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News Headlines
Health care news from around the state and nation

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Antibiotic Resistance Targeted in 21st Century Cures Act
HealthLeaders Media

A provision in the 21st Century Cures Act recently passed by the House would require the CDC to make sure some of the bill’s financial incentives aren’t encouraging antibiotic resistance.

The amendment, sponsored by Rep. Louise Slaughter (D-N.Y.), a microbiologist, requires the CDC to issue a report within 3 years on a provision in the bill that mandates additional payments for so-called DISARM drugs for Medicare beneficiaries. DISARM (Developing an Innovative Strategy for Antimicrobial-Resistant Microorganisms) drugs are defined as those which meet an unmet medical need and that treat an infection associated with high rates of mortality or significant patient morbidity.

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Bogus enrollees kept getting ‘Obamacare’
Modern Healthcare

A Government Accountability Office report that revealed HealthCare.gov lacks the ability to verify user information is drawing both support and criticism.

GAO officials posed as phony applicants for coverage on HealthCare.gov and were able to get subsidies two years in a row, even though they provided fake information. The findings raise questions about whether HealthCare.gov is able to detect fraud, according to the GAO. One Republican lawmaker wasted no time in questioning the success of the Affordable Care Act. The Senate Finance Committee will host a hearing Thursday to discuss the findings.

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Sacramento County lands $5.7M grant for mental health crisis programs
Sacramento Business Journal

Sacramento County has landed $5.7 million in grant funding for three new 15-bed crisis residential treatment programs. The California Health Facilities Financing Authority grant will provide capital for the facilities themselves; Sacramento County will pay for treatment. The county applied for the grants in late March. The next step is to launch competitive bidding for vendors.

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Obamacare Was Supposed To Kill Medicare Advantage. It Only Made It Stronger.
Forbes

Marilyn Tavenner is about to make an unprecedented move: From head of Medicare, to the nation’s top lobbyist for private insurers — in just six months.

Tavenner will succeed Karen Ignagni as the CEO of America’s Heath Insurance Plans, the New York Times reported on Wednesday. Tavenner had served as the administrator of CMS for more than three years, where she was responsible for Medicare, Medicaid, and much of Obamacare’s implementation.

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Head of Obama’s Health Care Rollout to Lobby for Insurers
New York Times

Marilyn B. Tavenner, the former Obama administration official in charge of the rollout of HealthCare.gov, was chosen on Wednesday to be the top lobbyist for the nation’s health insurance industry.

Ms. Tavenner, who stepped down from her federal job in February, will become president and chief executive of America’s Health Insurance Plans, the trade group whose members include Aetna, Anthem, Humana, Kaiser Permanente and many Blue Cross and Blue Shield companies.

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Report: ACA plans have a third fewer providers than employer-based plans
Washington Post

Consumers who bought insurance on the health exchanges last year had access to one-third fewer doctors and hospitals, on average, than people with traditional employer-provided coverage, according to an analysis released Wednesday.

The study by consulting firm Avalere Health provides a statistical basis for anecdotal reports from consumers and others about the more limited doctor and hospital choices in plans offered on marketplaces created by the Affordable Care Act.

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Fewer choices of doctors under ObamaCare, study finds
The Hill

ObamaCare plans on average offer a choice of 34 percent fewer healthcare providers in the insurance plans’ network, a new analysis finds.

The study from the consulting firm Avalere Health says that overall figure includes an average of 42 percent fewer cancer and heart doctors to choose from. In addition, there are 24 percent fewer hospitals to choose from and 32 percent fewer primary care doctors.

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Just how narrow are Obamacare’s ‘narrow networks’?
San Francisco Business Times

The average Obamacare health plan’s provider network includes 34 percent fewer health care providers than the typical commercial plan, according to an analysis by Avalere, a Washington, D.C.-based health care consultancy. Such exchange plan networks include 42 percent fewer oncologists and cardiologists, 32 percent fewer mental health experts and primary care doctors, and 24 percent fewer hospitals, Avalere said Wednesday.

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New lobbying group to grease wheels for ‘Cadillac’ tax repeal
Modern Healthcare

Big businesses and unions, traditionally foes at the bargaining table, have both voiced disdain for the Affordable Care Act’s “Cadillac” tax on generous health plans. Now, they plan on turning up the heat to repeal it.

A coalition of large employers, business groups and unions—including the American Benefits Council, the Blue Cross and Blue Shield Association, Cigna Corp., Pfizer and Laborers International Union of North America—registered last week as a lobbying group. The group, called the Alliance to Fight the Forty, has the explicit goal of repealing the 40% excise tax.

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States make laws to protect patients from hidden medical bills
Southern California Public Radio

It’s a situation that occurs all too often: Someone goes to the emergency room and doesn’t learn until he gets a hefty bill that one of the doctors who treated him wasn’t in his insurance network. Or a diligent consumer checks before scheduling surgery to make sure that the hospital she plans to use and the doctors who will perform the operation are all in her network. Then she learns later that an assistant surgeon she didn’t know — and who wasn’t in her network — scrubbed in on her operation, and charged her for it.

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How a drug shift set the stage for a potential winner for ALS patients
San Francisco Business Times

Just as the Great Recession’s hardest blows landed on the biotech industry, Cytokinetics Inc. did a version of the bob and weave. The result may be the best hope for extending the lives of patients with Lou Gehrig’s disease.

The South San Francisco company seven years ago decided to ditch its cancer drug work in favor of muscle programs: heart, skeletal and smooth muscles that offered potentially quicker routes to drug approval and less competition.

Now, as Cytokinetics announced Tuesday, it is taking one of those experimental treatments into a late-stage trial for patients with Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis, or ALS.

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Physician Accountability Gets a Big Push Forward
The Health Care Blog

Doctors are human. Their talents and skills differ. They make mistakes. And as with every other area of human endeavor: some doctors are really good; some are pretty bad; most are average. If you are over age 50, you’ve likely met an example of all three.

In the past decade there’s more open recognition of this reality and the need to address the failures it creates in medicine and the delivery of care.

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SoCal health tech startup nabs $20 million, plans S.F. expansion
San Francisco Business Times

HomeHero, a Santa Monica-based online marketplace that helps consumers find in-home care givers, raised $20 million last week in a Series A funding round that gives it total funding of $23 million. The money will help it expand in the Bay Area, which CEO and co-founder Kyle Hill sees as perhaps its strongest target market. Graham Holdings led the new round, with help from Tencent Holdings Ltd., the Social+Capital Partnership and Inside Holdings Inc.

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UnitedHealth tops Street 2Q forecasts, raises forecasts
San Francisco Chronicle

UnitedHealth juiced up its business outside health insurance in a better-than-expected second quarter while key competitors scrambled to add enrollment in a wave of mega-mergers sweeping the sector. The nation’s largest health insurer said Thursday that operating earnings climbed about 19 percent to $864 million for its Optum business segment, which provides pharmacy benefits management and technology services, among other products. That contributed to 13 percent overall profit growth in the quarter and another earnings forecast increase for the company.

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UnitedHealth profit up amid Aetna speculation
USA Today

Insurance giant UnitedHealth Group (UNH) reported stronger profit and revenue for the second quarter of 2015 while speculation continues that the company is actively pursuing a bid to acquire rival Aetna (AET).

UnitedHealth beat Wall Street expectations as the company’s Optum technology and services division surged and the company added patients.

Minneapolis-based UnitedHealth recorded net earnings of $1.59 billion for the quarter, up 13% compared to the same period a year earlier. Total revenue increased 11% to $36.263 billion.

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UCSF Medical Center Named One of 2015’s ‘Most Wired’ Hospitals
UCSF Today

UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco have been named one of HealthCare’s Most Wired™ for 2015, in recognition of the focus on security and patient engagement through information technology.

Health data security and patient engagement are top priorities for the nation’s hospitals, according to the results of the 17th annual HealthCare survey released July 9, by the American Hospital Association’s Health Forum and the College of Healthcare Information Management Executives (CHIME).

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New clinics at Pioneers Memorial Hospital open
Imperial Valley Press Online

The Pioneers Memorial Health Care District continues to expand its services with the opening of two new clinics, the Center for Digestive & Liver Disease and the Pain Center here. The two clinics, along with the Wound Clinic, are housed in the district’s new Pioneers Medical Arts Building west building which had its official grand opening Wednesday.

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Los Gatos: El Camino Hospital funds $2.8 million in community grants
The Mercury News

More than two dozen organizations have been singled out by El Camino Hospital to receive $2.8 million in grants through its Community Benefit Program. The grants range in size from about $30,000 to $100,000. School districts, youth and senior organizations and even the Santa Clara County Court system are among the recipients.

So is the Los Gatos hospital-based RoadRunners group. “We take seniors to medical appointments, to the pharmacy or to daily activities so they can remain independent,” El Camino’s community benefit director Barbara Avery said. “It’s the kind of service you’d want to put your parents in.”

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Rehab Hospital Takes on HHS Over RAC Appeal Delays
HealthLeaders Media

California’s only non-profit independent rehabilitation hospital has filed suit to force the federal government to resolve disputed Medicare billing appeals within its mandated 90-day window.

Felice Loverso, president and CEO of the 68-bed Casa Colina Hospital and Centers for Healthcare in Pomona, says the federal government has “for years, years” been holding about $1.1 million in claims that were flagged by recovery audit contractors. Casa Colina has appealed the claims denials, but, he says, HHS hasn’t come close to providing a hearing in front of an administrative law judge within the 90-day window mandated by Medicare law.

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