First Edition: June 10, 2014

Today's headlines include details of an extensive, nationwide audit of the wait times for care at VA hospitals and clinics.   

Kaiser Health News: Health On The Hill: Budget Referees Make It Harder To Evaluate Obamacare Costs
The Congressional Budget Office will no longer evaluate the fiscal implications of some parts of the Affordable Care Act, partly because of all the changes made during implementation. Kaiser Health News' Mary Agnes Carey and The Fiscal Times' Eric Pianin discuss the developments (6/9). Watch the video or read the transcript.

Kaiser Health News: Insuring Your Health: School Nurses' Role Expands With Access To Students’ Online Health Records
Kaiser Health News’ consumer columnist Michelle Andrews writes: “Although the school nurse is a familiar figure, school-based health care is unfamiliar territory to many medical professionals, operating in a largely separate health care universe from other community-based medical services. Now, as both schools and health care systems seek to ensure that children coping with chronic conditions such as diabetes and asthma get the comprehensive, coordinated care the students need, the schools and health systems are forming partnerships to better integrate their services” (Andrews, 6/10). Read the column.

Kaiser Health News: Capsules: Study Puts A Price Tag On Autism
Now on Kaiser Health News’ blog, Jenny Gold reports: “Autism exacts a heavy toll on families across the country, but what is the financial cost of the disorder? Now we have an actual price tag: the lifetime cost of supporting a person with autism ranges from $1.4 million to $2.4 million in the United States, depending on whether the person also has an intellectual disability” (Gold, 6/10). Check out what else is on the blog.

The Wall Street Journal: Insurers Fill Gaps in Health-Law Plans
Health insurers in several states are adding to the choices of doctors and hospitals in their health-law plans amid concerns among some consumers and state officials about access to care. In states including New York, Connecticut and Ohio, insurers have bolstered their health-care provider networks in recent months. In California, three of the biggest insurers— WellPoint Inc. 's Anthem Blue Cross, Blue Shield of California and Health Net Inc. have all added substantially to their lists (Wilde Mathews, 6/9).

The New York Times: Audit Shows Extensive Medical Delays For Tens Of Thousands Of Veterans
More than 57,000 patients have been waiting more than three months for medical appointments at hospitals and clinics run by the Department of Veterans Affairs, and nearly 64,000 others have been enrolled in the system for a decade but have still not been seen by doctors despite their requests, according to a nationwide audit released Monday (Oppel, 6/9).

Los Angeles Times: New Audit Of VA Finds 3-Month Waits For Medical Appointments
The audit's results came as the inspector general announced at a House hearing that his office had widened its investigation to include 69 sites across the country where employees may have falsified records to conceal long waits for care. That number is in addition to the Phoenix VA, which was the epicenter of the scandal and the focus of an inspector general's investigation into whether patients died as a result of delays in care (Simon and Zarembo, 6/9).

The Wall Street Journal: Nearly 60,000 Veterans Face Delays Receiving Health Care—VA Audit
During a nearly monthlong audit of 731 VA facilities and nearly 4,000 employees, the VA found widespread problems with appointment scheduling and pressure on employees to change data. More than 10% of scheduling staff were given instruction on how to alter patient appointment scheduling, according to the audit (Kesling, 6/9).

The Wall Street Journal: VA Halted Visits To Troubled Hospitals
Starting in 2011, when the VA instituted a new system to track performance standards, five VA hospitals notched consistently poor scores on a range of critical-care outcomes, including mortality and infection rates. By the first quarter of this year, that bottom-performing group had expanded to at least seven hospitals, records show. During most of that time, VA senior management suspended a long-standing program that had sent teams of doctors and monitors to its worst-performing hospitals to try to improve them, agency doctors said (Burton, 6/9).

NPR: Audit Reveals Vast Scale Of VA Waitlist Issues
Before former Veterans Affairs Secretary Eric Shinseki stepped down, he ordered an audit of the VA system, hoping to find how many hospitals were lying about wait times. The audit found that approximately 100,000 veterans are waiting too long for care at the VA (Lawrence, 6/9).

The Washington Post: VA Audit: 57,000 Veterans Waiting More Than 90 Days For Appointment At Medical Facilities
Gibson — who took over on May 30 after his predecessor, Eric K. Shinseki, resigned under pressure — outlined a series of emergency measures Monday to ensure that veterans stuck on long waiting lists will receive care as quickly as possible in the coming days and weeks. The interim VA secretary said he would spend $300 million to increase hours for VA medical staffers and contract with private clinics to see veterans who are unable to get care through VA medical centers. Gibson also promised to institute new patient satisfaction surveys and said he had eliminated the 14-day scheduling goal for VA appointments, a measure that VA officials said was unrealistic and led to widespread cheating among hospital administrators whose bonuses were tied to hitting the mark (Jaffe and Hicks, 6/9).

Politico: VA Report: Months-Long Waits For 57,000-Plus Vets
Since taking over for Shinseki, Acting Secretary Sloan Gibson has taken an aggressive posture, vowing to restore confidence in the beleaguered agency and punish VA officials who retaliated against whistleblowers. Gibson said the release of the audit reflected a commitment to transparency and showed the “extent of the systemic problems we face, problems that demand immediate actions” (Wheaton, 6/9).

Los Angeles Times: Veterans Frustrated By Long Delays In Opening Of New VA Hospitals
It was a day of shiny shovels and high hopes on that hot August morning in 2009. Politicians and dignitaries beamed at the cameras and congratulated themselves for finally breaking ground on a new medical facility dedicated to veterans, at the time projected to be the largest of its kind in the nation. … Nearly five years later, the project is still less than half finished even though work is continuing. The expected cost has risen to $1 billion, and the earliest patients will be seen is 2017 — if then. New VA hospitals in New Orleans, Las Vegas and suburban Orlando, Fla., also face delays as long as five years and construction costs that have risen a total of $1.5 billion, according to a 2013 review by the General Accounting Office (Deam, 6/9).

The Washington Post: GOP Has Claimed Control Of Va. Senate, Forced Democrats To Cave Over Medicaid Impasse
Virginia Republicans snatched control of the state Senate on Monday, immediately ending a budget stalemate by pushing Democrats to agree to pass a spending plan without Medicaid expansion, Gov. Terry McAuliffe’s top priority. The power shift forced Senate Democrats to yield after a protracted standoff that had threatened to shut down state government in less than a month, according to several lawmakers with direct knowledge of the deal. Democratic negotiators agreed in a closed-door meeting Monday to pass a budget without expanding health coverage to 400,000 low-income Virginians (Vozzella and Laris, 6/9).

The New York Times: State Senator’s Resignation Deepens Political Turmoil In Virginia
The resignation of a Democratic state senator in Virginia that flipped control of the Senate to Republicans set off charges on Monday of an unseemly deal and threatened Gov. Terry McAuliffe’s chances of expanding Medicaid under the president’s health care law (Gabriel, 6/9).

The Wall Street Journal: Senator's Resignation Complicates Medicaid Expansion Plan In Virginia
Republicans claimed temporary control of the Virginia Senate Monday after veteran Democratic state Sen. Phillip Puckett resigned, giving the GOP a one-seat majority. The move for now allowed the GOP to block Democratic Gov. Terry McAuliffe's plan to expand the federal-state health insurance program for the poor to as many as 400,000 Virginians. … Democrats on Monday reached a budget agreement that won't include Medicaid, though the governor could use a special session to again debate expansion (Armour and O’Connor, 6/9).

The Associated Press: Senator Quits, Imperiling Virginia Medicaid Push
he resignation of a Democratic state senator on Monday has dealt a serious blow to his party’s push for Medicaid expansion in Virginia and cleared a path for Republicans to pass a budget without compromising on the health care plan. Sen. Phil Puckett’s resignation gives the GOP a 20-19 majority in the chamber to go with their control of the House. Senate Democrats had linked passage of the state’s $96 billion biennial budget to expanding Medicaid, creating the threat of a government shutdown on July 1 if Republicans wouldn’t relent (6/9).

The Associated Press: Top Va. Dem Wants Budget Passed Before Medicaid
A Senate Democrat says he wants to pass a state budget without expanding Medicaid eligibility and revisit the issue in a special session. Senate Finance Co-Chairman Sen. Chuck Colgan made the comments Monday following Democratic Sen. Phil Puckett’s resignation. His position largely mirrors what GOP lawmakers have pushed for (6/9).

The Wall Street Journal’s Washington Wire: Virginia Drama Puts Spotlight on Medicaid Expansion Holdouts
When the Supreme Court gave states the option of opting in or out of the Affordable Care Act’s Medicaid expansion, the thinking among Democrats was that after some initial grumbling states would eventually opt in. … Perhaps more revealing is the fact that, some two years after the Medicaid expansion became available for states, 24 still have not done so. Of those only five – Indiana, Missouri, Pennsylvania, Utah and Virginia – are even considering it, according to the Kaiser Family Foundation. And of the states that haven’t moved and aren’t debating the expansion, only Florida, Maine and Wisconsin have competitive state elections this year in which a Democrat could feasibly win and seek to change the dynamic (Epstein, 6/9).

The Wall Street Journal: Taxpayers Face Big Medicare Tab For Unusual Doctor Billings
The government data show that out of the thousands of cardiology providers who treated Medicare patients in 2012, just 239 billed for the procedure, and they used it on fewer than 5% of their patients on average. The 141 cardiologists at the Cleveland Clinic, renowned for heart care, performed it on just six patients last year. Dr. Weaver's clinic administered it to 99.5% of his Medicare patients—615 in all—billing the federal health-insurance program for the elderly and disabled 16,619 times, according to the data (Carreyou, Stewart and Barry, 6/9).

The New York Times: For Virginia Democrat, Obama’s Still A Positive
A candidate running for the Democratic nomination in Virginia’s Eighth Congressional District, which includes the suburbs outside Washington, Mr. Beyer said in a radio ad that the president was “absolutely right” about health care, and that is just the start. “In Congress, I’ll fight all efforts to repeal Obamacare, because making sure millions of Americans get affordable health care is the right thing to do,” he continued. And his television ads check through a host of progressive positions — reproductive rights, equal pay, “common sense” gun laws and a carbon tax (Parker, 6/9).

The Wall Street Journal: In Northern Virginia, Democratic Contenders See Obama As Asset
Virginia is one of six states holding primary elections or runoffs Tuesday. In South Carolina, the focus is on whether Sen. Lindsey Graham can top 50% in the GOP primary and avoid a runoff. In the Richmond, Va., area, House Majority Leader Rep. Eric Cantor, the chamber's No. 2 Republican, is expected to beat a conservative challenger, but his margin of victory will be watched for clues to the depth of unhappiness with House leadership among GOP voters. … The candidates are uniform in backing the Affordable Care Act, a higher minimum wage and efforts to rein in greenhouse gases. That is a contrast to the message some vulnerable Democrats elsewhere have been sending, as they emphasize how they would fix the health-care law, for example, rather than hail its benefits (Ballous, 6/9).

NPR: In Oregon, End Of Life Orders Help People Avoid The ICU
In Oregon these instructions are called Physician Orders for Life-Sustaining Treatment, or POLST. The orders are few, simple and to the point. You can request or refuse CPR or intensive care. You can ask for comfort measures only, limited additional interventions or full treatment. That last includes being taken to the ICU. A study conducted by the Oregon Health Sciences University looked at the 58,000 people in the state who died of natural causes in 2010 and 2011 (Jaffe, 6/9).

NPR: A Reason To Smile: Mexican Town Is A Destination For Dental Tourism
Sitting in a dentist's chair hardly rates as a vacation. But every year, tens of thousands of people go to a tiny border town near Yuma, Ariz., that has proclaimed itself the dental capital of Mexico. Los Algodones is a virtual dental factory. Some 350 dentists work within a few blocks of downtown Algodones. With low prices and fast service, most patients come for major work (Robbins, 6/9).

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