Archive for February, 2013

Hospital Consolidation Dance Heats Up In NYC

The health care game of musical chairs is picking up speed in New York City, one of the most competitive markets in the country. The Mount Sinai Medical Center and Continuum Health Partners announced Thursday that their boards of trustees have reached a tentative agreement on a possible merger.

The announcement comes less than nine months after Continuum, which owns Beth Israel Medical Center, St. Luke’s Hospital and Roosevelt Hospital,  all in Manhattan, reached a similar merger agreement with NYU Langone Medical Center.  The NYU-Continuum discussions fell apart  just two weeks later, however, when Mount Sinai suddenly stepped in and made Continuum a counteroffer; NYU suspended merger discussions, suggesting that Continuum had jilted it after eight months of “good faith” negotiations.

Mount Sinai and NYU are two of the largest and most powerful hospitals in New York, and either merger would create a behemoth health care organization, rivaling current giant New York-Presbyterian, which was the result of a 1998 merger between Columbia University and Weill Cornell Medical Centers and has 2,409 beds.  A united Continuum and Mount Sinai would create a system with 3,351 beds. Any merger would need approval by government regulators.

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Thursday, February 28th, 2013

Tenet Shows Hospitals Will Cut Prices For Exchange Patients — But Only So Much

How much will hospitals reduce prices in an effort to win what are expected to be millions of newly insured patients under the Affordable Care Act? A little, not a lot, if deals disclosed this week by Tenet Healthcare are any indication.

The Dallas-based hospital chain told analysts that its first contracts to treat patients buying policies in the ACA’s online marketplaces next year include total discounts of less than 10 percent compared with existing business. The agreements were made with three Blues plans in undisclosed locations.

“At an investor conference in January, there was some talk about the possibility of deeper discounts in pricing — at [low] Medicare and Medicaid levels,” Tenet CEO Trevor Fetter told stock analysts on a Tuesday conference call. “Our recent negotiations should reassure you that this is not the case and that this market is turning out as expected.”

What insurers pay for hospital care will be a key factor in the affordability of plans for people seeking coverage in the ACA marketplaces, also known as exchanges. With the health act’s requirement that everyone obtain insurance, exchanges are projected to furnish coverage for 24 million by 2016. But even with generous subsidies for those on lower incomes, questions loom about whether those lacking coverage will feel they can afford the plans on the exchanges or will choose to pay relatively low penalties for remaining uninsured.

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Thursday, February 28th, 2013

Messaging Your Doctor? There’s An App For That

Last year Dr. Michael Nusbaum introduced a mobile application in an effort to make scheduling a medical appointment as easy as sending a Facebook message to a friend, and as safe as sharing your medical information in person at the doctor’s office.

The New Jersey-based surgeon said he designed MedXCom “to bring doctor-patient communication to the twenty-first century” by sharing medical records, prescriptions and treatments on smartphones. The app is one of hundreds that promote health and health care, but it’s one of the first designed to meet the patient privacy standards set by the Health Insurance Portability and Accountability Act. With millions of Americans having their medical information compromised, privacy and security were at the forefront of Nusbaum’s venture.

Now Nusbaum, CEO of MedXCom, is building on this technology with a new app to prevent the spread of sexually transmitted diseases. And he’s hoping that MedXSafe, which targets the touchscreen-friendly 20-something generation, will prove to be more catchy than the STDs that affect a quarter of U.S. college students.

“Most college students are responsible enough to do it — as long as it’s not too invasive,” he said about testing and sharing STD results.

The app syncs STD test results from clinics onto a student’s personal mobile page. The idea is that a student can share the secure test results with a sexual partner by either showing them  or using the “bump” function, a way of transferring information between phones by physically touching them.

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Wednesday, February 27th, 2013

Ways & Means Chairman Hopes To Move Medicare ‘Doc Fix’ Plan

The chairman of the House Ways and Means Committee made clear Tuesday that finding a solution to the vexing issue of setting Medicare physician payment rates is on his to-do list this year, and he got some tepid support from a key Democrat.

Rep. Dave Camp (Photo by Pete Marovich/Getty Images)

Rep. Dave Camp, R-Mich., said that the effort could be helped by a recent reassessment of how much it would cost. Earlier this month, the Congressional Budget Office lowered its cost estimate for fixing Medicare’s physician payment formula over the next decade to $138 billion due to lower Medicare spending on physician services during the past three years. In January 2012, the CBO estimated the cost of the fix at $316 billion, which it reduced to $245 billion last August.

“Cutting scores in half is certainly helpful,” the committee chairman told reporters Tuesday, adding later, “that’s still a very large number.” It may be even harder to find funding amid the ongoing fight over “sequestration,” a package of automatic spending cuts set to kick in March 1. President Barack Obama and lawmakers are also battling over how to fund the government after the current continuing resolution expires on March 27.

Camp did not say where he would find the money to pay for the SGR overhaul, but he has promised it “will not add a dime to the deficit.” He said he is working on the proposal with a fellow Michigan Republican — House Energy and Commerce Committee Chairman Fred Upton.  It might be part of a larger piece of legislation or it might move on its own.

“It’s hard to know right now,” he said. “I wouldn’t close off any avenue on that.”  Camp said the SGR legislation is part of a broader committee agenda to examine safety net programs. (more…)

Wednesday, February 27th, 2013

Americans Uncomfortable Around Mentally Ill Despite Acknowledging Discrimination


The public has a contradictory view of mental illness, according to a new poll. While most Americans believe people with such ailments are the victims of prejudice and discrimination, a substantial portion of the public say they have qualms about working in the same place or having their children attend a school where someone with a “serious” mental illness is employed.

Seventy-six percent of Americans believe the mentally ill experience discrimination, according to the poll from the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.) That was a greater portion of Americans than those who said they thought discrimination burdens people with HIV or AIDS; Hispanics; blacks; people with physical disabilities, or women. Immigrants were the only group to rank higher than those with mental illness.

But the pollsters noted that that the survey “suggests that many Americans are themselves uncomfortable with the idea of interacting with people who have a serious mental illness.” Sixty-six percent of parents said they would be “very” or “somewhat’ uncomfortable if a person with a serious mental illnesses worked in their child’s school. Forty-seven percent said they would be uncomfortable living next door to someone with a serious mental illness, and 41 percent said they were uncomfortable working with someone who has a serious mental illness. These concerns were less severe among people under 30, and people with their own mental health issues or experiences with family members.

The poll questions were prompted by the Newtown, Conn.,  elementary school shooting on Dec. 14 and the subsequent debate about whether stronger gun control laws and better mental health services might prevent similar attacks.

The poll also found a post-election drop in popularity for the 2010 health care law, which had been narrowly more popular than not in November. This month, 42 percent of Americans expressed an unfavorable opinion of the law and 36 percent said had a favorable opinion. Another 23 percent either said they didn’t know or refused to answer the question—the most that dodged the issue in the nearly three years that Kaiser has been testing public perceptions about the law. The pollsters attributed the change to a drop in support among Democrats.

The poll was conducted Feb. 14 through Feb 19 among 1,209 adults. The margin of error was +/- 3 percentage points.

Wednesday, February 27th, 2013

Medicaid, Sequester Weighing On Govs’ Minds At Annual Winter Meeting

This story comes from our partner ‘s Shots blog.

When the nation’s governors gathered in Washington, D.C., over the weekend for their annual winter meeting, the gathering’s official theme was about efforts to hire people with disabilities.

But out of the public eye, at the sessions for “governors only,” the discussion reportedly was dominated by two more pressing issues of the day: whether or not to expand the Medicaid program as part of the Affordable Care Act; and the potential upcoming budget cuts set for the end of the week, known as the sequester.

President Obama even used his meeting with the governors at the White House on Monday to do a little lobbying.

“This morning, you received a report outlining exactly how these cuts will harm middle-class families in your states,” he said, referring to a document released to the media Sunday night. “Thousands of teachers and educators will be laid off. Tens of thousands of parents will have to deal with finding child care for their children. Hundreds of thousands of Americans will lose access to primary care and preventive care, like flu vaccinations and cancer screenings.”

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Tuesday, February 26th, 2013

3 Hill Panels Examining Changes To Medicare

Updated at 12:10 p.m.

With $85 billion in automatic federal spending cuts set to take effect on Friday and predictions of economic disruption, much of official Washington is focused on the “blame game.” Publicly, there has been no sign that Congress or administration officials has made any progress on averting these cuts or finding common ground on tackling the country’s fiscal problems.

Photo by Karl Eisenhower/KHN

But there are small signs that Democrats and Republicans are beginning to wrestle with the issue of what role Medicare should play in deficit reduction. Three Capitol Hill committees with jurisdiction over health care have scheduled hearings this week to examine Medicare’s current benefit design and to review provisions in the 2010 health care law aimed at making the program more efficient.

In his State of the Union address, President Barack Obama said the “biggest driver” of the nation’s long term debt is the rising cost of health care for an aging population.  “And those of us who care deeply about programs like Medicare must embrace the need for modest reforms – otherwise, our retirement programs will crowd out the investments we need for our children, and jeopardize the promise of a secure retirement for future generations,” he said.

The House Ways and Means Health Subcommittee’s Tuesday hearing will focus on Medicare’s traditional fee-for-service program “and consider ideas to update and improve the benefit structure to better meet the needs of current and future beneficiaries,” according to a news release.

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Monday, February 25th, 2013

Survey: Better Hours For Residents? Not So Fast

The new rules regulating duty hours were supposed to make life easier for medical residents, but both program directors and doctors-in-training give the changes mixed reviews.

These latest changes, implemented in July 2011, limit first-year residents, also called interns, to 16-hour shifts. They were put in place by the private, nonprofit Accreditation Council for Graduate Medical Education, and were intended to prevent medical errors resulting from sleep deprivation. Second- and third-year residents are still be permitted to work 28 hours at a time. But in the last four hours, they can’t take on new patients.

A survey of residency program directors was published Thursday in the New England Journal of Medicine. Of 549 responses, 73 percent reported that under the new rules residents were less prepared to take on more senior roles. Another 65 percent said that resident education had gotten worse, and only 6 percent reported that patient safety and quality of care had improved.  Meanwhile, less than half thought resident quality of life had improved.

The residents themselves also negative views of the changes.  A similar survey of 6,201 residents published in NEJM in June found that while 62 percent felt that quality of life had improved for interns, half reported that quality of life had gotten worse for senior residents, who were picking up the slack. Meanwhile, 41 percent reported that the quality of their education had gotten worse, and 48 percent disapproved of the rule changes.

Dr. Brian Drolet, who conducted both surveys and is also a fourth year resident at Rhode Island Hospital, says he was surprised that reactions to the regulations were so negative. “The intentions were good, but the actual impact has not actually been what was intended,” he says. Resident hours, he explains, are always a “trade-off between continuity and fatigue.” Tired doctors may make errors more likely, but so does increasing the number of times a patient is handed off from one doctor to another at the end of a shift.

The changes can also make life more difficult for senior residents and attending physicians who take on more responsibility when interns are off duty.

“A certain degree of regulation is needed to prevent abusive situations, but you have to be careful about how strict you make the learning environment,” Drolet argues. The accrediting council “should be responsive to the potential that the impact is negative and maybe add some flexibility.”

Drolet plans to present the surveys at the ACGME annual meeting next week.

Friday, February 22nd, 2013

Doctor Groups Unite Against Unnecessary Tests & Procedures

This story comes from our partner ‘s Shots blog.

Doctors do stuff — tests, procedures, drug regimens and operations. It’s what they’re trained to do, what they’re paid to do and often what they fear not doing.

So it’s pretty significant that a broad array of medical specialty groups is issuing an expanding list of don’ts for physicians.

Don’t induce labor or perform a cesarean section for a baby who’s less than full-term unless there’s a valid medical reason, say the American College of Obstetrics and Gynecology and the American Academy of Family Physicians. (It can increase the risk of learning disabilities and respiratory problems.)

Don’t automatically do a CT scan on a child with a minor head injury, warns the American Academy of Pediatrics. (Currently half of all such children get them, when simple observation is just as good and spares radiation risk.)

Don’t try to normalize blood sugar in most diabetic patients over 65, exhorts the American Geriatrics Society. (It can lead to higher mortality rates.)

And on and on. The latest list totals 90 tests and procedures that are often unnecessary and potentially harmful, compiled by 17 specialty groups representing more than 350,000 doctors.

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Thursday, February 21st, 2013

Dartmouth Study Questions Widely Used Risk-Adjustment Methods

In evaluating a hospital and health plan in the increasingly expensive U.S. health care system, federal officials and researchers often first factor in an assessment of how sick their patients are. A new study, however, challenges the validity of several widely used “risk-adjustment” efforts and suggests that Medicare is overpaying some plans and facilities while underpaying others.

Without these risk adjustments to level the comparisons, a hospital with more frail and very ill patients—who are more likely to die — might incorrectly appear to be doing a worse job than a hospital with healthier patients — who are more likely to survive.

Medicare risk-adjusts when determining how much to pay private Medicare Advantage insurance plans. It also used risk adjustments when deciding that 2,217 hospitals should be penalized for having high rates of patient readmissions.  Risk adjustment is also a key component in new models of delivering care, such as the accountable care organizations.

The new study by the Dartmouth Atlas Project, published today in the health journal BMJ, faults the practice of trying to assess how sick patients are by looking at records to see patient diagnoses. The authors argue that the more times patients see doctors or get tests, the more new diagnoses they are given. “The more one looks, the more one finds,” the authors wrote. The Atlas researchers have asserted in three decades of research that areas of the country with gluts of hospital beds, specialists and other proviers tend to deliver more care, whether it’s needed or not.

“You would think sicker places would have higher visit rates, but they don’t,” said Dr. John Wennberg, the lead author and the founder of the Atlas.

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Thursday, February 21st, 2013

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