News Headlines

News Headlines
Health care news from around the state and nation

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Federal Rule Limits Aid to Families Who Can’t Afford Employers’ Health Coverage
New York Times

The Obama administration adopted a strict definition of affordable health insurance on Wednesday that will deny federal financial assistance to millions of Americans with modest incomes who cannot afford family coverage offered by employers.

In deciding whether an employer’s health plan is affordable, the Internal Revenue Service said it would look at the cost of coverage only for an individual employee, not for a family.

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Access Denied? Implications of Medi-Cal Pay Cut
California Healthline

In 2014, about 1.5 million adults in California are expected to gain access to Medi-Cal under the Affordable Care Act. However, insurance coverage could be all they get, as some observers say there might not be enough doctors willing to treat them. The fiscal year 2013-2014 budget proposal that Gov. Jerry Brown (D) released this month could be read as contradictory.

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Medicare cliff looms: Status quo isn’t sustainable
The Hill

President Obama just named protecting Medicare for future generations as one of his chief goals in the negotiations over the federal deficit and national debt. Unfortunately, by championing Medicare’s structural status quo, the president is putting current seniors’ care at risk — and may still leave the entitlement program short of funds to pay for future retirees. Take the portion of the “fiscal cliff” deal that cuts $15 billion in payments to hospitals.

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Five more flu deaths in San Diego County
Los Angeles Times

Five more people in San Diego County have died from influenza-related causes, bringing the tally of flu deaths to 19 for the season, health officials announced Wednesday. The 19 ranged in age from 46 to 97 and all but one had underlying medical conditions. The 19 deaths is the fourth highest ever recorded in San Diego County; last season’s count was 14. “”It is not too late to get vaccinated,” said Dr. Wilma Wooten, the county’s public health officer. “The flu season could last for a few more months.”

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White House Proposes Individual Mandate Rules
Health Leaders Media

The Obama administration’s proposed rules governing the individual mandate include such extensive exemptions that only 2% of the population would owe a penalty, or “shared responsibility payment” for not having coverage under a health plan. The proposed rules, issued Wednesday, came in the form of two documents, one from the Internal Revenue Service and the other from the Health and Human Services Agency.

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Some families to be priced out of health overhaul
Modern Healthcare

Some families could get priced out of health insurance due to what’s being called a glitch in President Barack Obama’s overhaul law. IRS regulations issued Wednesday failed to fix the problem as liberal backers of the president’s plan had hoped.

As a result, some families that can’t afford the employer coverage that they are offered on the job will not be able to get financial assistance from the government to buy private health insurance on their own. How many people will be affected is unclear.

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People with pre-existing conditions may become eligible for insurance
Lodi News-Sentinel

State Assemblyman Richard Pan, D-Sacramento, introduced legislation on Tuesday that, if approved by the Legislature and signed by Gov. Jerry Brown, will ensure that Californians with a pre-existing medical condition may purchase insurance at what Pan describes as a reasonable rate. Assembly Bill 1X2 would limit the reasons health plans can charge Californians higher premium rates due to age, family size and geographic region.

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No penalty for Medicaid-eligible uninsured, proposed rule says
Modern Healthcare

The Internal Revenue Service will not penalize low-income residents who fail to get health insurance in states that decline to raise Medicaid eligibility under the healthcare reform law, HHS said in new proposed regulations. Two proposed rules from HHS and the IRS issued Wednesday describe how the government intends to apply the law’s individual insurance mandate effective in 2014. Tax filers will need to begin verifying in 2015 that all of their dependents have qualifying coverage or pay tax penalties for them.

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Republicans threaten to subpoena IRS records on health law’s subsidies
The Hill

House Republicans on Tuesday reiterated their threat to issue subpoenas in their investigation into the Affordable Care Act’s insurance subsidies. Republicans believe the IRS exceeded its legal authority by writing regulations to make the subsidies available in both state-run and federally facilitated exchanges, and have repeatedly asked to review documents about the IRS’s decision making process.

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LAFD considers plan to beef up ambulance service for flu season
Los Angeles Times

Fire officials in Los Angeles are considering a plan to beef up ambulance service to deal with expected increases in the number of patients who need to be transported to hospitals if the flu virus wreaks havoc across the region. Officials with the Centers for Disease Control and Prevention have warned that the flu season started early this year, signaling that it could be a bad season for the illness.

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Stem cell agency not doing enough to avoid conflict of interest
Los Angeles Times

Compromise, defined as the art of getting part of a loaf when the whole loaf is out of reach, comes in many forms. But surely the strangest of all is what comes of trying to compromise with yourself. That’s what California’s stem cell agency is attempting to do. And judging from its record of pioneering new ways of funding and managing scientific research, you can rest assured that the results will be fraught with interest.

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$14 million improvement – SVDH moving forward with lab, cancer center addition
Porterville Recorder

Sierra View District Hospital Board of Directors voted to move forward with two large projects Tuesday during a special meeting in the SVDH boardroom.

The hospital’s new laboratory, and an addition and remodeling of the Roger S. Good Cancer Treatment Center, were both approved and estimated to cost $4.76 million and $9.2 million, respectively.

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Small surgeries, huge markups
Los Angeles Times

A Southern California surgery center charged teacher Lynne Nielsen $87,500 for a routine, 20-minute knee operation that normally costs about $3,000.

Despite the huge markup, the Long Beach Unified School District and its insurer, Blue Shield of California, paid virtually all of the bill from Advanced Surgical Partners in Costa Mesa. Blue Shield mailed the $84,800 check to the high school Spanish teacher last month and told her to sign it over to the surgery center.

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North Bay gets new model for health care
Santa Rosa Press Democrat

Meritage Medical Network, a rapidly growing group of physicians and hospitals in the North Bay, has won approval to launch the region’s first “accountable care organization,” a new type of health care delivery model poised to play a significant role under Obamacare.

As an ACO, Meritage will see its Medicare reimbursements linked to its ability to provide quality care at a lower cost. Any savings it achieves for the government will be shared with Meritage, formerly known as the Marin-Sonoma IPA.

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Long-term outcomes similar for prostate surgery, radiation: study
Modern Healthcare

Men who underwent surgery or radiation therapy for treatment of prostate cancer experienced no significant differences in patient-reported outcomes at 15 years post-diagnosis, according to a newly published study in the New England Journal of Medicine. The study, which assessed health status in more than 1,600 men with prostate cancer, showed similar rates of incontinence and sexual dysfunction at the 15-year mark, despite differing rates at two years and five years post-diagnosis among surgery and radiation therapy patients.

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Aetna profit falls on costs and legal settlement
Yahoo! News

Aetna Inc said on Thursday that fourth-quarter earnings fell sharply, as costs rose in parts of its employer-based insurance business and it took charges for settling litigation over payment practices for out-of-network care. The health insurer also said Chief Financial Officer Joseph Zubretsky would lead a new business internally. Shawn Guertin, who has been with Aetna since 2011 and was previously CFO of Coventry Health Care Inc , which Aetna is buying, will replace Zubretsky on February 25.

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Kaiser holds 40% market share in California
FierceHealthPayer

Kaiser Permanente has a 40 percent share of California’s health insurance market for employers and individuals, according to a new report from Citigroup analyst Carl McDonald. California’s market is important because it impacts the nationwide health insurance industry. “As California goes, so goes the results of the publicly traded plans, with the California the largest market at four of the six publicly traded plans,” McDonald wrote in his report.

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Yolo County makes public health officer position permanent
Sacramento Business Journal

Dr. Constance Caldwell has been appointed Yolo County Public Health Officer, a position she has held on an interim basis since April 2012. She replaces Dr. Christian Sandrock, who returned to University of California Davis last year. Caldwell has served as a physician in the county health department for seven years, including time as consultant for the California Children’s Services program.

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Specialty hospital to bring 150 jobs to Modesto
Modesto Bee

A group of investors has purchased a building in downtown Modesto and plans to open Central Valley Specialty Hospital in April. Gia Smith, hired as chief executive officer, said the facility will fill a need for long-term acute care and nursing care for patients on ventilators. The hospital will have 36 long-term acute- care beds and 64 beds for skilled nursing and subacute patients.

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Students call for end to UC health insurance cap
San Francisco Chronicle

Students have called on the University of California to end caps on health care coverage that could leave them to foot the bill for their medical treatment. Most UC campuses limit students’ coverage to $400,000, the San Francisco Chronicle reported Tuesday. Students say that is not enough for illnesses such as cancer that require prolonged, expensive treatment. Thousands of students have joined a petition drive to end the caps.

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Report finds spike in HSAs, assets
Modern Healthcare

The number of consumer-directed health plan accounts grew by more than one-third last year, and the average balance in savings accounts also increased, as employers and workers invested more in accounts for healthcare costs, a newly released report said. The aggregate amount in U.S. health savings accounts and health reimbursement arrangements—the savings vehicles tied to consumer-directed health plans—increased last year by 43% to $17.8 billion, and the total number of accounts climbed by 36% to 11.6 million, the annual Consumer Engagement in Health Care Survey found.

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CMS sees savings in new DME prices; others see trouble
Modern Healthcare

The CMS revealed new prices for durable medical equipment and supplies under an expanded competitive-bidding program that the agency says will save billions but that industry experts say could mean headaches for beneficiaries. Those prices apply to Round 2 of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, or DMEPOS, competitive-bidding program, which will expand to 91 major metropolitan areas on July 1 and add new product categories and a mail-order competition for diabetic testing supplies.

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How Doctors Think About New Technologies
The Health Care Blog

“Hey doctor, what do you think about this product/solution/service?” These days, I look at a lot of websites describing some kind of product or solution related to the healthcare of older adults. Sometimes it’s because I have a clinical problem I’m trying to solve. (Can any of these sleep gadgets provide data — sleep latency, nighttime awakenings, total sleep time — on my elderly patient’s sleep complaints?)

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Report: Mayor Ed Lee says CPMC-Cathedral Hill compromise is ‘imminent’
San Francisco Business Times

A “compromise agreement is imminent” that would allow California Pacific Medical Center to move forward on its $2.5 billion plans to rebuild St. Luke’s Hospital and build a new, albeit smaller than planned, hospital on Cathedral Hill, the San Francisco Examiner reported Tuesday.

Mayor Ed Lee said Tuesday that the San Francisco Board of Supervisors had postponed its latest planned vote on the project until March 12, the Examiner reported late Tuesday. But “this is the last extension,” Lee predicted, saying the two sides are very close “to the kind of compromise that needs to get done.”

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