Daily Health Policy Report

Thursday, May 3, 2012

Last updated: Thu, May 3

KHN Original Reporting & Guest Opinion

Health Care Fraud & Abuse

Health Reform

Campaign 2012

Capitol Hill Watch

Health Care Marketplace

Public Health & Education

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Analysis: ACOs Could Have The Medicare Muscle To Transform Health System

In this Kaiser Health News analysis, Michael L. Millenson writes: "A radical change just getting underway in the U.S. health system could transform how medical treatment has been paid for since Hippocrates made his first house call. But the new payment method faces conflicting dangers: either it won't be strong enough to upend entrenched incentives or it will be so successful it will prove too politically disruptive to survive" (Millenson, 5/2). Read the story.

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Capsules: 200 Years Of Surgery In Eight Pages (With Drawings!); Report: U.S. Has High Rate Of Babies Born Early; Costly Heart Procedures Thrive In Some Places

Now on Kaiser Health News' blog, Jordan Rau reports on how Atul Gawande notes a landmark for the New England Journal of Medicine: "For the 200th anniversary of the New England Journal of Medicine, Atul Gawande — surgeon, journalist, author, researcher, public speaker, father of three — takes a fun spin through two centuries of surgery by going back to the first volume of the publication, then known by the slightly less succinct name of the New England Journal of Medicine and Surgery, and the Collateral Branches of Science" (Rau, 5/2).

Also on the blog, Julie Appleby reports on new findings about the U.S.'s high rate of pre-term births: "About 12 percent of U.S. babies are born at 37 weeks or less, according to the report, which found a worldwide range of as few as 4.1 percent of babies in Belarus to as many as 18 percent in Malawi. Full term is considered 39 weeks" (Appleby, 5/2).

In addition, Jordan Rau also explores why doctors continue to choose to do a costly heart procedure: "Why do some doctors keep doing expensive medical procedures after it becomes apparent there are cheaper and equally safe ways to treat patients? A new study of cardiac procedures in Michigan takes a crack at this question, and while it comes up short on definitive answers, it has some interesting findings" (Rau, 5/2). Check out what else is on the blog.

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Political Cartoon: 'Contagious?'

Kaiser Health News provides a fresh take on health policy developments with "Contagious?" by Steve Greenberg.

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


Reorganize it .
Aging services need more.
Respect our elders.
-Janice Lynch Schuster

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

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Health Care Fraud & Abuse

107 Charged In Medicare Fraud Busts, Scams Totaled $452M

Federal authorities rounded up doctors, nurses and even social workers in what they called "a national takedown" of medical professionals who allegedly bilked Medicare out of nearly half a billion dollars. 

Reuters: U.S. Charges More Than 100 For Medicare Fraud Schemes
U.S. authorities have charged 107 people, including doctors and nurses, for trying to defraud the federal Medicare healthcare program for the elderly and disabled of about $452 million, the biggest Medicare fraud sweep to date, the Obama administration said on Wednesday. At least 91 people were arrested in Miami; Houston; Baton Rouge, Louisiana, and four other cities on a variety of charges: from submitting false billing for home healthcare, mental health services, HIV infusions and physical therapy to money laundering and receiving kickbacks (Pelofsky, 5/2).

Los Angeles Times: 107 Charged In Medicare Fraud Crackdown
Doctors, nurses and social workers from across the country, 107 in all, were charged in what federal officials in Washington called a "nationwide takedown" of medical professionals accused of fraudulently billing Medicare out of nearly half a billion dollars (Serrano, 5/2).

The Associated Press/Washington Post: More Than 100 Charged In Massive Medicare Fraud Busts In 7 Cities In Scams Totaling $452 Mil
It was the latest in a string of major arrests in the past two years as authorities have targeted fraud that's believed to cost the government between $60 billion and $90 billion each year. Stopping Medicare's budget from hemorrhaging that money will be key to paying for President Barack Obama's health care overhaul (5/2).

The Wall Street Journal: U.S. Charges 107 With Defrauding Medicare
Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius said that charges were being brought against defendants in seven cities, including doctors and nurses, for seeking to defraud the federal health program for the elderly and disabled. At least 83 of the defendants were arrested Wednesday morning, officials said (Radnofsky, 5/2).

CBS News: Feds Charge 107 People In $452 Million Medicare Fraud Crackdown
In the biggest crackdown of Medicare fraud in history, Attorney General Eric Holder announced Wednesday that the Medicare Fraud Strike Force had uncovered $452 million dollars worth of false billings in seven cities across the nation. More than 100 people have been arrested in relation to the fraud, including doctors, nurses and social workers (Dore, 5/2).

Politico Pro: Holder Details Medicare Fraud 'Takedown'
Federal authorities have arrested more than 100 health care providers suspected of Medicare fraud, money laundering and accepting kickbacks, Attorney General Eric Holder announced Wednesday, calling the sweep the largest single "takedown" in the history of his agency's Medicare Fraud Strike Force. The 107 individuals in seven cities, including doctors, nurses and other health care providers, fraudulently billed about $452 million in Medicare claims, Holder told reporters at a press conference at DOJ headquarters (Cheney, 5/2).

The Hill: Obama Officials Tout Record 'Takedown' By Medicare Fraud Force
The announcement could help strengthen the administration's credibility on anti-fraud efforts in government programs, traditionally a high priority for Republicans. HHS Secretary Kathleen Sebelius emphasized that the 2010 healthcare law empowered the fraud "strike force" to stop payments to 52 fraud suspects as investigations proceed (Viebeck, 5/2).

In related news -

Modern Healthcare: Senators Ask Providers To Weigh In On Fraud Prevention
A bipartisan group of six lawmakers from the Senate Finance Committee issued an open letter to healthcare providers, payers and patients seeking input on better ways to prevent waste and fraud in healthcare, including ideas on improving the current audit system for alleged overpayments. The letter highlights estimates that between $20 billion and $100 billion a year are lost to fraud and misspending in Medicare, Medicaid and other federal healthcare programs (Carlson, 5/2).

The Hill: Senators Solicit Ideas From Health Care Industry On Fighting Fraud
The bipartisan group, led by Senate Finance Committee Chairman Max Baucus (D-Mont.) and ranking member Orrin Hatch (R-Utah), published an open letter to the healthcare community asking for "suggestions and solutions" to address waste, fraud and abuse in the systems (Viebeck, 5/2).

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Health Reform

High Court Ruling Could Have 'Unintended Consequences' For Medicare Payments

The Associated Press reports that a high court decision to strike down the health law could be disruptive to Medicare's payment systems.

The Associated Press: Medicare Disruptions Seen If Health Law Is Struck
Tossing out President Barack Obama's health care law would have major unintended consequences for Medicare's payment systems, unseen but vital plumbing that handles 100 million monthly claims from hospitals and other service providers, the administration has quietly informed the courts. Although the law made significant cuts to providers and improved prescription and preventive benefits for seniors, Medicare has been overlooked in a Supreme Court debate focused on the law's controversial requirement that individuals carry health insurance. Yet havoc in Medicare could have repercussions in an election year when both parties are avidly courting seniors (Alonso-Zaldivar, 5/3).

In other health law news -

Politico Pro: Advocates Worry Over Risk Adjustment
Consumer advocates say HHS's new risk adjustment guidance may further weaken health reform rules designed to prevent insurers from discriminating against sicker people. The guidance released Tuesday covered technical details of the risk adjustment program to shore up the finances of health plans covering high-cost people after the Affordable Care Act takes full effect in 2014.  ... Many consumer advocates were already disappointed that final rules issued by HHS in March left a critical step in the hands of the insurance industry. They feared this would make it easier for the health plans to game the system if they could calculate the risks scores for their covered population in states where HHS oversees risk adjustment (Feder, 5/2).

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Campaign 2012

Women's Health, Health Law Issues Heating Up Campaigns

News outlets examine how women's health issues and the health law are affecting the presidential race as well as specific campaigns for Senate, congressional and state races.

CNN: Obama Campaign: Romney, McDonnell And Women Voters
The Obama campaign renewed its focus on women voters Thursday with a stepped up attack on Mitt Romney. … The campaign is releasing the tool and memo on the same day Romney plans to appear with Virginia Gov. Bob McDonnell, who is widely believed to be among the top contenders for the GOP vice presidential slot. McDonnell has become something of a lightning rod among left-leaning women's groups after he supported -- then modified -- legislation that would have required women seeking abortion to submit to an invasive ultrasound before the procedure (Yellin and Steinhauser, 5/3).

Politico: Issue Of Health-Care Reform Emerges In Races
Barack Obama and Mitt Romney are the marquee names in this year's partisan fight over health care, but the undercard is pretty compelling, too. In House and Senate races across the country, from New York to Wisconsin to Montana, the president's health care law is re-emerging as a central issue in the fight for control in Congress (Allen and Haberkorn, 5/2).

The Associated Press: Democrats In GOP-Leaning House Races May Aid Obama
The best example of the trend is former Iowa first lady Christie Vilsack, challenging GOP Rep. Steve King in Iowa's 4th Congressional District. ... King supports repealing the [health law]. Vilsack said she supports aspects of it but stopped short of saying whether she would have supported it or whether she supports its central provision of requiring all Americans to obtain health insurance (Beaumont, 5/3).

Politico: House GOP Keeps Up Health Care Messaging
The National Republican Congressional Committee released a TV ad this morning targeting Pennsylvania Rep. Mark Critz on the issue of health care, criticizing him for not opposing "Obama's radical policies." Critz won a primary last month against fellow Democratic Rep. Jason Altmire, and is one of the few incumbent Dems with a real reelection fight on his hands. Says the ad: "Critz has opposed efforts to repeal or defund Obamacare 20 times." The ad -- coming at the very start of the general election -- clearly signals that House Republicans plan to continue campaigning on the issue of health care, despite having a presidential nominee with a less-than-orthodox record (Burns, 5/2).

Boston Globe: Scott Brown: Elizabeth Warren's Criticism Of His Health Insurance Decision Is 'Sad'
Senator Scott Brown said today that "it's sad" for rival Elizabeth Warren to criticize his decision to continue insuring one of his daughters through the Obama administration health care law that he has opposed and tried to repeal. "For her to call me a hypocrite as to how Gail and I provide for our family, it's sad," Brown told reporters after a speech at Bunker Hill Community College. His wife is former Boston television reporter Gail Huff (Johnson, 5/2).

Reuters/Chicago Tribune: Wisconsin Governor, Likely Rival Tied In Recall Vote -- Poll
Walker enraged Democrats and unions representing government workers last year when he pushed through the legislature a measure reducing the powers of public sector unions. The law forced workers to pay a portion of the cost of health insurance and pensions, capped wage increases and required most unions to be recertified every year (O'Brien, 5/2).

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Capitol Hill Watch

TRICARE Fees, CBO Numbers Draw Scrutiny

Politico reports that the House Armed Services Committee is preparing to take on defense spending issues -- including TRICARE fee increases. The Fiscal Times reports that questions about Congressional Budget Office analyses are coming from both sides of the political spectrum.

Politico: Panel Gears Up For Defense Spending Bill
In what's become an annual rite of spring, the House Armed Services Committee is preparing to set the parameters for defense spending and lay out the new priorities for a downsized military. … The president's budget plan would raise fees for TRICARE, which provides health care benefits for many servicemembers and veterans. The fee hikes have proved extremely unpopular, with veterans groups lobbying against them on Capitol Hill. And Republican presidential candidate Mitt Romney has seized on the issue on the campaign trail. The budget plan to be considered in committee next week would do away with the hikes. And in a preview of the debate to come (Wright, 5/2).

The Fiscal Times: New Assault on CBO's Numbers and Transparency
Neither CBO nor [the Joint Committee on Taxation] has the legal authority to pass legislation. However, their analyses often help determine whether a bill lives or dies. Both [Richard] Gephardt and [Grover] Norquist questioned the CBO's track record for accuracy. For example, they said that the CBO was way off in a projection of the long term cost of Medicare under President Obama's health care reform package (Hirsch, 5/2).

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Health Care Marketplace

Accretive Health Says Minnesota Attorney General Misled Public, Acted In Bad Faith

The Chicago-based company says last week's report by the Minnesota Attorney General did harm, and that the company will seek legal remedies.  

Chicago Tribune: Accretive Health Blasts Minnesota Attorney General Office, Says Agency's Report Has Harmed The Chicago-Based Hospital Billing And Collections Company
Embattled hospital billing and collections company Accretive Health Inc. said Wednesday that it was blindsided by the critical report released last week by Minnesota's attorney general, and it vowed to explore "legal remedies for the damages" resulting from the fallout (Frost, 5/3).

Bloomberg: Accretive Health Lawyer Claims Minnesota Acted In Bad Faith
An Accretive Health Inc. (AH) lawyer accused Minnesota Attorney General Lori Swanson of negotiating in bad faith before suing the company in January and of disclosing its confidential data in an April 24 report. Accretive shares fell nearly 42 percent one day after Swanson issued her six-part report critical of the Chicago-based company's collections practices. Her federal lawsuit accused Accretive of breaching patient privacy laws. The company on April 30 asked U.S. District Judge Richard H. Kyle in St. Paul, Minnesota, to dismiss the case, calling it "factually baseless and legally indefensible" (Harris, 5/2).

(St. Paul) Pioneer Press: Accretive Health Accuses Minnesota Attorney General Of Misleading Public
Accretive Health is taking another swipe at Minnesota Attorney General Lori Swanson and asking her to "change course" in her public comments about the Chicago-based firm.  The consulting company, which was the subject of a scathing report last month from Swanson, says the attorney general has negotiated in bad faith and repeatedly misled the public by stressing Accretive Health's role as a debt collector. Most of Accretive Health's work with the Minneapolis-based Fairview health system involved helping the hospital group collect money from insurance companies - not from individual patients, according to a letter from an Accretive Health attorney to Swanson's office that was released Wednesday, May 2 (Snowbeck, 5/2).

Minnesota Public Radio: Accretive Health Accuses AG Of Misleading Public
[Minn. Attorney General Lori] Swanson filed a lawsuit against Accretive Health in January alleging the company broke federal and state privacy and debt collection laws. And last week her office released a six volume "compliance review" of Fairview's relationship with Accretive Health, alleging aggressive collection tactics by Accretive Health employees such as asking emergency room patients for payment at their bedsides (Dunbar, 5/2). 

Modern Healthcare: Lawmakers Request Client List From Accretive
Members of the U.S. House asked Accretive Health's CEO for a list of clients and information on the company's policies on compliance with federal emergency room access, patient privacy and debt collection laws. The far-reaching request comes ahead of a scheduled May 4 congressional briefing by Accretive Health, the Chicago-based healthcare billing and collection company facing questions about its practices after an investigation by Minnesota's attorney general (Evans, 5/2).

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Study Confirms U.S. Health Spending Far Outpaces Other Industrialized Nations

According to The Commonwealth Fund, the U.S. spends more than 12 other industrialized countries, but the care here is not necessarily better.

Politico: U.S. Health Care Spending 'Dwarfs' Other Countries
The United States spends more on health care than 12 other industrialized countries, a new Commonwealth Fund study finds -- but that doesn't mean this country's care is any better. The U.S. spent nearly $8,000 per person for health care services in 2009, the study found, confirming that "health care spending in the U.S. dwarfs that found in any other industrialized country" (Smith, 5/3).

Modern Healthcare: U.S. Outspends 12 Other Countries On Health Care, Report Says
The U.S. outspends 12 other industrialized countries on health care, but does not provide superior care to those nations, according to a report from the Commonwealth Fund. ... The study showed that the U.S. spent almost $8,000 per capita on health care in 2009, while Japan and New Zealand spent about one-third as much and Norway and Switzerland spent about two-thirds as much. And health care spending in the U.S. was about 17 percent of the country's gross domestic product compared with all of the countries, where spending was 12 percent or less of GDP (Zigmond, 5/3).

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Public Health & Education

In Global Study, U.S. Ranks Very Low In Preventing Premature Births

A World Health Organization/United Nations/March of Dimes report ranks countries on their premature birth rates.

The New York Times: U.S. Lags In Global Measure Of Premature Births
Fifteen million babies are born prematurely each year, and the United States fared badly in the first country-by-country global comparison of premature births, which was released Wednesday by the World Health Organization and other agencies (McNeil Jr., 5/2).

Kaiser Health News: Report: U.S. Has High Rate Of Babies Born Early
About 12 percent of U.S. babies are born at 37 weeks or less, according to the report, which found a worldwide range of as few as 4.1 percent of babies in Belarus to as many as 18 percent in Malawi. Full term is considered 39 weeks (Appleby, 5/2).

Reuters: As Preterm Births Soar Globally, U.S. Ranks 130 Of 184
The world's developed countries have seen their average rate of premature births double to 6 percent since 1995, despite efforts to reduce the phenomenon, according to a report released on Wednesday. Worldwide, 15 million of the 135 million babies born in 2010 were premature and 1.1 million died, according to the "Born Too Soon" report, which was compiled as part of the United Nations' "Every Woman Every Child" initiative (Begley, 5/2).

Boston Globe: US Babies Fare Poorly On Preterm Births
Despite all the dollars we spend on health care, American babies are getting short shrift when it comes to good health outcomes. The premature birth rate in the United States is abysmal; our country ranks 131st — with a preterm birth rate of 12 per 100 live births — which puts us near Somalia, Thailand, and Turkey, according to a report released Wednesday by the March of Dimes and the World Health Organization (Kotz, 5/3).

The Associated Press: 15 Million Of World's Babies Are Born Prematurely
Experts can't fully explain why the U.S. preemie rate is so much worse than similar high-income countries. But part of the reason must be poorer access to prenatal care for uninsured U.S. women, especially minority mothers-to-be, said March of Dimes epidemiologist Christopher Howson. African-American women are nearly twice as likely as white women to receive late or no prenatal care (Neergaard, 5/2).

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Health Information Technology

Can Doctors In Small Practices Catch A Break On Meaningful Use Requirements?

MedPage Today: Health IT Break Sought for Docs in Small Practices
The chair of a House subcommittee on health technology has asked the Centers for Medicare and Medicaid Services (CMS) to exempt doctors in small practices or those who are nearing retirement from new health IT requirements. In a May 1 letter to CMS Acting Administrator Marilyn Tavenner, Rep. Renee Ellmers (R-N.C.) expressed concern about the "meaningful use" requirements contained in the 2009 HITECH Act (Walker, 5/2). 

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State Watch

State Governments Wrestle With Medicaid Expenses, Lawsuits

Officials reckon with health care costs in the context of budget dilemmas in Illinois, Kentucky, Connecticut, Alabama and Wisconsin.

The Associated Press: Budget Dilemma Looms For Illinois Democrats
Facing one of the nation's worst budget crises, the Democrats who run Illinois insist they're serious about overhauling the state's expensive health programs and employee pensions. ... [Gov. Pat] Quinn proposes cutting $2 billion from a Medicaid program that totals about $14 billion, throwing more than 35,000 people off the rolls entirely and eliminating services like dental care for others (Wills, 5/2).

Modern Healthcare: Ky. System Suing State, Medicaid Contractors
Appalachian Regional Healthcare, Lexington, Ky., is suing the state of Kentucky and two Medicaid contractors in a move that speaks to deeper-seated concerns about the state's adoption last year of a mandatory managed-care program. Kentucky implemented its managed-care program Nov. 1 ... In its suits, Appalachian alleged that the Kentucky Cabinet for Health and Family illegally set Medicaid reimbursement rates for inpatient and acute-care services that covered only 75% of its costs (Kutscher, 5/2). 

The Connecticut Mirror: New Budget Figures Make Agreement On Medicaid Changes Likely
Key Democratic lawmakers have bristled at the governor's proposal to scale back a Medicaid program that serves some of the poorest adults in Connecticut. But in light of new budget figures released this week showing that the state has a nearly $200 million budget deficit, some said they're willing to consider changes (Levin Becker, 5/2). 

The Associated Press/Modern Healthcare: Ala. Governor Promises Veto Of Budget If Medicaid Cut
Alabama Gov. Robert Bentley said that he will veto the state's General Fund budget if lawmakers do not find an additional $200 million for Medicaid. Bentley and State Health Officer Don Williamson said at a news conference Tuesday that there would be dire effects if the budget for non-education state services is adopted as it passed the House, with only $400 million for Medicaid. Williamson said at least $602 million is needed to fund the program (5/2).

Milwaukee Journal Sentinel: State Sending Letters On Medicaid Changes 
The state is sending out letters to 111,000 low-income Wisconsinites warning them that they could see changes to their state health coverage, including premium increases. The letters are being sent after federal officials announced Friday their approval of plans by Gov. Scott Walker's administration to cut costs in those Medicaid programs. Officials estimate that the plans will lead to more than 17,000 people leaving or being turned away from the state's BadgerCare Plus health programs (Stein, 5/2).

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State Roundup: Pittsburgh Insurer, Hospital Extend Contract Despite Ongoing Fight

News outlets report on a variety of health policy issues in California, Colorado, Connecticut, Iowa, Kansas, Louisiana, Massachusetts, New York, Oregon and Pennsylvania.

Los Angeles Times: L.A. Program Offers Health Care For Illegal Restaurant Workers
A restaurant workers' group and a Los Angeles community clinic have launched a unique cooperative to provide health coverage to a group of people excluded from federal health care reform -- illegal immigrants. The pilot program, believed to be the first of its kind in the nation, offers preventive and primary care to low-wage, uninsured workers in the restaurant industry. Legal immigrants and other restaurant workers who don't meet the criteria or cannot afford coverage under the health care law are also eligible (Gorman, 5/3).

The Wall Street Journal: Highmark, Hospitals Reach Pact
Under pressure from Pennsylvania officials, insurer Highmark Inc. and the University of Pittsburgh Medical Center reached an agreement to extend their contracts until the end of 2014, and negotiate new terms for certain services after that date (Mathews, 5/2).

Philadelphia Inquirer: Highmark, UPMC Extend Relationship
Hospitals and insurers never have an easy time negotiating contracts, but the level of brinkmanship in Pittsburgh between Highmark Inc. and the University of Pittsburgh Medical Center was unusual by any measure. In a bid to compete if it failed to get a contract with UPMC, which has more than 20 hospitals and its own health insurance company, Highmark even went as far as buying the financially ailing West Penn Allegheny Health System in a deal valued at up to $475 million when it was announced last year (Brubaker, 5/3).

Des Moines Register: After Abortion Foe Rejected, Branstad Nominates Priest To Medical Board
Three weeks after the Iowa Senate rejected a Dubuque anti-abortion activist for a seat on the Iowa Board of Medicine, Gov. Terry Branstad has nominated a prominent Catholic priest for the spot. Msgr. Frank Bognanno, the pastor at Des Moines' Christ the King Catholic Church, has spoken against abortion, which his faith condemns. The medical board, which licenses physicians, gets involved in the issue when abortion opponents file complaints about abortion providers (Leys, 5/2).

Kansas City Star: Kansas Lawmakers Pass Bill Giving Pharmacists Leeway On Abortion Drugs
A bill that would allow pharmacists to bow out of providing drugs they believe might cause an abortion cleared the state legislature Wednesday. The Senate voted 23-16 to approve the bill, which is primarily intended to broaden legal protections for health care providers who don't want to be involved in abortion procedures. Already passed by the House in March, the bill now awaits the signature of Republican Gov. Sam Brownback, a staunch opponent of abortion (Cooper, 5/2).

The Wall Street Journal: Espada's Clinic Is Scaling Back
As Pedro Espada Jr. awaits a verdict in his corruption trial, the Medicaid-funded Bronx health clinic controlled by the former state senator says it plans to stay open despite efforts by the state to shut it down. Officials at Soundview Health Center in the South Bronx, say the nonprofit is running out money, claiming it is owed hundreds of thousands of dollars from Medicaid managed-care plans and the state (Gershman, 5/2).

The Connecticut Mirror: Privacy Dominates Debate On Health Care Database
After a lengthy debate centered on patient privacy, the House of Representatives on Wednesday approved a proposal to develop a statewide database of medical, dental and pharmacy claims information aimed at getting a comprehensive view of health care usage, cost and quality. ... Several other states have or are developing similar programs, known as all-payer claims databases (Levin Becker, 5/2). 

Boston Globe: Haverhill To Save $1.1M In Health Care Costs
Haverhill Mayor James J. Fiorentini announced the city has reached an agreement with its local unions on a new health care plan for municipal employees and retirees that officials predict will save local taxpayers more than $1.1 million annually. The plan, which is scheduled to go into effect with the start of the new fiscal year July 1, affects all city and school department employees and retirees except for those whose contracts run until 2014 (Buote, 5/3).

Kansas Health Institute News: Senate Approves Budget
The Kansas Senate today, by a wide, bipartisan margin, approved its latest version of the state budget after members agreed to add about $77 million for public schools, $5 million to help reduce the waiting list for services for the disabled and $1.9 million to help deal with understaffing at Larned State Hospital (Shields, 5/2). 

California Healthline: Health Plans' Quality For Duals In Question
Seven of the eight health plans in California's pilot project to shift dual eligibles into managed Medi-Cal have inferior quality ratings for treating Medi-Cal beneficiaries, according to a report released yesterday. The ambitious plan for 1.1 million Californians eligible for both Medicare and Medi-Cal benefits will start with a pilot program in four counties -- Los Angeles, Orange, San Diego and San Mateo. The state hopes to expand the pilot project to as many as 10 counties (Gorn, 5/3). 

KQED's State of Health blog: Cash-Only Practices: Better For Patients Or Just Better For Doctors?
Some wealthy patients pay thousands of dollars each month to keep a personal physician on call at all times. ... Now this "concierge medicine" model is being scaled down to reach people with more modest financial resources. One such practice that's starting up in Northern California is called MedLion. ... there is a monthly fee to buy a spot on the doctor's limited roster, and an additional $10 fee for each office visit. For everything else, the patient pays out of pocket -- including basics like x-rays and blood tests (Menghrajani, 5/2). 

WBUR: State Legislature Readies Next Chapter Of Health Care Reform
The House and Senate plan to roll out separate bills soon that will launch the next round of health care reform in Massachusetts. Chapter One of the great Massachusetts health care novel -- what some people call health reform 1.0 -- built to this dramatic moment. ... The House and Senate are expected to build on movements that are already under way: global payments, electronic health records and the increased focus on primary care (Bebinger, 5/3). 

Related, from KHN: Different Takes: How Massachusetts Can Control Health Care Costs (4/12). 

The Lund Report (an Oregon news service): Regence BlueCross BlueShield Sets Off Fury Among Members
When Regence BlueCross BlueShield of Oregon decided to slash the medical benefits for people in the Portland metropolitan area, its management team could never have imagined the fury that it set off. ... Unless people are willing to pay more out-of-pocket costs to see their physician of choice, they’ll be transitioned to the provider networks at Tuality Healthcare or Adventist health care systems (Lund-Muzikant, 5/2). 

Health Policy Solutions (a Colorado news service): The Town That's Tackling Obesity
[W]hen it comes to the most stubborn health epidemic now facing the U.S., Las Animas wants to succeed at a tough goal -- becoming the little town that beats the highest obesity rates in Colorado. Health is a key component of the area's new comprehensive plan. And the irrepressible head of LiveWell Bent County, Tammy Westerman-Pryor, is attacking obesity on three key fronts: creating safe paths for walking and bike riding, increasing access to healthy foods and empowering young people through school wellness initiatives (Kerwin McCrimmon, 5/2). 

New Orleans Times-Picayune: House Committee Rejects Expanded Role For Nurse Practitioners
Nurse practitioners and other advanced practice nurses met an unfriendly House committee Wednesday that rejected the profession's push to provide their services in certain locales without being affiliated with a physician. The Health and Welfare Committee's 12-4 vote to spike House Bill 951 honored the wishes of the Louisiana State Medical Society, which asked lawmakers to leave in place existing requirements that the advanced practice nurses see patients only with a "collaborative agreement" with a physician (Barrow, 5/2).

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Editorials and Opinions

Viewpoints: Doctor-Led Frugality; George Will On His Son's Life With Down Syndrome; Facebook Spurs Organ Donors

Los Angeles Times: Healthcare: The Testing Glut
In case you missed it, a recommendation came out last month that physicians cut back on using 45 common tests and treatments. ... Most doctors will agree with the recommendations on the list. But the problem of overuse is less one of bad doctors (although there are a few); the problem is more one of good doctors working in a bad system. ... But we have to start somewhere — and this list is a good start. Now it needs to be extended (H. Gilbert Welch, 5/2).

Boston Globe: Doctors Should Take Responsibility For Cutting Unnecessary Procedures
The best hope for achieving significant savings in medical costs is through the elimination of unnecessary or duplicative procedures, which waste hundreds of billions of dollars a year. Government attempts to set boundaries inevitably run into cries of "death panels" and rationing, along with prideful reactions from many doctors, who assert the right to test patients as they see fit. But so many factors complicate that decision — from patients' demands to doctors' financial interests and fear of lawsuits — that a system without limits is untenable. It's also unhealthy, in the sense that some patients are exposed to unnecessary risks. That's why it's welcome that the medical profession — encompassing the people best qualified to set guidelines — is starting to take responsibility (5/3).

New England Journal of Medicine: From An Ethics Of Rationing To An Ethics Of Waste Avoidance
Whereas the "R word" is a proverbial third rail in politics, ethicists rush in where politicians fear to tread. The ethics of rationing begins with two considerations. First, rationing occurs simply because resources are finite and someone must decide who gets what. Second, rationing is therefore inevitable; if we avoid explicit rationing, we will resort to implicit and perhaps unfair rationing methods. ... Will U.S. physicians rise to the occasion, committing ourselves to protecting our patients from harm while ensuring affordable care for the near future? (Dr. Howard Brody, 5/2).

New England Journal of Medicine: Beyond the "R Word"? Medicine's New Frugality 
Useless care, critics note, is easy to spot after the fact; it's much more difficult to recognize at the moment of clinical decision. ... Even if we could eventually eliminate that waste, we would merely postpone the reckoning. ... Democrats and Republicans must come together to tell Americans that we can't afford all the things that medicine can achieve — and that we must make painful choices between health care and other needs (Dr. M. Gregg Bloche, 5/2).

The New York Times: Short-Term Fixes
Federally subsidized student loan rates were bound to become an election-year fight, since Congress provided only enough money for five years of low-interest rates in 2007. Now that the rates are about to double, both Democrats and Republicans are failing to do the right thing again. The Republican proposal, passed by the House last week, is unquestionably worse than the Democrats' plan. To cover the $6 billion cost of keeping interest rates at 3.4 percent for a year, it would eliminate a farsighted fund established by the health care reform law to help states and communities prevent obesity, heart disease, diabetes, cancer and infectious diseases, among other ailments (5/2).

The Washington Post: Jon Will's Gift
When Jonathan Frederick Will was born 40 years ago — on May 4, 1972, his father’s 31st birthday — the life expectancy for people with Down syndrome was about 20 years. That is understandable. ... Whether warehoused or just allowed to languish from lack of stimulation and attention, people with Down syndrome, not given early and continuing interventions, were generally thought to be incapable of living well, and hence usually did not live as long as they could have (George F. Will, 5/2).

Houston Chronicle: Texas Ideology Above Women's Health
In its admitted zeal to cut off all funding to Planned Parenthood, the state of Texas is making it perfectly, chillingly clear that it is willing to wreak havoc with the lives and health of low-income Texas women to achieve that goal…. The end result is that for now, ideology is trumping the Constitution. Planned Parenthood clinics that by law have no connection with providing abortion cannot give essential preventive health care and family planning services to poor women in Texas. Unintended pregnancies and abortion rates will rise, families will suffer and taxpayers will also be paying a heavy price (5/2).

Minneapolis Star Tribune: Modernize Medical Payment Systems
The answer to improving the payment system in health care is not "everyday shakedowns for payment in advance" or "high-pressure boiler-room-style" tactics…. The key is technology…. Using modern technology to improve the patient experience by providing transparency at the point of service and to eliminate multiple, confusing billing statements will go a long way to helping providers remain focused on giving care (Brian Beutner, 5/2).

San Francisco Chronicle: The E-Record Cost-Saving Myth
Researchers from Harvard University and the City University of New York have cautioned that the federal government's multibillion-dollar investments in health information technology might not be the boon their proponents claim…. Of course, hospitals and doctors' offices should be free to adopt useful and cost-effective technological innovations. But government mandates that they do so distort incentives -- and could end up doing more harm than good. By trying to speed the adoption of HIT, the government might slow it down -- and cost taxpayers a lot of money in the process (Sally C. Pipes, 5/3).

The Seattle Times: The Affordable Care Act Is Health-Care Justice For All
As a nurse, I'm worried that we're losing sight of a much more essential issue: health-care coverage saves lives…. We are making measurable steps toward improving patient safety and quality of care. This is not the time to dismantle or repeal this law (Diane Sosne, 5/2).

San Jose Mercury News: Facebook Organ Donor Registry Takes It To New Level
Facebook just went from being mostly a fun pastime -- sometimes even a time waster -- to a lifesaver. And "friending" takes on a whole new meaning. The social media site's intrinsic value soared this week with the numbers on California's organ donor registry, which by Wednesday was reported to have grown by 5,000 percent (yes, that's three zeros) after Facebook launched its organ donor initiative (5/2).

New England Journal of Medicine: Freedom From The Tyranny of Choice — Teaching The End-of-Life Conversation 
[T]he typical approach to discussing resuscitation status has evolved from a paternalistic one to one in which patients and their families are often asked to choose from a bewildering array of medical possibilities. To rectify a perceived violation of patients' autonomy, health care institutions now require physicians to involve patients and families in these decisions. But ... the few studies that have assessed residents' ability to lead end-of-life conversations indicate that they're not being taught this critical skill (Drs. Daniela Lamas and Lisa Rosenbaum, 5/3).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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