News Headlines

News Headlines
Health care news from around the state and nation

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RAC Appeals Process ‘Broken,’ AHA Says
Health Leaders Media

Overly aggressive and inappropriate audits and denials of hospital claims are holding up more than $1 billion in Medicare payments and the appeals process hospitals have pursued to overturn denials is mired in backlogs, contends The American Hospital Association. In a Jan. 14 letter to Marilyn Tavenner, administrator for the Centers for Medicare & Medicaid Services, the AHA pleads for fundamental changes to Medicare’s claims auditing system.

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Digital changes spawn new health careers
San Diego Union-Tribune

Not long ago a career in health care conjured visions of stethoscopes, scrubs and doctors scratching barely legible prescriptions on paper notepads.

But these days, it’s all digital. From doctors’ orders to test results, health providers are doing away with paper records and automating the process of making an appointment, getting a checkup and filling a prescription.

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Illumina’s New Low-Cost Genome Machine Will Change Health Care Forever
Bloomberg.com

Dr. Bradley Patay, who is tanned and handsome, with a constant smile that pushes the limits of cheek physics, has an office at the Scripps Clinic, next to the Torrey Pines Golf Course and the Pacific Ocean. An internal medicine specialist, he also happens to be very well versed in genetics. If, like me, you’ve had your entire genome sequenced, Dr. Patay can tell you what the results mean. He’ll pull your data up on a computer and show you how to explore your own genetic makeup. Having this genome decoding skill makes him a rarity for the moment.

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How sustainability programs cure health-care woes
GreenBiz

Hospitals are full of creative, passionate people doing all kinds of work from all kinds of backgrounds. But their passion can get squashed in the health-care environment due to endless regulations, reporting, protocol, tasks, steps and limited time and dollars.

And with the constant changes underfoot, it’s inevitable that there will be a misstep or two (or slip or fall). According to Eric Parmenter, vice president of employer solutions at Evolent Health, “With health-care reform, employees of hospitals and health systems are experiencing a tsunami of change in their industry, and by extension their career.

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Federal Judge Upholds Health Care Subsidies
New York Times

A federal judge rejected a legal challenge on Wednesday to a central part of President Obama’s health care law, ruling that millions of low- and moderate-income people could obtain health insurance subsidies regardless of whether they bought coverage through the federal insurance exchange or in marketplaces run by the states.

Critics of the law had said that a literal reading of it would allow subsidies only in the 14 states that ran their own exchanges.

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Bare-Bones Health Plans Survive Through Quirk in Law
The Wall Street Journal

The health-care overhaul was supposed to eliminate insurance plans that offer skimpy coverage at cut rates. But a quirk in the law stands to help some companies keep them going for years to come.

AlliedBarton Security Services, a closely held firm that employs more than 63,000 people nationwide, has offered a modestly updated version of its so-called mini-med plan to employees this year and it intends to do so in 2015 as well, even though the cheap coverage fails to meet requirements of the Affordable Care Act.

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HealthCare.gov security again under scrutiny by politicians
Reuters

A cybersecurity professional warned that the U.S. government failed to implement fixes to protect the HealthCare.gov website from hackers at a congressional hearing that Democratic lawmakers claimed was politically motivated.

“HealthCare.gov is not secure today,” David Kennedy, head of computer security consulting firm TrustedSec LLC, said at a Thursday hearing of the House Science, Space and Technology Committee.

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Public Hospitals Hope to Attract More Upscale Patients Under Affordable Care Act
New York Times

Todd Obolsky lives in a studio apartment in Manhattan, drives a leased Toyota Corolla and occasionally splurges on experimental cuisine in the East Village. When the Affordable Care Act allowed him to buy insurance for the first time in years, he was so price-sensitive that $30 a month made a difference in which plan he picked.

So the obvious choice was MetroPlus. It offered the best deal at the coverage level he was looking for — about $400 a month for a gold plan, the second-highest of the four levels.

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Some Insurance Consumers Not Defrauded by Obama
The Wall Street Journal

It turns out that for some workers in company-sponsored health insurance plans, you really can keep your plan if you like it. As long as companies include an expensive ObamaCare-compliant plan as an option, they can also offer a less expensive alternative, although consumers may still have to pay a penalty. Meanwhile, another legal challenge to the Affordable Care Act suffered a setback, as a federal judge said the federal government can provide subsidies through an exchange not run by states.

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How Much Does It Cost to Have a Baby in California?
KQED Radio

The most common reason for hospitalization in the United States is childbirth. A new study published Thursday adds to the depth of research on cost variation in the American medical system. In the study, researchers at U.C. San Francisco looked at 110,000 uncomplicated births across California and found that hospital charges for a vaginal delivery ranged from $3,296 to $37,227 and for a caesarian section the range was $8,312 to $70,908.

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Baby Birth Costs Vary 10-Fold in Hospitals, Study Finds
Bloomberg.com

The cost of giving birth at a hospital can vary by tens of thousands of dollars, a price range that is “largely random” and unexplainable by market factors, a California study found.

Charges for a non-complicated vaginal delivery in the most populated U.S. state ranged from $3,296 to $37,277, and $8,312 to $70,908 for a non-complicated cesarean section, according to researchers at the University of California at San Francisco. Institutional and market factors could only explain 35 percent to 36 percent of the variation in charges, according to the study, released online today in the medical journal BMJ Open.

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H1N1 flu strain hits hospitals hard
San Diego Union-Tribune

The same H1N1 flu strain that hit pandemic levels five years ago is surging through the region and is hitting young people harder than usual, according to a report Wednesday by the county health department. Six people who tested positive for H1N1 died last week, bringing the total for the season to seven, the San Diego County Health and Human Services Agency said.

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Medi-Cal agency to overhaul drug rehab program after critical audit
Center for Investigative Reporting

California’s Medi-Cal agency is launching an overhaul of its drug rehabilitation program in light of a damning internal audit that spotlights ham-handed oversight and confirms many findings of a yearlong investigation by The Center for Investigative Reporting and CNN.

The Department of Health Care Services pledged a multitude of changes in a report to the Legislature last week, including tightening rules through emergency regulations and using an “elite strike team” to detect fraud by mining data.

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What do changes to Medicare payment policy mean for you?
Los Angeles Daily News

After years of legislative wrangling and last-minute patches, expectations are high among physician groups, lawmakers and Medicare beneficiaries that Congress could act this year to permanently replace the current Medicare physician payment formula. While committees in both chambers have approved their own “doc fix” proposals, the approaches have yet to be reconciled, and none have identified how they would pay for a repeal. Below are some frequently asked questions and answers about the formula – known as the “sustainable growth rate” – and how Congress may change it.

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Researchers debunk ‘obesity paradox’ for people with diabetes
Los Angeles Times

For people with Type 2 diabetes who had hoped that their love handles might serve some purpose by reducing their risk of premature death, Harvard researchers have some bad news: The “obesity paradox” does not exist. “We found no evidence of lower mortality among patients with diabetes who were overweight or obese at diagnosis, as compared with their normal-weight counterparts, or of an obesity paradox,” the research team reported in a study that appears in Thursday’s edition of the New England Journal of Medicine.

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Check your blood pressure, (unwittingly) sell your contact information
Los Angeles Daily News

Health insurance companies are on the prowl for more customers. There are still three months to go for people to enroll in health plans under the Affordable Care Act, but insurers don’t want to rely solely on state or federal websites to find them.

Some are finding a path to new customers by partnering with companies that operate health-screening kiosks –- those machines in supermarkets and drug stores where people check their blood pressure or weight.

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Dignity Health building gets another look in Citrus Heights
Sacramento Business Journal

Citrus Heights residents will get another look at a three-story medical office building proposed for Greenback Lane, but unlike a previous iteration, a new city hall isn’t part of the plan. The community meeting this evening is designed to get more feedback on Dignity Health’s proposed 68,727-square-foot building near the corner of Greenback and Fountain Square Drive. Becky Furtado, a spokeswoman for Dignity, said final city approvals for the project could come some time this summer, with construction to start as soon as August.

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Jackson, Williams to Host Health Care Reform Meeting
Santa Barbara Independent

State Sen. Hannah-Beth Jackson and Assemblymember Das Williams will host a town-hall forum on 1/18 at 10:30 a.m. at the Franklin Elementary School cafeteria to explain how federal health-care reform will affect Californians. The enrollment period for health insurance began in October and goes through March 31. This week, Covered California Executive Director Peter Lee said nearly 500,000 Californians have already signed up.

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Potential hospital sale has officials in holding pattern
San Mateo Daily Journal

The possible sale of six Daughters of Charity Health System hospitals has local officials cautiously optimistic about the future of Daly City and coastside facilities that provide a large piece of the county’s health care to the indigent and residents further away from the main medical center. But with news of the proposed sale barely announced this week, these same officials say they are largely taking a wait-and-see approach because it is unclear whether a potential buyer will continue operating Seton Medical Center and Seton Coastside and, if so, commit to existing arrangements with San Mateo County for its low-income patients.

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Insurer UnitedHealth’s 4Q profit rises 15 percent
San Francisco Chronicle

UnitedHealth Group’s fourth-quarter earnings jumped 15 percent and topped expectations, as the nation’s largest health insurer added millions of customers and booked a sizeable gain from a business that doesn’t sell insurance.

But the Minnetonka, Minn., company’s shares slipped more than 2 percent Thursday in premarket trading as analysts waited for more insight into potential funding cuts for a key element of its business.

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Daughters of Charity’s weak market presence cited as reason for failed acquisition deal
Modern Healthcare

Amid a surge of consolidation in healthcare as the industry responds to healthcare reform, a hospital deal that broke down this week underscores the premium on size, market leverage and geographic reach.

Ascension Health, the nation’s largest private not-for-profit health system, and the Daughters of Charity, a struggling six-hospital system in Los Altos Hills, Calif., announced they had ended acquisition talks. Instead, the Daughters of Charity, which first opened a California hospital in 1856, would seek buyers interested in one or more of the system’s hospitals.

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