News Headlines

News Headlines
Health care news from around the state and nation

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This Is How Easy It Is to Scam Obamacare

When opened in late 2013, it was so crippled by technical problems that critics questioned whether people would be able to sign up for coverage. Now, it may actually be too easy to enroll.

That’s according to a new government audit, presented in testimony from the Government Accountability Office, delivered at a Senate Finance Committee hearing on Thursday. When federal auditors tried to apply for insurance coverage and tax credit subsidies using fictitious applicants, they succeeded 11 out of 12 times. Here are some highlights from the GAO’s undercover investigation:

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Lives Grow Longer, and Health Care’s Challenges Change
New York Times

If you’re living with multiple ailments, you’re not alone.

According to an analysis published last month in the British medical journal The Lancet, 2.3 billion people, almost one-third of humanity, suffered from five or more health problems in 2013. More than 80 percent of those people were younger than 65 years old. And between 1990 and 2013, the number of people in developed countries who suffered from 10 or more ailments increased by 52 percent.

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Vaccinemakers have fingers crossed for this flu season
Modern Healthcare

U.K.-based drugmaker GlaxoSmithKline announced Thursday that it has started shipping its Fluarix flu vaccine to U.S. pharmacies and healthcare providers. Last year’s ineffective vaccinations are top of mind as drugmakers and physicians hope this year’s vaccine formula is on target.

More than half of the influenza cases reported during the 2014-2015 flu season came from a mutated virus strain that the vaccine didn’t protect against.  Last year, flu vaccines from various manufacturers had an effectiveness rate of just 23%, while in other recent years, the vaccine has had an efficacy rate of 47% to 60%, according to the Centers for Disease Control and Prevention.

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How Much Does It Cost To Have A Baby? Hospital Study Finds Huge Price Range
Kaiser Health News

Which hospital parents pick to deliver their baby can have serious cost consequences, according to a new study.

Hospital costs for women who had no maternal or obstetric risk factors to complicate childbirth ranged from less than $2,000 to nearly $12,000, the analysis of discharge data found. The wide variation in cost means that for expectant parents, it can pay to shop around.

The variability was surprising, says study co-author Dr. Jessica Illuzzi, an associate professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine.

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How Is Health Reform Impacting Insurance Switching Patterns?
The Health Care Blog

Americans typically don’t switch health insurance, and that has not changed much with healthcare reform. Despite controversy with the converse scenario – the ability to keep the same insurance – and the introduction of health insurance marketplaces, data from ACAView suggests switching behavior has been modest.

For this latest ACAView research, our team set out to determine how the ACA’s insurance coverage expansion has influenced patient behavior in switching insurance coverage. We looked at patients’ switching patterns, and how those have shifted for a subset of patients who have visited primary care providers at the same practice at least once a year between 2013 and 2014 and/or between 2014 and 2015.

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Democrats decry undercover probe of
Washington Post

Senior Democrats pushed back Thursday against an undercover government probe of President Barack Obama’s health care law, saying it didn’t uncover any real fraud.

Investigators for the nonpartisan Government Accountability Office signed up 11 bogus beneficiaries for 2014 coverage then got to continue benefits this year for all but one.

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California may let undocumented immigrants buy Obamacare

California lawmakers and activists are spearheading a first-in-the-nation plan to let undocumented immigrants buy Obamacare health insurance. Supporters say the California proposal, which would need federal approval and couldn’t start until 2017, is the next logical step in expanding health insurance to a population that was intentionally excluded from the president’s health-care law. But uniting the two highly combustible issues of Obamacare and immigration could reignite a fierce health-care reform controversy.

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Out-of-network costs lurk even at in-network hospitals
Los Angeles Times

Lorena Martin’s 18-year-old son, Robert, hurt his ankle playing football one recent Friday evening. He was in pain and unable to walk, and she was concerned that he’d done real damage.

Both her doctor’s office and the nearby urgent care center were closed, so with no other options, she took him to the emergency room.

The hospital was in her health plan’s network — she’d made sure of that. Once there, Martin paid a $50 co-pay and later received a bill for an additional $270, which she expected.

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Home Health Agencies Get Medicare’s Star Treatment
Kaiser Health News

The federal government released on Thursday a new five-star rating system for home health agencies, hoping to bring clarity to a fast-growing but fragmented corner of the medical industry where it’s often difficult to distinguish good from bad.

Medicare applied the new quality measure to more than 9,000 agencies based on how quickly visits began and how often patients improved while under their care. Nearly half received average scores, with the government sparingly doling out top and bottom ratings.

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Most home health agencies get mediocre ratings
Modern Healthcare

On a star-rating scale ranging from one to five, with five being the best, the national average for more than 9,000 home health agencies is three, according to new federal data released Thursday. The providers are the latest subjected to the CMS‘ five-star rating program, which helps consumers compare quality and safety at U.S. healthcare facilities.Of the more than 12,200 home health agencies listed, 9,359 had reported enough data to receive a rating. Only 239 got five stars; 201 got either one or 1.5 stars; and 4,274 got three stars on the new rating scale.

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Merger mania helps health insurers think big
San Francisco Business Times

Whether Obamacare, the recent U.S. Supreme Court decision saving it, or simply the normal corporate tendency toward getting bigger and bigger is to blame, many of the nation’s top health insurers are looking to merge.

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Foster kids bills should give doctors a pass
Daily Democrat

A package of four bills headed through the California Legislature this summer will help stem the tide of powerful psychotropic medication prescribed for as many as 1 in 4 foster children — the state’s most vulnerable kids.

The legislation may not be enough. But it’s a good start, even though it steers clear of imposing requirements directly on doctors who prescribe the drugs to foster kids. The bills should become law.

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State regulator slams Aetna’s 21 percent small biz increase
Sacramento Business Journal

The state’s managed-care regulator blasted Aetna on Thursday for a July 1 small-business rate hike of 21 percent. The increase affects about 13,000 members. Shelley Rouillard, director of the California Department of Managed Health Care, said four of the last six rate increases she has found “unreasonable” have been Aetna’s. In the past eight months, Aetna has subjected more than 40 percent of its small business members to unreasonable rate increases, she added.

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Aetna Breaks Ties To Man Who Sold Policies To Hundreds Of Homeless
Kaiser Health News

Aetna is ending its relationship with a Charlotte insurance agent who used the Affordable Care Act to sell premium-free policies to hundreds of homeless people while the N.C. Department of Insurance continues its review of the arrangement.

The state has scheduled a Sept. 3 “informal administrative conference” on the sales, which sparked questions and criticism from Charlotte advocates for the homeless and national experts on the health care act. That session will be closed to the public, spokeswoman Kerry Hall said this week.

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Aetna’s 21% rate hike amounts to ‘price gouging,’ California regulator says
Los Angeles Times

California’s managed-care regulator slammed health insurance giant Aetna Inc. on Thursday for “price gouging” after it raised rates on small employers by 21%.

This marked the fourth time since 2013 that California officials have found Aetna’s premium increases on small businesses unreasonable.

Aetna, the nation’s third-largest health insurer, is raising rates by 21%, on average, for about 13,000 people covered by small employers. This change in premiums took effect July 1.

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Tenet takes over Hi-Desert Medical Center
Hi-Desert Star

Tenet Healthcare Corporation began operating Hi-Desert Medical Center and its related healthcare facilities under an agreement with the Hi-Desert Memorial Health Care District on Wednesday, July 15. Tenet will manage operations of the 59-bed primary care hospital and the 120-bed skilled nursing facility on the hospital campus and associated programs previously operated by the hospital. The district will continue to operate two family health clinics. The longterm lease agreement was approved by district voters on June 23 by a margin of 90.6 percent to 9.4 percent.

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Autism center ribbon-cutting scheduled at Valley Children’s Hospital
Fresno Bee

A ribbon-cutting will be held at 10 a.m. Friday at Valley Children’s Hospital for a satellite location for the Autism Center at Fresno State.

Valley Children’s President and CEO Todd Suntrapak and Joseph Castro, president of California State University, Fresno, will celebrate the opening of the center.

The satellite center will allow the Autism Center to expand its services and provide more opportunities to train undergraduate and graduate students.

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Valley’s surgical complication rates considered typical
The Desert Sun

Using five years worth of Medicare billing data, the journalism nonprofit ProPublica has calculated rates of surgical complications for nearly 17,000 U.S. surgeons and the hospitals where they operate.

While nationally the analysis found a wide range of complication rates — even among surgeons working in the same hospital —rates for surgeons in the Coachella Valley were generally considered typical.

Eisenhower Medical Center in Rancho Mirage, the largest of the valley’s three hospitals, had the lowest overall complication rates among the three, according to the ProPublica data.