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News Headlines
Health care news from around the state and nation

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Docs will need to enroll in Medicare if they want to prescribe Part D drugs
Modern Healthcare

Doctors and other medical professionals will be required to enroll in the Medicare program to prescribe drugs that are paid for by the federal healthcare program, under a rule finalized Monday by the CMS. The new requirement takes effect June 1, 2015, five months later than the federal agency had initially proposed.

“We have been concerned about instances where unqualified individuals are prescribing Part D drugs,” the CMS wrote in explaining the rationale for the change.  “In fact, in a June 2013 report, the OIG found that the Part D program inappropriately paid for drugs ordered by individuals who clearly did not appear to have the authority to prescribe.”

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New Medi-Cal Renewal Process Could Lead to Loss of Coverage, Advocates Say
HealthyCal.org

New enrollment forms the Medi-Cal program is using because of changes brought about by federal health reform are so confusing that they could lead to tens of thousands of eligible recipients losing their benefits, say advocates for the poor.

County officials say the new format will ultimately make it easier for recipients to remain eligible from one year to the next. But critics say the forms ask for detailed information about income and tax deductions that many recipients might not understand or have at their disposal.

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Transitions of Care Go Digital
Health Leaders Media

Still too often in healthcare, transition of care information chases caregivers. Patients often don’t possess it or fail to bring it with them to subsequent encounters. Unanswered phone calls pile up in voice mailboxes, and faxes sometimes fruitlessly pursue physicians and specialists moving from practice to practice. The burden imposed upon staff and doctors alike is widely cited as one of the reasons healthcare costs continue to rise and gaps in care persist.

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Rating a Health Law’s Success
New York Times

Charting the number of deaths from diseases that could have been prevented if the patient had access to appropriate health care, called the “amenable mortality” rate, shows that the United States is far behind European nations. These diseases — like heart disease, diabetes and certain cancers — are tracked because early treatment significantly increases the likelihood of survival.

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Network nightmares: When your doctor and hospital don’t mix
Bakersfield Californian

What good is it to have a health plan if you can’t find doctors and hospitals to accept it?

That question rushes to mind every time a frustrated reader writes in to describe his or her Kafkaesque quest to find care.

I’m also hearing from frustrated medical providers, including Dr. Nelson Branco, a pediatrician in Marin County.

Branco was one of more than 2,300 California doctors who participated in a survey conducted by the California Medical Association (CMA) in April.

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States stick to insurance exchange models
Modern Healthcare

Few states could claim Obamacare’s first enrollment period was smooth—whatever the final numbers—but most will approach their insurance exchanges the same way for the 2015 window. None has asked the Obama administration to take over its marketplace or elected to abandon HealthCare.gov in favor of running its own.

For the 2014 enrollment period, 26 states and the District of Columbia opted to run their own marketplaces, while 17 states relied completely on HealthCare.gov, and the remaining seven resorted to partnerships intended as bridges to independent exchanges.

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Medi-Cal expands to cover 30 percent of Californians
Sacramento Bee

A half-century ago, a governor named Brown persuaded the California Legislature to embark on what those involved thought would be a modest new program of health care for poor Californians.

Medi-Cal, as it was dubbed, was California’s version of the national Medicaid program that had been attached to the new Medicare system of health care for the elderly.

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Calif. ballot issue heats up discussion over med-mal caps
Modern Healthcare

The debate in California over raising the cap on noneconomic damage awards in medical malpractice suits to account for inflation reminds many physicians of one of their biggest complaints about Obamacare—that it did not include damage caps or other limits on medical liability suits.

The arguments for and against caps are guaranteed to be the topic of renewed discussion now that California Secretary of State Debra Bowen has certified a ballot initiative to raise the state’s cap on pain and suffering damages from $250,000 to about $1.1 million to account for inflation. The measure will appear on the Nov. 4 ballot. The cap has not changed in the nearly 40 years since the law was passed.

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CMS eHealth Summit: Physicians Call for Simplification
Health Leaders Media

Simplification of everything from quality measures to physician workflow in electronic health record systems turned out to be a main theme of CMS’s fourth annual eHealth Summit in Baltimore Monday.

An official of the HHS Office of the National Coordinator for Health IT said the agency recently pared down a list of 60 diabetes measures to five measures to be implemented agency-wide.

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Significant rate increases ahead for 2015 open enrollment, initial filings show
Modern Healthcare

The first batch of 2015 rate filings for health insurance plans to be offered on exchanges show that premiums are likely to increase significantly, although in some cases not as steeply as initially anticipated. Insurers, basing rates on incomplete data on enrollees in this year’s recently concluded sign-up period, are erring on the side of caution, in many cases with double-digit planned increases.

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Developing Physician Culture in New Risk Models
The Health Care Blog

There is a saying that “culture eats strategy for lunch.” Never has this been truer than when looking at primary care or physician group delivery system innovation. Health care industry leaders must invest more time creating and scaling the right culture as they innovate. There has been a great deal of controversy on the ability of the Primary Care Medical Home (PCMH) to impact total medical costs. Critics have noted that PCMH is adding additional costs to the structure without systematically demonstrating improvement in total costs and quality.

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Blue Shield of California Sued for Smaller Obamacare Network of Providers
All Gov

Two San Francisco residents sued Blue Shield of California last week, claiming the insurance company misled them into purchasing their policies through Covered California by not informing them the networks of doctors and hospitals would be much smaller, which it is.

Terry Baynes at Reuters said the lawsuit, filed in San Francisco County Superior Court on behalf of John Harrington and Alex Talon, is seeking class-action status on behalf of all those who came away from the Obamacare website thinking it assured enrollees access to the entire network.

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Dignity Health reports $17.4M loss in operating income
Sacramento Business Journal

Dignity Health lost $17.4 million on operations in the first quarter of 2014, a huge swing from operating income of $42.3 million for the same quarter last year. Overall, the parent company to local Mercy hospitals reported net income of $65.6 million on revenue of almost $2.6 billion for the quarter. That’s down from net income of $248.1 million on revenue of $2.5 billion for the same period last year, according to company financial data posted on its website May 15.

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Alameda County pilot program decreases hospital readmission for HIV/AIDS patients
The Daily Californian

A UC-funded pilot program tasked at providing higher quality care to HIV/AIDS patients in Alameda County has reduced hospital readmission rates at one hospital in Oakland.

Operating under a comprehensive health care model, the program has decreased readmission rates by 17 percent at Highland Hospital since its implementation, according to George Lemp, director of the California HIV/AIDS Research Program through the University of California.

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Lucile Packard Children’s rebrands as Stanford Children’s Health as it focuses on expansion
Silicon Valley Business Journal

Lucile Packard Children’s Hospital has launched a new brand called Stanford Children’s Health. The Packard name isn’t fading away — the hospital itself will still be named after the philanthropist and wife of Hewlett Packard Co. co-founder David Packard. But the new Stanford Children’s Health moniker will apply to the expanding network of the Palo Alto-based children’s health-care service provider.

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Sacramento County is biggest client in Sutter HMO
Sacramento Business Journal

When Sutter Health shopped for members at its new HMO plan for 2014, Sacramento County became the biggest client. Roughly one in five Sutter Health Plus members are Sacramento County employees or their dependents. Worried about over dependence on Kaiser Permanente and hammered by rising costs at Blue Shield and a decision by Health Net to bow out of the pool in 2014, the county decided to replace Blue Shield and Health Net with two local plans: Sutter Health Plus and Western Health Advantage.

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