Daily Health Policy Report

Friday, August 15, 2014

Last updated: Fri, Aug 15

KHN Original Reporting & Guest Opinion

Health Reform

Medicare

Veterans Health Care

Health Care Marketplace

State Watch

Health Policy Research

KHN Original Reporting & Guest Opinion

Government Streamlining Medicare Coverage For Cancer Test

Kaiser Health News consumer columnist Michelle Andrews writes: "Medicare beneficiaries may get speedier coverage for a newly approved screening test for colorectal cancer under a pilot project in which two federal agencies reviewed the product at the same time instead of one after the other. The Cologuard test, which detects the presence of DNA mutations that may be cancers in the stool, was approved by the Food and Drug Administration this week. The same day, the Centers for Medicare& Medicaid Services issued a proposal to cover the test once every three years in asymptomatic people over age 50 who are at average risk for the disease" (Andrews, 8/15). Read the story.

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Capsules: Wide Variation In Hospital Charges For Blood Tests Called ‘Irrational’

Now on Kaiser Health News’ blog, Roni Caryn Rabin writes: “One California hospital charged $10 for a blood cholesterol test, while another hospital that ran the same test charged $10,169 — over 1,000 times more. For another common blood test called a basic metabolic panel, the average hospital charge was $371, but prices ranged from a low of $35 to a high of $7,303, more than 200 times more” (Rabin, 8/15). Check out what else is new on the blog.

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Political Cartoon: 'The Doctor Is In-Active?'

Kaiser Health News provides a fresh take on health policy developments with "The Doctor Is In-Active?" by Chris Wildt.

Meanwhile, here's today's haiku:

A GAME PLAN

Keep me out of jail
Coaches treat addiction risk
Everybody wins
-Julie Miller

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

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Health Reform

Health Law's Next Push: Maintaining Sign-Up Momentum

The Huffington Post explores why the people who did not sign up for health coverage during the 2014 open enrollment period may be much harder to reach. News outlets also report on developments from Massachusetts regarding the state's online insurance marketplace.

The Huffington Post: Why Obamacare May Have Trouble Signing Up As Many Uninsured Next Year
Obamacare made huge strides in extending health coverage to millions of uninsured people in its first year. Keeping up that momentum could be challenging. An estimated 54 million Americans are still uninsured. But many of those who haven't yet been helped by the Affordable Care Act might be some of the hardest people to get signed up, according to the people trying to reach them (Young, 8/14).

The Boston Globe: About 400,000 In Mass. Must Seek New Health Plan
Nearly 400,000 people in Massachusetts will need to reapply for health insurance before the end of the year, and many of them probably do not even know it. They are people who do not have employer-sponsored health insurance and who instead sought insurance through the state. After the Massachusetts insurance website failed last year, most of them were enrolled in temporary coverage that ends Dec. 31, which is why they must select a new plan. This is the newest challenge facing the Massachusetts Health Connector, the state agency that provides an online place to shop for insurance, as it struggles to emerge from the disastrous rollout of its website last year (Freyer, 8/15).

WBUR: Mass. Seeks $80M More From Feds For Health Website
Massachusetts will ask the federal government for another $80 million to build a new health insurance shopping website tied to the Affordable Care Act. Massachusetts received $174 million for multi-state planning and a website that never worked. The state has about $65 million left, but says it will need the additional money to build a new site. So the total cost of the site — which is expected to be ready for the next open enrollment period that begins Nov. 15 — will be roughly $254 million. If the federal government agrees to the additional expense, it would end up spending about $224 million for the insurance exchange. The balance, about $30 million, would come out of the state’s capital budget (Bebinger, 8/14).

In other health law implementation news -

The Fiscal Times: So Far, Obamacare’s Hospital Reform Isn’t Working
The Affordable Care Act includes a handful of measures aimed at improving the hospitals’ overall performance and the quality of care. The problem is some of those measures don’t seem to be working, while others are having unintended consequences. One provision in particular, called Hospital Value Based Purchasing, which rewards or penalizes hospitals depending on their performance—is not leading to any substantial improvements in care, a new study found (Ehley, 8/15).

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Calif.'s Medicaid Expansion Renews Concerns About Doc Pay

Some advocates fear that state efforts to cut payments to doctors and other providers will make it hard for new enrollees to get care. Also, committees in Texas and Idaho look at ways to expand care for low-income residents.

Los Angeles Times: Medi-Cal Struggles To Provide Services To Ever-Growing Clientele
Concerns about access to care have taken on a new urgency since Medi-Cal enrollment began to swell in the wake of President Obama's federal healthcare overhaul. The program, the state's second-largest expense after schools, is expected to cover one in three Californians by next year. But the current state budget continues a 10% cut in reimbursements to some healthcare providers, a lingering sore point for advocates, lobbyists and lawmakers who have pushed to reverse the reduction (Megerian, 8/14).

Houston Chronicle: Lawmakers Seek "Texas Solution" On Health Care
State lawmakers renewed efforts Thursday to find a "Texas solution" to expand health-insurance coverage for low-income residents without accepting the Medicaid expansion in President Barack Obama's signature health care law. Social-services advocates and local officials are among those pushing for a compromise measure that gives the state more flexibility than in the law to spend the money available from the federal government to cover more residents (Rosenthal, 8/14).

Austin American-Statesman: County Judges Urge 'Texas Way' To Address Medicaid Coverage Gap
County judges from the state’s six largest counties are urging members of the state Senate Health and Human Services Committee to find a “Texas way” to provide care for 1.9 million Texans living without health care coverage as the state declines to expand Medicaid coverage under the Affordable Care Act. In a letter sent Wednesday, judges from Travis, Dallas, El Paso, Harris, Tarrant and Bexar counties said the so-called coverage gap places an expensive burden on urban counties that are required pay for indigent care (McSwane, 8/14).

The Associated Press: Texas Lawmakers Mull Alternatives To Medicaid Expansion
Health and Human Services Commissioner Kyle Janek told the committee that Texas’ Medicaid caseload could increase by 600,000-plus — even though the state isn’t expanding the program under the federal law. Janek said that Affordable Care Act-related Medicaid enrollments may rise from around 90,000 in fiscal year 2014 to more than 722,000 by fiscal year 2017. That's mainly because the law changed income requirements to qualify, meaning more young Texans will move from the state’s children’s health care program to Medicaid (Weissert, 8/14).

The Associated Press: Idaho Work Group Favors Medicaid Expansion
An Idaho work group says the state should expand its Medicaid eligibility, but some committee members voiced concerns that their recommendation will be ignored by both the governor and legislators. The 15-member group voted 10-3 Thursday to submit their recommendation to Gov. Butch Otter. The governor had tasked the panel to evaluate the best health care coverage option for low-income adults (Kruesi, 8/14).

The Spokesman Review: Otter’s Work Group Backs Accepting Medicaid Expansion Funds
More than 100,000 uninsured Idahoans would qualify for health coverage and state and local taxpayers would save $44 million in 2016, under a plan for accepting expanded federal Medicaid funds approved by a working group appointed by Gov. Butch Otter on Thursday. The group's proposal, approved on a 10-3 vote, is just a recommendation to Otter, who will decide what to propose to state lawmakers in January. Three GOP lawmakers who served on the work group cast the dissenting votes (Russell, 8/14).

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Fox News Poll Finds Slim Majority Continues To Oppose The Health Law

According to Fox News, opposition among voters has been above 50 percent for more than a year. Meanwhile, Politico Pro takes a look at the congressional district of the new House Majority Leader Kevin McCarthy, R-Calif., where constituents who appear to be benefiting from new health law coverage are still supporting politicians like McCarthy, who want to repeal it. Also in the news, the overhaul and abortion issues come to light during a Colorado congressional campaign debate.  

Fox News: Fox News Poll: Slim Majority Continues To Oppose Obamacare
Opposition to the 2010 health care law has been above 50 percent for over a year. And that continues to be true, as the latest Fox News national poll finds voters oppose the law by a 52-41 percent margin. Support for Obamacare has been as high as 43 percent (May 2014) and gone as low as 36 percent (January 2014). The number opposing the law has ranged from 49 percent (June 2012) to a record-high 59 percent (January 2014). As in the past, the new poll shows that most Democrats favor Obamacare (74 percent), while most Republicans (84 percent) and independents (61 percent) are against it (Blanton, 8/14).

Politico Pro: Lots Of Newly Insured Back Home, But McCarthy’s Still Anti-Obamacare
Nearly 70,000 people in the Central Valley’s Kern County have gotten health care coverage this year because of Obamacare. But their congressman, new House Majority Leader Kevin McCarthy, faces no danger of those newly insured kicking him out of office for voting dozens of times to repeal the law. It’s a sharp disconnect, one that is taking place not just in McCarthy’s deep-red Bakersfield district but in many other Republican districts throughout the country ahead of the 2014 midterm elections: Constituents benefiting from Obamacare coverage aren’t turning against the politicians who want to repeal it. And even as Obamacare beneficiaries grow into the millions, there doesn’t appear to be a tipping point in the near future when Republicans’ opposition to the health care law could actually hurt them politically (Haberkorn, 8/14).

The Associated Press: Candidates Clash In Colorado Congressional Debate
[Rep. Mike] Coffman said he opted out of the congressional health plan and bought his insurance on the Affordable Care Act exchange, which was significantly worse. “If every member of congress did what I did, Obamacare would not be standing today,” he said, earning cheers and boos when he called for repealing the law. Romanoff replied: “It’d be a good idea to fix the law rather than repeal it and replace it with nothing but empty phrases.” Romanoff supports abortion rights and Coffman opposes them (8/14).

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Medicare

Cops, Computer Analysts Hunt For Medicare Fraud

The Wall Street Journal looks closely at the work of the Medicare Strike Force, which includes FBI agents and CMS workers. Meanwhile, the Government Accountability Office finds Medicare audit contractors may hammer hospitals with multiple reviews of the same payment claims.

The Wall Street Journal: How Agents Hunt For Fraud In Trove Of Medicare Data
Eleven armed FBI agents crept around a stone-and-glass house here just before dawn. An AR-15 rifle and four other guns were registered to the man in the house. … It was no drug lord. The target was a doctor who moonlighted as a movie producer with an Alec Baldwin comedy to his credit. The Justice Department charged the doctor, Robert A. Glazer, with writing prescriptions and certifications resulting in $33 million of fraudulent Medicare claims. The raid in May capped a year-long investigation by the Medicare Fraud Strike Force, a joint effort by the Justice Department and Department of Health and Human Services. Raids that day in six cities resulted in the busts of 90 Medicare providers, including 16 doctors, who were separately charged with generating a total of $260 million of false Medicare billings (Stewart, 8/14).

Modern Healthcare: GAO Finds Medicare’s Audit Contractors May Duplicate Efforts
The CMS' audit contractors may overlap duties and hammer hospitals with multiple reviews of the same payment claims, according to a new Government Accountability Office report that echoes concerns the provider community has voiced for years. The GAO report looked at Medicare's alphabet soup of auditors: RACs, MACs, CERTs and ZPICs. RACs, or general recovery auditor contractors, are the most well-known and have been in place since October 2009. They review hospital claims for inappropriate payment after Medicare has already paid. Four companies—Performant Recovery, CGI Federal, Connolly and HealthDataInsights—serve as the Medicare RACs (Herman, 8/14).

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Veterans Health Care

VA Begins Discipline Process For Workers Involved In Health System Waiting Scandal

The Department of Veterans Affairs plans to recommend action against six employees at veterans' medical facilities in Colorado and Wyoming. Meanwhile, news outlets report on questions about whether offering veterans the option of private care will address some of the VA health system's problems.

The Associated Press: VA Chief: Firings Of Workers A Deliberate Process
The Veterans Affairs Department is in the process of holding bad employees accountable amid a scandal about long wait times for patients and other problems, VA Secretary Robert McDonald said Thursday, but he declined to say how many people were being fired and who they were. McDonald visited with veterans and employees at the Memphis VA hospital on Thursday, a day after addressing the American Veterans national convention (Sainz, 8/14).

NBC News: VA's Opaque Discipline Process Clouds Outcomes In Wait-Time Scandal
The Department of Veterans Affairs says it has recommended disciplinary actions against six employees at VA medical facilities in Colorado and Wyoming for manipulating patient wait times, but the punishments that are being meted out –- and what the employees did to receive them –- remain unclear. Even the chairman of the House Veterans Affairs Committee says he would like to know more so that he can determine if the penalties fit their actions. So far, though, he hasn’t gotten any answers (Gusovsky, 8/14).

Philadelphia Inquirer: Some Worry Veteran’s Private Care Option Is No Fix
Veterans seeking appointments at the VA hospital in University City often face longer waits -- two weeks longer for a new-patient primary-care slot and more for specialists -- than if they sought private treatment, a comparison of wait times shows. Data from the city's VA show thousands have been waiting more than 30 days to be seen. But opening the door to private care -- as the embattled VA is in the process of doing for hundreds of thousands of veterans -- may not fix the problem, experts say. Veterans could be entering an overwhelmed system with its own delays and little room left to give. It could also, they say, cause longer delays for those with poor health insurance who already struggle to get care (Nadolny, 8/15).

Modern Healthcare: VA Expands New Care Program, But Providers May Balk At The Low Rates It Pays
The Veterans Affairs Department has decided to expand, to include primary-care services, a relatively new program that allows vets to seek certain types of care from non-VA providers. The move likely will enhance the possibility of quicker access to care for veterans, but for how many is unclear. That's because some providers may decline to join the program because of what they see as financially unviable reimbursement rates (Dickson, 8/14).

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Health Care Marketplace

Physician Disclosure Website Back On Track

The Centers for Medicare & Medicaid Services announces it has fixed the glitch that took down the website where doctors and hospitals can review information about payments from drug and device makers.  Meanwhile, The New York Times looks at how costly compounded medicines are drawing the ire of health insurers, and a U.K. agency recommends the government pay for a costly new hepatitis treatment.

The Wall Street Journal’s Pharmalot: CMS Fixes Tech Glitch That Hobbled Pharma Payment Disclosures
The federal government is back online with a website where U.S. doctors and teaching hospitals can review information about payments they have received from drug and device makers, about 11 days after a government agency shut it down to investigate a data mix-up. In a brief statement Thursday afternoon, the Centers for Medicare and Medicaid Services said: “The Open Payments system is once again available for physicians and teaching hospitals to register, review and dispute financial interaction information received from health care manufacturers and Group Purchasing Organizations.” CMS plans to provide additional details about the program “by tomorrow” (Loftus, 8/14).

The New York Times: Pharmacies Turn Drugs Into Profits, Pitting Insurers Vs. Compounders
Compounded medicines are the Savile Row suits of the pharmacy, made to order when common treatments will not suffice. Pharmacists say it is the doctors who decide what to prescribe. But many pharmacies have standard formulations and some promise six-figure incomes to sales representatives who call on doctors (Pollack, 8/14).

The Wall Street Journal’s Pharmalot: UK Recommends Covering Sovaldi Hepatitis C Pill
The U.K. agency that evaluates the cost effectiveness of prescription drugs has recommended the government pay for the controversial Sovaldi hepatitis C treatment, although not for all patients. The move, which still requires a final endorsement, comes as the medicine causes a ruckus in the U.S. The price tag–$84,000 for a 12-week regimen–has insurers and state Medicaid directors worried that the Gilead Sciences medication will become a budget buster and helped to fuel a national debate over the rising cost of prescription drugs (Silverman, 8/14).

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Worker Health Costs Drag Down Walmart Profits Even As Retailer Makes Play To Be Shoppers' Health Care Source

Walmart plans to open a dozen clinics by the end of this fiscal year that will provide a broad range of primary care services.   

The Washington Post’s Wonkblog: Wal-Mart Wants To Be Your Doctor
Wal-Mart's newest effort to make a play in the booming health clinic space comes after the big-box retailer has fallen far behind its rivals. And this time, Wal-Mart is shaking up its approach with a new model that's getting some attention in the health-care world. Wal-Mart this year has opened six clinic locations across South Carolina and Texas in which the retailer is providing a broad range of primary care services, as described in a recent New York Times story. The company plans to have a dozen of these clinics open by the end of this fiscal year, executives said on a Thursday earnings call (Millman, 8/14).

The Hill: Wal-Mart: Health Costs Drag Down Profits
Wal-Mart on Thursday blamed a recent profit slump on rising U.S. healthcare costs. The company lowered its guidance estimate for earnings per share from a range between $5.10 and $5.45 to a new range of $4.90 to $5.15 during a conference call with investors. Charles Holley, Wal-Mart's executive vice president and chief financial officer, said that's because of "headwinds from higher healthcare costs in the U.S. than previously estimated" (Cirilli, 8/14).

The Wall Street Journal: Health Costs, Weak Store Traffic Hinder Wal-Mart
One unexpected headwind came from health care, where costs are rising quickly as more employees sign up for coverage. The company said it now expects to shell out an additional $500 million in health-care expenses related to increased employee enrollment and higher costs, up from the $330 million in increases it originally expected. "Health-care costs increased approximately $180 million versus last year and were well above our initial estimates," said Wal-Mart U.S. CEO Greg Foran, who stepped into the role this week following the departure of Mr. Simon (Banjo and Calia, 8/14).

In other marketplace news -

The Associated Press: U.S. Stocks Perk Up In Sleepy August Trading
Better corporate earnings helped nudge the stock market up on Thursday in one of the quietest sessions this year. Health-care companies led the major indexes to slight gains, while Berkshire Hathaway crossed another milestone, trading above $200,000 a share for the first time. With many who work in the markets on vacation, trading volume on the New York Stock Exchange thinned out: just 2.6 billion shares on Thursday. An average day this year is nearly 1 billion higher (8/14).

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State Watch

State Highlights: TB Outbreak In Alabama Prisons

A selection of health policy stories from Alabama, California, Washington, Texas, Georgia, Minnesota and Oregon. 

The Associated Press: Worst TB Outbreak In 5 Years Hits Alabama Prisons
Alabama’s prison system, badly overcrowded and facing a lawsuit over medical treatment of inmates, is facing its worst outbreak of tuberculosis in five years, a health official said Thursday. Pam Barrett, director of tuberculosis control for the Alabama Department of Public Health, said medical officials have diagnosed nine active cases of the infectious respiratory disease in state prisons so far this year (8/14). 

Kaiser Health News: Capsules: Wide Variation In Hospital Charges For Blood Tests Called 'Irrational'
One California hospital charged $10 for a blood cholesterol test, while another hospital that ran the same test charged $10,169 — over 1,000 times more. For another common blood test called a basic metabolic panel, the average hospital charge was $371, but prices ranged from a low of $35 to a high of $7,303, more than 200 times more (Rabin, 8/15).

Seattle Times: Ban On Boarding Mentally Ill In ERs Could Force Release Of Many
More than 100 severely mentally ill patients in need of care could be released from Washington hospitals before the end of the month, as the state struggles to comply with a recent ban on warehousing psychiatric patients in emergency rooms. The state has been scrambling for a week to respond to the state Supreme Court’s ruling, but so far has been able to free up only a fraction of the long-term beds that will be needed when the decision goes into effect Aug. 27, said Andi Smith, Gov. Jay Inslee’s policy adviser on health and human services. ... This poses a serious dilemma for hospitals. By adhering to the order and knowingly discharging dangerous or unstable patients, they fear they could be in violation of the federal Emergency Medical Treatment and Labor Act (EMTALA), said Taya Briley, general counsel for the Washington State Hospital Association (Mannix, 8/14).

Reuters: The Other Texas Border Deployment: Doctors, Dentists, Opticians
For the Texas State and National Guard, Operation Lone Star is a disaster preparedness exercise. For public health experts, it is a humanitarian mission. And for Itzel, a teenage schoolgirl, it is a chance to finally get glasses so she can read textbooks. Operation Lone Star started 16 years ago to help the guard prepare for emergencies such as hurricanes or pandemics in south Texas. Since then it has expanded its medical care component, treating thousands in a region that hugs the Mexican border, including some who come because no identification papers are required. "It feels weird to see things in focus," Itzel said as she tried on newly made prescription glasses (Herskovitz, 8/14).

Georgia Health News: State Health Plan Choices For 2015 Draw Praise
Many state employees and teachers will see no increase in their health insurance premiums next year under rates approved by a state agency’s board Thursday. The State Health Benefit Plan members will have choices among plans offered by three health insurers, rather than a single insurance company this year. The SHBP covers 650,000 state employees, teachers, other school personnel, retirees and dependents. With those numbers, the members of the health plan have proved to be a potent political force in this election year (Miller, 8/14).

Minnesota Public Radio: Minnesota Security Hospital Gets OSHA Citation
The Minnesota Occupational Safety and Health Administration has issued a citation related to working conditions at the Minnesota Security Hospital in St. Peter, which has faced repeated problems over the years connected to employee and patient safety. The state Department of Human Services confirmed that OSHA inspectors visited the site on Aug. 1. Deputy Commissioner Anne Barry wasn't available for comment, but released a statement about OSHA's findings. "Everyone deserves to work in a safe environment. Over the past two years, Minnesota Security Hospital has made significant progress in employee safety by increasing the amount of staff and providing specialized training," Barry said (Collins, 8/14).

The Oregonian: Oregon Adds Transgender Procedures To Oregon Health Plan
A full range of state medical coverage for low-income transgender people will be offered for the first time starting early next year. The Health Evidence Review Commission, a 13-member board charged with setting Oregon Health Plan priorities, made that decision Thursday during a meeting in Portland. The decision was hailed by advocates, who called it an historic step toward equality in medical care (Tims, 8/14). 

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Health Policy Research

Research Roundup: Benefits Of Smaller Practices; Rx Price Growth

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

GAO: Medicare Program Integrity: Increased Oversight And Guidance Could Improve Effectiveness And Efficiency Of Postpayment Claims Reviews
The Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS) has taken steps to prevent its contractors from conducting certain duplicative postpayment claims reviews—reviews of the same claims that are not permitted by the agency—but CMS neither has reliable data nor provides sufficient oversight and guidance to measure and fully prevent duplication. ... GAO recommends that CMS take actions to improve the efficiency and effectiveness of contractors' postpayment review efforts, which include providing additional oversight and guidance regarding data, duplicative reviews, and contractor correspondence. In its comments, the Department of Health and Human Services concurred with the recommendations and noted plans to improve CMS oversight and guidance (King et al, 8/13).

Health Affairs: Small Primary Care Physician Practices Have Low Rates Of Preventable Hospital Admissions
It is often assumed that larger practices provide better care, although there is little evidence for or against this assumption. ... We conducted a national survey of 1,045 primary care–based practices with nineteen or fewer physicians to determine practice characteristics. ... Compared to practices with 10–19 physicians, practices with 1–2 physicians had 33 percent fewer preventable admissions, and practices with 3–9 physicians had 27 percent fewer. ... In an era when health care reform appears to be driving physicians into larger organizations, it is important to measure the comparative performance of practices of all sizes (Casalino, 8/13).

Altarum Institute: Health Care Price Growth Moderates
Health care prices in June 2014 were 1.7% higher than in June 2013, a tenth lower than the May year-over-year reading. ... Hospital price growth fell to 1.9% from 2.1% in May, and this was largely responsible for pushing the aggregate HCPI lower despite rapid prescription drug price growth. At 4.1% (up from 3.6% last month), it is the highest drug price growth reading since March 2012, and it follows negative growth as recently as July 2013. Price growth for the other categories showed little movement (8/7).

Health Affairs: More Than Half Of US Hospitals Have At Least A Basic EHR, But Stage 2 Criteria Remain Challenging For Most
The national effort to promote the adoption and meaningful use of electronic health records (EHRs) is well under way. However, 2014 marks an important transition: For many hospitals, penalties will be assessed in fiscal year 2015 for failing to meet federal meaningful-use criteria by the end of fiscal year 2014. We used recent data from the American Hospital Association Annual Survey of Hospitals—IT Supplement to assess progress and challenges. EHR adoption among US hospitals continues to rise steeply: 59 percent now have at least a basic EHR. Small and rural hospitals continue to lag behind their better resourced counterparts. Most hospitals are able to meet many of the stage 2 meaningful-use criteria, but only 5.8 percent of hospitals are able meet them all (Adler-Milstein et al., 8/7).

Health Affairs: Despite Substantial Progress In EHR Adoption, Health Information Exchange And Patient Engagement Remain Low In Office Settings
In 2013, 78 percent of office-based physicians had adopted some type of EHR, and 48 percent had the capabilities required for a basic EHR system. However, we also found persistent gaps in EHR adoption, with physicians in solo practices and non–primary care specialties lagging behind others. Physicians’ electronic health information exchange with other providers was limited, with only 14 percent sharing data with providers outside their organization. Finally, we found that 30 percent of physicians routinely used capabilities for secure messaging with patients, and 24 percent routinely provided patients with the ability to view online, download, or transmit their health record (Furukawa, 8/7).

Rand Corp: The 340B Prescription Drug Discount Program
The 340B Drug Pricing Program is a federal program that allows specific categories of safety-net providers—including some hospitals, clinics, and health centers—to procure outpatient prescription drugs at discounted prices. ... The discussion surrounding 340B escalated to debate and often disagreement as provisions expanding eligibility for 340B were included in the 2010 Affordable Care Act (ACA). This RAND Perspective describes the purpose, history, and current implementation of the 340B program (Mulcahy, Armstrong, Lewis and Mattke, 8/12).

Employee Benefit Research Institute: Satisfaction With Health Coverage and Care: Findings From The 2013 EBRI/Greenwald & Associates Consumer Engagement In Health Care Survey
The overall satisfaction rate among consumer-driven health plan (CDHP) enrollees increased in most years of the EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey (CEHCS), while it decreased in most years among traditional enrollees. Differences in out-of-pocket costs may explain some of the differences .... In 2013, 44 percent of traditional-plan participants were extremely or very satisfied with out-of-pocket costs (for health care services other than for prescription drugs), while 20 percent of high-deductible health plan (HDHP) enrollees and 31 percent of CDHP participants were extremely or very satisfied. Satisfaction has been trending upward among CDHP enrollees (Fronstin, 8/13).

Kaiser Family Foundation: One Year into Duals Demo Enrollment: Early Expectations Meet Reality
July 2014 marks a year since the first beneficiaries dually eligible for Medicare and Medicaid began receiving services through one of the new financial alignment demonstrations. The demonstrations seek to maintain or decrease health care costs while maintaining or improving health outcomes for this vulnerable population of seniors and non-elderly people with significant disabilities. ... At this early stage of implementation, some initial insights about the demonstrations are beginning to emerge [including] the work required before the demonstrations were ready to start enrolling and providing services to beneficiaries has taken longer than anticipated (Musumeci, 8/13).

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

Medscape: Only 10% of Medicaid Enrollees' ED Use Is Unnecessary
Medicaid enrollees use emergency departments (EDs) more often than privately insured and uninsured people, but that use accounts for just 4% of total Medicaid spending, a literature review by the Medicaid and CHIP Payment and Access Commission (MACPAC) indicates. The review also found that only 10% of ED visits by nonelderly patients are for nonurgent reasons, which compares with the rate of use by privately insured patients. MACPAC researchers reviewed recent studies on ED use and did not find consistent links between Medicaid status and disproportionate ED use for nonemergency situations (Frellick, 8/11).

MedPage Today: Readmission Rates High In Lupus
One in six patients with lupus discharged from the hospital was readmitted within a month, with underserved minority populations being most vulnerable, researchers found. ... Compared with whites, the adjusted odds ratios for readmission were 1.18 for blacks and 1.12 for Hispanics, the researchers reported online in Arthritis & Rheumatology (Walsh, 8/11).

Medscape: Racial Disparity In CRC Screening Despite Similar Access
Colorectal cancer screening (CRC), particularly colonoscopy, is low in blacks, despite similar access to care across races, according to a Veterans Affairs (VA) healthcare system study published online March 25 and in the August issue of Gastrointestinal Endoscopy. "African Americans have the highest incidence and mortality from [CRC]," write Folasade P. May, MD, Mphil, from the Department of Medicine, Division of Gastroenterology, VA Greater Los Angeles Healthcare System, California, and colleagues. "Despite guidelines to initiate screening with colonoscopy at age 45 in African Americans, the CRC incidence remains high in this group" (Barclay, 8/11).

Reuters: Nonprofit Hospitals At A Tipping Point From Mounting Challenges
Small and stand-alone nonprofit hospitals are facing mounting pressure from weak operating margins and lower patient volumes, with more signals of stress on the way, according a report released Wednesday from Standard & Poor's Rating Services. The rating agency warned the healthcare sector was at "a tipping point where negative forces have started to outweigh many providers' ability to implement sufficient countermeasures." Beginning in 2013 and continuing into this year, credit downgrades outpaced upgrades at an accelerating rate (Respaut, 8/13).

Reuters: Many Meds Taken By Seniors Can Raise Risk Of Falls
Half of the 20 most commonly prescribed medications taken by older adults may raise the risk of falls, according to new research. Painkillers and antidepressants were most strongly tied to a greater likelihood of being injured in a fall, the study of 64,000 Swedes over age 65 found. Severe injuries were significantly more common with 11 out of the 20 medications studied (Kennedy, 8/12).

Medscape: 2 In 5 American Adults Will Develop Diabetes
About 40% of US adults will develop diabetes, primarily type 2, in their lifetime, and over 50% of some ethnic minorities will be affected, according to new research from the Centers for Disease Control and Prevention (CDC) and Emory University, Atlanta, Georgia, published online August 13 in Lancet Diabetes & Endocrinology. This is substantially higher than previous estimates that were based on incidence and mortality from the 1990s, say the researchers (Hackethal, 8/13).

Medscape: Physician Assistants More Than Double In A Decade
The number of certified physician assistants (PAs) grew 219% from 2003 to 2013, almost 6% alone during the last year of that decade, according to the 2013 Statistical Profile of Certified Physician Assistants published online by the National Commission on Certification of Physician Assistants (NCCPA). The number of certified PAs stood at 95,583 across the United States at the end of 2013, compared with 90,227 in 2012 and 43,500 in 2003. PAs practice in all 50 states and the District of Columbia, according to the NCCPA, the only certifying organization for PAs in the country (Hand, 8/12). 

Reuters: Dentists Miss Chances To Urge Patients To Quit Smoking 
Healthcare providers, particularly dentists, frequently miss opportunities to advise patients about ways to stop smoking cigarettes, a new study shows. Since 1996, the U.S. Public Health Service has been urging all healthcare workers to ask every one of their patients if they smoke and to counsel smokers to quit, said senior author Amy Ferketich, a professor at the Ohio State University College of Public Health in Columbus. But when she and her colleagues analyzed survey data from 2010, they found that less than 12 percent of smokers who visited a dental worker and only half of smokers who saw a doctor reported receiving guidance about how to break the habit (Cohen, 8/8).

Medscape: 'Vanished' In US, Sigmoidoscopy Saves Lives In Norway 
Screening with flexible sigmoidoscopy significantly reduces colorectal cancer (CRC) incidence and mortality, compared with no screening, a large randomized trial has found. The study results were published in the August 13 issue of JAMA. The findings from the Norwegian Colorectal Cancer Prevention Trial are not surprising. Three previous randomized clinical trials have reported similar results with sigmoidoscopy. The sum total of evidence is, however, "ironic" for clinicians in the United States, according to an accompanying editorial. "Screening by sigmoidoscopy has all but vanished" in the United States, writes editorialist Allan Brett, MD, professor of clinical internal medicine at the University of South Carolina in Columbia (Mulcahy, 8/12).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.