News Headlines

News Headlines
Health care news from around the state and nation

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California Can Cut Medi-Cal Reimbursements, Court Rules
Bloomberg.com

California can cut reimbursement rates for medical-care providers in Medi-Cal, the state health program for the poor, a federal appeals court ruled, overturning a lower-court judge who had blocked the reductions. The U.S. Court of Appeals in San Francisco today said the California Department of Health Care Services and U.S. Health and Human Services secretary acted properly in reviewing and approving the cuts.

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Medicare, Hospitals at Odds Over Payment for Sicker Patients
Health Leaders Media

A patient classification system that was installed in 2008 to better measure the severity of illnesses and payment accuracy for Medicare beneficiaries shows that hospitals are successfully contending with a more complex and costlier caseload, the American Hospital Association reports.

And now that the federal government’s Medicare Severity-adjusted Diagnostic Related Groups data makes that clear, AHA officials say, the federal government doesn’t want to pay for the results.

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Hospitals could face higher borrowing costs under ‘fiscal cliff’ proposal
Modern Healthcare

Borrowing costs could climb for hospitals in tax-exempt bond markets under one White House-backed proposal to help avoid the so-called fiscal cliff.

The proposal, one the president most recently included in his 2013 budget, would limit the tax exemption on municipal bonds for wealthy households.

Investors who buy tax-exempt bonds do not pay tax on the interest income, which is typically reflected in lower interest rates for borrowers.

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Incoming Blue Shield CEO replaces top executives
San Francisco Business Times

With longtime Chairman and CEO Bruce Bodaken retiring at year-end and Paul Markovich officially taking over Jan. 1, a major reshuffling of top executives at Blue Shield of California is already under way. The changing of the guard has seen at least three additional top officers announce their decisions to leave, including Blue Shield’s chief financial officer, chief medical officer and top human resources executive. Its chief information officer left several months ago.

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Aetna sued in health IT patent dispute
Modern Healthcare

HealthTrio, a developer of health information technology for payers, providers and consumers, has sued Aetna and two of its technology subsidiaries, ActiveHealth Management and Medicity, for infringement of 10 software patents, the Denver-based company announced. ActiveHealth provides Aetna customers with a Web-based personal health record and claims administration software; Medicity is the developer of a system for health information exchange used by state, regional and local information-exchange organizations as well as providers.

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UCR opens new medical building
The Press-Enterprise

The patient didn’t look too good. He was pale. His unfocused eyes gazed toward the ceiling, and his mouth gaped. His arms and legs were motionless as he lay on the hospital gurney. But occasionally he blinked, and his chest regularly rose and fell. A check of his carotid artery revealed a pulse, and a listen to his chest showed that his heart was beating. Only it wasn’t. He had no heart at all.

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Sonoma care center loses primary license
San Francisco Chronicle

The state’s largest board-and-care center for the severely disabled has lost its primary license to operate after regulators found it repeatedly exposed patients to abuse and shoddy medical care. State regulators cited the Sonoma Developmental Center, which houses more than 500 patients, for dozens of cases in which patients were put at risk of injury or death. In issuing the citations, the state moved Wednesday to shut down a major portion of the century-old institution in the town of Eldridge.

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Court ruling could cut California spending on Medi-Cal
Los Angeles Times

In a potential windfall for the state, a federal appeals court decided unanimously Thursday that California may cut reimbursements to doctors, pharmacies and others who serve the poor under Medi-Cal.

A three-judge panel of the 9th Circuit U.S. Court of Appeals overturned injunctions blocking the state from implementing a 2011 law that slashed Medi-Cal reimbursements by 10%. Medi-Cal, a version of Medicaid, serves low-income Californians.

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Fewer health care options for illegal immigrants
Yahoo! News

For years, Sonia Limas would drag her daughters to the emergency room whenever they fell sick. As an illegal immigrant, she had no health insurance, and the only place she knew to seek treatment was the hospital — the most expensive setting for those covering the cost. The family’s options improved somewhat a decade ago with the expansion of community health clinics, which offered free or low-cost care with help from the federal government.

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CMS won’t delay on insurance exchange rules
Modern Healthcare

A senior CMS official rejected a call by Republican senators to extend the comment period for rules governing coming health insurance exchanges.

Gary Cohen, director of the Center for Consumer Information and Insurance Oversight at the CMS, told reporters Thursday that he would not consider extending the comments period for various exchange rules and delaying their finalization.

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US faces task of running dozens of health exchanges
Yahoo! News

Fourteen U.S. states and the District of Columbia so far have told the federal government they plan to operate healthcare exchanges under President Barack Obama’s reform law, leaving Washington with the daunting task of creating online marketplaces for at least two-thirds of the country. On the eve of a federal deadline for states to say whether they will run their own exchanges, a top U.S. healthcare policy official told lawmakers that the exchanges will start enrolling eligible families starting on October 1, 2013.

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Prescribing pain pills a dilemma for doctors
Sacramento Business Journal

The rapidly growing problem of prescription drug abuse in the U.S. is taking a huge toll — not just on patients, but on doctors as well. Nearly 7 million Americans are abusing prescription pain-killers, more than the number of people using cocaine and heroin combined, federal statistics show. The figure has jumped 80 percent in six years. For doctors, the epidemic can pose a career-threatening dilemma — give patients the habit-forming medications they demand to ease their pain, or refuse prescriptions at some point because of concerns about addiction.

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Healthcare’s Senior Leadership Pay Continues to Rise
Health Leaders Media

Across the C-suite, salaries and total cash compensation continue to rise, though changes to incentive structures may be influencing the size of the increase.

INTEGRATED Healthcare Strategies’ 2012 National Healthcare Leadership Compensation Survey reports that though the use of annual incentives for executives remains very common, with approximately 80% of all hospitals and systems providing this type of plan for executives, the use of long-term incentives is slowly increasing, explains Kevin Talbot, executive vice president and practice leader at Integrated Healthcare Strategies.

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Appeals court rules Medi-Cal cuts can happen
Sacramento Business Journal

A federal appeals court has reversed a lower court decision that blocked California’s attempt to cut Medi-Cal provider fees, affirming the state’s right to make authorized cuts to the federal health care program for the poor. Last January, a federal court blocked the controversial fee cut, ruling the state’s fiscal crisis does not outweigh the irreparable injury patients would suffer.

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Court rules California can cut pay to those who treat the poor
Sacramento Bee

A federal appeals court ruled Thursday that California can cut rates to doctors, pharmacists and other providers for serving Medi-Cal patients, overturning a lower court decision that blocked a 2011 state budget reduction.

A three-judge panel of the 9th U.S. Circuit Court of Appeals determined that the U.S. Health and Human Services secretary has authority to determine whether California and other states can cut Medicaid rates – the federal program of which Medi-Cal is part.

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Fewer health care options for illegal immigrants
News10.net

After health care reform is complete, states that have the most illegal immigrants could be left with a disproportionate number of uninsured people – and a financial burden.

Two-thirds of the nation’s estimated 11 million illegal immigrants live in eight states. None of them are covered by President Barack Obama’s reform law.

So when the plan is fully implemented, illegal immigrants could make up a quarter of the uninsured.

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Will Health Coverage For Older, Sicker Patients Become A Target for Cuts?
National Journal Magazine

As lawmakers search for ways to rein in chronic budget deficits, health coverage for people who are both old enough to qualify for Medicare and poor enough to receive Medicaid might end up as a target for cuts. These patients, who are known as dual eligibles, are costly to cover and their care is often poorly coordinated. Because of that, many budget cutters are convinced there are ways to make their coverage more efficient, which would save the government money.

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Health care exchange deadline for states
San Francisco Chronicle

Nineteen states have turned down the Obama administration’s invitation to run the new health insurance markets that will begin serving millions of uninsured Americans less than a year from now. That puts a huge task on the federal government, a defining challenge for President Obama’s second term. Friday is decision day for states to notify Washington if they will set up their own insurance exchanges under the federal health care law. Despite the misgivings of some state officials, half the states now say they will participate in some way.

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Setting Priorities in Health Care Special Session and Beyond
California Healthline

California’s march toward health care reform may be picking up speed after clearing several hurdles over the past year coupled with the election of a supermajority of Democrats in the state Legislature. Three major obstacles slowed and threatened to halt the process in 2012: a Supreme Court challenge, the presidential election and voters’ approval of new taxes.

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Medicare: Is 67 the new 65?
Los Angeles Times

Looking for ways to slow the growth of entitlement programs, budget negotiators in Washington are considering making seniors wait two years longer to qualify for Medicare — from age 65 to 67. Many Republicans have endorsed the idea, noting that Medicare beneficiaries now live far longer on average than they did when Congress created the program in 1965. The problem with the proposal is that it wouldn’t save the federal government much money overall, even though it might cut Medicare’s costs.

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Getting the runaround on long-term care insurance
Los Angeles Times

Rita Corwin, 90, conscientiously paid her premiums for long-term care insurance for 21 years to make sure that if she needed help as she grew older and more fragile, she’d get it.

Yet now that she finds herself in a position to require such assistance, her insurer, Washington National Insurance Co., is denying her claims.

“She bought this insurance for the same reason anyone would,” said Corwin’s daughter, Leni, who has been representing her mother in their dealings with the company.

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Federal appeals court OKs lower payments to Medi-Cal providers
Sacramento Bee

The U.S. Court of Appeals for the 9th Circuit ruled today that California can cut rates to doctors, pharmacists and other providers for serving Medi-Cal patients, overturning a lower court decision that blocked a state budget cut from last year. A three-judge appeals court panel determined that U.S. Health and Human Services Secretary Kathleen Sebelius has authority to determine whether California and other states can cut Medicaid rates — the federal program of which Medi-Cal is part — and still comply with the program’s rules.

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More Signs of Rate Shock and Awe
The Health Care Blog

Last week, I reported on my informal survey of health insurance companies and their estimate for how much rates will rise on account of the Affordable Care Act (“Obamacare”). Today, there are press reports quoting the CEO of Aetna with their estimate. The Aetna estimate is worse than mine.

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