Daily Health Policy Report

Friday, August 8, 2014

Last updated: Fri, Aug 8

KHN Original Reporting & Guest Opinion

Veterans Health Care

Health Reform

Capitol Hill Watch

Health Information Technology

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

FAQ: The Next Abortion Battle: The Courts And Hospital Admitting-Privilege Laws

Kaiser Health News staff writer Julie Rovner reports: “Even if you’re trying, it’s tough to keep score on what’s happening with various lawsuits challenging some state abortion laws. States led by anti-abortion governors and legislatures have been passing a broad array of measures over the past few years aimed at making the procedure more difficult for women to obtain. About two dozen states enacted 70 such measures in 2013” (Rovner, 8/8). Read the story.

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Short-Term Health Plans Might Offer Some Relief But They Have Significant Gaps

Kaiser Health News consumer columnist Michelle Andrews writes: “Consumers who missed open enrollment on the state health insurance marketplaces this spring or who are waiting for employer coverage to start don’t have to "go bare." Short-term policies that last from 30 days up to a year can help bridge the gap and offer some protection from unexpected medical expenses. But these plans provide far from comprehensive coverage, and buyers need to understand their limitations” (Andrews, 8/8). Read the article.

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Capsules: Exchange Assisters Want More Training To Help Consumers — Even After They Enroll

Now on Kaiser Health News’ blog, Shefali Luthra reports: “With the Nov. 15 kick-off for this year’s health law enrollment season fast approaching, the need for more training for the people who help consumers navigate the health insurance marketplace is growing increasingly clear” (Luthra, 8/7). Check out what else is on the blog.

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Political Cartoon: 'Clear?'

Kaiser Health News provides a fresh take on health policy developments with "Clear?" By Gary Varvel.

Meanwhile, here's today's haiku:


More risk in dying
When governors don't bring out
enough safety net
-Keanan Lane  

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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Veterans Health Care

Obama Signs $16.3B Overhaul Of Vets' Health Care System

Military veterans who have been suffering long waiting times for medical care or live significant distances from VA facilities should be able to turn to private doctors almost immediately as a result of this law, which President Barack Obama signed Thursday. The measure also provides funding to hire new health care professionals. Already, though, some say that recruiting physicians to come into the system will present a challenge.

The New York Times: Obama Signs Bill Aimed At Fixing V.A. Shortfalls
Promising a major change in the “way the V.A. does business,” President Obama traveled to this Army base outside Washington on Thursday to sign a bill that will expand access to health care for veterans and strengthen the powers of the Department of Veterans Affairs’ new leader to clean up abuses in its troubled network of hospitals (Landler, 8/7).

Los Angeles Times: Obama Signs $16.3-Billion VA Bill, Calls Mismanagement 'Outrageous'
The new law represent an unusually rapid response, and a rare increase in spending, from a Congress bitterly divided by most issues and bogged down in budget fights. It took a scandal to shake lawmakers into trying to reform the long troubled VA, which has faced growing stresses after more than a decade of American wars overseas (Hennessey, 8/7).

The Associated Press: Boost For Vets’ Health: Obama Signs New Law
Tens of thousands of military veterans who have been enduring long waits for medical care should be able to turn to private doctors almost immediately under a law signed Thursday by President Barack Obama. Other changes will take longer under the $16.3 billion law, which is the government’s most sweeping response to the problems that have rocked the Veterans Affairs Department and led to the ouster of Eric Shinseki as VA secretary (8/7).

The Wall Street Journal: Obama Signs VA Overhaul Bill
Congress passed the bill following months of turmoil at the VA, including the resignation of Secretary Eric Shinseki in late May. The agency's widespread problems included manipulation of official records to hide the fact that veterans had to wait months to receive proper care. The VA has since taken steps to correct the worst deficiencies, the White House said, including reaching out to more than 217,000 veterans to get them off wait lists and into clinics. The agency also has added more clinic hours, recruited additional staff and deployed mobile medical units. The new law gives the VA secretary more power to fire underperforming executives in the department (Sparshott and Kesling, 8/7).

USA Today: Obama Signs Veterans Health Care Bill
The $16.3 billion plan enables the VA to hire more doctors and nurses at nearly 1,000 hospitals and other medical facilities across the country. It also makes it easier to dismiss poorly performing VA officials, and protects the rights of whistle blowers who point out the system's shortcomings. The legislation arose after reports of long wait times and sub-standard care at VA hospitals, and efforts by officials to cover up the problems. The job of improving veterans' health care does not end with a bill signing, Obama said (Jackson, 8/7).

Politico: Obama Signs Veterans Bill Into Law
Some veterans groups hailed the legislation, arguing that it marks an important step in fixing the VA. John Stroud, national commander of the Veterans of Foreign Wars, said in a statement that the law will help McDonald “fix what’s broken, hold people accountable and restore the faith that veterans must have in their VA.” Still, some cautioned that there remains more work ahead. Paul Rieckhoff, chief executive and founder of Iraq and Afghanistan Veterans of America, said in a statement that the legislation represents a “good first step toward healing the VA,” but it’s not a “silver bullet” (Wright, 8/7).

Modern Healthcare: VA Bill Signed Into Law, Now Doc-Recruitment Challenge Looms
|President Barack Obama has signed a bill that not only gives the Veterans Affairs Department billions more to contract out care for vets but also roughly $5 billion to hire more medical personnel. However, experts caution that the VA will need to do a superior marketing job to lure doctors away from the private sector. The process could prove challenging, they say (Dickson, 8/7).

McClatchy: Obama Signs Bill With More Money for VA Care
President Barack Obama signed a bill into law Thursday designed to restore trust in the beleaguered Department of Veterans Affairs following a national uproar over long waits and poor care at veterans’ hospitals and clinics across the nation. The $16.3 billion bill includes money for thousands of doctors, nurses and health care specialists at nearly 1,000 hospitals and outpatient clinics. The money also will pay for veterans to receive private care if they live 40 miles or more from a VA facility, and it will finance the opening of 27 new medical facilities (Kumar, 8/7).

Bloomberg:  Obama Says Law Will Help Ends 'Inexcusable' VA Misconduct
President Barack Obama signed a bill into law that gives the secretary of the Veterans Affairs Department new powers to fire agency executives for misconduct, saying it will ensure a “culture of accountability.” The law also permits veterans to seek private health care if waiting times at a government facility are too long and authorizes spending of $17 billion over five years to expand medical care and reduce case backlogs. In remarks to an audience that included service members preparing to leave the military, Obama called mismanagement at the VA “inexcusable" (Runningen, 8/7). 

In related news -

CNN: VA Blames ‘Confusion’ For Misstatements About Deaths
The Department of Veterans Affairs apologized on Thursday for causing "confusion" in communicating about the number of deaths caused by delayed care at its medical facilities, but said "there was no intent to mislead anyone." In a statement to CNN, the VA said two separate reviews were "intertwined in written and oral statements leading to confusion. ... VA inadvertently caused confusion in its communication on this complex set of reviews that were ongoing at the time. For that, we apologize" (Griffin, Bronstein and Black, 8/7).

The Wall Street Journal: Disability Payments To Veterans More Than Doubled Since 2000
Disability payments to veterans ballooned to $54 billion in 2013 from $20 billion in 2000, according to a report released Thursday by the nonpartisan Congressional Budget Office. Overall, disability compensation accounted for 70% of the Veterans Benefits Administration's total mandatory spending in 2013 (Phillips, 8/7).

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Health Reform

Narrow Networks Still A Trouble Spot For Health Law Plans, Experts Say

The need for up-to-date information on participating providers, more training for navigators and the release of 2015 premium costs are some of the issues that continue to draw headlines.  

Modern Healthcare: Exchanges Need Better Tech Or Better Info On Narrow Networks, Experts Say
Experts and consumer advocates have faulted the Obamacare insurance exchanges for not providing clear, accurate and up-to-date information to consumers about which providers are in the health plans offered on the exchanges. Experts say in the future, exchanges will have better technological tools to offer accurate provider information. But for now, they say, such tools don't exist and insurers have to do a better job themselves at making sure their lists are up to date (Tahir, 8/7).

Kaiser Health News: Capsules: Exchange Assisters Want More Training To Help Consumers — Even After They Enroll
With the Nov. 15 kick-off for this year’s health law enrollment season fast approaching, the need for more training for the people who help consumers navigate the health insurance marketplace is growing increasingly clear (Luthra, 8/7).

The Denver Post: Colorado Health Insurance Premiums Could See Slight Rise, Study Says
Colorado could see an average health insurance premium increase of 3.6 percent next year for plans under the Affordable Care Act, according to a preliminary analysis of 2015 individual market rate filings by a research group. The Health Research Institute of PricewaterhouseCoopers this week said the 2015 insurance landscape is beginning to emerge for the 27 states that have publicly released rate filings. The average rate increase from reporting states and the District of Columbia is 7.5 percent, with an average monthly premium before federal subsidies of $384 (Draper, 8/7).

Meanwhile, on the Medicaid expansion front -

The Idaho Statesman: Idaho Losing $3.3 Billion In Federal Medicaid Funds, Says Study
A new report says Idaho will lose $3.3 billion in federal Medicaid funds, and $1.5 billion for hospital reimbursement, over roughly the next decade by not expanding its Medicaid program to all poor adults. The report from the Urban Institute and the Robert Wood Johnson Foundation, released Thursday, says Idaho's savings and new state revenues from a Medicaid expansion would the cost of implementing an expansion. Hospitals also would get reimbursed for newly eligible Medicaid patients who now lack insurance (8/7).

Sioux Falls Argus Leader: Sen. Johnson Urges Daugaard To Expand Medicaid
U.S. Sen. Tim Johnson appealed to South Dakota’s sense of right and wrong Thursday as he urged Gov. Dennis Daugaard to reconsider his opposition to expanding Medicaid under terms of federal law. “Expanding Medicaid is the moral thing to do, but it also makes economic sense,” Johnson said. “I continue to urge our state to work with the federal government to identify a path forward to expand Medicaid.” His comment brought a swift response from the governor’s office, where spokesman Tony Venhuizen said Johnson should buy into South Dakota’s proposal for resolving the issue (Jon Walker, 8/7).

In other news, exemptions to the health law's individual mandate continue to be examined -

The Fiscal Times: More Obamacare Exemptions Won’t Spike Premiums This Year
On Thursday, several news outlets highlighted a new government analysis that says the overwhelming majority of uninsured people are expected to qualify for exemptions under Obamacare—meaning they won’t have to pay a penalty if they forgo health coverage. The news stories raised concern that this could destabilize the insurance market and cause premiums to rise—since more exemptions means fewer people in the risk pool. But don’t freak out just yet (Ehley, 8/8).

CBS News: Obamacare Individual Mandate Isn’t So Much of a Mandate
One of the central planks of Obamacare was the individual mandate -- the requirement for every American to buy health insurance. Those who didn't would be required to pay a fine, ostensibly to cut down on free riders who'd refuse to pay for insurance and then stick taxpayers with the emergency room bill when they got sick. But thanks to a series of exemptions that have pushed wide swaths of Americans out of the reach of the individual mandate, almost 90 percent of uninsured Americans won't be forced to pay a fine in 2016, the Wall Street Journal reports (Miller, 8/7).

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Ariz. Gov. Backs GOP Candidate With Similar Medicaid Expansion Position

In the meantime, House Speaker John Boehner isn't hammering the health law while making speaking appearances ahead of this year's elections.

The Associated Press: Arizona Governor Makes Key Endorsement In Primary
Arizona Gov. Jan Brewer weighed in on the crowded Republican primary race to replace her Thursday, throwing her support behind a relatively moderate Republican who has backed her positions on border security, Medicaid expansion and school standards. The endorsement of former Mesa Mayor Scott Smith could transform the race and give a big boost to his candidacy, given the conservative governor’s popularity among GOP primary voters and the large number of undecided voters in the race (8/7).

Politico: What John Boehner's Not Saying On The Road
In the opening days of the tour, Boehner only once talked about President Barack Obama’s health care law, and it was an offhand remark. He said entitlement programs need "tweaks," not the massive overhaul Republicans have voted for. There was no explicit mention of suing Obama -- just a brief nod to trying to "stop the president’s overreach" (Sherman, 8/6).

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Capitol Hill Watch

Emails Sought In House Health Law Probe May Not Be 'Retrievable'

The Centers for Medicare & Medicaid Services acknowledged to the House Oversight and Government Reform Committee that the agency's director Marilyn Tavenner may have deleted "most but not all" of the emails being sought by the panel in its investigation of problems associated with the rollout of healthcare.gov.    

Fox News: Key Obamacare Official Likely Deleted Emails Now Sought In House Probe
A key ObamaCare official involved in the rocky rollout of Healthcare.gov likely deleted some of her emails that are now being sought as part of an investigation into the problems by a House committee, Fox News confirmed Thursday. The Department of Health and Human Services informed House Oversight and Government Reform Committee Chairman Darrell Issa in a letter Thursday that some of the emails belonging to Marilyn Tavenner, who leads the Centers for Medicare & Medicaid Services, may not be "retrievable" (8/8).

The Hill: Obamacare Office May Have Lost Emails Sought In Oversight Probe
The federal agency in charge of ObamaCare acknowledged this week that its chief may have deleted some emails that are now being sought by congressional Republicans. A records management official with the Centers for Medicare and Medicaid Services (CMS) alerted the National Archives of the potential breach in a letter dated Wednesday. First reported by MSNBC, the letter said that "most, but not all" of CMS Administrator Marilyn Tavenner's emails were saved in agency records as required by law (Viebeck, 8/7).

Reuters:  U.S. Says Some Health Care Emails Sought By Congress Missing 
The emails were from a public email account maintained by Marilyn Tavenner, who heads the Centers for Medicare and Medicaid Services (CMS), the Department of Health and Human Services (HHS) agency chiefly responsible for implementing President Barack Obama's healthcare reform law. "While we have not identified any specific emails that we will be unable to retrieve, it is possible that some emails may not be available," a CMS records official said in an Aug. 6 letter informing the National Archives of the situation (8/7). 

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Health Information Technology

Hospitals Slow To Adopt Electronic Health Records

Few hospitals met strict federal guidelines intended to speed adoption of electronic health records, a new study finds.

The Washington Post’s Wonkblog: Electronic Health Records Were Supposed To Be Everywhere This Year. They’re Not — But It’s Okay.
We were all supposed to have our health records online by now — the past two presidents told us as much. Why that hasn't happened yet isn't a surprise, but the country has made some good progress toward that goal, a new report finds. Ten years ago, then-President George W. Bush set a goal for most Americans to have an electronic health record by 2014. Five years later, President-elect Obama doubled down on that just before he took office, calling for all Americans to have a digital health record by this year (Millman, 8/7).

CQ Healthbeat: Hospitals Struggle To Meet CMS Goals For Electronic Health Records
Only about 5.8 percent of hospitals last year met all the requirements of a “stage 2” federal standard intended to more fully realize the potential of electronic health records, a troubling sign even amid the rising use of the technology, a new study found. Medicare and Medicaid offer higher payments to providers if they make “meaningful use” of health IT, a definition that becomes increasingly difficult to meet over the three stages of a rulemaking program being put in place over a period of years (Young, 8/7). 

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Health Care Marketplace

Feds Delay Launch Of Database Showing Drugmakers' Payments To Doctors

The system, which had been expected to go public on Sept. 30, will show payments from drug and medical device makers to doctors. The Centers for Medicare & Medicaid Services says it temporarily took down the system to investigate a possible problem.

The Hill: Doctors' 'Conflict of Interest' Database Gets Delayed
The Centers for Medicare and Medicaid Services (CMS) will delay publicly launching a new database intended to disclose potential conflicts of interest among physicians. The agency’s Open Payments System lists payments from drug and medical device makers to doctors. It was supposed to have gone public on Sept. 30 after doctors had been given a chance to dispute any information on it by Aug. 27. However, the agency released a statement Thursday noting that the database "has been taken offline temporarily to investigate a reported issue" and physicians won't be able to review their data on the site until it is fixed (Al-Faruque, 8/7).

The Wall Street Journal's Pharmalot: Still Down? Tech Glitch Hobbles Pharma Payment Disclosure System
U.S. doctors and teaching hospitals remain unable to review an online federal government database of payments they have received from drug and device makers, after a government agency shut it down to investigate a data mix-up. The Centers for Medicare and Medicaid Services took the so-called "Open Payments" system offline Sunday night and doesn't have an estimate of when it will be working again, a CMS spokesman said Thursday. The data mix-up involved at least one doctor being able to see the payment data for another doctor whose records were erroneously linked (Silverman, 8/6).

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Marketplace News: Walmart Positions Itself As A Primary Care Provider

The big-box retailer is stepping up efforts to become a destination for medical services, including chronic disease management.

The New York Times: In Ambitious Bid, Walmart Seeks Foothold In Primary Care Services
Welcome to Walmart. The nurse will be right with you. Walmart, the nation’s largest retailer, has spent years trying to turn some of its millions of customers into patients, offering a simple menu of medical services that consumers can buy along with everything from a bag of chips to a lawn mower. Now, the store is making an aggressive push to become a one-stop shopping destination for medical care (Abrams, 8/7).

Earlier, related KHN coverage: The Walmart Opportunity: Can Retailers Revamp Primary Care? (Appleby, 11/17/11).

Meanwhile, Novartis fails to secure a dismissal of kickback case -

Reuters:  Novartis Loses New Bid To Dismiss U.S. Lawsuit Over Kickbacks 
A Manhattan federal judge on Thursday said the U.S. Department of Justice may pursue most of its lawsuit accusing Novartis AG of civil fraud for allegedly using kickbacks to boost sales of drugs covered by Medicare and Medicaid. U.S. District Judge Colleen McMahon allowed the government to continue its False Claims Act case against the Swiss drugmaker over claims submitted to Medicare and some state Medicaid programs for Myfortic, used by patients with kidney transplants, and Exjade, for patients who get blood transfusions. She also dismissed a part of the case covering claims submitted to state Medicaid programs other than New York's prior to March 23, 2010, when the Affordable Care Act, also known as Obamacare, was enacted (Stempel, 8/7). 

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State Watch

State Highlights: Partners HealthCare Explains Loss; Conn. Hospital Contract Fight

A selection of health policy stories from New York, Massachusetts, Connecticut, Georgia and California.

The Associated Press: NY Awards $21.5 Million Toward Health Overhaul
New York's health department has awarded more than $21.5 million in grants to 43 hospitals, medical centers and health systems to explore redesigning their approaches to patient care to reduce avoidable hospital use and costs (8/7). 

Modern Healthcare: Partners HealthCare Blames Medicaid Underpayments, Sovaldi For Loss in Insurance Division
Partners HealthCare blamed ongoing underpayments from Massachusetts' Medicaid program for contributing to an $89 million operating loss in its insurance division during the quarter ended June 30. The Boston-based system, which has both insurance and hospital operations, said the challenges facing Medicaid managed-care organizations offset income growth in its hospital division during its fiscal third quarter. After adding in non-operating gains, Partners booked a surplus of $46.9 million on $2.8 billion in the quarter compared with a surplus of $69.5 million on revenue of $2.6 billion in the prior-year period (Kutscher, 8/7).

The CT Mirror: A Hospital Contract Dispute In A Changing Health Care Landscape
Connecticut's largest hospital network and largest insurer are in the midst of a contract dispute. It's a type of clash that's become familiar, but it's occurring in a new context, against the backdrop of significant changes in health care: the consolidation of hospitals into larger networks and efforts by insurers to change how they pay for care. The dispute pits Hartford HealthCare, the parent company of five Connecticut hospitals, against Anthem Blue Cross and Blue Shield. The two say they’ll sever ties Oct. 1 if they can’t reach a deal on new contracts (Becker, 8/8).

The Boston Globe: Steward Health Care Expanding Psychiatric Facilities
Steward Health Care System is spending millions to open new psychiatric units in its Massachusetts hospitals, filling a gap in mental health care and marking a reversal from the recent years in which hospitals had little interest in expanding these services. Psychiatric care has long been considered a drain on hospital finances, but Steward executives said sweeping changes in the way health care is paid for are shifting that calculation. The for-profit company, which owns 10 hospitals in Massachusetts, has added 40 beds for adults with mental illness or substance abuse disorders in the past nine months, and plans to expand by another 30 beds this year — a total increase of 21 percent (Kowalczyk, 8/7).

Atlanta Journal-Constitution: Two Plead Guilty In Massive Medicaid Scam
Two people have pleaded guilty to receiving money for Medicaid-related patient referrals to hospitals in Atlanta and on Hilton Head Island, S.C. Tracey Cota, 50, of Dunwoody, and Gary Lang, 58, of Atlanta, both admitted to conspiracy to violate the Anti-Kickback Statute by taking and receiving payment in exchange for Medicaid patient referrals to hospitals (Shaw, 8/7).

The California Health Report: UCSF Team Works To Meet Physical Care Needs Of Mental Health Patients
While staff at the Progress Foundation have been helping Sheila manage her mental health, nurse practitioners in the University of California San Francisco School of Nursing’s faculty practice -- Primary Care Outreach for the Mentally Ill (PCOM), which delivers primary care to Progress Foundation residents during their stay, have worked with Sheila to help her lower her blood sugar and prevent her condition from progressing to type 2 diabetes. They also want to ensure that Sheila, and other patients, continue to receive both medical and psychiatric care after they leave the residential care program (Childers, 8/8).

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Health Policy Research

Research Roundup: Medicaid's Hospital Readmissions; CHIP Enrollment

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

Health Affairs: Medicaid Admissions And Readmissions: Understanding The Prevalence, Payment, And Most Common Diagnoses
Reducing hospital readmissions is a way to improve care and reduce avoidable costs. However, there have been few studies of readmissions in the Medicaid population. We sought to characterize acute care hospital admissions and thirty-day readmissions in the Medicaid population through a retrospective analysis in nineteen states. We found that Medicaid readmissions were both prevalent (9.4 percent of all admissions) and costly ($77 million per state) and that they represented 12.5 percent of Medicaid payments for all hospitalizations. Five diagnostic groups appeared to drive Medicaid readmissions, accounting for 57 percent of readmissions and 49 percent of hospital payments for readmissions. The most prevalent diagnostic categories were mental and behavioral disorders and diagnoses related to pregnancy, childbirth, and their complications, which together accounted for 31.2 percent of readmissions (Trudnak, 8/4).

Health Affairs: Children's Health Insurance Program Premiums Adversely Affect Enrollment, Especially Among Lower-Income Children
Both Medicaid and the Children’s Health Insurance Program (CHIP), which are run by the states and funded by federal and state dollars, offer health insurance coverage for low-income children. Thirty-three states charged premiums for children at some income ranges in CHIP or Medicaid in 2013. Using data from the 1999–2010 Medical Expenditure Panel Surveys, we show that the relationship between premiums and coverage varies considerably by income level and by parental access to employer-sponsored insurance. Among children with family incomes above 150 percent of the federal poverty level, a $10 increase in monthly premiums is associated with a 1.6-percentage-point reduction in Medicaid or CHIP coverage. ... Among children with family incomes of 101–150 percent of poverty, a $10 increase in monthly premiums is associated with a 6.7-percentage-point reduction in Medicaid or CHIP coverage and a 3.3-percentage-point increase in uninsurance (Abdu et al., 8/4).

The Urban Institute: Prison Inmates' Prerelease Application For Medicaid Take-Up Rates In Oregon
People leaving prison often return to the community lacking health insurance and thus access to appropriate health care. Many have mental illness, substance abuse, and other health issues that need treatment and compound reintegration challenges. Left untreated, they are at risk of falling into a cycle of relapse, reoffending, and reincarceration. Providing Medicaid coverage upon release has the potential to improve continuity of care that may interrupt this cycle.  This report examines whether [Oregon's pre-health law] efforts to enroll people in Medicaid prior to their release from prison are successful in generating health insurance coverage after release. ... Inmates, on average, were slightly more successful than the general population in enrolling. Only 22 percent of those who applied were denied—which was about half of the denial rate for applicants in general (Mallik-Kane, 8/5).

JAMA Internal Medicine: Use Of Medical Consultants For Hospitalized Surgical Patients
Payments around episodes of inpatient surgery vary widely among hospitals. As payers move toward bundled payments, understanding sources of variation, including use of medical consultants, is important. ... [This is a] observational retrospective cohort study of fee-for-service Medicare patients undergoing colectomy or total hip replacement (THR) between January 1, 2007, and December 31, 2010, at US acute care hospitals. ... More than half of patients undergoing colectomy (91 684) or THR (339 319) received at least 1 medical consultation while hospitalized (69% and 63%, respectively). ... Our findings of wide variation in medical consultation use—particularly among patients without complications—suggests that understanding when medical consultations provide value will be important as hospitals seek to increase their efficiency under bundled payments (Chen et al., 8/4).

JAMA Surgery: Factors Associated With General Surgery Residents' Desire To Leave Residency Programs
Despite structural changes to residency programs during the past decade, including adoption of the 80-hour and then 16-hour rules, resident attrition continues to be a problem facing general surgery programs across the country. Modern attrition rates for general surgery residents remain between 3% and 5.1% annually and total 19% during the course of a 5-year to 7-year residency program. ... This multi-institutional survey of 288 categorical general surgery residents at 13 residency programs sought to determine how often residents seriously considered leaving residency and to identify what factors were associated with this response. Overall, 58.0% of respondents seriously considered leaving their training, with a median frequency of a few times a year. ... Residents were most likely to cite sleep deprivation on a specific rotation and excessive work hours on a specific rotation, but not work hours overall, as influencing their desire to leave (Gifford et al., 7/30).

The Heritage Foundation: How The Affordable Care Act Fuels Health Care Market Consolidation
The growth of monopoly power among health care providers bears much responsibility for driving up the cost of health care over recent years. By mandating that general hospitals provide uncompensated care, state and federal legislators have given them cause to insist on regulations and discriminatory subsidies to protect them from cheaper competitors. Instead of freeing these markets to allow the provision of care by the most efficient organizations, the Affordable Care Act endorses these anti-competitive arrangements. It extends the premium paid for treatment in general hospitals, employs the purchasing power of the Medicare program to encourage the consolidation of medical practices, and reforms insurance law to eliminate many of the margins for competition between carriers (Christopher Pope, 8/1).

Avalere Health: Few Medicare Beneficiaries Receive Comprehensive Medication Management Services
A new analysis from Avalere Health finds that less than half of all Medicare prescription drug (Part D) enrollees eligible for medication therapy management (MTM) programs receive these services. Under Medicare rules, the Centers for Medicare & Medicaid Services (CMS) requires all Part D plans to provide MTM services to beneficiaries who meet certain criteria and have high drug utilization. MTM services involve providing high-utilizing beneficiaries with a complete review of their medication regimens by a clinical pharmacist in order to provide education, improve adherence, and detect adverse drug events or inappropriate medication use. Specifically, CMS estimates that 25 percent of beneficiaries are eligible for MTM (2010 Medicare Part D MTM Programs Fact Sheet). Yet, only 11 percent of all Part D enrollees were part of a MTM program in 2012 (Pearson, 8/7).

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

Reuters: Paying To Lose: Cost Effectiveness Of Weight Loss Programs
As weight loss becomes more about health than vanity, insurers might increasingly be footing the bill for non-surgical reducing methods, researchers say. And they'll want to know which ones are the best investment. In a new analysis, the popular Weight Watchers program and the drug Qsymia were the most cost-effective strategies to lose weight. ... Insurers and employers are under increasing pressure to cover weight loss strategies for their customers and employees, Finkelstein said. "As such, they care both about the costs and potential benefits," he said. "To date, no study has been conducted that compares all programs against each other" (Seaman, 8/5).

Reuters: About Half Of Heart Procedure Patients Make End-Of-Life Plans
Less than half of the patients who underwent a risky heart surgery at one medical center completed advanced directives to guide their care in the event they could no longer articulate their wishes, according to a new study. In addition to ensuring patients receive care that's in line with their wishes, the study’s senior author said advanced directives reduce the burden on family members who would otherwise make those decisions (Seaman, 8/5).

WBUR: 'Cowboy' Doctors Could Be A Half-A-Trillion-Dollar American Problem
When Dartmouth economics professor Jonathan Skinner was speaking recently at the University of Texas about the “cowboy doctor” problem, an audience member objected: “You have a problem with cowboys?” Well, actually, we all have a problem with cowboys — when they’re doctors. Including the Texans. New research written up in a National Bureau of Economic Research paper finds that “cowboy” doctors — who deviate from professional guidelines, often providing more aggressive care than is recommended — are responsible for a surprisingly big portion of America’s skyrocketing health costs. The paper concludes that “36 percent of end-of-life spending, and 17 percent of U.S. health care spending, are associated with physician beliefs unsupported by clinical evidence”  (Goldberg, 8/1).

The Washington Post: Promising New Approach Helps Curb Early Schizophrenia In Teens, Young Adults
The program involves an intensive two-year course of socialization, family therapy, job and school assistance, and, in some cases, antipsychotic medication. What makes the treatment unique is that it focuses deeply on family relationships, and occurs early in the disease, often before a diagnosis. So far, the results have been striking: In Portland, Maine, where the treatment was pioneered, the rate of hospitalizations for first psychotic episodes fell by 34 percent over a six-year period, according to a March study (Somashekhar, 8/6).

NPR: House Calls Keep People Out Of Nursing Homes And Save Money
In a study conducted by MedStar Washington Hospital Center in Washington, D.C., 722 such patients were provided with home-based health care delivered by a team: a physician, a nurse practitioner, licensed practical nurses and social workers. The visits were frequent, and there was someone on call for urgent situations 24/7 (Jaffe, 8/7).

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Editorials and Opinions

Viewpoints: Finding Drug Discounts In Canada; Mo.'s Answer To Rural Doctor Shortage

Los Angeles Times: An O.C. Couple Do The Math: Same Drug Is Far Cheaper In Canada
Prescription drugs are an especially fertile source of profits. Captive markets of sick people may have no choice but to pay whatever is charged by drug companies. When [Bent] Christensen and I spoke, he was particularly incensed about prices charged for Advair, a popular asthma medication required by his 77-year-old wife. ... So Christensen did what many Americans do in the face of soaring healthcare costs: He took his business north of the border (David Lazarus, 8/7). 

Los Angeles Times: Not Enough Primary-Care Doctors? Try Missouri's Prescription.
One exceedingly controversial idea has just become law in Missouri. Missouri will allow medical school graduates to work as "assistant physicians" treating patients in underserved rural areas, even though they have not been trained in a residency program. In the U.S., at least one year of residency after medical school is usually required to practice medicine independently. Most medical school graduates spend at least three years in residency before starting to practice on their own. Under the new law, an assistant physician must have passed the first two sections of the national licensing exam for doctors but not the final one. If they want to become full-fledged physicians, they will still have to pass the last test and do a one-year residency
(Arthur L. Caplan, 8/7). 

Los Angeles Times: It's Too Soon To Give Out Ebola Drugs
Why would the United States decline to provide a serum that can cure Ebola to poor and desperate victims in several African nations where close to 1,000 people have died of the virus? Because it doesn't have such a serum. What the U.S. does have are a number of possible treatments for Ebola that are in the experimental stages. Most were developed with the help of federal financing after 9/11; drug companies previously had little financial incentive to develop drugs for an illness that affected relatively few people, all of them in developing countries. But after the 2001 attacks, the government became interested in staving off possible bioterrorism (8/7). 

The Wall Street Journal: The Battle Against Misdiagnosis
There are times when a single, unexpected death sparks a change in medical practice. In 2012 a 12-year-old boy named Rory Staunton died after being misdiagnosed in a New York City emergency room. Multiple physicians missed the symptoms, signs and lab results pointing to a streptococcal bacterial infection that led to septic shock and overwhelmed Rory's body. The tragedy prompted New York state in January 2013 to introduce "Rory's regulations," a set of stringent protocols aimed at preventing similar incidents in hospitals (Hardeep Singh, 8/7). 

The New Republic: MAP: Your State Lost Billions By Refusing To Expand Medicaid
About half the states have not expanded Medicaid, which means they didn’t make it available to all low-income people as the Affordable Care Act’s architects originally intended. ... Conservatives state officials and their supporters frequently justify the decisions by arguing that they are simply looking after their states’ finances. ... A new report from researchers at the Urban Institute, and supported by the Robert Wood Johnson Foundation, shows just how shortsighted that decision is. Yes, states have to spend money to expand Medicaid. But they get much, more back from the federal government (Jonathan Cohn, 8/7).

The New Republic: The Latest Obamacare 'Glitch' Isn't A Glitch At All—And It's Democrats' Fault
If you enrolled in a health plan through an Obamacare exchange in the past 10 months, you could be forgiven for assuming that your work was mostly done—that if your income didn't rise significantly, and you were satisfied with your plan, you were good to go until, say, your employment or marital status changed. But you actually have to re-enroll every year. And there’s no guarantee that a) your existing plan will still be available, b) its premiums won’t increase, or c) the government’s contribution to your premium won’t fall. ... beneficiaries who do the easy thing and re-enroll automatically are likely to discover at some point in 2015 that they’re on the hook for more money than they were this year (Brian Beutler, 8/7).

The New England Journal of Medicine: Time Off To Care For A Sick Child — Why Family-Leave Policies Matter
Health care providers and public health officials routinely recommend that acutely ill children stay home from school and, if necessary, see a clinician. Otherwise, their illnesses can worsen or spread to others, health care costs can increase, and small problems can become serious threats. But for many employed parents, taking time off to care for a sick child means losing income or, worse, risking their job. ... Paid sick days could help families and communities avoid such consequences. According to a 2010 national study, employees who receive paid sick days are substantially less likely than employees without such benefits to send a sick child to school. But it's not only preventable hospitalizations and contagion that are at issue: when children are sick enough to require medical attention, we need parents to be with them (Drs. Mark A. Schuster and Paul J. Chung, 8/7).

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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.