Archive for November, 2011

Clash Between Hospital, Insurer May Reach Pa. Statehouse

This story is part of a reporting partnership that includes WHYY, NPR and Kaiser Health News.

State lawmakers are signaling a willingness to referee a fight between southwest Pennsylvania’s dominant health insurer and the region’s largest medical system.

Highmark, a Blue Cross Blue Shield affiliate, and UPMC, the University of Pittsburgh Medical Center health system, tried for months to set a new reimbursement rates for doctors’ visits and medical procedures.

Negotiations broke down when Highmark announced plans to buy Pittsburgh’s No. 2 hospital network, the much smaller and struggling West Penn Allegheny Health System.

UPMC officials say that move makes Highmark a competitor.


Wednesday, November 30th, 2011

Iowa Hospitals to NYC: Stop Blaming Your Patients

Photo by Matt Carman via Flickr

As Medicare moves with plans to pay hospitals in part by how well they score on reviews by patients, hospitals in low satisfaction regions such as New York have been complaining that their patients are harder to please. Those arguments, however, aren’t going over well in places like Iowa where patients tend to be more positive about their inpatient experience.

“New York, State of Whine,” was the title of a piece the Iowa Hospital Association recently published on its web site. The posting observed:

The implication seems to be that you can step all over patients anywhere else, but only those persnickety New Yorkers will actually hold you accountable when Medicare asks them how things went and starts withholding payment for hospitals that fall short.

Don’t tell that to Bob Peebles, who helped run hospitals in New York City and Detroit before becoming CEO at Mercy Medical Center-Sioux City.  “I don’t buy it, not for a minute,” said Peebles, whose stint in NYC put him about 10 blocks away from the World Trade Center on the morning of Sept. 11, 2001.  “Patient expectations are the same wherever you go.  But that’s not really the point – the point is, what do you expect from your staff, and how well is that being communicated?”

In other states, hospitals are bracing for Medicare’s new emphasis on patient experience in setting payment. An executive at the Georgia Hospital Association told Georgia Health News that in places like Atlanta, where “hospitals have been using patient satisfaction scores to compete with each other,” connecting these scores to payments “takes it to another level.”

New York isn’t the only state where hospital officials are unhappy with Medicare’s plan.  In Florida, where hospitals fare relatively poorly on the patient surveys, Dr. Scott Medley, North Florida Regional Medical Center chief medical officer, told the Gainesville Sun that Medicare is emphasizing the wrong scores. “I’m not sure the patient survey is the best measure of patient satisfaction,” he told the Sun. “We might have chosen different questions,” he said.

Wednesday, November 30th, 2011

Today’s Headlines – November 30, 2011

Good morning!

The Washington Post: Democrats To Attack Republicans For Pushing Medicare Cuts
The Democratic Party will begin a campaign on Wednesday to attack Republican lawmakers for pushing cuts to Medicare benefits during the latest round of failed federal deficit talks, a new turn in a drama that not long ago featured top Democrats expressing a willingness to tinker with the popular entitlement program (Wallsten, 11/29).

NPR: GOP Governors Hedge Bets On Insurance Exchanges
Obama administration officials have announced another round of grants to states to help build the insurance marketplaces, called “exchanges,” that will help individuals and small businesses buy health insurances beginning in 2014 (Rovner, 11/29).

For more headlines … (more…)

Wednesday, November 30th, 2011

Support Of Health Law Rebounds A Bit

It’s up. It’s down. Americans’ views about the health care law are, well, fluid.

The latest Kaiser Family Foundation monthly poll shows that the law’s popularity rose a bit after hitting a new low last month. (Kaiser Health News is a program of the foundation.) Still, more people don’t like the law than do: 44 percent to 37 percent.  That was a small improvement from October, when 51 percent panned the law, but the law’s popularity remains below where it has been.

Democrats, whose gloominess about the law was responsible for bringing it down in October, got a bit more positive about the law in November, with 62 percent giving it a thumbs up, a 10 percentage point increase.

Pollsters found that when they asked people about elements of the law, many got it wrong. The poll found 56 percent think the law includes a government-run insurance plan as an option for consumers, which it doesn’t. Thirty-five percent of people said the law permits a government-run panel to make decisions about end-of-life care, even though such “death panels” were widely dubunked during the debate over the law.

The poll also found many people didn’t know some details of the law, including such benefits as a requirement that health insurers explain what they cover in clear, simple language.

The survey was conducted Nov. 10 through Nov. 15 among 1,209 adults. Its margin of error was +/- 3 percentage points.

Wednesday, November 30th, 2011

More States Taking Federal Funds For Insurance Exchanges

Despite widespread opposition to the 2010 health law, a majority of states have now accepted federal funding to establish their own health insurance exchanges.

The Department of Health and Human Services today announced nearly $220 million in new grants to 13 states.

HHS also pushed back by six months the deadline for applying for level-one grants, from Dec. 30 to June 29, 2012, accommodating requests from several states where the issue will be up for legislative discussion.

Exchanges will provide an in-state, online marketplace for consumers and small business owners to compare and purchase insurance plans, with the hope of driving down costs through competition.

Twelve of the grants are for single-year, so-called “Level One” funding. States do not have to commit to an exchange for this type of grant. State officials do, however, agree to make a serious investment toward implementing an exchange in the future.


Tuesday, November 29th, 2011

Study: Florida Leads Nation In Getting More Kids Insured

Florida leads the nation in reducing the number and rate of uninsured children, according to a study released Tuesday.

From 2008 to 2010, the number of uninsured children in Florida fell by more than 160,000 to 506,934, says the report by researchers at the Georgetown University Center for Children and Families. The state’s rate of uninsured kids dropped from 16.7 percent to 12.7 percent.

Florida was one of 34 states and the District of Columbia to reduce its rate of uninsured children since 2008. But there remain wide differences between states. Nevada has the highest rate of uninsured children — 17.4 percent — while Massachusetts has the lowest at 1.5 percent, according to the study which was based on an analysis of Census data. Texas leads the nation in number of uninsured kids with nearly 1 million although it was able to lower its uninsured rate to 14.5 percent from 17 percent.

Nationally, the uninsured rate for children fell from 9 percent to 8 percent from 2008 to 2010, as the number of uninsured children fell by 960,000, the study said.

“I feel very encouraged. This is exciting news,” said Jodi Ray, project director of Florida Covering Kids & Families at the University of South Florida, a statewide coalition that aims to get more children health coverage.

She attributes part of the drop to numerous local outreach efforts that have used a mix of state and federal grants to target uninsured children through billboards, television advertising and other marketing methods.

Joan Alker, co-executive director of the Georgetown Center for Children and Families, attributes the big drop in Florida to more kids becoming eligible for Medicaid due to families’ declining income in the economic downturn. Medicaid is the state-federal health insurance program for poor and disabled.

She said the state has also reduced barriers for its Children’s Health Insurance Program (CHIP), a government program that helps families with incomes that are too high to qualify for Medicaid. In 2009, the state lowered the penalty for failure to pay CHIP premiums from 6 months loss of eligibility to 60 days. Florida has also done a better job at coordinating coverage between CHIP, Alker said.

“It is especially rewarding to know that in these tough economic times with the state’s higher than national average unemployment rates, Florida KidCare (Florida’s CHIP progam) proves to be a valuable resource for families and children,” said  Rich Robleto, executive director of Florida Healthy Kids Corp., a public-private partnership which helps administer the state’s CHIP program.

Tuesday, November 29th, 2011

Ballot Campaign To Repeal Insurance Mandate Ends In Mass.

This story is part of a reporting partnership that includs WBUR, NPR and Kaiser Health News.

If Massachusetts residents chafe at the requirement that they have health insurance, they’ll have to endure it longer. They won’t have a chance to vote against it — not in the next election, anyway.

Backers of a ballot measure to repeal the state’s insurance mandate sent out an email last week saying they had failed to gather the needed signatures. (Points to policy-types-turned-crack-reporters Brian Rosman of Health Care for All and John McDonough of Harvard for reporting that development here and here.)

The ballot initiative’s organizers say their bid to derail the individual mandate failed because supporters were torn.

One group, those involved with Massachusetts Citizens for Life, worried about dividing their efforts between two ballot questions next year, one that would allow assisted suicide and one that would repeal the insurance mandate. In the end, fighting the assisted suicide question won.


Tuesday, November 29th, 2011

Today’s Headlines – November 29, 2011

Good morning, all.  Here are the morning headlines to help you start your day:

Politico: Mandatory Budget Cuts After Supercommittee Failure Will Trigger Pain For Some
By any name, they mean pain, both for the Pentagon and for the weaklings among domestic programs. But there are winners, too: A protected class of individuals and programs — including congressional pensions — won’t bear any burden. The writers of the August debt-limit deal ensured that the deficit wouldn’t be closed with automatic cuts to Social Security or Medicaid, tax hikes or even changes to their own pensions or death benefits (Allen, 11/28).

The Washington Post: States Face Bleak Economic Forecast, Report Says
The report says that Medicaid, the combined federal-state health program for the poor and the disabled, will place the biggest budgetary burden on states. Because of increasing caseloads, declining federal help and spiraling health-care costs, state Medicaid spending is growing much faster than state revenue, crowding out funding for other priorities (Fletcher, 11/29).

For more headlines … (more…)

Tuesday, November 29th, 2011

2 States Survey Nursing Home Residents To Assess Care

BOSTON – When choosing the right nursing home, most consumers lack one of the best sources of inside information about the facilities – from the residents themselves.

But at the annual meeting of the Gerontological Society of America, researchers from Minnesota and Ohio explained how consumers in those states can find summaries of nursing home residents’ online reviews. More than 3,800 researchers, educators, scientists and health professionals attended the five-day conference held in Boston last week.

“This is institutionalized word of mouth,” said Jane Karnes Straker, a senior research scholar at Scripps Gerontology Center at Miami University in Ohio.  Straker and the Benjamin Rose Institute, a social service agency in Cleveland, created a questionnaire that has been used by an independent research firm since 2001 for an annual survey of a representative sample of the state’s nursing home residents.


Monday, November 28th, 2011

Treating A Scorpion Sting: $ 100 In Mexico Or $ 12,000 In U.S.

Say you’re trekking through the desert in Mexico, minding your own business, when all of a sudden a scorpion scrambles up your boot and stings your leg. You hobble over to a nearby clinic, where you’re given a dose of anti-venom that brings you fast relief. The charge for the serum is about $100.

Photo by midwinter via Flickr

Now imagine instead that you happen to be hiking in Arizona, and the same type of scorpion stings you. You make it to the emergency room, where the charge for a dose of the same anti-venom costs can cost as much as $12,000, according to a survey by The Arizona Republic.  Since patients need three to five doses, the cost can reach about $50,000.

The vast difference in cost is causing some consternation among doctors and hospitals in Arizona, where about 11,000 people are stung by scorpions each year. But the large markup is common for drugs that are used for rare conditions, also called “orphan drugs.”


Monday, November 28th, 2011

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