News Headlines

News Headlines
Health care news from around the state and nation

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1 In 6 Insured Hospital Patients Get A Surprise Bill For Out-Of-Network Care
Kaiser Health News

About 1 in 6 Americans were surprised by a medical bill after treatment in a hospital in 2017 despite having insurance, according to a study published Thursday.

On average, 16% of inpatient stays and 18% of emergency visits left a patient with at least one out-of-network charge. Most of those came from doctors offering treatment at the hospital, even when the patients chose an in-network hospital, according to researchers from the Kaiser Family Foundation. Its study was based on large employer insurance claims. (Kaiser Health News is an editorially independent program of the foundation.)

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Senate health bill includes pay cap for surprise bill disputes
Modern Healthcare

The Senate health committee has landed on a policy to ban surprise medical bills through a cap on the pay physicians, hospitals and air ambulances can collect for out-of-network care.

The panel’s chair, Sen. Lamar Alexander (R-Tenn.), formally introduced the policy Wednesday as part of a bipartisan legislative package aimed at lowering costs in hospitals and across the healthcare system.

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Senate committee leaders tangle over drug pricing reform
Modern Healthcare

The Senate Finance Committee is still negotiating major pieces of legislation to lower drug costs, and leaders are staying mum on what’s holding up the bill as they seek to cut prices within Medicare Part B and Part D.

“There are a couple of very tough issues you have to work out,” Senate Finance Committee Chair Chuck Grassley (R-Iowa) said Wednesday. “But there’s one sure thing: I want cheaper drug prices and we’re going to do everything we can to work towards cheaper drug prices.”

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Redefining Who Is In Poverty Could Bump Thousands From Medi-Cal
capital public radio

California’s push to give everyone access to affordable health insurance could be disrupted by a federal plan to change the standards for poverty, according to analysts.

The Trump administration announced last month that it’s considering changes to the way it sets the federal poverty line — a measure of household income used by the federal government to determine who is eligible for certain government programs and benefits — in an attempt to better measure inflation. New options on the table could raise the annual income thresholds for households to qualify for Medi-Cal, CalFresh and other government programs.

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Miracle Machine Makes Heroic Rescues — And Leaves Patients In Limbo
Kaiser Health News

The latest miracle machine in modern medicine — whose use has skyrocketed in recent years — is saving people from the brink of death: adults whose lungs have been ravaged by the flu; a trucker who was trapped underwater in a crash; a man whose heart had stopped working for an astonishing seven hours.

But for each adult saved by this machine — dubbed ECMO, for extracorporeal membrane oxygenation — another adult hooked up to the equipment dies in the hospital. For those patients, the intervention is a very expensive, labor-intensive and unsuccessful effort to cheat death.

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A Clearer Map For Aging: ‘Elderhood’ Shows How Geriatricians Help Seniors Thrive
National Public Radio

Dr. Louise Aronson says the U.S. doesn’t have nearly enough geriatricians — physicians devoted to the health and care of older people: “There may be maybe six or seven thousand geriatricians,” she says. “Compare that to the membership of the pediatric society, which is about 70,000.”

Aronson is a geriatrician and a professor of medicine at the University of California, San Francisco. She notes that older adults make up a much larger percentage of hospital stays than their pediatric counterparts. The result, she says, is that many geriatricians wind up focusing on “the oldest and the frailest” — rather than concentrating on healthy aging.

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Health systems eye commercial payers for more downside risk
Modern Healthcare

Finance executives at hospitals and health systems see the most opportunity to work with commercial insurers to increase downside risk in payment contracts, according to a new survey.

The survey, published Wednesday by consultancy Navigant, found 64% of finance leaders said they plan to assume additional risk in contracts with commercial payers in the next one to three years.

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Stem Cell Company Persuades Employers To Steer Workers Toward Controversial Therapy
Kaiser Health News

A Midwestern grocery chain, Hy-Vee, is taking an unusual — and highly controversial — approach to reducing health care costs.

Before employees in certain cities can undergo knee replacement, they first must visit a stem cell provider. Hy-Vee has contracted with one of the United States’ leading stem cell companies — Regenexx, based in Des Moines, Iowa — that claims injections of concentrated bone marrow or platelets can help patients avoid expensive joint surgery.

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FTC approves UnitedHealth-DaVita deal with conditions
Modern Healthcare

UnitedHealth Group announced Wednesday it has closed on its $4.3 billion purchase of DaVita Medical Group after the parties reached a settlement with the Federal Trade Commission that resolves the federal government’s concerns about harm to competition in Nevada.

Under the FTC settlement, UnitedHealth Group has agreed to sell DaVita Medical Group’s Las Vegas operations, known as HealthCare Partners of Nevada, to Salt Lake City, Utah-based Intermountain Healthcare within 40 days of the deal’s closing. Without that tweak, the FTC said the deal would reduce competition in the Las Vegas area for managed care provider organization (MCPO) services sold to Medicare Advantage insurers and Medicare Advantage plans sold to individual Medicare Advantage members.

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CalPERS health insurance will cost more next year, but not as much more as insurers wanted
Sacramento Bee

Health insurance premiums for CalPERS members are going up next year, but rates will be lower than insurers initially requested, according to 2020 rates published Tuesday.

Premiums will go up 4.65 percent on average next year. Last month, insurers submitted requests for increases to CalPERS that would have raised rates by an average of 7.2 percent.

At last month’s meeting, CalPERS staffers said some insurers likely would reduce premiums for competitive reasons after seeing one another’s published rates. Board members strongly encouraged staff to do all they could to tamp down rate hikes.

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Why Gilead could pay more than $2 billion in deal with this small S.F. biotech
San Francisco Business Times

Founded by three professors from UC Berkeley and UCSF, Nurix’s protein-degradation approach to cancer, and potentially other diseases, could stop cancer in its tracks.

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County floats regional plan for mental health as Tri-City decries threats of state scrutiny
San Diego Union-Tribune

The county released new plans to re-invest in the region’s psychiatric infrastructure Wednesday even as Tri-City Medical Center in Oceanside fired back against recent criticism that it still has not released a road map for re-opening behavioral health units it shut down in 2018.

Contained in a fresh set of staff reports intended to underpin presentations to the county Board of Supervisors on Tuesday, the plan calls for creating a network of regional crisis stabilization centers that would be open 24 hours a day, seven days a week, offering walk-in service, and the ability to accept emergency transfers from local law enforcement agencies.

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