News Headlines

News Headlines
Health care news from around the state and nation

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What’s At Stake When The Supreme Court Rules On Health Plan Subsidies
Kaiser Health News

Later this month, the Supreme Court is expected to rule on King v. Burwell, a case challenging the validity of federal tax subsidies helping millions of Americans buy health insurance if they don’t get it through an employer. If the court rules against the Obama administration, those subsidies could be cut off for people in the approximately three dozen states using healthcare.gov, the federal exchange website.

Here are answers to some frequently asked questions about the case.

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ACOs say Medicare rule doesn’t bend far enough
Modern Healthcare

Despite the Obama administration’s efforts to retain and attract participation in the Medicare Shared Savings Program for accountable care organizations, some may walk away because the agency failed to budge on some of their concerns. The ACO initiative creates financial incentives for providers to reduce costs while meeting quality benchmarks. In a rule updating the program, which was outlined in the Affordable Care Act and launched in 2012, the agency finalized a proposal to allow ACOs to stay in the program longer than three years without progressing to a track that includes downside risk— meaning they would have to return money to Medicare if they fail to reduce costs.

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Emergency room visits spike for children in California with asthma
San Bernardino Sun

Children in California increasingly are flocking to emergency rooms for treatment of asthma, despite millions of dollars spent on programs to control the disease.

Statewide, the rates of ER visits for asthma symptoms rose by about 18 percent for California children ages 5 to 17 and by 6 percent for children under 5 between 2005 and 2012, according to a Kaiser Health News analysis of the latest available rates by county.

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Productivity? In Healthcare?
The Health Care Blog

Obamacare is built on the assumption that healthcare can be more productive, that we can squeeze more health per dollar out to the system that is built to give it to us. Practically everything I write is based on the same idea — big time. I believe we could do healthcare better for half the money we pour into it now.

There is a widely-cited theory that this is fundamentally impossible, popularized by William Baumol, a New York University economist, in a 2012 book, The Cost Disease: Why Computers Get Cheaper and Health Care Doesn’t. Baumol trades on the idea that healthcare is mostly the individual labor of highly trained professionals (doctors, nurses, and technicians) whose labor cannot simply be baked into machines and software. So we can’t expect healthcare to become any more productive, especially as healthcare keeps getting more complex.

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Obamacare Enrollees Anxiously Await Supreme Court Decision That Threatens Their Coverage
The Huffington Post

Karen Hines is worried about getting two pieces of very bad news this June. The first would be her cancer returning. The second would be her health insurance becoming abruptly unaffordable.

“I’ve got my six-month, regular cancer checkup in June, and so I’m saying I hope they don’t come out with any kind of decision, just in case it’s bad news, until after,” Hines said. “You always get nervous, usually a day before or day of, going for a checkup. But I think I started a little more on the worrying ahead of time.”

Hines, 59, has been relying on health insurance purchased through the Affordable Care Act marketplaces to help cover the costs of those checkups. But she has the misfortune of residing in a state, Virginia, where the federal government is operating that marketplace. Because of that, she could end up losing her tax subsidy to help purchase coverage right at the time her health takes a dive for the worse.

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Quality and control, not choice, is what insurance customers want
Modern Healthcare

Health insurers are trying to figure out what makes consumers tick as the market increasingly becomes a direct-to-consumer business.But new surveys suggest that some of the previous ideas have been misguided. The backlash against restrictive health maintenance organizations in the 1990s gave rise to the idea that what consumers want is choice, said Jean-Pierre Stephan, a managing director at Accenture.

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Medi-Cal boom brings capacity questions
San Diego Union-Tribune

As a pediatric endocrinologist, Dr. Sherry Franklin usually does not treat adults. But the San Diego specialist said she recently made an exception for a 24-year-old Medi-Cal patient from Truckee who said she was unable to schedule a diabetes checkup closer to home.

Doctors and patients are telling these kinds of stories more often as state Medi-Cal rolls have increased by 4 million under an expansion program created by the Affordable Care Act.

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MSSP Final Rule Panned by Providers
HealthLeaders Media

Providers are bracing for a bumpy ride in the drive to quicken adoption of value-based payment at Medicare.

The least risky accountable care option available on the Centers for Medicare & Medicaid Services value-based payment palette was released last week with the Final Rule for the Medicare Shared Savings Program.

When the rule goes into effect, on August 3, MSSP participants will be allowed to bank a share of cost-effectiveness gains. The vast majority of participating providers have signed up for MSSP Track 1, where they avoid downside risk if performance benchmarks are not met.

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Bill To Speed FDA Approvals Includes Rewards For Drugs Designed For Kids
Kaiser Health News

Advocates for children with rare diseases are watching closely a congressional effort to streamline the nation’s drug approval process because the bill includes a provision extending a federal program that rewards companies making remedies for these young patients.

The reward program, the advocates say, offers hope to families that often have very few options.

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Cybersecurity Insurance Basics for Healthcare Organizations
HealthLeaders Media

“Why are you doing this? We’re a hospital. No one will want our data,” was a comment Holly Meyers, RN, FACHE, then the senior vice president of quality, risk management, and insurance at Sylvania Franciscan Health frequently heard when she decided in late 2007 that carrying insurance to protect the seven-hospitals system in the event of a cyberattack or a data breach was a responsible choice.

“At the time, no one had really heard of any hospitals having security breaches, but we felt things had changed, or were about to,” says Meyers, who left Sylvania Franciscan Health recently. “We were looking at what we had, at all the personally identifiable patient and employee information. We knew that if there was ever a cyberattack, we couldn’t handle it all by ourselves.”

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Healing continues for cancer survivors
San Diego Union-Tribune

Twenty-nine.

That’s how old Michelle Fernandez was when she was told she had stage-three breast cancer.

“The first thing she said to me was, ‘I’m sorry,’ ” Fernandez said of the call from a nurse. “Right when she said that, I knew. I was speechless.”

That was six years ago. Now, after six months of chemotherapy, a mastectomy, radiation, another mastectomy and no reconstruction, Fernandez is cancer free.

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Bonus bonanzas: Association CEOs got healthy pay raises in 2013
Modern Healthcare

Median total pay for healthcare association chief executives earning $1 million or more increased 8.5% from 2012 to 2013, while total pay for all healthcare association CEOs jumped 18.9%, according to Modern Healthcare’s analysis of the latest association tax reports.Twenty association CEOs earned between $1 million and $5 million, compared with 17 in 2012, as the not-for-profit groups regained their financial footing following the Great Recession. The median total compensation among CEOs who earned $1 million or more was $1.5 million.

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More Preventive Health Services Approved For No-Cost Coverage
National Public Radio

The Affordable Care Act says that preventive health tests or services recommended by the U.S. Preventive Services Task Force have to be available to most insured consumers without any out-of-pocket cost.

Since the law was enacted, the list of services that people are entitled to has grown. In 2014, the task force recommended two new services and tweaked a handful of others that had previously been recommended.

Under the health law, preventive care that receives a grade of A or B on the recommended list by the nonpartisan group of medical experts must be covered by health plans without charging consumers. Only grandfathered plans are exempt from the requirement.

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California can do better by poor kids’ teeth
Sacramento Bee

Few pains are more debilitating than toothaches. For kids, a rotten tooth can mean lost days in school.

So when a state audit in December chastised the California Department of Health Care Services for shortcomings that limited access to dentistry for children of low-income parents, legislators and policymakers rightly took notice.

Part of the problem is a lack of dentists in rural California who will treat patients through Medi-Cal. One reason is that reimbursement rates are simply too low.

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Blue Shield faces more heat over nonprofit status, $1.2-billion deal
Los Angeles Times

Health insurance giant Blue Shield of California is facing more questions over its loss of tax-exempt status as it tries to win state approval of a $1.2-billion acquisition.

A former Blue Shield executive is accusing the San Francisco insurer of giving contradictory answers to state officials about its corporate structure. And consumer advocates are calling on Blue Shield to disclose details of a state audit that examined the company’s taxpayer subsidy.

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Kaiser Permanente workers to get raises
Inside Bay Area

Capping negotiations involving hundreds of people over three months, Kaiser Permanente has reached a three-year agreement offering annual raises of 2 to 4 percent to 105,000 health-care employees ranging from maintenance workers to pharmacists.

The contract covers workers in 28 local unions in eight states and Washington, D.C. For California workers, the wage increases will range from 3 to 4 percent, depending on the region and the year of the contract.

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Bay Area hospitals seeing birthrates inching back up after recession
The Mercury News

Every time a baby is born at John Muir Medical Center in Walnut Creek, the sounds of Brahms’ Lullaby stream through the halls of the hospital. On a recent spring day, the tune rarely stopped playing as the entire 35-bed mother-and-baby unit in the Long Tower was occupied.

“It was beautiful,” said Nicole McCaughin, John Muir’s interim director of women and children’s services. “We had 35 moms with babies, and that was the first time since we built the Long Tower (in 2011) that every single room was full.”

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El Dorado joins rural counties in urging legislature to eliminate Medi-Cal rate cuts
Tahoe Daily Tribune

El Dorado County joins the Rural County Representatives of California (RCRC), the California Hospital Association, and a broad-based coalition of Medi-Cal providers known as We Care for California in urging the Legislature and Administration to eliminate Assembly Bill 97 (2011) Medi-Cal rate cuts, and increase Medi-Cal payments to healthcare providers and health plans during the upcoming State Budget negotiations.

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