Archive for September, 2011

A Surgeon Examines His Professional Development

Every week, reporter Jessica Marcy selects interesting reading from around the Web.

The New Yorker: Personal Best
I’ve been a surgeon for eight years. For the past couple of them, my performance in the operating room has reached a plateau. I’d like to think it’s a good thing—I’ve arrived at my professional peak. But mainly it seems as if I’ve just stopped getting better. During the first two or three years in practice, your skills seem to improve almost daily. It’s not about hand-eye coördination—you have that down halfway through your residency. As one of my professors once explained, doing surgery is no more physically difficult than writing in cursive. Surgical mastery is about familiarity and judgment. … As I went along, I compared my results against national data, and I began beating the averages. My rates of complications moved steadily lower and lower. And then, a couple of years ago, they didn’t. It started to seem that the only direction things could go from here was the wrong one (Atul Gawande, 10/3).


Friday, September 30th, 2011

Today’s Headlines – Sept. 30, 2011

Happy Friday! Today’s headlines include reports about how new and old health policy positions are playing on the campaign trail.

The New York Times: Some Common Ground For Legal Adversaries On Health Care
The 2010 health care overhaul law has provoked an unprecedented clash between the federal government and 26 states, dividing them on fundamental questions about the very structure of the federal system. But the two sides share a surprising amount of common ground, too, starting with their agreement in briefs, filed on Wednesday, that the Supreme Court should resolve the clash in its current term (Liptak, 9/29).

Politico: Republicans Target Health, Education For Cuts
House Republicans on Thursday released their draft 2012 budget for labor, health and education programs, a giant $153.4 billion measure that moves toward the Democrats in total dollars but still challenges President Barack Obama almost across the board on labor rules and his prized education and healthcare reforms (Rogers, 9/29).

For more headlines … (more…)

Friday, September 30th, 2011

Focus Of Health Law Challenges Shifts To The Supreme Court

The Justice Department Wednesday asked the Supreme Court to hear their appeal of the 11th Circuit’s August ruling that found the individual mandate unconstitutional. The moves increase the likelihood that the Supreme Court will take the case up in its next term, potentially ruling on the constitutionality of health law before the 2012 elections. Kaiser Health News is tracking the progress of the legal challenges to the 2010 health law.

Here’s how some bloggers handled the Obama administration decision and what they think it means for the law and for the politics of the 2012 elections.

At The Washington Post’s Wonkblog, Sarah Kliff describes three reasons the Obama administration decided to go straight to the Supreme Court: “The Obama administration will definitely handle the case.” Delaying it until 2013, which many argued would result from the 11th circuit appeal, would come with a big risk: “a Republican administration could be in power, and arguing the case” Another reason: “The review might not have been granted — or gone against the administration.” Also, “[t]he move shows confidence. Asking for review of the 11th Circuit decision would have been widely interpreted as foot-dragging, the administration attempting to slow a case that’s almost inevitably headed to the Supreme Court. For the White House to proactively pursue a faster timeline makes the administration look more confident that it will prevail in court.”

At The Incidental Economist, Kevin Outterson is tracking amicus briefs on the health reform law challenge.

At ThinkProgress Health, Ian Millhiser writes: “It is not the least bit surprising that the Obama Administration passed up this potential opportunity to delay the case until after the next Supreme Court term. For one thing, the Administration has consistently chosen not to engage in delay tactics throughout this litigation. Most recently, DOJ refused to argue that the courts lack jurisdiction to hear the case until 2015 despite the fact that one court of appeal concluded that they do lack jurisdiction and another expressed sympathy with that view. More importantly, the Administration should be eager to get this case in front of the justices since they are overwhelmingly likely to win once the case gets there.”


Thursday, September 29th, 2011

Florida CHIP Program ‘Treading Water’

Despite the tough economy, Florida’s Children’s Health Insurance Program added just 2,000 children in the year ended June 30, for a growth rate of less than 1 percent. Among school-age kids, the program added just 700 children.

Before last year, the Florida CHIP progam was growing by about 8 percent a year. It now has about 275,000 kids enrolled.

Rich Robleto, executive director of Florida Healthy Kids Corp., which runs the low-income health insurance program for children who don’t qualify for Medicaid, cites two factors. He said each month the CHIP program loses up to 8,000 children who transfer to Medicaid because their parents’ income fell; Medicaid added 98,000 children last year.

In addition, Robleto said, a new federal rule requires parents to provide proof they are United States citizens before children can be covered. The documention requirement caused about 10,000 kids to drop off CHIP, he said.

Florida has limited dollars to advertise the CHIP program, and Robleto said many families who lost health coverage during the economic downturn are not familiar with the government program. He said the program is trying to find both children who are eligible and have not been insured and children who have recently lost private coverage because their parents lost their jobs. Florida and two other states account for 40 percent of the 5 million children who are eligible for Medicaid or CHIP but not enrolled. The other states are California and Texas.

“It’s almost as if we are treading water,” he said.

More than 5 million children are enrolled in CHIP across the country.

Thursday, September 29th, 2011

Today’s Headlines – Sept. 29, 2011

Today’s early morning highlights from the major news organizations, including reports that a Supreme Court ruling on the 2010 health law is now likely before the 2012 presidential election.

The New York Times: Supreme Court Is Asked To Rule On Health Care
The Obama administration asked the Supreme Court on Wednesday to hear a case concerning the 2010 health care overhaul law. The development, which came unexpectedly fast, makes it all but certain that the court will soon agree to hear one or more cases involving challenges to the law, with arguments by the spring and a decision by June, in time to land in the middle of the 2012 presidential campaign (Liptak, 9/28).

For more headlines … (more…)

Thursday, September 29th, 2011

HHS Announces Coordinated Care Initiative

If the Department of Health and Human Services has its way, hundreds of physician practices will follow the money and take up a coordinated model of health care.

The Comprehensive Primary Care Initiative, announced Wednesday, will increase Medicare  payments to primary care providers who adopt a coordinated care model. A four-year demonstration, overseen by the Centers for Medicare and Medicaid Services, begins next year in several health care markets. Providers in HHS-supported accountable care organizations, which also promote coordinated care, will not be able to participate.

Coordinated care is based on teamwork among primary care doctors, specialists and other providers, with a particular focus on prevention and better managing chronic disease. HHS officials said that coordination yields both quality improvements and significant savings — primary goals of the 2010 health law this initiative stems from.

Richard Baron, director of the Seamless Care Models Group at the Center for Medicare and Medicaid Innovation, said the HHS initiative “recognizes the need to see changes in the primary care practice model, but that we first need to see changes in the payment model for primary care.”

CMS will select five to seven health care markets for its demonstration. According to Baron, CMS is looking for areas with multiple interested insurers, both public and private. These insurers will then help target and select about 75 practices in each market. Providers will be paid an extra $20 per month, on average, per Medicare beneficiary in the first two years; the funds will cover a little over 330,000 Medicare patients total. The money can be used at providers’ discretion to build up infrastructure for coordinated care, likely with increased staff, longer hours of access and electronic health records.

The $20 per month represents a “very significant contribution” toward coordinated care efforts, said Bob Dougherty, a senior vice president with the American College of Physicians. Combined with the support of their insurers, practices will have certainly have enough resources to implement coordinated care, he added.

Practices will also financially benefit from cost savings for Medicare. After a year, CMS will begin evaluating providers based on yet-to-be-decided criteria for quality of care. This information will determine how much of the expected savings to Medicare that individual practices can share in. In the end, CMS expects that with decreased costs and coordinated methods in place, providers will expand the care model to all patients.

Insurers must submit a letter of intent by Nov. 15, while full applications are due Jan. 17. Once markets are selected, individual practices will apply for funds, likely in the spring, and funds will begin to be distributed in the summer.

Wednesday, September 28th, 2011

N.C. Insurer Invests $15M In Docs’ Health IT

Blue Cross and Blue Shield of North Carolina planned to announce Wednesday that the insurer will spend $15 million to arm as many as 750 physicians in the state with state-of-the-art electronic medical records.

Photo by Tricia Wang via Flickr

Blue Cross, the dominant financier of the state’s health system with 54 percent of the insured on its rolls, stands to benefit if the electronic records help doctors practice a more efficient style of medicine. For instance, the computer can prompt doctors to do blood tests or other follow-ups with patients.

And the doctors, who all work for either free clinics or in independent small practices, get a free piece of technology they may not otherwise be able to afford. The 2009 stimulus bill makes as much as $44,000 available to each physician who successfully adopts electronic records, but those payments only begin to arrive after doctors make investments.


Wednesday, September 28th, 2011

Today’s Headlines – Sept. 28, 2011

Good morning health policy world! Today’s headlines include reports about the costs of employer insurance plans and the final installment of KHN’s Building Ambitions series.

Kaiser Health News: Building Ambitions: The Big Money World Of Kids’ Care – Children’s Hospitals May Face Leaner Future (Part 3 of 3)
Reporting for Kaiser Health News, in collaboration with McClatchy, reporter Gilbert M. Gaul writes: “Last October, executives from some of the largest and most prestigious children’s hospitals gathered in Philadelphia to talk about the future of children’s care. Panel topics ranged from the impact of the federal health overhaul law on children’s hospitals to the nation’s debt crisis and the significant role that health spending plays in it. In the past, the mood at such gatherings was largely upbeat, reflecting the exceptional market power of children’s hospitals, which were enjoying strong profits and record growth. But now, confronted with a rapidly shifting landscape for children’s care and a battering economy, the leaders were worried” (Gaul, 9/26).

KHN also reports in a related story, Heads Of Largest Children’s Hospitals Receive Big Salaries And Rich Benefits, that critics say generous compensation of CEOs raises questions about the tax-exempt status of nonprofit hospitals.Check out charts detailing the growth of children’s hospitals over the past decade and the 2009 pay packages for the CEOs of the top 25 children’s hospitals.

For more headlines … (more…)

Wednesday, September 28th, 2011

Cutting Hospital Readmissions: Revolving Doors Still Spinning, Study Finds

As Medicare figures out how to financially penalize hospitals with high readmission rates, a new Dartmouth Atlas study finds hospitals have made very little progress in ensuring that fewer patients return. One possible reason raised by the study: fewer than half of patients had a follow-up appointment with a doctor within two weeks of discharge.

Dartmouth Medical School professor David Goodman, lead author of the study, said that findings underscore the “chaotic” and “balkanized” state of the medical system, where hospitals can spend thousands on treatments, but then no one ensures the patient’s recovery doesn’t stumble.

Medicare could save several billion dollars a year by cutting unnecessary readmissions, according to government estimates. Hospitals are nervous as Medicare develops the new readmission rules, which were mandated in last year’s health care law. Hospitals with high readmission rates are going to lose up to 1 percent of their Medicare billings starting in October 2012. The penalties will rise to 3 percent in 2014. The American Hospital Association has been pushing back against the rule, saying that not all readmissions can or should be avoided.”


Wednesday, September 28th, 2011

Addressing Childhood Obesity: From Public Health To Social Justice

Moving her hips and shaking her hands, U.S. Surgeon General Regina Benjamin danced the Cupid shuffle alongside elementary school kids to kick off the NAACP’s initiative on childhood obesity inside the Thurgood Marshall Center, where the famous civil rights lawyer stayed in Washington, D.C. while fighting for desegregation. It seemed like an appropriate backdrop to welcome NAACP’s effort to refocus discussion of childhood obesity as not strictly a public health crisis, but also a civil rights and social justice issue.

Surgeon General Regina Benjamin shows off her "Cupid shuffle" for Washington children on Tuesday (Photo by Jessica Marcy/KHN).

“That was fun,” Benjamin said as she took her seat. “Exercise is medicine.”

Childhood obesity, which has nearly tripled over the past three decades, impacts children from across racial groups. Yet, more than a third of black children who are obese or significantly overweight often come from communities with socio-economic conditions that hinder their ability to tackle the problem.

The NAACP held the event to release its Childhood Obesity Advocacy Manual, which they developed with CommonHealth Action, to provide tools to help local members advocate for policy changes at the local, state and federal level.

The NAACP, which also has a major initiative on HIV, hopes to use its influence as the nation’s oldest and largest civil rights organization with nearly 1,200 active local affiliates and 10,000 health educators to implement the childhood obesity plan over a two-year period. “That’s where the power of the NAACP comes in,” said Benjamin Jealous, the group’s president and CEO. “We have a volunteer network that no other organization in the black community has.”


Tuesday, September 27th, 2011

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