News Headlines

News Headlines
Health care news from around the state and nation

 

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Billing squeeze: Hospitals in middle as insurers and doctors battle over out-of-network charges
Modern Healthcare

When Dr. Kelly Kyanko was giving birth to her second son a couple of years ago, there were signs her baby was facing a higher risk of complications after delivery. A pediatrician was called in, and everything turned out fine for mother and newborn baby.But after she left the hospital, Kyanko faced a surprise $636 bill from the pediatrician that her insurer, UnitedHealthcare, did not cover. Before her delivery, she had checked to make sure the hospital and the OB-GYN were in her plan’s network. She had no way of knowing, however, that the consulting pediatrician was out-of-network.

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Insurers begin to review coverage of costly cholesterol drugs
Modern Healthcare

Now that the Food and Drug Administration has given the OK to two pricey drugs that treat high cholesterol, health insurers and pharmacy benefit managers are evaluating if one drug should receive preferred coverage over the other.

In exchange for the preferred designation, drugmakers offer price discounts on their products. A flurry of these types of deals occurred this year with high-cost hepatitis C drugs.

This week, the FDA approved Repatha, an injectable drug made by Amgen that lowers a person’s “bad” cholesterol level. It can be used only for patients who have certain inherited conditions or a history of serious heart ailments. Estimates put that patient base at around 5 million to 10 million people. These types of cholesterol drugs are called PCSK9 inhibitors.

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‘Cadillac tax’ could wreck popular medical accounts
POLITICO

A popular middle class tax benefit could become one of the first casualties of the Affordable Care Act’s so-called Cadillac tax, affecting millions of voters. Flexible spending accounts, which allow people to save their own money tax free for everything from doctor’s co-pays to eyeglasses, may vanish in coming years as companies scramble to avoid the law’s 40 percent levy on pricey health care benefits.

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Insurers say private Medicare plans are better, but we really don’t know
Yahoo! News

Health insurers have been telling us for years that their Medicare Advantage plans, which are federally funded but privately run alternatives to traditional fee-for-service Medicare, can provide better care—at lower cost—than the government.

One of my priorities when I worked in the industry was to perpetuate that notion. And I believed the PR, so much so that I encouraged my own parents to enroll in a Medicare Advantage plan. But is the PR true? The answer is, we don’t know, and we may never know.

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Millions Facing a Hefty Increase in Medicare Premiums in 2016
The Fiscal Times

Nearly a third of the roughly 50 million elderly Americans who depend on Medicare for their physician care and other health services could see their premiums jump by 52 percent or more next year.

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Half of states aren’t switching workers’ comp claims to ICD-10 on Oct. 1
Modern Healthcare

While the CMS says Medicare contractors are ready to switch their claims processing to ICD-10 coding on Oct. 1, about half of state workers’ compensation claims payment systems are taking a pass.

According to the Workgroup for Electronic Data Interchange, a not-for-profit healthcare industry trade group that promotes computerization in healthcare, only 21 states have adopted the Oct. 1, 2015 deadline for switching over their workers’ comp systems to processing physician and hospital inpatient and outpatient claims to ICD-10. Another four states have pending ICD-10 regulations for workers’ comp claims.

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Heart-Attack Patients More Likely To Die After Ambulances Are Diverted
NewsOK

Heart-attack patients whose ambulances were diverted from crowded emergency rooms to hospitals farther away were more likely to be dead a year later than patients who weren’t diverted, according to a recent study published in the journal Health Affairs.

The study, conducted by researchers at the University of California-San Francisco and the National Bureau of Economic Research, looked at ambulance diversions affecting nearly 30,000 Medicare patients in 26 California counties from 2001 to 2011.

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American Academy Of Pediatrics Recommends Individualized Counseling For Parents Of Premature Infants
Kaiser Health News

For the tiniest infants — those born before 25 weeks in the womb — survival is never guaranteed, and those who make it may be left with severe disabilities.

These micro-preemies are born in what’s known as the “grey zone.” Whether or not to resuscitate them depends on the decisions made by individual hospitals, doctors and parents. Decisions can vary greatly even among hospitals in the same area.

A new statement from the American Academy of Pediatrics aims to improve the way those decisions are made.

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California Health Care Personnel Roundup for August 2015
California Healthline

Joe Wilkins — chair of the California Hospital Association’s governance forum — has been elected to the American Hospital Association’s board of trustees, effective Jan. 1, 2016.

Wilkins also is board chair of St. Joseph Hoag Health in Irvine and a member of AHA’s committee on governance. His term will last three years (American Hospital Association release, 8/11).

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How to Deal With the Pain of a Surprise Medical Bill
NBC News

When it comes to “bill shock,” a surprise medical expense can be particularly damaging.

Over the past two years, nearly one-third of privately insured Americans has received an unexpected medical bill where their health plan paid less than expected, according to a May survey from the Consumer Reports National Research Center.

For many, it’s an expense that isn’t so easy to handle. A 2014 Kaiser Family Foundation report estimated one in three consumers have difficulty paying their medical bills, and earlier this year, Bankrate.com found that only 38 percent of consumers had enough liquid assets to cover an unanticipated expense like an emergency room visit or $500 car repair.

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Amgen wins FDA approval for cholesterol drug Repatha
Los Angeles Times

The Food and Drug Administration has approved Amgen Inc.’s cholesterol-lowering medication, Repatha.

The move follows FDA’s approval last month for a similar drug Praluent, from Sanofi and partner Regeneron Pharmaceuticals Inc. Both Praluent and Repatha belong to a class of injectable cholesterol-lowering drugs known as PCSK9 inhibitors.

The FDA on Thursday approved Amgen’s Repatha for patients who are unable to control their cholesterol with existing drugs and treatments, specifically, adults with extremely high levels of LDL, or bad cholesterol, due to inherited conditions; and patients with persistently high LDL levels and a history of heart attack, stroke and other cardiovascular problems, according to the Associated Press.

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Good news in the new year for North State health insurance
Redding Record Searchlight

There is some good news in 2016 for North State residents that purchase their insurance as individuals, rather than as part of a group. CaBut first let’s be clear.

One of the biggest misconceptions in the public today is that there is a difference in products available to individuals and/or families if the insurance is purchased on the California Exchange. There is no difference in networks if the plan is considered an individual and not an employer-sponsored group plan.

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Stanford Health Care brings human touch to cancer care in South Bay (Slideshow)
Silicon Valley Business Journal

Stanford Health Care, ranked No. 1 in California by U.S. News & World Report in its regional rankings for hospitals, has brought its expertise in treating cancer patients to the South Bay. This slideshow offers a closer look at some of the people behind this effort, and the medical expertise and technology now available in San Jose. Silicon Valley Business Journal subscribers can read all about it in this week’s cover story, ” The human touch: Treat the tumor, heal the soul.”

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College of the Redwoods to offer pharmacy technician program
Times-Standard

A longtime local pharmacist will help others break into a growing profession when he teaches a pharmacy technician course this fall at College of the Redwoods.

“I’ve had a lot of experience in teaching students on the job site and this is a way to do it in the classroom,” said Ken Robinson, a licensed California pharmacist who has a Doctor of Pharmacy degree from Washington State University. He is currently a staff pharmacist at Mad River Community Hospital and has also held pharmacist positions at Humboldt State University, St. Joseph Hospital and many other locations.

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New Goleta Valley Hospital Opens Its Doors
KEYT3 - Santa Barbara

The new Goleta Valley Cottage Hospital opened its doors, and welcomed residents to its newly expanded facility on Patterson Avenue. The hospital is replacing all of its inpatient care facilities at a cost of $126 million.

The emergency room has doubled in size, and there are now six surgical suites.

Part of the rebuilding ensures that the hospital is earthquake safe.

The California legislature mandated that all hospitals be rebuilt to withstand a 6.0 earthquake following the 1994 Northridge quake.

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