Daily Health Policy Report

Friday, September 14, 2012

Last updated: Fri, Sep 14

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Campaign 2012

Health Reform

Health Care Marketplace

Public Health & Education

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Q & A: What's The Difference Between A Doctor And A Nurse Practitioner? (Video)

Kaiser Health News consumer columnist Michelle Andrews answers a reader's question about the differences in practice and qualifications between doctors and nurse practitioners (9/14). Watch the video.

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Kansas Wrestles With Essential Health Insurance Benefits Decisions

Kansas Public Radio's Bryan Thompson, working in partnership with Kaiser Health News News and NPR, reports: "Kansas insurance officials – trying to develop a recommendation for 'essential health benefits' that individual and small group health insurance policies will be required to offer under the 2010 federal health law – are running into a problem: the calendar" (Thompson, 9/13). Read the story.

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Capsules: Long-Term Care A Big Time Worry In California; Workers' Poor Health Costs Employers $344 Billion

Now on Kaiser Health News' blog, Sarah Varney reports on a study regarding California voters' thoughts on long-term care: "It turns out Republicans and Democrats do have something they can agree on this election season – they're worried about how to pay for long-term care when they or a family member can no longer live at home. A new poll released Wednesday by The SCAN Foundation and the UCLA Center for Health Policy Research found that half of California voters say they'll need long-term care for a close family member in the next few years, but won't be able to afford it" (Varney, 9/13).

Also on Capsules, Julie Appleby reports on another study, this one regarding how workers' poor health costs money: " Health costs aren’t just about how much employers pay to provide health insurance: Workers’ poor health costs employers $344 billion annually in lost productivity and absenteeism, a research group estimates" (Appleby, 9/14). Check out what else is on the blog.

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Political Cartoon: 'Does Punctuation Matter?'

Kaiser Health News provides a fresh take on health policy developments with "Does Punctuation Matter?" by Nick Anderson.

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

Grassley And Kohl To CMS: Just Say When...

Ain't no sunshine on
deals between docs, drugmakers
'til the rule comes out.
-Anonymous

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

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Capitol Hill Watch

Spending Measure Passes House With Ryan's Support

House Budget Committee Chairman Paul Ryan, R-Wis., returned to the chamber Thursday for the first time since he became the GOP vice presidential candidate, casting his vote for a measure that raised spending above the levels in his own budget. Republicans hailed him, while Democrats released a video highlighting his proposal to overhaul Medicare as a fixed subsidy program.

The Wall  Street Journal: Spending Package Passes In House
The legislation was necessary because Congress hasn't passed any of the 12 spending bills required each year to fund the federal government. The six-month bill covers around a third of the federal spending. The remainder—including big-ticket programs like Medicare, Medicaid and Social Security—are renewed automatically without congressional action. House lawmakers separately on Thursday approved legislation aimed at forcing the president into coming up with a plan to avoid $110 billion in spending cuts, half to come from defense spending, that are set to be implemented early in 2013 under current law. That measure is almost certain not to be taken up by the Democratic-controlled Senate. The administration is expected to release a spending-cut outline as early as Friday (Boles, 9/13).

The New York Times: House Republicans Welcome Back Ryan, And His Vote, On A Spending Measure
Representative Paul D. Ryan, the Republican vice-presidential nominee, returned to the House on Thursday for a hero's welcome from adoring Republicans, jeers from opposition Democrats and a mission that was as painful as it was politically necessary: to give his blessing to legislation financing the government into next year at a level higher than the one set in his own budget. Democrats joined in the Ryan welcome in another way as well. Representative Steve Israel of New York, chairman of the Democratic Congressional Campaign Committee, thanked him for making his Medicare overhaul a centerpiece of the election. The House Democratic leadership released a mocking "Welcome Back, Mr. Ryan" video rapping him for boasting about securing automatic spending cuts that he now denounces and pressing for an overhaul that would offer future retirees a fixed subsidy to buy health insurance rather than a guaranteed government program (Weisman, 9/13).

The Washington Post: GOP Vice Presidential Candidate Paul Ryan Makes Low-Key Return To Capitol Hill
Ryan's return should have been a moment of celebration. By selecting the House Budget Committee chairman as his running mate, Romney affirmed the House Republicans as keepers of the GOP idea. But, in the risk-averse environment of a campaign, there were also good reasons for Ryan and his colleagues to avoid one another. A close association with Ryan could make trouble for some members in tight reelection campaigns. The cornerstone of Ryan's budget proposals, a plan to restructure Medicare for future recipients, is widely unpopular. And a close association with congressional Republicans might not be helpful for Ryan, either. In one late August poll, two-thirds of respondents disapproved of their job performance (Sonmez and Fahrenthold, 9/13).

The Associated Press/Washington Post: Ryan Votes For Spending Bill That Is $19 Billion Higher than Budget Outline He Authored
The House chamber later erupted in a loud cheer — mostly from the Republican side — when Ryan entered the hall. Ryan held court in the rear of the chamber as back-slapping colleagues surrounded him. … Democrats, meanwhile, worked to highlight components of Ryan's budget proposals that would fundamentally change seniors' health care and young voters’ education options. Democrats, including Obama's re-election campaign, have constantly linked Romney's presidential campaign with the Ryan-proposed cuts (9/13).

The Hill: Pelosi: 'Medicare Is On The Ballot' With Ryan On GOP Ticket
Rep. Paul Ryan's (R-Wis.) position as the GOP vice presidential nominee is good news for Democrats who oppose his plans for Medicare, House Minority Leader Nancy Pelosi (D-Calif.) said Thursday. "[Mitt] Romney embraced the repeal of Medicare" by choosing Ryan as his running mate, Pelosi said. "Governor Romney is making it easier" for Democrats on the campaign trail "by embracing the repeal of Medicare," she said. The comments closely mirror remarks from Democratic Congressional Campaign Committee chief Steve Israel (D-N.Y.), who said Thursday that Ryan is a "down-ballot disaster for Republicans across the country" (Viebeck, 9/13).

Politico Pro: Ryan Returns To Hill, Talks SGR
If you blinked, you missed him. House Budget Committee Chairman and vice presidential candidate Paul Ryan strode into the Capitol — security entourage in tow — past a swarm of reporters, offered brief pleasantries and disappeared into the speaker's suite to meet quietly with his colleagues. Nary a word about Medicare, block-grants, or repeal to be heard, although there was a bit of SGR talk. ... Rep. Michael Burgess (R-Texas) was among the few who said he approached Ryan to talk policy, specifically how to handle a sharp cut in reimbursement rates for Medicare providers due to take effect later this year (Cheney, 9/13).

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Campaign 2012

Medicare Policies Continue To Claim Campaign Trail Attention

The presidential and vice presidential candidates compare and contrast their plans, and some fact checkers set to work on sorting out what they are saying.

Politico: Obama: Best Medicare Solution Is 'Smarter' Health Care
President Barack Obama said Thursday that the right way to cut Medicare spending is by making health care "smarter" — not by shifting costs to seniors, as he claims the Mitt Romney-Paul Ryan Medicare plan would do. Campaigning in Golden, Colo., Obama said the best way to get Medicare savings is to cut out wasteful health care spending. In a more efficient health care system, "instead of five tests you get one test, and it's emailed everywhere," Obama said (Nather, 9/13).

The Washington Post's The Fact Checker: Romney's Medicare Remarks: Would He Pass Costs On To Seniors Or Not?
GOP presidential candidate Mitt Romney faced questions about his policy proposals during an interview that aired Sunday on NBC's "Meet the Press."… The Ryan plan would eventually cap government payments toward Medicare and provide future generations of seniors with premium-support payments …  to purchase coverage through traditional Medicare or on the private market. (David) Gregory asked Romney: "If competitive bidding in Medicare fails to bring down prices, you have a choice of either passing that cost on to seniors or blowing up the deficit. What would you do?" … Romney pointed to Medicare Advantage and Medicare Part D as proof that competitive bidding works to bring down costs. Let's look at how those entitlement programs impact federal spending and determine how much they really compare to the Ryan plan (Hicks, 9/13).

The Wall Street Journal's Washington Wire: Obama, Ryan Plan To Address AARP
Questions about Medicare and Social Security will be front and center in the presidential campaign next week when President Barack Obama and Republican vice presidential nominee Paul Ryan address the senior group AARP in back to back sessions on Sept. 21. Mr. Obama will speak via satellite, the group said (Meckler, 9/13).

The New York Times: Biden Hammers GOP Ticket's Domestic Policies
Mr. Biden attacked Mr. Ryan in particular, tying details from his House budget plan to Mitt Romney as he criticized the Republicans on education, tax cuts for the wealthy, Medicare and a refusal to compromise on debt reduction. Mr. Ryan's addition to the Republican ticket has raised the pressure on President Obama in Wisconsin, Mr. Ryan's home state, whose rightward tilt since 2010 already assured that it would not be the comfortable win Mr. Obama enjoyed four years ago. On Wednesday, Mr. Obama unveiled his first television advertisements in the state (Gabriel, 9/13).

Meanwhile, Democrats are focusing on the health law as a motivator for fundraising.

The Hill: Dems Raise Funds To 'Protect ObamaCare'
Democrats are hoping to draw on support for President Obama's healthcare law as they fundraise for November. In an email to supporters Thursday, the Obama Victory Fund 2012 asked for donations using an appeal from Stacey Lihn, the mother of a child with a heart defect. Lihn also spoke at the Democratic National Convention earlier this month — an event that conspicuously embraced the Affordable Care Act. "When you have a sick child, you have to constantly worry about so many things. For me, one of them is whether an insurance company can take away my daughter's health coverage," Lihn wrote in Thursday's email (Viebeck, 9/13).

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Obama Leads In Latest Polls

News outlets report that President Barack Obama fared well in several battleground states after the political conventions, posing a challenge for GOP nominee Mitt Romney.

USA Today: Obama's Lead Poses Test For Romney
In the week after the political conventions ended, President Obama has opened the most significant, sustained lead in the daily Gallup Poll since Mitt Romney emerged as the Republican nominee last spring (Page, 9/14).

Politico: NBC/WSJ Poll: Obama Leads In Florida, Virginia, Ohio
The latest NBC/WSJ/Marist swing state surveys of Ohio, Florida and Virginia do not hold good news for Mitt Romney following the two weeks of party conventions. President Obama leads Ohio, a crucial battleground, by seven points, according to the surveys. He leads by five points in the other two. And the undecideds are few (Haberman, 9/13).

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Health Reform

AHIP Offers Advice On Essential Benefits And Keeping Premium Costs Affordable

Meanwhile, Kansas officials are facing a ticking clock as they try to develop recommendations for what should make up the state's essential benefits in individual and small group health insurance policies.

CQ HealthBeat: AHIP Urges Leaner Benefits To Keep Premiums Affordable Under Health Law
A spokesman for the nation's biggest health insurance lobby testified in Congress this week that the health care law should be changed to require less generous benefits than it does now. "Consideration should be given to lowering the minimum actuarial value for coverage sold in the exchanges to ensure the availability of affordable coverage options and to allow smoother transitions to new benefits packages," said Daniel T. Durham, executive vice president with America's Health Insurance Plans. The law requires health coverage to meet a minimum set of "essential health benefits" that each state will determine based on one several benchmark plans. In addition, starting in 2014, policies sold through insurance exchanges must be at one of four benefit levels which vary based on the percentage of the actuarial value of the health care services the plans cover. The levels are bronze, 60 percent; silver, 70 percent; gold, 80 percent; and platinum, 90 percent (Reichard, 9/13).

Kaiser Health News: Kansas Wrestles With Whether To Decide Which Health Insurance Benefits Are Essential
Kansas insurance officials – trying to develop a recommendation for 'essential health benefits' that individual and small group health insurance policies will be required to offer under the 2010 federal health law – are running into a problem: the calendar (Thompson, 9/13).

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Health Care Marketplace

Why Are Health Care Costs Increasing At A Slower Rate?

National Journal: What's Behind The Slowdown In Health Care Costs?
Health care spending increased by just 3.9 percent in 2010 and 3.8 percent in 2009. And within Medicare, the spending slowdown has been even more dramatic: Instead of the program's average 6 percent annual increase per beneficiary in recent years, 2010's rate was 0.2 percent. In 2011, it was 2.8 percent. This benefits household budgets but also the government's coffers since the longer-term costs of Medicare and other health entitlements pose huge fiscal challenges for the nation. But economists on both sides of the political spectrum say that a variety of forces are at work in the more restrained increases in health care spending. One factor is a weak economy, which means Americans might opt to postpone elective procedures like cataract or knee surgery to avoid out-of-pocket costs that aren't covered by insurance (McCarthy, 9/13).

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Public Health & Education

NYC Board Of Health OKs Nation's First Ban Of Oversized Sugary Drinks

The mayoral-appointed panel outlawed the sale of sugary drinks in sizes larger than 16 ounces nearly everywhere, except in grocery and convenience stores.

Reuters: New York OKs Nation's First Ban On Super-Sized Sugary Drinks
New York City passed the first U.S. ban of oversized sugary drinks on Thursday in its latest controversial step to reduce obesity and its deadly complications in a nation with a weight problem. By an 8-0 vote with one abstention, the mayoral-appointed city health board outlawed sugary drinks larger than 16 ounces nearly everywhere they are sold, except groceries and convenience stores (Allen, 9/13).

The Wall Street Journal: New York City Bans Sale Of Big Sugary Beverages
The New York City Board of Health on Thursday approved Mayor Michael Bloomberg's controversial proposal to ban the sale of large sugary drinks in restaurants and other venues, a sweeping initiative that backers hope will reduce obesity and critics decry as government run amok (Saul, 9/13).

CNN (Video): New York Health Board Approves Ban On Large Sodas
New York City's Board of Health voted Thursday to ban the sale of sugary drinks in containers larger than 16 ounces in restaurants and other venues, in a move meant to combat obesity and encourage residents to live healthier lifestyles. The board voted eight in favor, with one abstention. "It's time to face the facts: obesity is one of America's most deadly problems, and sugary beverages are a leading cause of it," said New York Mayor Michael Bloomberg in a statement earlier this month. "As the size of sugary drinks has grown, so have our waistlines -- and so have diabetes and heart disease." But the move is expected to draw further protest from the soda industry and those concerned about government involvement in their personal choices (Lerner, 9/14).

Medpage Today: Big Apple Ban On Big Sodas Gets Go-Ahead
The New York City health department approved on Thursday a proposed ban on the sale of soda and other sugary drinks in containers larger than 16 ounces. "We're taking action in NYC because obesity is a national epidemic that is getting worse," New York City Mayor Michael Bloomberg said in a tweet. The 16-ounce cup will be the top size available at the city's restaurants, delis, fast-food chains, concession stands, movie theaters, Broadway theaters, workplace cafeterias, and other locations serving prepared foods. The size cap doesn't apply to water, diet sodas, or drinks sold in supermarkets or convenience stores, according to reports. When the ban was first announced in May, Bloomberg acknowledged that customers would still be able to order more than one cup to get a super-sized dose of soda (Fiore, 9/13).

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State Watch

Most Californians Say They Couldn't Pay For Nursing Home Care

A new survey of Californians finds that most residents say they couldn't afford to pay for care in a nursing home for a family member.

Kaiser Health News: Capsules: Long-Term Care A Big Time Worry In California, Study Finds
It turns out Republicans and Democrats do have something they can agree on this election season -- they're worried about how to pay for long-term care when they or a family member can no longer live at home. A new poll released Wednesday by The SCAN Foundation and the UCLA Center for Health Policy Research found that half of California voters say they'll need long-term care for a close family member in the next few years, but won't be able to afford it" (Varney, 9/13).

HealthyCal: Poll: Most Middle-Aged Voters Couldn't Afford Nursing Home Care
Nearly three-fourths of middle-aged Californian voters say they could not afford three months in a nursing home, and nearly half say they couldn't afford even a single month, according to a new poll released Thursday by the UCLA Center for Health Policy Research. The poll, conducted by Lake Research Partners and Chesapeake Beach Consulting, surveyed 1,667 registered California voters age 40 and older in English and Spanish. The poll was funded by The SCAN Foundation (9/13).

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Court Denies Maine Medicaid Lawsuit, Says To Give CMS Time To Rule On Cuts

A federal appeals court rejected a Maine lawsuit Thursday and said the state -- which wants to cut 30,000 from its Medicaid rolls -- needs to allow the Centers for Medicare and Medicaid Services time to review its request.

Politico Pro: Court To Maine: Can You Be Patient?
A federal appeals court told Maine today that the state will have to be patient as CMS reviews the state's request to cut almost 30,000 people from the Medicaid rolls. Maine had asked the court to force CMS to make an immediate decision on the state's requested Medicaid changes, but a 1st Circuit Court of Appeals judge said today there's no need to rush (Millman, 9/13).

The Associated Press: Federal Court Rejects Maine's Medicaid Lawsuit
A federal appeals court on Thursday rejected Maine's lawsuit that demanded swift action from the federal government on the state's Aug. 1 request to eliminate Medicaid coverage for more than 20,000 residents. The 1st U.S. Circuit Court of Appeals in Boston declared the lawsuit premature because the federal Centers for Medicare and Medicaid Services had 90 days -- until Nov. 1 -- by statute to consider Maine's waiver request (9/13).

In other Medicaid news --

The Associated Press: The Seattle Times: McKenna Touts Incentives To Save Money On Health Care
Attorney General Rob McKenna said Thursday he wants to tap Washington's creativity and use financial incentives to encourage doctors and consumers to save the state money on health care. At a news conference on Thursday across the street from the University of Washington Medical Center, the Republican candidate for governor also said he expects to negotiate with the federal government to give the state more flexibility on Medicaid. McKenna said he doesn't want to push anyone off the free or low-cost health insurance for those who can't afford private insurance, but he also doesn't want to make Medicaid so attractive that some people who have insurance through work will switch to Medicaid if they are eligible (Blankinship, 9/13).

Kansas Health Institute News: Provider Groups Nervous About Lack Of KanCare Details
Administration officials and insurance company representatives assured a legislative committee today that KanCare should be ready to launch as planned on Jan. 1, pending federal approvals. But spokespersons for hospitals, nursing homes and other Medicaid providers told members of the Joint Budget Committee that they were growing increasingly alarmed about the lack of operational details and remaining unanswered questions about how Gov. Sam Brownback's anticipated Medicaid system makeover is expected to work. "We are increasingly anxious about the lack of specific answers concerning how KanCare will actually operate," said Rachel Monger of Leading Age Kansas, an association of the state's nonprofit nursing homes that was generally supportive of KanCare after the initiative was announced in November 2011 (Shields, 9/13).

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Health Net Sued Over 'Medically Unnecessary' Coverage Denials

Some Californians are suing Health Net over the insurer's refusal to cover some treatments after it deemed them medically unnecessary.

Los Angeles Times: Health Net Faces Suit Over Refusals To Cover Treatments
Robert Mendoza of Monrovia says he had to come up with about $30,000 last year to pay for a cancer surgery that his insurer, Health Net Inc., refused to cover because it wasn't considered "medically necessary" (Terhune, 9/13).

Reuters: LA Doctors, Patients Sue Health Net For Denying Claims
The group representing Los Angeles doctors has joined with two patients to sue Health Net Inc for denying claims based on the insurer's definition of "medical necessity." The lawsuit, filed in Los Angeles Superior Court, accuses Health Net of unfair and unlawful business practices. The managed care plan operates mostly in the western United States and has 2.3 million members in California (Beasley, 9/13).

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State News: Calif. To Probe Hospital/Doctor Consolidations

News outlets report on a variety of health issues in California, Illinois, Massachusetts, Minnesota, Oregon and Virginia.

The Wall Street Journal: Doctor, Hospital Deals Probed
California's attorney general has launched a broad investigation into whether growing consolidation among hospitals and doctor groups is pushing up the price of medical care, reflecting increasing scrutiny by antitrust regulators of medical-provider deals (Mathews, 9/13).

Los Angeles Times/Chicago Tribune: Chicago Teachers, School District Seem Closer To Ending Strike
Under the latest deal offered by Chicago Public Schools, evaluations of tenured teachers during the first year could not result in dismissal; later evaluations could be appealed; and health insurance rates would hold steady if the union agreed to take part in a wellness program (Doyle, Delgado and Hood, 9/14).

Virginian-Pilot: Cuccinelli Issues Warning Over Abortion Rules
Attorney General Ken Cuccinelli has threatened Board of Health members that they could be denied state legal counsel and have to pay for their own defense if they again disregard his advice about relaxing controversial abortion clinic rules and litigation ensues. That warning is spelled out in a memo Wednesday from the Attorney General's Office – the lawyer for state agencies and boards – obtained by The Virginian-Pilot days before a board meeting to reconsider regulations for the licensure of clinics (Walker, 9/13).

The Wall Street Journal: Cities' Revenue Keeps Shrinking
The skyrocketing costs of pensions and health care are also taking a toll on cities. Among the 324 cities surveyed, 77% said pension costs increased in 2012 from the previous year, and 81% said the same of health-care costs (Vara, 9/13).

CQ HealthBeat: Massachusetts Business Leaders Have a Message: A Health Care Law Can Work
A health care overhaul that brings business and politicians to the same table for debate, negotiation and ultimately successful legislation sounds like a deal forged in never-never land. But Massachusetts business leaders said at a forum at Georgetown University this week that it really did happen that way in their state, and that their 2006 law has been good for the business climate as well as the newly insured. "We were willing to compromise when we had to, without giving up on our core values," said Richard C. Lord, CEO of the Associated Industries of Massachusetts (Norman, 9/13).

(St. Paul) Pioneer Press: Minnesota: State Rolls Out Strategy To Address Prescription Opiate Abuse, Heroin
State officials announced Thursday, Sept. 13, a new strategy to deal with growing health and public safety problems involving prescription opiate abuse as well as heroin. One goal is to train physicians in the basics of addiction, opiate prescribing and alternative approaches to pain management, according to a report from the state Department of Human Services. The state also hopes to train a range of front-line professionals about prescription drug abuse, treatment options for opium addicts and how to reduce an opium overdose (Snowbeck, 9/13).

The Oregonian: Oregon Health Reforms Proceeding As Issues Arise, Lawmakers Told
A top state health administrator told lawmakers Thursday that reform of the state's Oregon Health Plan is proceeding quickly but not without issues, while some lawmakers questioned whether it is moving quickly enough. In laws passed in 2011 and 2012, lawmakers approved new provider organizations called coordinated care groups to rein the growth of state Medicaid spending. Since August, 13 of these groups have started up and three more are awaiting approval, meaning about 75 percent of the health plan's 650,000 members will be enrolled, Bruce Goldberg, director of the Oregon Health Authority, said in a joint meeting of the state Senate and House health care committees (Budnick, 9/13).

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Health Policy Research

Research Roundup: Patients' Experiences At Safety-Net Hospitals

Each week KHN reporter Ankita Rao compiles a selection of recently released health policy studies and briefs.

Archives of Internal Medicine: Patient Experience In Safety-Net Hospitals
Safety-net hospitals, which provide care to low-income patients, perform lower than other hospitals on measures of patient experience, according to this sample of 2,096 hospitals examining patient evaluations about the quality of care they received. About 64 percent of patients rated the hospital a nine or 10 on the 10-point scale compared to 69.5 percent of patients at non-safety-net hospitals. The federal health law will tie part of a hospital's Medicare reimbursements to several measures of quality, including patient satisfaction.  The researchers concluded that the safety net hospitals "have lower performance than non-SNHs on metrics of patient-reported experience, improved somewhat more slowly under public reporting, and are likely to fare poorly under" the health law's "value-based purchasing program" (Chatterjee et al., 9/10/12).  

Health Affairs: Visits To Retail Clinics Grew Fourfold From 2007 to 2009, Although Their Share To Overall Outpatient Visits Remains Low
Researchers found that visits to retail clinics grew from 1.48 million (2000-2006) to 5.97 million (2007-2009). The  increasingly popular clinics in pharmacies, grocery stores and other retail outlets are expanding their services and sometimes partnering with health care systems. The authors write: "Preventive care—in particular, the influenza vaccine—was a larger component of care for patients at retail clinics in 2007–09, compared to patients in 2000–06 (47.5 percent versus 21.8 percent). Across all retail clinic visits, 44.4 percent in 2007–09 were on the weekend or during weekday hours when physician offices are typically closed. The rapid growth of retail clinics makes it clear that they are meeting a patient need" (Mehrotra and Lave, 8/12).

Journal of General Internal Medicine: Health-Care Costs At End Of Life Exceed Total Assets For 25 Percent Of Medicare Population
Average out-of-pocket spending for seniors in the last five years of life is $38,688 for individuals and $51,030 for couples in which one spouse dies. Using data from the biennial Health and Retirement Study, researchers found that for 25 percent of "subjects" expenditures exceeded baseline total household assets." Results varied by race or ethnicity; minorities had the lowest mean income and assets, and were in the lowest quartile for spending. The authors conclude that Medicare does not cover "a variety of services particularly valuable for those with chronic diseases or a life limiting illness. ... elderly households face considerable financial risk from out-of-pocket healthcare expenses at the end of life. Disease-related differences in this risk complicate efforts to anticipate or plan for health-related expenditures in the last 5 years of life" (Kelley et al., 9/8/12).

Journal of General Internal Medicine: A Randomized, Controlled Trial of Implementing The Patient-Centered Medical Home Model In Solo and Small Practices
A patient-centered medical home is usually a physician-directed practice that integrates and improve acute and preventive care. Researchers compared two sets of small physicians practices: one set received support, including help in practice redesign, care management and revised payment schedules, the other group of physicians practices did not get support. They conclude: "Irrespective of size, practices can make rapid and sustained transition to a PCMH when provided external supports, including practice redesign, care management and payment reform. Without such supports, change is slow and limited in scope" (Fifield et al., 9/7/12).

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

Medscape: Access to Primary Care Improves Breast Cancer Outcomes
For breast cancer patients, receiving adequate care in the primary care setting could improve outcomes. Specifically, more office visits to a primary care physician was associated with earlier diagnosis and improved outcomes. ... according to a study published in the September/October issue of the Annals of Family Medicine. In addition, breast-cancer-related mortality was 41% lower and overall mortality was 27% lower in these women than in those who had made 1 or no visits (Nelson, 9/11).

Medscape: Hospitals Cut Central-Line Infections 40% With Safety Plan
More than 1000 hospitals in 44 states lowered their rate of central line-associated bloodstream infections (CLABSIs) by 40% over 4 years through a program that features a checklist of precautions such as hand washing and donning sterile apparel, the federal Agency for Healthcare Research and Quality (AHRQ) announced today. AHRQ estimates that the program prevented more than 2000 CLABSIs, saved more than 500 lives, and avoided more than $34 million in healthcare costs (Lowes, 9/10).

Medscape: Extended Office Hours Linked to Lower Health Expenditures
Patients with access to regular healthcare that included extended office hours had less use of and more than 10% lower total expenditures for office visits, prescription medications, emergency department visits, and hospitalizations, according to data from 30,714 patients surveyed for the Medical Expenditure Panel Survey between 2000 and 2008. ... [according to] the Annals of Family Medicine (Brown, 9/10).

MedPage Today: When Drugs Go OTC, Risks Get Fewer Mentions
Ads for prescription drugs that made the leap to over-the-counter (OTC) status were far less likely to warn about potential risks, ... Jeremy Greene, MD, PhD, of Brigham & Women's Hospital in Boston, and colleagues reported in a research letter in the Journal of the American Medical Association (Fiore, 9/11).

MedPage Today: More Heart Docs Working for Hospitals
Although most cardiology practices are still owned by physicians, the percentage owned by hospitals has increased in the past 5 years, a survey by the American College of Cardiology (ACC) showed. In 2007, 73% of practices were owned by physicians and 8% were owned by hospitals, but this year those proportions have shifted to 60% and 24%, respectively, according to findings from the ACC Cardiovascular Practice Census (Neale, 9/11).  

Politico Pro: Report: Risk Pools Won't Work Scaled Up
The health reform law's high-risk insurance pools, one of the first pieces of the law to be enacted, are operating at a loss and prohibitively expensive — but they also provide needed coverage to a small group of people, according to a new report out Thursday. The Commonwealth Fund report found that the Pre-Existing Condition Insurance Plans are providing a solid "bridge" to extend insurance coverage until the health insurance exchanges and other pieces of the law are set up in 2014. But the report's authors warn that Republican proposals to set up more widespread high-risk pools would not work (Haberkorn, 9/13).

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Editorials and Opinions

Viewpoints: While Health Care Demand Rises, Medical Schools Turn Away Thousands; Jeb Bush On State-Based Medicaid Changes

The New York Times: America's Health Worker Mismatch
Despite high unemployment, there is one bright spot in the economy: while nearly all other sectors shrank during the recession, jobs in health care increased by more than 1.2 million, with most paying salaries of over $60,000. And demand for those workers will keep improving. ... But for American health workers, this is hardly good news. Despite a labor shortage, our crowded medical professional schools are turning away hundreds of thousands of qualified applicants; to fill the gap, we are importing tens of thousands of foreign workers. ... (schools in the health professions) have done little to expand their output. Even worse, ... public medical school tuitions have increased 312 percent (Kate Tulenko, 9/13).

The Washington Post: Health Care's Heap Of Wasteful Spending
How much waste is there in this nation's health care system? Try $765 billion. That's the estimate from the Institute of Medicine, covering everything from unneeded tests to excessive administrative costs. The estimate is for 2009, when health spending totaled $2.5 trillion. "Waste" was 31 percent, or almost one dollar in three (Robert J. Samuelson, 9/13).

USA Today: Bold Ideas Come From The States, Not Washington
Our Medicaid health insurance program is dysfunctional and costly. Instead of exponentially expanding this broken system, why not allow states to implement consumer-driven options that could be less costly with better health outcomes? Unlike Washington, states can't just print money, throw it at a program, and cross their fingers. Because most states are required to balance their budgets, they have become leaders in right-sizing government and investing tax dollars wisely (Jeb Bush, 9/13).

Christian Science Monitor: Health-Care Costs Shift From Employer To Employee
Employer outlays for workers' health insurance slowed from a 9 percent jump last year to less than half that — 4 percent — this year, according to a new survey from the Kaiser Foundation. Good news? Our political class believes it is. ... But both sides ignore one big reason for the drop: Employers are shifting healthcare costs to their workers. ... When it comes to health insurance, employees increasingly have to choose between health-insurance policies with sky-high premiums or with sky-high co-payments and deductibles. And since they can't afford the former they're opting for the big co-payments and deductibles – or no insurance at all. The result is fewer visits to the doctor and less use of other medical services (Robert Reich, 9/13).

Bloomberg: Romney Re-Explains Why He Can't Be Trusted On Health Care
Over the weekend, Mitt Romney muddied the waters about where he stands on health-care reform with a series of vague statements from himself and his campaign about health insurance for people with pre-existing conditions. His floundering is a subset of a larger problem: He has committed himself to a set of positions that won't allow for a replacement of Obamacare with something that actually fixes the problem of tens of millions of Americans without health insurance, including those with pre-existing conditions (Josh Barro, 9/13).

The Statesman Journal (Oregon): Health Care System In Future Will Require More Partnerships
Seismic change is coming to health care. ... Our current health care system excludes millions from decent coverage, is geared toward crisis care rather than keeping people healthy and produces outcomes that rank us well below other first-world countries. ... The Salem Health Board of Trustees sets the direction for Salem Hospital, West Valley Hospital and Willamette Health Partners. We pay attention to what people tell us they want, how health care is changing and how the system needs to change. We have determined that to thrive, health systems of the future must: Offer a depth and breadth of clinical services to a broader geographic area, work with physicians to integrate patient care so it is coordinated and effective, reduce variation in cost of care among physicians (Ken Sherman Jr., 9/13).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.