News Headlines

News Headlines
Health care news from around the state and nation

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A big Medicaid gap looms in Obama health care law
San Francisco Chronicle

Nearly 2 in 3 uninsured low-income people who would qualify for subsidized coverage under President Barack Obama’s health care law may be out of luck next year because their states have not expanded Medicaid. An Associated Press analysis of figures from the Urban Institute finds a big coverage gap developing, with 9.7 million out of 15 million potentially eligible adults living in states that are refusing the expansion or are still undecided with time running short.

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Healthcare Quality Metrics ‘Abysmal,’ Senate Panel Hears
Health Leaders Media

The nation’s efforts to measure healthcare quality has improved in recent years, but that isn’t saying much considering how much stakeholders are still in the dark, several quality experts told members of the Senate Finance Committee this week.

Rather, providers, employers and health consumers are increasingly befuddled by more than 1,100 measures used for scoring and payment just in the Medicare program alone, with little understanding of which ones, if any, really drive better outcomes.

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$543M in illegitimate Medicare claims uncollected by CMS, report says
Modern Healthcare

A new report says the federal government in 2010 identified more than half a billion dollars in illegitimate Medicare claims that it never collected.

That year, the most recent year for which data are available, the CMS classified $543 million as “currently not collectible” (CNC) debt, which includes Medicare overpayments made to bankrupt, hard-to-find and out-of-business providers, according to a report out today from HHS‘ inspector general’s Office of Evaluation and Inspections. CMS officials say these are some of the most difficult types of overpayments to collect.

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Are Young Doctors Failing Their Boards? Or Are We Failing Them?
The Health Care Blog

A short piece in The Health Care Blog reveals (albeit unintentionally) why so many outside of healthcare think the medical establishment still doesn’t get it. The post, written by a general internist and residency program director, asked why an increasing number of internal medicine doctors are failing their internal medicine board exams. The pass rate has reportedly declined over the last several years from 90% to 84%. (Disclosure: I passed this required test about a decade ago.)

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Here’s What Happens If You Don’t Sign Up For Obamacare
San Francisco Chronicle

We’re months away from cutting the ribbon on the new online marketplace for health insurance, but the vast majority of uninsured Americans — the very people the Affordable Care Act is meant to help — still have no idea whether they’ll be in the shopping mood or not. According to a recent survey, nearly two-thirds of uninsured Americans say they haven’t decided whether or not they’ll buy health insurance by the Jan. 1, 2014 deadline (even though they’ll have to pay a penalty if they don’t).

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Seniors and the Affordable Care Act
HealthyCal.org

As Californians gear up for the final phase of health-care reform in January, seniors around the state are still wondering what to expect. At a recent Senior Awareness Day event in Modesto, several people wandered between booths in the basement of the city library, gathering information about fitness programs, hospice care and legal advocacy. Many had questions about Medicare, the national health insurance program for some young people with disabilities and people over 65.

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Health law raises questions about subsidies for the purchase of insurance
Washington Post

This week, I answer readers’ questions about how income and other assets will affect health insurance choices and responsibilities under the Affordable Care Act, and whether having access to a student health plan will make a person ineligible for subsidized coverage on the exchanges. Q. In 2012, I earned only $25,000, but I have $300,000 in stocks. I have individual health insurance. Will I be ineligible for a subsidy beginning in January because I am presently insured, or because I have large assets?

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GOP lawmakers want assurances state exchanges for small business aren’t mandatory
Modern Healthcare

Three House Republicans are calling on HHS to make certain all states allow small employers and individuals to buy health insurance outside the new state insurance exchanges as well as inside the exchanges.

The request from House Oversight and Government Reform Committee Chairman Darrell Issa (R-Calif.), and Reps. Jim Jordan (R-Ohio) and James Lankford (R-Ohio) came as a result of requirements in Washington, D.C., and Vermont that would force individuals and small businesses to buy insurance coverage only through the public insurance exchanges.

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Home health stocks take a dive over CMS’ proposed payment cuts
Modern Healthcare

Publicly traded home health companies continued to take a beating in the markets Monday because of the CMS‘ June 27 proposal to drop payments by the maximum amount suggested under the Patient Protection and Affordable Care Act. The healthcare law calls for the CMS to “rebase” home health payments through 2017, and shareholders had hoped the final cut would be softer than the proposed 14% maximum rate reduction, which will be phased in evenly over four years. But the industry appears unlikely to get the break it was hoping for—with the first 3.5% reduction proposed for 2014.

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CMS proposes 9.4% cut for dialysis providers
Modern Healthcare

Dialysis service providers would see a 9.4% cut to their Medicare pay in 2014 under a proposed CMS update issued late Monday. Under a provision of the last-minute fiscal deal reached on New Year’s Eve, the CMS proposed recalculating payments to dialysis providers to obtain $4.9 billion in savings. Dialysis provider shares lost value in afterhours trading on word of the proposed rate cut. For instance, DaVita HealthCare Partners, the country’s second-largest dialysis provider, dropped 5.5% Monday night.

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Hill Physicians revenue up in 2012
Sacramento Business Journal

Hill Physicians Medical Group — the only medical group with a presence in the Sacramento area that reports its finances publicly — generated net income of $11.9 million in 2012, a figure up slightly from $11.6 million the year before. Revenue rose 2 percent to $492 million from $481 million. An independent practice association based in San Ramon, Hill has with more than 650 doctors in the Sacramento region.

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Supervisors weigh loan for public hospital
The Press-Enterprise

With five months left until a major phase of health care reform starts, Riverside County’s public hospital needs tens of millions of dollars to cover a cash crunch and could face an even bigger budget shortfall down the line. The county Board of Supervisors on Tuesday, July 2, will consider loaning the county-run hospital in Moreno Valley up to $40 million. The hospital must repay the loan with interest by June 30, 2014.

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Medical School: Governor’s Signature Final Step In Funding Quest
The Press-Enterprise

Gov. Jerry Brown has signed legislation that earmarks $15 million in last month’s budget package to a school of medicine at UC Riverside, capping years of efforts to secure the money. The centerpiece of the higher education budget trailer bill signed Monday was the creation of a college scholarship program for middle-income families. The assistance was a priority of Assembly Speaker John A. Perez, D-Los Angeles.

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UnitedHealth to exit individual insurance market in California
Los Angeles Times

The nation’s largest health insurer, UnitedHealth Group Inc., is leaving California’s individual health insurance market, the second major company to exit in advance of major changes under the Affordable Care Act.

UnitedHealth said it had notified state regulators that it would leave the state’s individual market at year-end and force about 8,000 customers to find new coverage. Last month, Aetna Inc., the nation’s third-largest health insurer, made a similar move affecting about 50,000 existing policyholders.

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Governor’s Office Appoints Children’s Hospital Los Angeles Nurse to California Commission on Emergency Medical Services
Business Wire

Kathy Stevenson, BSN, RN, PCS, pediatric disaster resource center manager and house supervisor at Children’s Hospital Los Angeles, has been appointed to California Commission on Emergency Medical Services by California Governor Edmund Gerald “Jerry” Brown Jr. “I look forward to serving on the Commission for Emergency Medical Services,” says Stevenson. “This new appointment will allow me to gain awareness of the statewide efforts and to provide input on pediatric emergency medical services.”

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California Attorney General investigates Hoag Hospital’s abortion ban
Southern California Public Radio

The office of Attorney General Kamala Harris is looking into a controversial agreement between Newport Beach’s Hoag Hospital and Catholic hospital, St. Joseph Health.

Under a deal reached earlier this year, the two hospitals are starting a formal affiliation, which means a lot of incoming dollars from St. Joseph will be going to Hoag.

Shortly after forging the new relationship, Hoag announced it would discontinue abortion procedures at the hospital.

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Sutter Health names Dr. Toni Brayer to head Sutter Pacific Medical Foundation
San Francisco Business Times

Sutter Health, one of the region’s largest health systems, named Dr. Toni Brayer as CEO of the 260-doctor Sutter Pacific Medical Foundation, officials said late Monday. The move takes effect Aug. 1. Brayer had been vice president and chief medical officer of Sutter’s West Bay region since 2010. She succeeds Michael Cohill as chief executive of the multi-specialty medical group, which includes physicians in San Francisco, Marin, Sonoma, Lake and Del Norte counties.

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U.S. health system has flaws, but not in quality of care
Los Angeles Times

The healthcare system, like the government, is easy to criticize until you need it. And then it’s indispensable. I’ve devoted my fair share of ink and digital bits to talking about what’s wrong with healthcare in the United States. I wrote last week about yet another example of loony billing practices. Today, let’s appreciate some of the things that make our system extraordinary — maybe not the best in the world, as conservatives are fond of gushing, but pretty darn impressive.

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Why no one should lose sleep because big insurers are taking a pass on exchanges
The Huffington Post

Aetna made the wrong kind of headlines in California a few days back. The health insurance giant said it plans to stop selling individual coverage in the state and would not renew the individual policies it currently has in effect. That decision means about 50,000 Californians will have to find another insurer. UnitedHealth Group, the nation’s largest insurer, announced yesterday that it is following Aetna’s lead and will also exit California’s individual market, a move that will affect 8,000 people.

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Not Walking Away From Medicare
The Health Care Blog

This past week, the NYT New Old Age Blog featured a post about me and my practice. Titled “Walking Away from Medicare,” it describes my decision to opt-out of Medicare and create a different kind of geriatric practice. It has generated quite a lot of comments: 163 at my latest count. Most of them judge me pretty harshly. It seems that many people feel that I’m doing this for the money. And that I don’t care about society or older people.

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The Insiders: Democrats are trying to suppress the confusion and hide the cost of ObamaCare
Washington Post

I don’t know if Members of Congress will be hearing about it in town hall gatherings and other meetings back home over the Fourth of July recess, but the rolling thunder of the approaching ObamaCare train can be heard in the distance. Smart Democrats are beginning to get frantic about the need to suppress the confusion and hide the cost of ObamaCare between now and the 2014 midterm elections.

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