News Headlines

News Headlines
Health care news from around the state and nation

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Plaintiffs’ Standing Challenged In ACA Appeal
Health Leaders Media

California-led defenders of the ACA say the plaintiffs are asking the court ‘to do what Congress—after years of debate and deliberation—repeatedly refused to do: dismantle the entire Affordable Care Act.’

The Trump Administration and Texas-led states hoping to see the Affordable Care Act repealed judicially don’t have the standing to gut the bill in its entirety, intervening Democratic attorneys general from 21 states said in a brief filed Wednesday.

The California-led defenders of the ACA told the 5th U.S. Circuit Court of Appeals that the plaintiffs are asking “this Court to do what Congress—after years of debate and deliberation—repeatedly refused to do: dismantle the entire Affordable Care Act.”

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Verma exploring outcome-based ideas to tackle high drug costs
Modern Healthcare

CMS Administrator Seema Verma said Wednesday there need to be “serious discussions” on how to pay for new and extremely pricey drug innovations but slammed the idea of giving Medicare negotiating power.

Verma told reporters that Medicare and Medicaid’s payment systems were not expected to deal with high costs for new and curative innovations.

“Last year we had a new drug for blindness that is about $850,000 and now we are hearing about price tags that could be reaching $5 million for a treatment,” Verma said.

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How insulin prices got out of control and what’s being done about it
San Francisco Business Times

Insulin prices have skyrocketed, especially in the past 20 years. Is any financial relief on the way for the millions of patients that need insulin to live?

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Medicare Advantage Dual Eligibles Have Fewer ER Visits Than Those Under FFS
HealthLeaders Media

Dual eligible Medicare Advantage beneficiaries had 42.1% less emergency room visits than their fee-for-service counterparts.

The cost of care and rate of hospitalizations for dual eligible Medicare Advantage (MA) beneficiaries was considerably lower than dual eligibles under fee-for-service (FFS), according to an Avalere Health study released Tuesday evening.

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House committee dodges Medicare for All’s fiscal details
Modern Healthcare

A U.S. single-payer system could redistribute doctor and hospital pay, congressional budget officials told a U.S. House of Representatives panel on Wednesday.

But ultimately a House Budget Committee hearing painted only a vague picture of what the hospital world would look like if the entire healthcare system were overhauled.

Some projections from Congressional Budget Office officials were promising for hospitals that struggle now. For example, rural hospitals that treat a high share of uninsured, Medicaid and Medicare patients could get a boost, according to CBO’s Jessica Banthin.

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The Health 202: There are still a lot of questions about Medicare-for-all
Washington Post

Those hoping for specific answers on the costs and benefits of moving to a Medicare-for-all-type health-care system may have been disappointed yesterday.

Congressional Budget Office analysts testifying before the House Budget Committee answered basically every question from lawmakers like this: It depends.

The carefully couched responses from CBO Deputy Director Mark Hadley and two other officials appeared to frustrate some lawmakers, who tried at times to bait them into offering value judgments on whether Medicare-for-all would help or hurt Americans.

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Are Surprises Ahead For Legislation To Curb Surprise Medical Bills?
California Healthline

Surprise medical bills — those unexpected and often pricey bills patients face when they get care from a doctor or hospital that isn’t in their insurance network — are the health care problem du jour in Washington, with congressional lawmakers from both sides of the aisle and the White House calling for action.

These policymakers agree on the need to take patients out of the middle of the fight over charges, but crafting a legislative solution will not be easy.

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HHS’ IT committee suggests nixing price transparency from interoperability rule
Modern Healthcare

The Health Information Technology Advisory Committee on Wednesday voted to remove price-transparency requirements from the proposed interoperability rule.

In its second meeting this month hashing out recommendations on how the federal government should address concerns related to information blocking and patient privacy, HITAC cautioned that tying price transparency to the information-blocking proposals would have an “unintended consequence of slowing down the finalization of the current ONC rule.” Instead, it recommended ONC create a separate price-transparency task force within HITAC to produce recommendations for future rulemaking.

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Senators tackle hospital ‘gag’ clauses
Modern Healthcare

Two senators want to stop hospitals from steering patients into costlier treatments through their insurance plans, as congressional lawmakers continue on their push to end industry gaming of the healthcare system.

A bill introduced late Tuesday by Sens. Bill Cassidy (R-La.) and Michael Bennet (D-Colo.) would ban health systems from using their insurer contracts to keep people from opting for less expensive treatment from a competitor. Currently, dominant hospitals can leverage their market power with insurance companies to insert so-called “gag clauses” in their contracts.

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Separate EHRs pose care-coordination challenge for ACOs, OIG finds
Modern Healthcare

Patient care coordination tends to be easier for accountable care organizations whose participants are using a single electronic health record system, HHS’ Office of Inspector General said Wednesday.

The need for reliable data-sharing has placed a burden on ACOs to either invest in the same version of an EHR system or rely on non-electronic means, such as phone calls and faxes, to communicate patient information, according to the OIG report.

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Few women reach healthcare leadership roles
Modern Healthcare

Women are being passed up for promotions in healthcare as few make it to leadership roles, according to a new survey.

More than half (55%) of nearly 200 hospital and health system executives said women in their organization have been overlooked due to gender, executive search firm Korn Ferry found. Nearly two-thirds ranked their development programs for women as fair, poor or non-existent, and 76% said their company does not have sponsorship programs to help women advance.

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Report: Retail clinics have what patients, healthcare execs want
Modern Healthcare

Early next year, shoppers visiting a Boston area mall to browse the racks at Express or grab lunch at Red Robin could pop in for an oncology visit just down the way.

Dana-Farber Cancer Institute plans to lease about 34,000 square feet of space at Patriot Place, a shopping and entertainment center in Foxborough, Mass., where it will offer both cancer treatment and hematology services.

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“If you think the system works, you’re dead wrong:” a discussion on mental health in California

A physician, an advocate, a public health specialist, a suicide-attempt survivor and a California state lawmaker gathered in downtown Sacramento today to offer their diagnosis of the state’s mental health system.

The consensus was summed up by Sen. Jim Beall: “We need to start from scratch.”

“I haven’t heard a lot of cheerleaders for the status quo,” said Beall, a Democrat from San Jose and the author of several bills that would expand access to mental health treatment. “If you think the system works, you’re dead wrong.”

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Blue Shield of California targets patients with complex needs in house call program

Blue Shield of California has teamed up with Landmark Health to offer more house calls to members with chronic conditions—at no additional cost.

The insurer has enrolled 3,500 people in the program over the last year and has provided 15,000 in-home visits in that opening window, Blue Shield announced Wednesday. The key, the team told FierceHealthcare, is making sure both members and physicians understand that this is not meant to replace primary care providers (PCPs).

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Paradise doctors back on the ridge Friday
Chico Enterprise Record

Friday marks the return of Paradise Medical Group to its Paradise base, a journey helped along by Blue Shield of California.

From 11 a.m. to 1 p.m. Friday, the group of Paradise physicians, their staff, Blue Shield executives, patients and elected officials will celebrate the reopening of their clinic at 6460 Pentz Road.

The well-established medical group was disrupted by the Nov. 8 Camp Fire. Some of the buildings were damaged, but the medical group transferred its services to Chico, with an eye to re-establishing in Paradise.