awaiting plan details and costs, which Colorado authorities plan to unveil Wednesday. For now, Colorados Commissioner of Insurance Jim Riesberg says he’s pleasantly surprised that 19 health insurance companies want to vie for business here (Kerwin McCrimmon, 5/16).

California Healthline: How Exchange Hopes To Reach Enrollees
Covered California exchange officials on Tuesday awarded $37 million in outreach grants to 48 community-based organizations. Those groups all have a wide reach, and represent a much bigger bloc of community organizations, according to Peter Lee, executive director of the California Health Benefit Exchange, now known as Covered California. … Lee said applicants were encouraged to aim high, because the exchange wants to reach as many people as possible and so much of the target market -- a multi-cultural, low-income and multilingual population -- is difficult to reach (Gorn, 5/16).

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CBO: Cadillac Tax's Bark May Be Worse Than Its Bite

Bloomberg: Health Law's Cadillac Tax Bite on Companies Drops by $57 Billion
The U.S. health-care law’s projected tax bite on businesses with more generous health benefits is dropping as medical spending slows and employers look to rein in the cost of coverage. The 2010 Affordable Care Act's so-called Cadillac tax on high-premium health plans was initially projected to bring in $137 billion over the next decade. That estimate has now been trimmed to about $80 billion, a $57 billion decrease, the Congressional Budget Office said in a report this week (Nusbaum, 5/16).

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Liberty University's Challenge To The Health Law Has A Day In Appellate Court

Mathew Staver, the university's lawyer, told the 4th U.S. Circuit Court of Appeals panel that Liberty would face millions of dollars in penalties if it refuses to provide employee health insurance that violates its religious beliefs.

The Associated Press/Washington Post: Appeals Court In Va. Hears Christian University's Suit Against Obama Health Care Law
A Liberty University lawyer urged a federal appeals court to overturn the Obama administration's health care reform law Thursday, arguing that it violates the school's religious rights by requiring it to provide insurance coverage for abortion-inducing drugs. Mathew Staver told a three-judge panel of the 4th U.S. Circuit Court of Appeals that the conservative Christian university founded by Jerry Falwell faces millions of dollars in penalties if it refuses to provide employee health insurance that violates its religious beliefs (5/16).

Politico: Liberty University Pivots In Health Law Challenge
Judges on the 4th Circuit Court of Appeals on Thursday appeared skeptical that Liberty University can challenge the Obama administration's rule that most employers provide contraceptives in their employee health plans. But at least one of the judges suggested that the health reform law's employer mandate could be at risk since last year's Supreme Court health care ruling narrowed the Commerce Clause (Haberkorn, 5/17).

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Some Hospitals Under The Microscope For Steep Pricing

The New York Times and Los Angeles Times report on specific hospitals that have been shown to be among the most expensive in the nation. Meanwhile, Modern Healthcare reports on interest from some senators in overhauling Medicare's hospital payment system.

The New York Times: New Jersey Hospital Is The Costliest In The Nation
The most expensive hospital in America is not set amid the swaying palm trees of Beverly Hills or the luxury townhouses of New York’s Upper East Side (Creswell, Meier and McGinty, 5/16).

Los Angeles Times: Cedars-Sinai Stands Out For Steep Pricing
When Medicare disclosed average charges from thousands of U.S. hospitals for 100 common procedures last week, only one hospital was near the top in every category: Cedars-Sinai Medical Center in Los Angeles. Be it a cardiac stent, a hip replacement or a pacemaker, Cedars-Sinai's list prices for these routine treatments ranked among the top 5 percent in the country (Terhune and Poston, 5/17).

Modern Healthcare: Senators Seek Overhaul Of Hospital Payment System
When it comes to Medicare hospital payment systems, the exceptions are the rule. Congress' nonpartisan investigative arm reported Thursday that 91 percent of hospitals paid by Medicare receive some dispensation or add-on to the program's standard payment system. The Inpatient Prospective Payment System was designed to maximize "cost-control, efficiency and access" when it was launched 30 years ago, according to the Government Accountability Office report. But Congress has piled an accumulating number of exemptions and carve-outs for various types of hospitals (Daly, 5/16).

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Public Health & Education

Updated Diagnostic Guidebook For Mental Disorders To Be Unveiled This Weekend

In advance of its release, the new edition of the Diagnostic and Statistical Manual of Mental Disorders has triggered debate and controversy surrounding the many changes included in this 947-page book.  

The Washington Post: Psychiatry's Revamped DSM Guidebook Fuels Debate
For ADHD, the definition is being broadened, meaning the disorder could be diagnosed in more children. In the case of autism, the opposite is true. The new criteria are among the changes that will be released with the publication this weekend of the long-awaited guidebook that psychiatrists and other mental health clinicians use to diagnose mental disorders. It's the first major update in nearly 20 years. The 947-page tome by the American Psychiatric Association adds some new disorders, broadens criteria for existing ones and tightens them for other illnesses (5/17).

Reuters: Psychiatrists Unveil Their Long-Awaited Diagnostic 'Bible'
The long-awaited, controversial new edition of the bible of psychiatry can be characterized by many numbers: its 947 pages, its $199 price tag, its more than 300 maladies (from "dependent personality disorder" and "voyeuristic disorder" to "delayed ejaculation," "kleptomania" and "intermittent explosive disorder"), each limning the potential woes of being human. But to the psychiatrist who shepherded the tortuous creation of the "Diagnostic and Statistical Manual of Mental Disorders," perhaps the single most important number is the "5" in its title: This is the DSM-5, not the DSM-V (Begley, 5/17).

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Health Care Marketplace

Patient And Physician Prescribing Information A Powerful Aide In Drug Marketing

The New York Times: Pills Tracked From Doctor To Patient To Aid Drug Marketing
The information allows drug makers to know which drugs a doctor is prescribing and how that compares to a colleague across town. They know whether patients are filling their prescriptions — and refilling them on time. They know details of patients' medical conditions and lab tests, and sometimes even their age, income and ethnic backgrounds (Thomas, 5/16).

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State Watch

State Highlights: State Medicaid Investigators Get More Money To Investigate Fraud

A selection of health policy stories from Texas, Kansas, Georgia, Wisconsin and California.

CQ HealthBeat: OIG Final Rule Allows Medicaid Investigators To Use Data Mining
State Medicaid fraud investigators will be able to get federal matching funds to electronically search for potential fraud, under a final rule to be published on Friday. The rule, which will be published by the Health and Human Services Office of Inspector General, is expected to save the federal government about $34.3 million from fiscal 2014 through fiscal 2023 in fraudulent claims that would have been paid (Adams, 5/16).

The Texas Tribune: End-Of-Life Bill Sparks Anger, Accusations
Political powerhouse Texas Right to Life is working overtime to try to defeat a compromise measure aimed at improving state laws governing "end of life" medical decisions. But with time running out to get Senate Bill 303 passed, the fight over the legislation has shifted from political to personal. Sen. Bob Deuell, R-Greenville, a family physician who has worked for years to craft legislation acceptable to faith-based groups, the disability community and medical professionals, said Texas Right to Life is acting like "the woman that went to Solomon and wanted the baby to be cut in two" (Aaronson, 5/17).

The Texas Tribune: House Backs Bill To Protect Medicaid Providers’ Rights
Medicaid providers would have clearer due process rights during fraud investigations under a measure the House gave tentative approval to on Wednesday. The bill would also codify the state's rules for withholding payments to providers during such investigations (Smith and Aaronson, 5/16).

Kansas Health Institute: Governor's Mental Health Initiative Panned At Manhattan Meeting
Karen McCulloh spent much of Wednesday afternoon listening to state officials explain how Gov. Sam Brownback's mental health initiative might work. She said she didn't hear much that she hadn't heard before. … Brownback has said his initiative, much of which remains undefined, is meant to "strengthen" the state's mental health system and better serve those most at-risk of hospitalization or incarceration (Ranney, 5/16).

Georgia Health News: Albany Hospital Merger Slowed By Latest Ruling
U.S. District Court Judge Louis Sands has issued a temporary restraining order against further moves by Phoebe Putney Health System to consolidate with the former Palmyra Medical Center in Albany. The ruling had been sought by the Federal Trade Commission. Phoebe Putney officials said in a statement that the judge's action won't alter day-to-day operations at the former Palmyra, which was purchased from HCA and has been renamed Phoebe North (Miller, 5/16).

Milwaukee Journal Sentinel: Uninsured, Low-Income Visits To Hospital 
More than 1 million visits to Wisconsin's hospitals were by patients who were uninsured and low-income in 2011 -- an increase of more than 30 percent since 2006, according to the Wisconsin Hospital Association Information Center's annual Guide to Wisconsin Hospitals. The Wisconsin Hospital Association Information Center also reported that 70 percent of surgeries and procedures now done at the state's 148 hospitals don't require an overnight hospital stay and are done in outpatient departments. The figure shows that the traditional measure of inpatient stays no longer is a valid way to gauge a hospital's patient volume and size (Boulton, 5/16).

California Healthline: Increasing Medical Residencies Could Help Inland Empire
As the Inland Empire grapples with a shortage of primary care physicians, experts say the solution hinges on creating more medical residencies. New state legislation could help. AB 1176 proposes to increase the number of primary care medical residencies in underserved regions, such as the Inland Empire. The new slots would be funded by levying a fee on insurers (McSherry, 5/16).

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Health Policy Research

Research Roundup: Surgical Residents Not Happy With New Schedules

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

JAMA Surgery: Surgical Residents' Perceptions of 2011 Accreditation Council For Graduate Medical Education Duty Hour Regulations – In 2011, the organization that oversees medical student training instituted a new regimen to replace the traditional 24-hour call schedule for medical residents, to improve patient safety and the residents' health. Under this new policy, residents in their first year of post-graduate training get increased supervision and are limited to 16-hour shifts.  Researchers interviewed more than 1,000 surgical residents and found nearly 66 percent of them disapproved. "Residents believe that the intended improvements in patient safety, resident quality of life, and education have not been borne out after implementation of the changes," the researchers write. "Furthermore, a concerning majority of surgical residents report noncompliance and falsification of duty hours. It may be difficult for residents, particularly in surgical fields, to learn and care for patients under the current ACGME regulations" (Drolet et al., 5/15).

JAMA Surgery: Effects Of Duty Hour Restrictions On Core Competencies, Education, Quality Of Life, And Burnout Among General Surgery Interns – Researchers aimed to measure the implications of the new work regulations by assessing the views and experiences of 213 surgical interns from 11 general surgery residency programs in July 2011 and  May 2012. They found that half of the participants believed the new regulations decreased the coordination of patient care and the time they spent in the operating room while 70 percent felt it reduced their ability to achieve continuity with patients. The majority did not believe that the regulations decreased their fatigue. "The high rate of burnout among US surgeons appear to begin during residency training, even under the … reduced work hours," they conclude (Antiel et al., 5/15).

American Journal Of Public Health: The Impact Of Cigarette Excise Tax Increases On Purchasing Behaviors Among New York City Smokers – While tax increases on cigarettes have been shown to be effective in preventing and reducing smoking, many people respond to the hikes by buying their cigarettes in other jurisdictions with lower taxes, over the Internet, on the street or from Native Americans selling untaxed products. Researchers found that "Following the 2008 tax increase [in New York City], 21% of smokers reported buying more cigarettes from another person on the street. ...Tax increases should be paired with enforcement strategies that limit the flow of untaxed, cheap cigarettes into jurisdictions with high cigarette pack prices," they conclude (Coady et al., 6/2013).

Academic Emergency Medicine: National Growth In Intensive Care Unit Admissions From Emergency Departments In The United States From 2002 To 2009 – Patient admissions to intensive care units (ICUs) have been increasing with an aging population, the authors write. The authors analyzed records from more than 4,000 patients admitted to the ICU from emergency departments from 2002 to 2009. "Over the study period, ICU admissions from EDs increased from 2.79 million in 2002/2003 to 4.14 million in 2008/2009," they write. The largest growth was among visits by patients 85 years or older. Nonwhite and Medicaid-covered patients were also major contributors to higher ICU admissions. They suggest that growth trends should be considered as decisions are made in regards to ICU capacity and add that "an increased emphasis" on the link between the emergency department and intensive care unit as well as "critical care training for emergency providers may be warranted, as many patients stay in EDs for prolonged periods of time" (Mullins, Goyal and Pines, 5/2013).

Kaiser Family Foundation/Health Management Associates: Profiles Of Medicaid Outreach And Enrollment Strategies: Helping Families Maintain Coverage In Michigan – Looking ahead to the 2014 implementation of the health law, the authors write: "This brief provides insight into lessons learned from Medicaid and CHIP outreach and enrollment strategies by profiling a successful initiative of the Michigan Primary Care Association to facilitate coverage renewals through a systematic, technology-based reminder system coupled with one-on-one assistance." The authors assert that a critical challenge will be to help people stay enrolled. "Losses in coverage at renewal interfere with individuals' access to and continuity of care and create unnecessary administrative costs associated with re-enrolling eligible individuals into coverage" (Edwards, Rodin and Artiga, 5/14).

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Editorials and Opinions

Viewpoints: Health Law's Effect On Patient Safety; Angelina Jolie's Surgery Is The Ultimate 'Choice'

The New York Times: Learning From Litigation
Much of the discussion over the Affordable Care Act has focused on whether it will bring down health care costs. Less attention has been paid to another goal of the act: improving patient safety. Each year tens of thousands of people die, and hundreds of thousands more are injured, as a result of medical error (Joanna C. Schwartz, 5/16). 

The New York Times: The Murky World Of Hospital Prices
Last week, the federal government made public a vast trove of information on the list prices charged by hospitals for a large array of procedures commonly performed on hospitalized patients. It was a good start toward providing greater transparency in hospital billing, which has long been shrouded in secrecy. But it fell short of providing full information that patients need to make informed decisions about which hospitals to use and which insurance to buy (5/16).

The Washington Post: Bill Gates: 'Death Is Something We Really Understand Extremely Well'
"I always use this chart of childhood death," Bill Gates says. "In 1960, 25 percent of kids died before the age of 5. And now we're down below 6 percent of kids dying before the age of 5." We're sitting in a bare conference room at his foundation’s D.C. headquarters. Gates is in town to talk to members of Congress about his top priority this year: Global health -- and, in particular, the total eradication of polio. He wants to drive that 6 percent even lower, and he believes he can. Wiping out a disease like polio sounds impossible. But it's actually, Gates tells me, completely achievable (Ezra Klein, 5/17). 

Reuters: A Woman's Choice
We use that word so often: choice. It has become the code word for abortion, alas, and thus a lightening rod for activists on both sides of that continuing battle. But this week Angelina Jolie redeemed the word and the idea behind it -- that a woman has a right to choose what happens to her body, however tough that choice sometimes is (Anne Taylor Fleming, 5/16).

Philadelphia Inquirer: Angelina Jolie's Lesson For Obamacare
Angelina Jolie's announcement that she underwent a double mastectomy to protect against a genetic form of breast cancer inspired widespread surprise and admiration. With her op-ed revelation in the New York Times, she put herself forward as a role model for millions of women who face a similar dilemma. Such candor and forthrightness are rare among celebrities. Yet, she is extremely fortunate in one respect. She has the financial resources to afford both the testing that found her heightened risk and the consequent surgery. As she noted in her op-ed, many women do not (Robert Field, 5/17).

Tampa Bay Times: Politics And My Double Mastectomy
During the same week that Angelina Jolie announced that she had a preventive double mastectomy as a precaution against her genetic predisposition toward breast cancer, House Republicans are likely to vote for the 37th time to repeal or replace Obamacare. These two events have more in common than you think. That's because, for everyone except the mega-wealthy like a Hollywood star, having Jolie-like health care options depends on good, affordable health insurance. And having access to that kind of coverage depends on reasonable and caring leaders in Washington -- something the Republican caucus is missing, as proved by the anticipated vote (Robyn E. Blumner, 5/16).

Fox News/Washington Examiner: ObamaCare Is About Power
Members of the House of Representatives are scheduled to vote Thursday to repeal all of ObamaCare. Given that the House voted to repeal the law last year, some commentators and observers have questioned the need for another repeal vote. However, the scandals coming to light over the last week perfectly make the case for why Congress must eradicate the law from the statute books (Jim DeMint, 5/16).

New England Journal Of Medicine: Expanding The Role Of Advanced Nurse Practitioners – Risks And Rewards
As the 2014 expansion of coverage mandated by the Affordable Care Act (ACA) looms larger, one question with no ready answer is how health care providers, policymakers, and payers will cope with an expected surge in patient demand for services. A shortage of primary care physicians to treat newly insured persons is the most immediate health workforce issue, but when added to the nation's population growth and more aging patients who require treatment, finding a practitioner may become an even more daunting challenge (John Iglehart, 5/16).

Tampa Bay Times: Hypocrisy In The House
Republican state lawmakers on Tuesday didn't want to talk about 1 million of the state's poor who don't have health insurance. Or about how Floridians and their health care system inevitably absorb the cost when the uninsured are in crisis. They tried to change the subject when asked at a Suncoast Tiger Bay meeting in St. Petersburg about news reports that juxtaposed Republican House members' generous taxpayer-covered health insurance with their votes to reject federal Medicaid expansion dollars to cover 1 million uninsured -- and pump $51 billion into the state economy. Floridians shouldn't so easily dismiss the hypocrisy (5/14).

Orlando Sentinel: Costly Expansion Wouldn't Improve Floridians' Health
The state Legislature's decision this year to reject Medicaid expansion was the correct decision for Florida. There is little evidence that growing the health care program for the poor would improve the health of state residents. A recent study in the New England Journal of Medicine is all the proof that Sunshine State legislators needed to reject Medicaid expansion. Those lamenting the failed implementation of this part of the federal Affordable Care Act in Florida can look to Oregon to see that Floridians won't be missing out on much (Bob Williams, 5/17).

Orlando Sentinel: Misrepresentations Blocked Care For A Million Floridians
Despite the support of Gov. Rick Scott and the Florida Senate, the 2013 legislative session ended with the Florida House unilaterally blocking the extension of health coverage to more than a million low-income, uninsured Floridians. Approving "Medicaid expansion" (or a comparable Senate-backed alternative) would have provided low-wage workers, parents and patients priced out of coverage with desperately needed access to care and protection from financial ruin. It would have infused $51 billion of our tax dollars into the economy, created 120,000 private-sector jobs, saved the state more than it would cost, and enabled service-sector employers to avoid hundreds of millions in penalties. In short, a "win-win-win." The only remaining impediment was purely political (Greg Willowe, 5/17). 

Cincinnati Enquirer: Kentucky Expands Medicaid, Why Not Ohio?
By virtue of Kentucky’s Medicaid laws, Gov. Steve Beshear was able to expand that state's program without going through the Kentucky General Assembly. Good for him and good for Kentucky. ... But in Ohio, the Republican-controlled General Assembly is taking a lifetime to ponder the issue (5/16).

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Stephanie Stapleton

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