News Headlines

News Headlines
Health care news from around the state and nation

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Stent Overuse Targeted by Federal Cardiology Program
HealthLeaders Media

When the Centers for Medicare & Medicaid Services rolls out its next value-based model for specialty physician payments, it just might look like SMARTCare, a $15.9 million experiment funded with a Centers for Medicare & Medicaid Innovation grant.

SMARTCare stands for Smarter Management and Resource Use for Today’s Complex Care Delivery. The two-year cardiology program, being launched at 11 specialty practices in Wisconsin and Florida, seeks to reduce unnecessary imaging, testing, and interventional procedures performed in non-acute patients with chest pain.

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Californians increasingly visiting hospital ERs for non-injury care
Los Angeles Times

Californians are increasingly likely to visit a hospital emergency room for complex medical problems rather than an injury, according to new research.

Although hospital emergency departments, or EDs, were once known as “accident rooms,” a review of all non-federal hospital emergency rooms in California from 2005 to 2011 found that injury-related visits have declined over that time period, according to a study published Monday in the journal Health Affairs.

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Measuring the Value of Surgery in the Pay-for-Performance Era
HealthLeaders Media

The task of defining and improving the value in surgery is the subject of two studies that offer insight into the challenges and rewards of measuring success in the pay-for-performance era.

Published in the April edition of The Journal of the American College of Surgeons, the studies take different paths to the same conclusion: value-based analysis of complex surgical procedures offers a powerful tool for providers trying to find ways to improve outcomes and reduce costs in the operating room.

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The medical system may treat you well, but less so after you reach age 80
Washington Post

The clinic was in a dilapidated old building, yet the entryway retained a worn grandeur. Tapering, semicircular walls extended like welcoming arms, and a half-moon of sidewalk stretched to the quiet side street.

That’s where I first saw her, standing at the curb with her cane propped on her walker, squinting toward the nearby boulevard. The woman was clearly well into her 80s, with a confident demeanor and with clothes and hair that revealed an attention to appearance. She had a cellphone in one hand and seemed to be waiting for a ride.

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Government payments for Medicare Advantage plans to rise in 2016

Payments to health insurers operating Medicare Advantage plans for the elderly and disabled will increase by 1.25 percent in 2016, the U.S. government said on Monday, in response to expected growth in health spending.

The announcement, by a division of the U.S. Department of Health and Human Services, comes after the U.S. government proposed a 0.95 percent cut in payments to insurers in February.

More than 16 million people are enrolled in these plans, in which healthcare benefits are managed by private insurers, including UnitedHealth Group Inc, Humana Inc and Aetna Inc.

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Medicare awards doc practices few bonuses under new value-based modifier
Modern Healthcare

So far, few provider practices have benefited from the CMS‘ value-based payment modifier program, according to agency data.

The payment initiative, outlined in the Affordable Care Act, is meant to encourage physicians and practice groups to provide high quality and cost-effective care. Eventually, the value modifier will apply to all healthcare practitioners, but this year it was voluntary and applied only to groups of 100 or more eligible professionals.As many as 1,278 groups fit this category, but only 127 groups elected to be evaluated under the modifier.

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Barriers to Care Persist Despite Expansion of Medi-Cal

The Affordable Care Act, with its promise of health care for most Americans, represents a welcome step forward for physicians who have cared for the uninsured.

Michael Core, a primary care doctor at The USC Eisner Clinic, treats some of the city’s poorest people in a spare no-frills office just south of downtown Los Angeles. Core says it’s great that his previously uninsured patients have access to a range of specialists that they never did before—at least on paper.

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ICD-10: Physicians Remain Skeptical About Oct. 1 Start
HealthLeaders Media

For years physicians’ associations have successfully lobbied the federal government to delay the implementation of the ICD-10 diagnostic coding set.

Now, with the ICD-10 implantation date looming on Oct. 1, a survey of more than 1,100 physicians, payers, and vendors from the Workgroup for Electronic Data Interchange finds that the biggest obstacle to industry readiness is the belief that there will be another delay.

Jim Daley, ICD-10 Committee chair at WEDI, is urging laggards to take heed.

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Feds fire back at hospital groups over alleged bias in antitrust workshop
Modern Healthcare

The Federal Trade Commission and U.S. Justice Department are rejecting claims by the nation’s major hospital groups that a workshop on healthcare competition was one-sided and derisive toward hospitals.It’s a dispute experts say is symptomatic of deep tensions between the government and hospitals over reforms in the age of the Affordable Care Act.The FTC and the Justice Department’s Antitrust Division defended their recent two-day joint workshop, Examining Health Care Competition, in a letter dated April 1.

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Democrats push to extend health, legal rights to immigrants
Sacramento Bee

Responding to federal inaction over immigration reform, California Democrats on Tuesday will propose a package of 10 bills that would extend health care, legal rights and business protection to immigrants who are illegally living in the state.

Assembly Speaker Toni Atkins, D-San Diego, and Senate President Pro Tem Kevin de Leon, D-Los Angeles, will lead the majority party’s push to expand health coverage to all Californians, regardless of their immigration status, although they are not proposing any funding to pay for the extensions.

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Case could change nursing meal breaks

A California court case concerning waived breaks could have widespread implications for healthcare workers encouraged to give up meal time during extra-long shifts.

The state’s Court of Appeal ruled in February that an industrial commission erred when it allowed nurses and other shift workers to surrender a second break required under state labor code. Three former employees of Orange Coast Memorial Medical Center filed a class-action suit, arguing they sometimes worked longer than 12 hours without two mandated breaks.

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Tracking Your Own Health Data Too Closely Can Make You Sick
National Public Radio

Last week, Dallas Mavericks owner Mark Cuban caused quite a stir on Twitter by suggesting that people, if they could afford it, get quarterly bloodwork to establish a baseline of their own health. A big failing of medicine, he wrote, is that “we wait till we are sick to have our blood tested and compare the results to ‘comparable demographics.’

” While that idea may seem logical, medical researchers have long cautioned that more testing is not a recipe for better health. I and others, including many doctors, countered Cuban’s views, saying they could produce dangerous outcomes for patients. (You can find my summary here and here.)

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How much doctors are paid for quality may not be as important as some think
Modern Healthcare

A sizable bonus or sharp pay cut riding on the quality of patient care did little to change doctors’ performance in a study. The research, published in the latest issue of Health Affairs, found doctors at Fairview Health Services in Minneapolis did no better on quality than doctors elsewhere in the state even after Fairview said 40% of its paychecks would be tied to quality performance. The result is notable as hospitals, medical groups and health insurers test how best to tailor incentives to change the quality and cost of healthcare. Money alone may not be enough to get results.

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California report finds cause of death varies from county to county
Daily Bulletin

Los Angeles County residents are more likely to die of influenza than most California residents, while those who live in San Bernardino County face higher cancer-related deaths, according to a state health report released Monday.

Compiled by the California Department of Public Health, the report delivers a county-by-county comparison of diseases and conditions across the state, including how those compare with the national goals established under Healthy People 2020. The initiative provides a set of health benchmarks launched by the federal government, and it monitors progress over time to measure the impact of prevention programs in communities across the nation.

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Nossaman affiliates with Carlsbad firm, boosts health-care practice
Sacramento Business Journal

Nossaman LLP has affiliated with a Northern San Diego County firm called DiCaro, Coppo & Popcke LLP, the firms announced Monday. The move brings together two complimentary health-care practices and enables both firms to expand services statewide. An “affiliation” rather than a merger or acquisition, the deal sets up a structure where attorneys at one firm can work “of counsel” for the other — and vice versa.

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Aetna hit with $1 million fine for bad information on pharmacy networks
Modern Healthcare

Aetna must pay the federal government $1 million because its websites and customer service agents allegedly relayed inaccurate information about which pharmacies were in-network for various Medicare Advantage and prescription drug plans.

According to a CMS notice, the company erroneously indicated that nearly 7,000 retail pharmacies were in-network. In addition to imposing civil monetary penalties, the agency has granted Aetna beneficiaries a special enrollment period to dis-enroll from Aetna plans and re-enroll in another Part D plan.

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NorthBay Healthcare proceeds with obtaining $40 million in tax-exempt bonds
The Reporter

NorthBay Healthcare Group is looking to Solano County to conduct a public hearing in order to receive tax-exempt bonds from the California Municipal Finance Authority in an amount not to exceed $40 million.

Today, the Solano County Board of Supervisors will conduct a public hearing, a requirement by the Tax Equity and Fiscal Responsibility Act of 1982 and also consider approving the issuance of bonds by the CMFA for the benefit of NorthBay Healthcare Group.

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Salinas hospital honored for respiratory care
The Californian - Salinas

Officials at Salinas Valley Memorial Hospital are celebrating the recognition of its respiratory care operation for the fifth consecutive year.

SVMH has earned 2015 Quality Respiratory Care Recognition from the American Association for Respiratory Care, an honor received only by about 15 percent of the hospitals in the U.S., according to a news release.

“We are proud to have our respiratory therapists and all of our clinical partners working together to achieve nationally recognized results,” said Pete Delgado, SVMH president/CEO.