News Headlines

News Headlines
Health care news from around the state and nation

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State lawmakers grapple with essential health benefits
California Watch

The federal health care reform act requires most Americans to have health insurance by 2014. But what exactly will those insurance plans have to cover?

California’s Legislature is now grappling with that question, in the wake of last month’s U.S. Supreme Court ruling upholding the law.

Under the law, policies sold to individuals and small businesses must cover 10 so-called “essential health benefits,” including hospitalization, maternity care and prescription drugs.

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Proposed OPPS Rule Holds Significant Changes
Health Leaders Media

The Centers for Medicare & Medicaid Services is proposing two major changes as part of the 2013 Outpatient Prospective Payment System proposed rule, released July 6. One has to do with how CMS proposes to calculate the relative weights of Ambulatory Payment Classifications. The other has to do with the reimbursement level for separately payable drugs and biologicals without pass-through status.

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EHR use leads to improved image review: study
Modern Healthcare

Using an electronic health record to review portal images can lead to improvements in patient care and safety, according to a new study.

The study—results of which are published in the July issue of the Journal of the American College of Radiology—found that use of an EHR improves compliance with record-keeping and timeliness policies. Better compliance, in turn, can improve patient care and safety, the authors said.

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Republicans focus on repealing, not replacing, ‘Obamacare’
Los Angeles Times

Congressional Republicans, who once promised to “repeal and replace” President Obama’s healthcare law, for now have all but given up pushing alternatives to the sweeping legislation the president signed in 2010.

In the last year and a half, House Republicans have sent the Senate just one 36-page bill designed to limit medical malpractice lawsuits, despite pledging to develop detailed legislation to slow rising healthcare costs, help Americans keep their health plans and broaden access to insurance.

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Blue Shield Policy Closures Blocked in CA
Health Leaders Media

The California Department of Insurance and Blue Shield of California are at odds over the insurer’s efforts to close 23 health plans and transfer those members to other products. Blue Shield contends that it is following the law, while the CDI has ruled that it has “disapproved” the block of business closures. That means Blue Shield can’t proceed “with the block closures period,” a CDI spokesperson told HealthLeaders Media in an e-mail exchange.

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Repeal of PPACA Would Be ‘Devastating’ Sebelius Says
Health Leaders Media

The vote scheduled for Wednesday in the U.S. House of Representatives to repeal the Patient Protection and Affordable Care Act would have “devastating” consequences for Medicare beneficiaries, if it were to pass, U.S. Health and Human Services Secretary Kathleen Sebelius said Tuesday.

During a routine press briefing to tout the latest statistics on how seniors have benefited from the law, Sebelius took an unusual detour to criticize the effort to undo the legislation.

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GOP offers health care repeal without alternative
San Francisco Chronicle

House Republicans generally avoided talk of replacement measures on Tuesday as they mobilized for an election-season vote to repeal the health care law that stands as President Barack Obama’s signature domestic accomplishment.

Instead, they lambasted the 2-year-old law as a threat to the nation’s economic recovery and predicted some Democrats would join them in repudiating it.

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Young, uninsured should weigh health care options
San Francisco Chronicle

They’re young, healthy and flat broke – and now the government says they have to buy thousands of dollars’ worth of medical insurance. What should tapped-out people in their 20s do?

Some may do nothing. The annual fine for shrugging off the new federal insurance requirement, to begin in 2014, starts out at a relatively low $95, depending on income. That would be far cheaper than paying premiums.

But that doesn’t necessarily make blowing off the mandate a good idea for the fit and frugal.

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Buying health insurance is a ‘moral duty,’ bioethicists say
Los Angeles Times

In the debate over the legitimacy of the Patient Protection and Affordable Care Act, known by many as “Obamacare,” the question that keeps coming up is this: If the government can force you to buy health insurance because it’s good for society as a whole, what’s to stop lawmakers from requiring you to eat broccoli and join a gym?

But that’s not the right way to look at it, according to a Viewpoint essay to be published in Wednesday’s edition of the Journal of the American Medical Assn.

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Lawmakers refuse to move beyond health care
The Press-Enterprise

After years of debate, dozens of repeal votes and even a landmark Supreme Court ruling, Congress still refuses to get past President Barack Obama’s controversial health care law. The U.S. House of Representatives is scheduled to vote as early as Wednesday, July 11, to repeal the bill in a measure that is decidedly political and assured to have no immediate impact on the law’s survival. Even in the unlikely event that the Democratic-controlled Senate would vote to repeal the law, Obama has promised a veto.

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Gov to lawmakers: Answers before action on ACA
San Francisco Chronicle

Gov. Bob McDonnell told state legislators Tuesday that Virginia policymakers need more answers from President Barack Obama’s administration about Medicaid before they respond to the U.S. Supreme Court ruling upholding the federal health care reform law.

In a letter to Virginia senators and delegates, McDonnell said there is no need for a special legislative session on the issue because too little is known about the state’s options under Medicaid, a program for the needy, elderly, blind, disabled and poor families with children that is funded jointly by federal and state governments.

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Contrasting views aired on ACA ‘tax’ issue
Modern Healthcare

A day before House members will vote on legislation to repeal the Patient Protection and Affordable Care Act, constitutional scholars testified before a House Ways and Means Committee to examine the tax ramifications of the U.S.

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Bill aims to crack down on illegal medical spas
California Watch

Proposed legislation in California would increase penalties for illegally owning and operating medical spas, which in some cases are performing procedures without required medical supervision.

Medical spas provide services such as laser hair removal, Botox injections and microdermabrasion. The cosmetic treatments are considered medical procedures, but at some medical spas, medical professionals aren’t giving or supervising the treatments.

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Community health centers sometimes top private practices
Los Angeles Times

Federally funded community health centers perform equal to or better than private practices on a number of quality-care measures, according to a new study. The results demonstrate that community health centers are capable of providing high-quality care to an often complex patient population. When the Patient Protection and Affordable Care Act goes into full effect in 2014, the government hopes it will add somewhere between 29 million and 32 million Americans to the rolls of the insured, many of whom will receive their care through a large expansion of Medicaid.

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Treating HIV and preventing it at the same time
Los Angeles Times

Treatment drugs can do more than improve the health of people with HIV: If administered early, medications can also reduce the spread of the disease to sexual partners and may help stem the AIDS epidemic. But many logistical hurdles stand in the way of making this strategy feasible, affordable and effective, according to experts writing in Tuesday’s edition of the journal PLoS Medicine.

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Closing ‘essential’ St. Luke’s Hospital could hurt poor
San Francisco Examiner

Despite a recent history of financial struggle, St. Luke’s Hospital in the Mission has become a crucial safety net for many of The City’s poor and underinsured residents.

The private acute-care facility’s future is at the center of deadlocked negotiations between the Mayor’s Office and California Pacific Medical Center, the Sutter Health affiliate that rescued the hospital from debt in 2001.

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CDC warned of prevention-fund grant misuse
Modern Healthcare

Prevention fund recipients apparently broke federal laws and used some of those funds for political lobbying, according to the HHS inspector general.

Investigators for the inspector general undertook the review of the Communities Putting Prevention to Work grant program after receiving complaints from members of Congress. Investigators reviewed quarterly reports submitted by grant recipients; met with officials from the Centers for Disease Control and Prevention that distributed the monies; and consulted with the HHS legal office.

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States urged to consult with hospitals on Medicaid-expansion decisions
Modern Healthcare

The importance of states checking with hospitals before rejecting the healthcare overhaul’s Medicaid expansion has drawn some bipartisan congressional support, even as the expansion remained politically divisive.

Hospital advocates have repeatedly stressed that those facilities would face the largest impacts of any type of provider if states declined to undertake the Medicaid expansion contained within the Patient Protection and Affordable Care Act.

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Cancer Center of Santa Barbara, Sansum Clinic join forces
Los Angeles Business Journal

Cancer Center of Santa Barbara and Sansum Clinic, along with their affiliated physician groups, formed a partnership to combine resources and expand services. Cancer care at Sansum Clinic will become part of the joint organization, which will be called Cancer Center of Santa Barbara or “Cancer Center” for short. In addition, Cancer Center’s endowment, major assets and fundraising team will be renamed the Cancer Foundation of Santa Barbara and will continue to raise funds to support cancer care.

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Your electronic health records and your privacy
San Francisco Chronicle

When an Internet company changes your e-mail without telling you or follows your every click to shower you with ads, you might be annoyed. But what if your most personal medical information could be monitored or altered or sold electronically and you wouldn’t know?

There are dozens of good reasons for people who provide you with health services to use electronic medical records (or electronic health records).

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Money flows in battle against health reform
Sacramento Bee

House Republicans today plan to take what for now will be a symbolic vote to repeal President Barack Obama’s Affordable Care Act, as a national campaign group backed by Aetna Insurance attacks Democrats over their health care stand.

Republicans took back the House two years ago in part by targeting Democrats who supported Obamacare. Now that the Supreme Court has upheld Obama’s signature achievement, the assault is accelerating. California is a major part of that fight.

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Health care reform needs a do-over
USA Today

The Affordable Care Act narrowly escaped death at the hands of the Supreme Court, but its troubles are far from over. Stability in how Americans will get their health care in the future is now just as much threatened by the ACA’s internal flaws as it is by Republican opposition and fresh lawsuits. Republican presidential candidate Mitt Romney’s plan to undermine the Obama administration’s health care reform effort if elected is well-known.

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Health insurers’ suits show they’re not keeping a lid on costs
Los Angeles Times

With federal healthcare reform still facing political head winds despite its validation by the Supreme Court, this probably isn’t the best time for health insurers to admit their utter incompetence in handling their most important role under the reform, which is keeping a lid on healthcare costs.

But that admission underlies a couple of lawsuits filed by Aetna and United Healthcare earlier this year, alleging that a Northern California chain of small surgical clinics fraudulently overcharged them tens of millions of dollars by counting on the insurers being asleep at the cost-contro

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