News Headlines

News Headlines
Health care news from around the state and nation

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Medicare Advantage insurers rail against “encounter data” to CMS
Modern Healthcare

While Medicare Advantage insurers are excited about getting more flexibility to tailor supplemental benefits for chronically ill patients in 2020, they aren’t happy with the CMS‘ plan to increase the use of “encounter data” to calculate their payments.

In the more than 200 comments on the 2020 Medicare Advantage and Part D Advance Notice and call letter, insurers were generally supportive of CMS’ plan to expand the supplemental benefits that plans may offer their chronically ill patients to include things like nonmedical transportation and home-delivered meals or produce, as called for by the Bipartisan Budget Act of 2018.

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CMS makes changes to nursing home star ratings
Modern Healthcare

The CMS will update the star ratings on Nursing Home Compare in April with several changes including new ratings for health inspection performance and stricter criteria for staffing level ratings.

The changes to the ratings, which will likely go live in mid-April, are part of an ongoing effort by the CMS “to improve the accuracy and value of the information found on the site,” the agency said Tuesday in a release. The CMS has made modified the ratings several times over the years, including most recently replacing the collection of staffing data from a self-reported process to the Payroll-Based Journal system, which is said to be more accurate because it requires nursing homes to submit their payroll information every quarter.

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Commentary: Congress can deliver on its promise with a federal reinsurance program
Modern Healthcare

When Americans are asked what issue is most important to them, healthcare continues to top the charts. The 116th Congress is dominated by lawmakers who pledged last fall to make healthcare more affordable.

Late last month, Rep. Angie Craig (D-Minn.) introduced the State Health Care Premium Reduction Act to lower health insurance premiums in the individual market. Craig has said she supports stabilizing the individual marketplace with bipartisan ideas such as a federal reinsurance program. In fact, the House Energy and Commerce Committee has set a hearing on a federal reinsurance program this week.

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Teen who defied anti-vax mom says she got false information from one source: Facebook
The Washington Post

An 18-year-old from Ohio who famously inoculated himself against his mother’s wishes in December says he attributes his mother’s anti-vaccine ideology to a single source: Facebook.

Ethan Lindenberger, a high school senior, testified Tuesday before the Senate Committee on Health, Education, Labor and Pensions, and underscored the importance of “credible” information. In contrast, he said, the false and deep-rooted beliefs his mother held — that vaccines were dangerous — were perpetuated by social media. Specifically, he said, she turned to anti-vaccine groups on social media for evidence that supported her point of view.

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18-Year-Old Testifies About Getting Vaccinated Despite Mother’s Anti-Vaccine Beliefs
National Public Radio

Eighteen-year-old Ethan Lindenberger appeared before the Senate Committee on Health, Education, Labor and Pensions on Tuesday to talk about how he decided to get vaccinated against the wishes of his mother, who is anti-vaccine.

Lindenberger is a senior at Norwalk High School in Norwalk, Ohio. He gained attention in November by asking about how to get vaccinated despite the opposition of his “kind of stupid parents” in a discussion on Reddit.

Anti-vaccine proponents espouse a widely discredited view that vaccines can cause autism or brain damage.

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Senate panel warns of dangers of anti-vaccine movement
Washington Post

A Senate panel warned lawmakers Tuesday about the dangers of false information about vaccines and called for a national campaign, similar to the one against smoking, to counter the public health threat posed by anti-vaccine groups.

Virtually all the witnesses and members of the U.S. Senate’s Committee on Health, Education, Labor and Pensions, which held the hearing, endorsed the safety and importance of vaccines. But one senator, Rand Paul, (R-Ky.), struck a defiant note.

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Bill Aimed at Preventing Another Hep A Crisis Has Drawn the Ire of Vaccine Opponents
Voice of San Diego

Assemblyman Todd Gloria’s legislative effort to prevent a replay of San Diego’s sluggish response to a deadly hepatitis A outbreak is facing unexpected backlash from vaccine opponents who say the measure could compel vaccinations.

Gloria’s office reports it has recently received dozens of daily calls from anti-vaccination activists who fear the bill could give health officials the authority to order immunizations.

AB 262, introduced by Gloria and Assemblywoman Lorena Gonzalez, doesn’t actually mention vaccinations. It aims to clarify public health officers’ responsibilities during outbreaks, including their ability to issue directives to other governments to take action during health scares.

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FDA Commissioner Gottlieb resigns
Modern Healthcare

FDA Commissioner Dr. Scott Gottlieb resigned from his post Tuesday.

“All of us at HHS are proud of the remarkable work Commissioner Gottlieb has done at the FDA,” HHS Secretary Alex Azar said in a statement. “He has been an exemplary public health leader, aggressive advocate for American patients, and passionate promoter of innovation. I will personally miss working with Scott on the important goals we share, and I know that is true for so many other members of the HHS family.”

The Washington Post first reported Gottlieb’s resignation.

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FDA Commissioner Gottlieb, who raised alarms about teen vaping, resigns
Washington Post

Food and Drug Commissioner Scott Gottlieb, who used his post to tackle difficult public health issues from youth vaping to opioid addiction – surprising early skeptics worried about his drug industry ties – resigned Tuesday, effective in about a month.

Gottlieb, who has been commuting weekly to Washington from his home in Connecticut, said he wants to spend more time with his family. The 46-year-old physician, millionaire and cancer survivor known for a self-assured, sometimes brash, manner lives in Westport, with his wife and three daughters – 9-year-old twins and a 5-year-old.

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Health-Care Industry Debates Hospital Accreditation Rules
The Wall Street Journal

Companies and organizations tied to health-care accreditation have offered differing views on whether the Trump administration should establish new rules or guidance to curb potential conflicts of interest in the industry, ahead of a possible action later this year.

The Centers for Medicare and Medicaid Services, or CMS, has received more than 120 comments over several months on actions it may take to rein in financial arrangements in the accreditation market.

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California Looks To Lead Nation In Unraveling Childhood Trauma
Kaiser Health News

Imagine identifying a toxin so potent it could rewire a child’s brain and erode his immune system. A substance that, in high doses, tripled the risk of heart disease and lung cancer and reduced life expectancy by 20 years.

And then realizing that tens of millions of American children had been exposed.

Dr. Nadine Burke Harris, California’s newly appointed surgeon general, will tell you this is not a hypothetical scenario. She is a leading voice in a movement trying to transform our understanding of how the traumatic experiences that affect so many American children can trigger serious physical and mental illness.

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Alzheimer’s Screenings Often Left Out Of Seniors’ Wellness Exams
National Public Radio

Primary care doctors are really good at checking seniors’ cholesterol levels and blood pressure but often fail to use tests that could detect dementia. Fewer than half of primary care doctors surveyed say they routinely test patients 65 and older for problems with memory and thinking, according to a report released Tuesday by the Alzheimer’s Association. And just 16 percent of older patients surveyed say they receive regular cognitive assessments during routine health checkups, the report says.

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Mental Health Treatment Denied to Customers by Giant Insurer’s Policies, Judge Rules
New York Times

In a scathing decision released Tuesday, a federal judge in Northern California ruled that a unit of UnitedHealth Group, the giant health insurer, had created internal policies aimed at effectively discriminating against patients with mental health and substance abuse disorders to save money.

U.S. Chief Magistrate Judge Joseph C. Spero found that United Behavioral Health, the insurer’s unit that administers treatments for mental illness and addiction in private health plans, had violated its fiduciary duty under federal law.

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CA insurer gives $2 million for Paradise health services after fire
San Francisco Chronicle

The health insurer Blue Shield of California has donated $2 million to one of the largest medical groups in the town of Paradise to help restore health care services to residents affected by November’s Camp Fire.

The contribution, announced Tuesday, is one of the largest publicly disclosed corporate donations to Paradise fire victims, and one of the only ones to focus specifically on restoring medical services in the area. The other, a $5 million gift to the town’s largest health provider, Adventist Health, came from a company that did not want to be named, but that money is also being used to restore health services, said Adventist Health spokesman Joshua Cowan.

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Appeals court dismisses Cigna fraud case
Modern Healthcare

A federal appeals court on Tuesday affirmed a lower-court ruling dismissing a lawsuit against insurer Cigna Corp. for allegedly committing fraud by misleading shareholders about its compliance with Medicare regulations.

The three-judge appellate panel agreed that Cigna’s alleged misstatements about its Medicare subsidiary HealthSpring can’t be considered fraud.

“We conclude that a reasonable investor would not rely on the challenged statements as representations of regulatory compliance,” Judge José Cabranes wrote for the unanimous panel.

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United loses in court on behavioral health coverage rules
Modern Healthcare

A federal judge ruled Tuesday that United Behavioral Health breached its fiduciary duty to patients by using unreasonable and overly restrictive guidelines to make coverage decisions for tens of thousands of mental health and substance abuse patients.

The decision, if upheld on appeal, could have wide ramifications of what insurers must cover in the fast-growing behavioral healthcare sector.

The case stems from two consolidated class-action lawsuits filed in 2014 against UnitedHealth Group’s United Behavioral Health, the nation’s largest behavioral health insurer. It went to trial in October 2017 before U.S. Chief Magistrate Judge Joseph Spero in San Francisco.

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Sutter Health opens $2.1 billion campus in San Francisco
Sacramento Business Journal

Sutter Health opened its 25th acute care hospital Monday, a $2.1 billion facility in San Francisco.

The new California Pacific Medical Center Van Ness Campus includes a 274-bed hospital within an 11-story structure. Across the street from the hospital is a 476,000-square-foot, nine-story medical office building, which Sacramento-based Sutter hopes to open later this year. 

Both structures are set to see Sutter consolidate its inpatient, outpatient, emergency services and affiliated medical offices all within one full block on the Van Ness Avenue corridor in San Francisco.

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