Daily Health Policy Report

Thursday, May 29, 2014

Last updated: Thu, May 29

KHN Original Reporting & Guest Opinion

Administration News

Capitol Hill Watch

Public Health & Education

Health Reform

Health Care Marketplace


Women's Health

Weekend Reading

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Georgia Looks To Reopen Some Closed Rural Hospitals As E.R.s

Reporting for Kaiser Health News, in partnership with NPR, Susanna Capelouto reports: "Four of Georgia's 65 rural hospitals have shut down over the past two years. A dozen more have cut services in response to shrinking budgets.There just wasn't enough money to keep Charlton Memorial going, says Doug Gowen, who stayed and is in charge of what's left of the defunct hospital. ... The state of Georgia just threw him a lifeline, offering a new kind of license to allow struggling hospitals and those that have closed in the past year to become rural freestanding emergency departments. 'The intent here is to have some kind of health care infrastructure in a community, as opposed to nothing at all,' says Clyde Reese, who runs the Georgia Department of Community Health" (Capelouto, 5/29). Read the story

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Capsules: 'National Dialogue' Urged On Cost Of New Hepatitis C Drug

Now on Kaiser Health News’ blog, Julie Appleby reports on the latest regarding Sovaldi, a $1,000-a-pill treatment for Hepatitis C: “While the drug is a significant advance over older treatments for the viral liver disease, the price set by the company 'represents an abuse of market power, said John Rother, president and CEO of the National Coalition on Health Care, which includes businesses, unions, insurers, consumers and some drugmakers, including the Generic Pharmaceutical Association. On Wednesday, the group urged a 'national dialogue' on the cost, saying Sovaldi’s price tag threatens the budgets of government run-health programs as well as the premiums for everyone who has private insurance” (Appleby, 5/28). Check out what else is on the blog.

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Medicaid Contractor Centene Was Top Financial Performer In St. Louis

The St. Louis Post-Dispatch's Jim Doyle, working in partnership with Kaiser Health News, reports: New business opportunities to serve the poor, elderly and sick in an expanding number of states, as well as new ventures outside its core business, drove Centene Corp. last year to record financial heights. The Clayton, Mo.-based manager of health care for the uninsured and downtrodden broadened its operations last year in Texas, Mississippi, Louisiana and Florida and began serving Medicaid beneficiaries in California, Kansas and New Hampshire (Doyle, 5/29).

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Political Cartoon: 'Pick Up Line?' By Ron Morgan

Kaiser Health News provides a fresh take on health policy developments with "Pick Up Line?" By Ron Morgan.


Still seeking a cure
For health care cost inflation
- Anonymous

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

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Administration News

Wait Times Of 115 Days, Hidden Patient Lists Detailed In VA Report

The inspector general's preliminary findings reveal that 1,700 patients at the veterans center in Phoenix were not on the official waiting list and that the average wait for new patients who did get appointments was nearly four months.

The New York Times: Severe Report Finds V.A. Hid Waiting Lists
In the first confirmation that Department of Veterans Affairs administrators manipulated medical waiting lists at one and possibly more hospitals, the department’s inspector general reported on Wednesday that 1,700 patients at the veterans medical center in Phoenix were not placed on the official waiting list for doctors’ appointments and may never have received care. The scathing report by Richard J. Griffin, the acting inspector general, validates allegations raised by whistle-blowers and others that Veterans Affairs officials in Phoenix employed artifices to cloak long waiting times for veterans seeking medical care (Oppel and Shear, 5/28). 

Politico: Eric Shinseki: I’m Fixing The VA
Facing growing calls from Congress to step down, Veterans Affairs Secretary Eric Shinseki on Thursday defended himself and vowed to "set things straight." "We are doing all we can to accelerate access to care throughout our system and in communities where veterans reside," Shinseki wrote in an op-ed in USA Today. "I've challenged our leadership to ensure we are doing everything possible to schedule veterans for their appointments. We, at the Department of Veterans Affairs, are redoubling our efforts, with commitment and compassion, to restore integrity to our processes to earn veterans' trust" (Topaz, 5/29).

The Wall Street Journal: 'Serious Conditions' At Phoenix Veterans Affairs Office, Watchdog Says
A watchdog's report found systemic problems at Department of Veterans Affairs health-care facilities, including improper procedures for scheduling patient appointments and efforts to hide excessive wait times, increasing the pressure on embattled VA Secretary Eric Shinseki. ... The White House said Mr. Obama found the interim report "extremely troubling" and wants the Veterans Administration to take immediate steps to improve access to care, a spokesman said Wednesday (Kesling, 5/28). 

The Washington Post: 'Troubling' Report Sparks New Wave Of Calls For VA Chief's Resignation
The agency has made it a goal to schedule appointments for veterans seeking medical care within 30 days. But the interim IG report found that in the 226-case sample, the average wait for a veteran seeking a first appointment was 115 days, a period officials allegedly tried to hide by placing veterans on "secret lists" until an appointment could be found in the appropriate time frame (Lowery and Hicks, 5/28).

Los Angeles Times: Pressure Grows On VA Chief Eric Shinseki To Quit After Critical Report
Shinseki "has said that VA will fully and aggressively implement the recommendations" of the inspector general, Carney said. "The president agrees with that action and reaffirms that the VA needs to do more to improve veterans' access to care. Our nation's veterans have served our country with honor and courage, and they deserve to know they will have the care and support they deserve" (Simon and Carcamo, 5/28).

The Arizona Republic: VA Inspector General Verifies Wait-Time Manipulations
The Department of Veterans Affairs inspector general on Wednesday confirmed whistle-blower allegations that the Phoenix VA Health Care System violated patient scheduling policies to conceal delays in medical care. However, investigators said that it will take more analysis to determine whether any veteran deaths resulted directly from falsified records and prolonged waits (Wagner, 5/28).

Reuters:  U.S. Veterans Health Probe Confirms Cover-Up Of Care Delays
Calls for U.S. Veterans Affairs Secretary Eric Shinseki to resign grew louder on Wednesday as the agency's inspector general confirmed "systemic" and widespread VA scheduling abuses to cover up long wait times for veterans' healthcare. The Department of Veterans Affairs' internal watchdog is probing manipulation of appointment data at 42 VA medical centers, up from 26 last week, it said in an interim report on allegations of secret waiting lists (Lawder, Rampton and Edwards, 5/28).

NPR: Report Finds Systemic Problems With VA Wait Lists
In a new report released Wednesday, the inspector general for the Department of Veterans Affairs says that the department has frequently manipulated records to hide medical care delays. Investigators focused their probe on a hospital in Phoenix, Ariz (Lawrence, 5/28). 

NBC News: VA Report Confirms Allegations At Phoenix Hospital 
A report from the Veterans' Administration Office of Inspector General identified at least 1,700 veterans at the agency's beleaguered Phoenix clinic who were not properly registered on waiting lists, putting them "at risk of being forgotten or lost." The independent report, released Wednesday, confirmed recent allegations that VA locations have been relying on sketchy scheduling practices amid treatment delays, some of which have resulted in the deaths of vets (Chuck and O'Donnell, 4/28).

CBS News: Growing Calls For Eric Shinseki To Resign In Wake Of New VA Report 
An interim report released Wednesday by the Veterans Affairs Office of Inspector General concluded that patients experienced "significant delays" in treatment at a VA health care facility in Phoenix, Ariz., providing the administration's first official confirmation of problems that have been widely reported in recent weeks. "While our work is not complete, we have substantiated that significant delays in access to care negatively impacted the quality of care at this medical facility," the report explained (Miller, 5/28).

Fox News: Watchdog Finds 'Systemic' Problems At VA, Shinseki Faces Bipartisan Calls To Resign 
The official watchdog for the Department of Veterans Affairs claimed in a scathing report that the department has a "systemic" problem with clinics lying about patient wait times, as lawmakers on both sides of the aisle joined calls for Secretary Eric Shinseki to resign (5/29).

Meanwhile, one senator is not backing down from his criticism of some veterans groups.

Politico: Richard Burr: No Apology To Veterans' Groups
Sen. Richard Burr said on Wednesday that he isn’t backing down from his recent attack on veterans’ groups and even stepped up his assault, charging the organizations are more upset by his comments than they are by the scandal at the Department of Veterans’ Affairs. "I absolutely stand by my statement," the North Carolina Republican said in an email to POLITICO, referring to his controversial open letter blasting some of the organizations for not pressing for the ouster of Secretary Eric Shinseki in the wake of the VA scandal (Topaz, 5/28).

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Hospitals Worry Over Billing, Treatment As Vets Move To Private Facilities

The administration has announced that more veterans will be able to use private facilities since the VA system is overcrowded, but hospitals are concerned it could strain their systems.

Modern Healthcare:  Hospitals Brace For Billing, Treatment Challenges Serving Veterans
A new federal policy to refer more veterans for care outside the overwhelmed Veterans Affairs Health System could end up straining some non-VA hospitals with lags in reimbursement and patients who have needs that civilian providers aren't accustomed to treating. Over Memorial Day weekend, the White House and the VA announced that more veterans will be able to use private medical services in order to address long wait times reported in several areas throughout the U.S. In Phoenix, the department's inspector general concluded, in a report issued Wednesday, that 1,700 veterans in need of care were kept off the facility's official wait list and the average wait time was 115 days, although VA guidelines say veterans should get appointments within 14 days of the date they ask to be seen (Dickson, 5/28).

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Food Fight Shaping Up Over School Lunch Waivers

Agriculture Secretary Tom Vilsack says he could accept a Senate compromise on school lunch standards but that he strongly opposes a House Appropriations Committee plan that would grant waivers to school districts that say they can't afford to comply with the Healthy Hunger-Free Kids Act.

The Washington Post: School Cafeteria Food Fight Becomes An All-Out Food War
The nation’s school cafeteria food fight escalated Wednesday as lobbying groups, the Secretary of Agriculture and even a group of retired generals weighed in on whether the new federal school lunch program is working effectively -- or needs to be put on hold. The House Appropriations Committee is expected to vote Thursday on legislation that would grant waivers to school districts that report they are having financial problems as they comply with the dietary requirements of the Healthy Hunger-free Kids Act, which passed in 2010. First Lady Michelle Obama came out swinging against the waiver idea on Tuesday (Hamburger, 5/28).

The Hill: Vilsack Says Senate School Lunch Compromise Is Acceptable
Agriculture Secretary Tom Vilsack said Wednesday the Agriculture Department could accept compromise Senate language on school lunch standards, even as it vehemently opposes a House spending bill provision that would grant waivers to struggling schools. “We would obviously work with that,” Vilsack said of the Senate compromise, adding that he views it as “consistent” with the USDA efforts to help schools cope with new tougher standards. The Senate compromise emerged last week. It opens up the possibility of delaying or voiding sodium standards set for 2017, expands flexibility on whole wheat requirements and requires the USDA to report to Congress on efforts to help schools having trouble enticing students to eat the healthier meals (Wasson, 5/28).

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Obama Hosts Summit On Sports-Related Concussions

The president is overseeing a day-long White House meeting today with more than 200 medical researchers, athletes, coaches, league officials and others to raise awareness about this public health issue. Officials announced a commitment of $65 million in private funds to boost related clinical and scientific work.

The New York Times: Obama To Host Concussions Summit
President Obama on Thursday will seek to elevate a national conversation about the dangers of sports-related concussions, especially among children and other young athletes, by pushing for more medical research and more money spent on public awareness campaigns. The president will host a daylong summit at the White House that will include researchers, professional athletes, parents, coaches, league officials and sportscasters. Officials said the goal was to use the power of the presidency to accelerate progress on one of the most serious health issues to confront sports in a decade (Shear and Belson, 5/28).

The Wall Street Journal: White House To Focus On Sports Concussions At Summit
President Barack Obama on Thursday will host a sports summit as the White House looks to raise awareness of sports-related concussions among young athletes and start to fill in gaps in scientific research into brain injuries. Research has suggested a link between concussions and dementia, depression and other brain-related illnesses, sparking lawsuits and raising concerns for athletes. The National Football League last year reached a settlement with a group of 4,500 former players who sued it over concussion-related issues (Sparshott, 5/28).

The Washington Post: Obama To Host A White House Summit On Growing Concerns Over Sports Head Injuries
The threat of brain damage from America’s most popular sport has become a widespread cultural concern, with profound implications for professional sports, the health of athletes and worried parents across the country. Now Obama is taking the unusual step of joining the discussion, both as president and as an avid sports fan and sympathetic parent of two teenage daughters (Eilperin, 5/28).

Los Angeles Times: Private Donors Commit $65 Million To Studying Youth Concussions
Readying for a White House event Thursday focusing on youth sports and brain safety, officials announced a fresh commitment of $65 million in private funds to boost clinical and scientific work. In addition to $30 million from the NCAA and a new pledge of $25 million from the NFL for separate endeavors, a $10-million gift to UCLA from Hollywood executive and New York Giants co-owner Steve Tisch will help get a national tracking system for concussions off the ground (Healy, 5/28).

CBS News: Obama, Congress Aim to Tackle Sports-Related Concussions 
The White House on Thursday is bringing together more than 200 sports officials, parents, youth athletes and others to bring awareness to sports-related concussions, promote ways parents can keep their children safe, and shine a spotlight on the gaps in medical research on the matter. President Obama became interested in hosting the summit, the White House explained, after discussing the issue with his press secretary, Jay Carney (Condon, 5/29).

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Capitol Hill Watch

House Approves Funding For Justice To Investigate VA

In a vote shortly after midnight, the House approved funding for the Justice Department to look into allegations of mismanagement at VA facilities.

The Hill: House Votes To Fund DOJ Probe Of VA
The House late Wednesday night adopted a proposal to provide funding for a Justice Department investigation of the alleged mismanagement of Department of Veterans Affairs facilities. Rep. Mike Coffman's (R-Colo.) amendment to the 2015 appropriations bill for the Justice Department, Commerce Department and science programs was adopted on a voice vote after 12 minutes of debate at nearly midnight (Marcos, 5/29).

Politico: House Members Rip Into VA
House members lashed out at Veterans Affairs officials Wednesday evening over a broadening VA medical scandal that has increasingly prompted calls for VA Secretary Eric Shinseki to resign. Lawmakers on both sides of the aisle criticized the Department of Veterans Affairs, aggressively cutting off the VA officials sent to testify and promising stepped-up oversight. The House Veterans Affairs Committee hearing, which began without opening statements for the three VA officials, stretched past 10 p.m. with a second round of questioning for members (Herb, 5/28).

ABC News: VA Official Denies Destroyed Lists Were Secret 
A senior official at the center of the Department of Veterans Affairs wait list scandal told Congress that he does not believe the documents, which are all believed to have been destroyed, were secret. The House Veterans Affairs Committee held an uncommon primetime hearing Wednesday evening that extended late into the night to examine the VA’s lack of compliance with a May 8 congressional subpoena for documents that lawmakers hope could shine light on a hidden wait list that schedulers allegedly used to manipulate a backlog of veterans waiting for health care (Parkinson, 5/28).

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Conservatives Push For GOP Alternative To Health Law

Conservatives put pressure on House GOP leaders to adopt their own health care plan as an alternative to the health law. And Senate Minority Leader Mitch McConnell argues on the campaign trail that if Kentucky residents like their health exchange they can keep it -- even if Republicans repeal the law.

The Wall Street Journal: House Conservatives Push For GOP Health-Care Bill
After years of bashing the Affordable Care Act, conservative House Republicans are pushing for a vote on a GOP health-care plan to show they have a policy position beyond repealing the current law. Majority Leader Eric Cantor (R., Va.) said in January the House would vote this year on a health-care alternative. Four months later, Republican leaders are working with committee chairmen, as well as with GOP lawmakers who are also physicians, to reach a consensus on what that plan should include. Now, some lawmakers are asking to speed up the process (Peterson and Meckler, 5/28).

Politico: Steve Scalise To Push GOP Leaders On Obamacare Alternative
Rep. Steve Scalise is gearing up to put new pressure on Speaker John Boehner and other top Republican leaders to repeal Obamacare in favor of a conservative-backed health care package. Scalise (R-La.) will push for a House vote on an alternative health care plan crafted by the GOP Conference’s more hard-line members during a closed-door meeting of the Republican Study Committee on Thursday (French and Bresnahan, 5/29).

The Hill: GOP Health Care Confusion
If Kentuckians like their health care exchange, can they keep it — even if ObamaCare is repealed? Mitch McConnell’s (R-Ky.) campaign has been arguing just that this week after the Senate minority leader said last Friday that his push for the health care law’s repeal was “unconnected” to the existence of Kynect, the state’s own exchange. Health care experts have widely panned McConnell’s claims, with one calling him “delusional” (Jaffe and Viebeck, 5/29).

The New York Times: Democrats, To Counter G.O.P., Turn Their Focus To Local Issues For Midterms
If Republicans are trying to nationalize the 2014 midterms, tying Democrats to President Obama and his signature health care law, Democrats considered vulnerable are countering by going local, doubling down on state-specific issues that are more typically the province of Republicans. Facing a hostile national climate — with Mr. Obama’s approval rating stalled below 50 percent and that of Congress barely in double digits — Democrats say they believe their path to victory hinges on a series of individual contests rather than a referendum on the president and his policies (Parker, 5/28).

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Public Health & Education

California Shootings Revive Debate Over Involuntary Commitment

A bill in the House, which would make it easier for family members and authorities to force people to be treated, is giving some lawmakers pause, while NPR reports how counties in California have been slow to adopt a 2002 state law that gives authorities the ability to mandate outpatient mental health care for people who have been refusing it.

The Wall Street Journal: Isla Vista Rampage Reanimates Debate Over Mental-Health Bill
The bill from Rep. Tim Murphy (R., Pa.) is drawing attention in light of Friday's rampage near Santa Barbara, Calif., as the failure of gun-control proposals has left mental-health legislation as the most likely response from lawmakers to a string of mass shootings in recent years. Mr. Murphy, a psychologist by training, is working with the encouragement of the House Republican leadership, who have yet to schedule it for a floor vote. But his bill is giving some lawmakers pause because it revives a long-standing question about the rights of the mentally ill to determine their own treatment. Mr. Murphy would make it easier for family members or authorities to force people to be treated even if they haven't shown themselves to be a danger to themselves or others (Hughes, 5/28).

NPR: The Divide Over Involuntary Mental Health Treatment
The attack near the University of California, Santa Barbara, is renewing focus on mental health and intervention programs in general — and raising questions about whether enough is being done to prevent mass shootings and other violence. In California, a 2002 law allows authorities to mandate outpatient mental health care for people who have been refusing it. Proponents argue this kind of intervention could prevent violent acts. But counties within the state have been slow to adopt the legislation, and mental health professionals are divided over its effects (Siegler, 5/29).

The Associated Press: California Rampage Shows Gaps In Mental Health Law
Elliot Rodger's murderous rampage near Santa Barbara has tragically exposed the limitations of involuntary-commitment laws that allow authorities to temporarily confine people who are deemed a danger to themselves or others. ... Like many other states, California has a law intended to identify and confine dangerously unstable people before they can do harm. It allows authorities to hold people in a mental hospital for up to 72 hours for observation. To trigger it, there must be evidence a person is suicidal, intent on hurting others or so "gravely disabled" as to be unable to care for himself (Blood and Abdollah, 5/28).

Los Angeles Times: Senate Democrats Propose More Spending On Mentally Ill Criminals
State Senate Democrats on Wednesday offered a $165-million package of proposals aimed at reducing the number of mentally ill people locked up in prisons and jails in California. The proposals, offered just days after a disturbed student killed six people in Isla Vista, Calif., also would provide $12 million in additional funds to train law enforcement officers to recognize and handle people who may be a threat to themselves and others (McGreevy, 5/28).

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Health Reform

Study Challenges Need For Employer Mandate

The report by the Urban Institute offers rationales for dropping the mandate that requires large employers to provide health insurance for full-time workers. Meanwhile, another analysis finds that while federal grants to states for health care are up, they are down for other categories.

NPR: Study Questions Need For Employer Health Care Requirement
When the Affordable Care Act was unveiled, business groups railed against the provision that requires companies with 50 or more employees to provide health insurance for their full-time workers. The Obama administration responded by pushing back the deadline for the coverage, so it hasn't yet taken effect. Now support for this so-called employer mandate is eroding in some surprising quarters. A study called "Why Not Just Eliminate the Employer Mandate?" has been published by the Urban Institute, a center-left think tank based in Washington, D.C. It lists a number of reasons why dropping the mandate might be a good idea (Ydstie, 5/28).

The Washington Post: Federal Grants To States Up For Health Care, Down For Everything Else
The federal government has paid out about 20 percent more to states since the start of the recession, an increase that's almost entirely driven by exploding health-care costs. Federal spending on health care spiked 34 percent between 2008 and 2014, though it dropped in nearly every other category, according to an analysis by the Pew Charitable Trusts (Ferris, 5/28).

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Oregon Races To Join Federal Exchange

Oregon invites 10 firms to bid for the job of transferring Cover Oregon to the federal marketplace, and lawmakers urge marketplace officials to have backup plans in case the work is not done in time for the next open enrollment period.

The Oregonian: State Invites 10 Firms To Shift Cover Oregon To the Federal Health Insurance Exchange 
Oregon has invited 10 firms to bid for the approximately $35-million job of transferring Cover Oregon to the federal health insurance exchange, and given them two weeks to reply. The "special procurement" issued by the Oregon Health Authority underlines the fact that time is short (Budnick, 5/28).

The Oregonian: Cover Oregon: Officials Talk Long Road Ahead For Health Insurance Exchange Transition 
Transitioning Cover Oregon to a federal health insurance exchange will require significant work in three areas: technology, efficiency and finance, administrators told legislators Wednesday. Interim Director Clyde Hamstreet and transition project director Tina Edlund laid out the long road ahead during legislative work sessions before two interim health care committees (Driessen, 5/28).

The Associated Press:  Lawmakers Question Cover Oregon On Backup Plans
Oregon lawmakers on Wednesday urged state officials to look into backup plans in case Cover Oregon isn't ready to use the federal government's online health insurance enrollment system before the November deadline. Officials told House and Senate health care committees Wednesday that consultants are preparing an in-depth analysis of the work that needs to be done to get the website ready by the time the enrollment period begins Nov. 15 (Cooper, 5/28). 

Meanwhile, in Washington state -

The Seattle Times:  It’s Not Too Late For Residents To Get Health Insurance
After all the hubbub over the end of open enrollment for individual health insurance, state officials have a message for the uninsured: For many of you, it’s not too late. That’s because there are  special circumstances that allow people — particularly younger people — to get insured throughout the year. The exemptions are mainly triggered by changes in someone’s family or work situation (Stiffler, 5/28).

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Health Care Marketplace

New Clinics Vie To Treat Men

The New York Times examines a new marketing effort by hospitals to attract men. In the meantime, data sharing among medical professionals remains elusive.

The New York Times: With Special Clinics, Hospitals Vie For Hesitant Patients: Men
NYU Langone and other medical institutions have long had services devoted to women, an outgrowth of the belief that the male-dominated medical establishment had not paid enough attention to their particular needs. Now men are beginning to get equal treatment as hospitals try to take advantage of an enormous untapped market: men who, studies show, avoid doctors for virtually anything short of a bullet wound. The new clinics offer one-stop shopping for services ranging from heart monitoring to hair removal to hormone therapy, from the life-prolonging to the life-enhancing, if medically debatable (Hartocollis, 5/28).

Marketplace: Data: The Secret Ingredient In Hospital Cooperation 
If you’ve got to go to the hospital -- one that’s near your home or very far from it -- you’d want your prescriptions, past procedures, and all the rest at your doctor’s finger tips. And while sharing that kind of data could reassure consumers and save perhaps as much as $80 billion a year, it remains a fantasy for most patients (Gorenstein, 5/28).

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Tavenner, Other CMS Officials Defend Medicare Payment Data Release

Elsewhere, the Health and Human Services inspector general says Medicare overpaid $6.7 billion for office visits in 2010.

Modern Healthcare: CMS Officials Defend Releasing Physician Payment Data 
Administrator Marilyn Tavenner, along with two other top officials within the CMS, are publicly defending last month's release of Medicare physician payment data, saying the move is part of a broader strategy of government transparency that will include more health data dumps in the future. Tavenner, Chief Medical Officer Dr. Patrick Conway and Niall Brennan, acting director of CMS' Offices of Enterprise Management, co-authored an article in the New England Journal of Medicine made public Wednesday. It appears to be the agency's first public response to critics since its April 9 publishing of data on Medicare Part B payments of $77 billion to 880,000 providers (Herman, 5/28).

ProPublica: Medicare Overpays Billions For Office Visits, Patent Evaluations 
Medicare spent $6.7 billion too much for office visits and other patient evaluations in 2010, according to a new report from the inspector general of the U.S. Department of Health and Human Services. But in its reply to the findings, the Centers for Medicare and Medicaid Services, which runs Medicare, said it doesn't plan to review the billings of doctors who almost always charge for the most-expensive visits because it isn't cost effective to do so (Ornstein, 5/29).

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Women's Health

Abortion Restrictions Spread Through South

New state laws and regulations are forcing women in the South to travel hundreds of miles to find a clinic where they can get an abortion. Meanwhile, anti-abortion activists lobby Congress to defund Planned Parenthood and distribute undercover videos accusing the group of failing to report sex trafficking.

The Associated Press: Abortion Doctors Restrictions Take Root In South
From Texas to Alabama, laws are being enacted that would greatly restrict access to abortion, forcing many women to travel hundreds of miles to find a clinic. The laws, requiring abortion doctors to have privileges to admit patients to local hospitals, could have a profound impact on women in poor and rural sections of the Bible Belt (Pettus, 5/28).

The Hill: Activists Renew Fight Over Taxpayer Funding For Planned Parenthood
Abortion-rights opponents are targeting Planned Parenthood with a new report that accuses the organization of a variety of offenses, including a failure to report sex trafficking. Live Action, a group that uses undercover videos to promote its agenda, distributed the report to each member of Congress in an effort to reignite the debate over taxpayer funding for Planned Parenthood (Viebeck, 5/28).

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Weekend Reading

Longer Looks: 'Abandoning' Patients; Commiting People With Mental Illness

Health Affairs: 'I Don’t Want Jenny To Think I’m Abandoning Her': Views On Overtreatment
For years I had tried and failed to understand why so many of my physician colleagues persisted in ordering tests, procedures, and treatments that seemed to provide no benefit to patients and even risked harming them. I didn’t buy the popular and cynical explanation: Physicians do this for the money. It fails to acknowledge the care and commitment that these same physicians demonstrate toward their patients. Besides, Jenny’s oncologist would make no money from the intrathecal chemotherapy procedure. Instead, the impulse motivating him to order more tests and interventions was as an expression of his continued commitment to helping her. ... His words transformed my understanding of what I’ve viewed as inexplicable behavior in the face of progressive and terminal illness (Dr. Diane E. Meier, May 2014).

The Health Care Blog: Will Tech Revolutionize Health Care This Time?
After decades of bravely keeping them at bay, health care is beginning to be overwhelmed by "fast, cheap, and out of control" new technologies, from BYOD ("bring your own device") tablets in the operating room, to apps and dongles that turn your smart phone into a Star Trek Tricorder, to 3-D printed skulls. ... Each new category, we are told, will Revolutionize Health Care .... Yet the experience of the last three decades is that each new technology only adds complexity and expense. ... In an insurance-supported fee-for-service system, we don't get paid to solve problems. We get paid to do stuff that might solve a problem. The more stuff we do, and the more complex the stuff we do, the more impressive the machines we use, the more we get paid (Joe Flower, 5/28). 

The Atlantic: Confusing Mental-Health Intervention And Violence Prevention
So why didn't law enforcement detain Elliot Roger, or any of the other recent mass shooters who had some contact or had some concern raised about their wellbeing before they went on to kill? ... The question of using the civil mental health system to involuntarily detain someone who hasn't committed a crime, but who we fear may commit one at some point in the future is fundamentally one of human rights. The civil mental health system is set up the way it is now, with strict rules guiding how it can be used to treat someone without their consent and tight checks and balances against abuse including repeated hearings in front of a judge every few days to prevent someone from being unnecessarily detained, to protect citizens from others using the system against them for abusive reasons (Jeff Deeney, 5/26).

The New York Times: A Revolutionary Approach To Treating PTSD
Psychomotor therapy is neither widely practiced nor supported by clinical studies. In fact, most licensed psychiatrists probably wouldn’t give it a second glance. It's hokey-sounding. It was developed by a dancer. But [Dr. Bessell] van der Kolk believes strongly that dancers — and musicians and actors — may have something to teach psychiatrists about healing from trauma and that even the hokey-sounding is worthy of our attention. He has spent four decades studying and trying to treat the effects of the worst atrocities we inflict on one another: war, rape, incest, torture and physical and mental abuse. ... If there's one thing he’s certain about, it's that standard treatments are not working. Patients are still suffering, and so are their families. We need to do better (Jeneen Interlandi, 5/22).

The New Republic: The Media Forgets That AIDS Is Still An Epidemic, But Hollywood Doesn't
Given the paucity of coverage in the media lately, audiences can be forgiven for not thinking much about the disease. After all, AIDS is hardly the scourge it once was, and the proliferation of advanced antiretroviral medication means most people with HIV who get treatment will live long with few complications. ... Perhaps AIDS gets less coverage today because the face of the disease has changed. Today, Hispanic and African American populations are disproportionately affected, and new HIV infections appear to be rising in areas like the Deep South, where there's less access to adequate healthcare and the stigma of HIV remains high (Eric Sasson, 5/26).

Medscape: Doctors Are Talking: EHRs Destroy the Patient Encounter
There's no doubt that electronic health records (EHRs) spark strong emotions in doctors -- and many of those emotions are negative. The gripes cover three main areas: One, EHRs have made the patient encounter far more annoying and complex than it ever was before. Two, many physicians feel that EHRs take doctors who were trained to be independent thinkers and constrain their ability to make independent decisions, causing them to feel like data entry clerks, with a computer telling them how to practice medicine. Last but not least, a large number of physicians feel that EHRs erode the doctor-patient relationship by creating a barrier between the two (Neil Chesanow, 5/22).


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State Watch

State Highlights: Fla. Plans Alleged To Have Kept Out AIDS Patients; Ill. Restores Some Medicaid Services

Miami Herald:  Health Insurers Used High Drug Co-Pays To Discourage HIV/AIDS Patients From Enrolling
Four Florida insurance companies offering Affordable Care Act policies are discriminating against people with HIV or AIDS, according to two health-rights organizations that plan to file a formal complaint with the federal government Thursday. The complaint by the AIDS Institute and the National Health Law Program -- nonprofits advocating for the health rights of the poor and those living with chronic diseases -- cites CoventryOne, Cigna, Humana and Preferred Medical for creating prescription-drug policies that the groups say discourage people with HIV/AIDS from enrolling in their Florida healthcare marketplace plans (Borns, 5/29).  

The Associated Press:  Illinois House Restores Some Medicaid Services 
The Illinois House has voted to expand Medicaid despite Republican concerns about how to pay for it. Lawmakers voted 75-37 on Wednesday to restore funding for adult dental and podiatry services. Those services were cut in 2012 as a cost-saving measure. But Democratic Rep. Greg Harris says the cuts didn't save the state money because people wound up in the emergency room, where care is more expensive (5/28).  

Miami Herald:  Gov. Rick Scott To Sue Feds For Stonewalling State Health Inspectors From VA Hospitals 
Florida will sue the U.S. Department of Veterans Affairs because the agency is “stonewalling” state healthcare inspectors who have been denied access to veterans’ hospitals, Gov. Rick Scott said Wednesday. The announcement sets up a legal fight between Florida officials who say they need access to VA facilities and records to protect veterans and VA leaders who insist no state has oversight of federal hospitals (5/28).

The New York Times: Cool And Calm At Center Of An E.R. Maelstrom In The Bronx
Dr. Jara has become an expert at juggling patients while running what may be the single busiest emergency room in New York City. As chairman of the emergency medicine department at Lincoln Medical and Mental Health Center, he and his staff handled a staggering 173,000 visits in 2013, from patients who showed up with everything including gunshot wounds and chronic conditions like asthma, diabetes and hypertension. Many of them had no health insurance, no access to regular checkups and nowhere else to turn (Hu, 5/28).

Kaiser Health News: Georgia Looks To Reopen Some Closed Rural Hospitals As E.R.s
Four of Georgia's 65 rural hospitals have shut down over the past two years. A dozen more have cut services in response to shrinking budgets. There just wasn't enough money to keep Charlton Memorial going, says Doug Gowen, who stayed and is in charge of what's left of the defunct hospital. ... The state of Georgia just threw him a lifeline, offering a new kind of license to allow struggling hospitals and those that have closed in the past year to become rural freestanding emergency departments (Capelouto, 5/29).

Reuters:  Deadly 2012 Outbreak at 'Medical Spa' Linked To Workers 
Outbreaks of group A Streptococcus infections at weight loss clinics in Maryland and Delaware in 2012 were probably caused by poor infection control practices on the part of the staff, according to a new study. All of the patients had undergone liposuction, in which doctors suction excess fat out of the body using special surgical equipment. The outpatient treatment centers where they had the surgery were part of a chain of so-called medical spas, with licensed doctors or nurses, but not subject to state regulation (Doyle, 5/28).

MinnPost:  One Woman’s Effort To Understand The Problem Of Nursing And Addiction 
Marie Manthey is celebrating 78 years of life, 37 years of recovery, and 50 years as a nursing administrator and care-delivery consultant. Her work is never done, not even now in semi-retirement, and she’s more than OK with that. No. 1 on her to-do list these days is helping to found a nonprofit peer-support group for nurses who are struggling with substance use disorders. ... Though nurses are not statistically more likely than the general population to become addicted (about 1 in 10 for both), they have unusually high-risk and high-stress environments, easy access to painkillers, and “privileged access” to vulnerable people (Williams, 5/28).

The Associated Press:  Nebraska Hospital May Lose Medicare Funding After Patient Died
The Winnebago Indian Health Services Hospital in northeast Nebraska has been put on notice that it is set to lose Medicare funding within the next week, after an investigation found problems with the care of a patient who died there in April. A public notice from the U.S. Centers for Medicare & Medicaid Services says the hospital's Medicare agreement will be terminated June 4, the Sioux City Journal reported Wednesday. That means the hospital would no longer be reimbursed for treating patients enrolled in the health care program for the elderly and disabled (5/28).  

The Denver Post:  Denver Wins Grant From Drink-Makers To Combat Childhood Obesity 
A Denver pilot program focused on reducing childhood obesity will tap a $150,000 grant from a trade group representing the makers of sugary drinks. The program will enlist five to 10 child care centers in west Denver neighborhoods where children have among the highest obesity rates in the city, says the Denver Department of Environmental Health. The centers will get training and materials on ways to integrate healthy eating and active living into their programs from the University of Colorado School of Public Health (Murray, 5/28).  

WBUR: Report: Mass. Child Welfare Agency Underfunded, Understaffed 
The final report on the internal failings of the embattled Massachusetts Department of Children and Families concludes that the agency should not be held responsible for last year’s death of 5-year-old Jeremiah Oliver. Released on Wednesday, the report -- written by the Child Welfare League of America at Gov. Deval Patrick’s request -- also identifies continuing problems with the agency, including under-staffing and outdated policies and protocols (Pfeiffer, 5/28).  

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Editorials and Opinions

Viewpoints: Michelle Obama And School Lunches; More About The VA Health System 'Scandal'

The New York Times: The Campaign For Junk Food 
When we began our Let’s Move! initiative four years ago, we set one simple but ambitious goal: to end the epidemic of childhood obesity in a generation so that kids born today will grow up healthy. To achieve this goal, we have adhered to one clear standard: what works. The initiatives we undertake are evidence-based, and we rely on the most current science. Research indicated that kids needed less sugar, salt and fat in their diets, so we revamped school lunch menus accordingly (Michelle Obama, 5/28).

Bloomberg: Congress Flunks Lunch
New federal standards for school lunches, phased in over the last two years, set a calorie cap for meals, encourage kids to eat whole grains and require them to put a fruit or vegetable on their plate. (No, they don't have to eat it.) This is too much for some House Republicans, who have taken up the cause of finicky eaters with a zeal once reserved for Soviet dissidents or Mitt Romney. ... To be clear, no one is forcing anyone to eat anything. Unlike some other congressional debates, this is not about the use of force. The issue is how best to fight obesity, which has more than doubled in children and quadrupled in adolescents in the U.S. in the last 30 years. Better school lunches won't reduce obesity all by themselves. But the obesity problem cannot be addressed without changing how children eat in school, where they consume half their calories. In the age-old battle between grown-ups and kids about eating better, schools and parents need to work together (5/29).

Los Angeles Times: Do People Really Overuse Healthcare When It Is Free?
Call it the "skin-in-the-game" argument: the notion that people will use medical care more sparingly -- and presumably more prudently -- if they have to pay a larger share of the costs out of their own pockets (Michael Hiltzik, 5/28).

The Washington Post: Ben Carson, Doctor Of Division
In the 16 months since his speech to the National Prayer Breakfast made him an instant conservative celebrity, he has drawn a parallel between same-sex marriage, and pedophilia and bestiality; he has declared the United States "very much like Nazi Germany"; he has likened Obamacare to slavery; and he has called the veterans’ health-care scandal, in which some died while on waiting lists for medical appointments, "a gift from God" because it shows the ills of government health care. Along the way, Carson has exhibited the demagogue’s belief that those who don’t agree with him aren’t just wrong: They are un-American and dangerous (Dana Milbank, 5/28).

Bloomberg: Republican Candidates Blur the Lines On Obamacare
The Affordable Care Act is creating as many problems as opportunities for Republican Senate candidates in the November midterm elections, an indication of the futility of the party's effort to significantly change, much less repeal, the law. A number of Republican candidates, while they still assail Obamacare, are modifying their positions; others are stumbling over the issue. The most prominent misstep was by Senate Minority Leader Mitch McConnell (Albert R. Hunt, 5/29).

Bloomberg: Obamacare's Muffled Midterm Effect
Most people, in most elections, don’t vote directly on policy issues. So the fact that “Obamacare” in general is unpopular doesn’t necessarily mean anything. Most people vote based on party. And in House and Senate elections, they may base their votes on what they know about the candidates, especially if there’s a big gap between them.1 That suggests Obamacare could hurt some Democrats on the margins, if a candidate's support of something people don’t like is one of the main things they know about that candidate. It also suggests the ACA could hurt some Republicans on the margins, if a candidate's support for repeal of a popular item is something people know about the candidate (Jonathan Bernstein, 5/28).

The New York Times' Taking Note: How Big A V.A. Scandal?
The inspector general of the Department of Veterans Affairs has confirmed allegations that the agency’s medical center in Phoenix kept veterans waiting unconscionably long times to see a doctor and hid the fact by creating fictitious wait lists. However, the report issued today did not address the most explosive charges — that veterans have died because of delays in getting treatment and that hidden delays are endemic throughout the Veterans health care system (Phillip M. Boffey, 5/28).

USA Today: VA Secretary: I'm Committed To Restoring Integrity
The findings of the interim report of VA's Office of Inspector General on the Phoenix VA Health Care System are reprehensible to me and to this department, and we are not waiting to set things straight. I immediately directed the Veterans Health Administration (VHA) to contact each of the 1,700 veterans in Phoenix waiting for primary care appointments in order to bring them the care they need and deserve (Eric K. Shinseki, 5/28).

USA Today: VA Scandal Defies Quick Cures: Our View
With a scandal exploding around them, President Obama and Veterans Affairs Secretary Eric Shinseki have insisted on getting to the bottom of what happened before starting the cleanup. Well, the first results arrived Wednesday, and they confirmed the need for a whole lot of mops (5/28).

The Denver Post: VA Secretary Shinseki Isn't Up To The Task 
An inspector general's finding of a "systemic" practice of delaying care and manipulating records at Veterans Affairs facilities is a dismaying development in a growing scandal. Though others surely bear blame, it has become clear that VA Secretary Eric Shinseki must go. He has been at the helm of this sprawling bureacracy for five years — enough time to tackle the long-known problem of treatment backlogs (5/28).

The New England Journal Of Medicine: The Medicare Physician-Data Release — Context And Rationale 
On April 9, the Centers for Medicare and Medicaid Services (CMS) released detailed information on utilization by more than 880,000 physicians and other health care providers who care for Medicare beneficiaries. This data release was unprecedented in its size and scope: it included nearly 10 million records ... Although this data release has, in general, been viewed positively, we are aware of the concerns of certain stakeholders, particularly physicians, regarding the accuracy or meaning of the data. ... CMS is committed to producing and releasing high-quality data ... We believe that transparency will drive health system improvement. (Niall Brennan, Patrick H. Conway and Marilyn Tavenner, 5/28).

The New England Journal Of Medicine: Caution Advised: Medicare's Physician-Payment Data Release
On April 9, 2014, Health and Human Services Secretary Kathleen Sebelius announced the release of privacy-protected data concerning services provided to beneficiaries enrolled in the fee-for-service Medicare program in 2012 ... Processes for the use of these data for research and policymaking would clearly be strengthened by efforts to ensure their validity and to account for patients' disease complexity and risk level. Insights gleaned from linking these data to quality measures and health outcomes would inform conversations regarding the value proposition to which we all aspire. One critical next step will be the proactive engagement of informed patients in discussions about their care, including its cost when appropriate (Patrick T. O'Gara, 5/28).

JAMA Forum: On Its Merits, ACA Should Be As Popular As Medicare Rx Drug Program 
In the past decade, 2 new, large federal health insurance programs have been implemented: Medicare’s prescription drug program (Part D) and the Affordable Care Act’s (ACA’s) coverage expansion. These programs have some similarities, but have received very different public and political treatment. Although both were controversial at time of passage, only the ACA remains as controversial, if not more so, than it was on the day it was signed into law. Is this disparate treatment warranted by the evidence on the merits of the 2 programs? (Austin Frakt, 5/28).

USA Today: Right To Try Experimental Drugs: Column
This year, more than 5,000 Americans will lose their battle with ALS, commonly known as Lou Gehrig's disease. What begins as a muscle twitch will give way to joint deformation and paralysis. No medicine on the market meaningfully improves the quality of life, or extends the lives, of ALS patients. But there is a promising new treatment in a Food and Drug Administration clinical trial (Darcy Olsen and Richard Garr, 5/28).

Los Angeles Times: You Say Gun Control Doesn't Work. Fine. Let's Ban Them All Together.
In a post Tuesday, I listed the mass shootings since January 2013 in which at least three people were killed. It’s an agonizingly, depressingly long list, and I cited it as the prime reason we need meaningful gun control. The post received the usual blowback from gun owners, most of whom skipped over the scope of gun deaths in this country to look more myopically at last week’s tragic events at Isla Vista. ... But we do know that guns are often used by angry men to kill their wives and kids; the mentally ill to act out whatever pain they are suffering; violent criminals; the suicidal (who may kill themselves anyway by other means, but ready access to a gun makes it easier); or children who find guns kept by “properly trained” owners and accidentally shoot themselves or others. In fact, two-thirds of homicides in the U.S. involve guns, according to the CDC. And yes, we need to have stronger, better programs and laws to help the mentally ill, but in the end, it’s their access to weapons that have caused so much mayhem at such a big scale. Mental illness is a factor in some of the violence, but guns are part of most of the killings (Scott Martelle, 5/28).

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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.