Archive for the ‘Health Care In The States’ Category

Fast Track For Primary Care Docs At One Calif. University

Some doctors in the state of California will soon be able to practice after three years of medical school instead of the traditional four. The American Medical Association is providing seed money for the effort in the form of a $1 million, five-year grant to the University of California at Davis.

UC Davis medical student Ngabo Nzigira interacts with a patient at a Kaiser Permanente clinic in Sacramento. (Andrew Nixon/Capital Public Radio)

Student Ngabo Nzigira is in his sixth week of medical school and he’s already interacting with patients, as he trains under the guidance of a doctor at Kaiser Permanente in Sacramento. (KHN is not affliated with Kaiser Permanente).

In a traditional medical school, Nzigira wouldn’t be in a clinic until his third year.  In this accelerated course, students can shave up to $60,000 off their education debt. Still, Nzigira initially had hesitations.

“I thought ‘Oh man, you want me to put the intensity and stress that is medical school in four years, you want me to condense it down to three years? I’m not sure about that,’” Nzigira says. But, after learning more, he became convinced it was a good path for him.

The curriculum cuts out summer vacations, electives and the residency search. It’s designed to get primary care physicians into the field faster, says Dr. Tonya Fancher, director of the program, called Accelerated Competency-based Education in Primary Care, or ACE-PC .

“There’s a huge problem, a huge shortage of primary care physicians,” Fancher says.

UC Davis says more people gaining health insurance coverage under the Affordable Care Act is expected to compound the need for primary care, and one of the goals of the new curriculum is to make family medicine a more appealing and lasting choice for young doctors.

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Thursday, August 7th, 2014

Large California Insurers Invite Others To Join Data Network

Now that two of California’s biggest health insurers have teamed up on a project to share patients’ digitized medical records, they are planning to invite other companies to join.

The project will initially cover about 9 million Californians, making it possible for doctors and hospitals to quickly access patients’ medical histories and avoid unnecessary tests and procedures.

Heads of the two rival insurers — Blue Shield of California and Anthem Blue Cross – said Tuesday that they eventually want to include as many people as possible in the network, dubbed Cal Index.

“Ultimately our goal is to have all payers and all providers participating in Cal Index,” said Paul Markovich, president of Blue Shield, during a call with reporters. “We are open to anyone and everyone who can and will contribute data.”

Organizers said they plan to reach out to other insurers with the idea of creating a comprehensive, statewide system. The project is set to go live later this year, bringing patients’ digitized lab, pharmacy, outpatient and hospital records into one place that can be accessed by both patients and their medical providers.

California’s Secretary of Health and Human Services Diana Dooley said she was excited about the project but cautioned that it needs to protect the privacy rights of consumers.

“Patients have expectations that their records will be private at the same time they want their providers to have access to enhance their medical options and outcomes,” she said. “This is the balance we are all striving for.”

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Wednesday, August 6th, 2014

Survey: Insurance Rates Lag In Health Law Holdout States

A Gallup poll released Tuesday says that the Affordable Care Act is significantly increasing the number of Americans with health insurance, especially in states that are embracing the law. It echoes previous Gallup surveys, and similar findings by the Urban Institute and RAND Corp.

The latest Gallup survey found that, nationwide, the number of uninsured Americans dropped from 18 percent in September 2013, to 13.4 percent in June 2014. States that chose to follow the ACA’s provisions most closely, both by expanding Medicaid and establishing their own new health insurance marketplaces, as a group saw their uninsured rate drop nearly twice as much as states that declined to do so.

“Those states that have not embraced those two major mechanisms have had about half of the decline in uninsured,” said Gallup’s Dan Witters. “So there’s a clear difference in the states that have implemented those mechanisms versus those who haven’t.”

Arkansas saw the biggest decline in its uninsured rate, from 22 percent to 12 percent. Kentucky, Delaware and Colorado also saw significant declines.

“To drop 10 percent in the uninsured rate within really just six months is really an incredible achievement,” said Arkansas Surgeon General Dr. Joe Thompson. Thompson lobbied for his state’s unique, bipartisan Medicaid expansion, which uses federal funding to buy private insurance for low income people. He says about 80 percent of those with new, private insurance in Arkansas purchased it with Medicaid subsidies.

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Wednesday, August 6th, 2014

Advocates Say Florida Consumers To Pay For State Lawmakers’ Decision

Republicans were quick to pounce Monday on Florida’s announcement that residents buying health insurance on the individual market for next year will face a 13.2 percent average increase in monthly premiums — one of the steepest rate hikes announced for any state. “Obamacare is a bad law that just seems to be getting worse,” said Florida Gov. Rick Scott, a Republican who is running for re-election.

But consumer advocates and Sen. Bill Nelson, D-Fla., the state’s former insurance commissioner, blame the increases on Florida lawmakers’  decision last year to suspend the state’s authority to negotiate and approve premiums on policies sold to people who buy insurance themselves instead of getting it through an employer.

The Republican-controlled Florida legislature voted to cancel that authority until 2016 because it did not want to have any involvement with insurance plans sold through the Affordable Care Act, saying that job should be done by the Obama administration. The federal government has authority to review but not change insurance rates.

Most health experts agree that state regulation of insurance rates helps hold down premiums. According to the National Conference of State Legislatures, about two dozen states empower regulators to approve or disapprove insurance premium changes, although the power varies widely.

A report by the Kaiser Family Foundation in 2012 found that one out of every five insurer’s requests for higher rates submitted to states in 2011 resulted in a lower rate increase or no increase at all. On average, approved rate increases were 1.4 percentage points lower than what insurers initially requested, a reduction of about one-fifth.

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Tuesday, August 5th, 2014

Some California Hospitals, Insurers Disappointed in ‘Bundled Payments’

Giving health-care providers a lump sum payment for certain treatments – touted as a way to save money and improve coordination of care — yielded disappointing results for some major California hospitals and insurers, a study found.

The RAND Corp. study, funded by a $2.9-million federal grant,  looked at “bundled payments” for care of insured orthopedic patients under 65 at a handful of large hospitals and insurers in California.

Six of the state’s biggest insurers and eight hospitals started out in a pilot program in 2010, but only three insurers and two hospitals actually decided to enter contracts to adopt bundled payments. The others dropped out because they didn’t think bundled care, such procedures as total knee replacement surgery, would change the delivery of care significantly or lower costs, according to the study, published in the journal Health Affairs Monday.

The pilot project resulted in such a small number of hospital cases that it was hard to draw conclusions about how bundled payments affect health care quality or costs, which were the initial goals of the study, the researchers reported. Two ambulatory surgery centers managed to partner with an insurance company and had a higher volume of cases, but generally health plans have been slow to contract with them, the study found.

“That was unexpected,” said Susan Ridgely, the lead author of the study and a senior policy analyst at RAND, a Santa Monica, Calif.-based think tank. “They were a bit more flexible and also wanted the business, but hospitals began to see that it required too much time and effort or maybe that it was not in their best interest.”

Under bundled payments, doctors, hospitals and other health providers share a fixed payment that covers the average cost of a “bundle” of services – caring for a person with a hip replacement, for instance.

Hospital and payer incentives were sometimes at odds. It’s in the best interest of doctors and hospitals, for example, to limit bundles to the lowest-risk patients. Also, to keep costs down and maximize profits, they want to shorten the period during which the bundled payment covers treatment. Insurers, on the other hand, want providers to treat a diverse population of patients for as long — and for as little money — as possible.

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Tuesday, August 5th, 2014

Poverty Linked To Diabetic Amputations In California

People with diabetes in low-income neighborhoods in California are twice as likely to have a leg or foot amputated as those living in wealthier areas, according to a study released Monday.

The study, published in the journal Health Affairs, underscores the stark differences in outcomes for diabetes patients throughout the state.

“We are not particularly surprised, but we are disturbed,” said Carl Stevens, one of the authors and a clinical professor at UCLA David Geffen School of Medicine. “Is it okay that we are losing limbs … in low-income people? Most Americans would find this inequality in outcomes unacceptable, regardless of their political leanings or their opinions.”

About one in seven Californians has diabetes, a metabolic disease that leads to high blood sugar. The vast majority are Type 2 cases, in which the body doesn’t use insulin properly. Amputations are a serious complication of the disease but are generally preventable with proper care. The disease can lead to blindness, kidney disease and death.

The study didn’t determine the cause of the higher rates of amputations, but researchers said less access to ongoing primary care, coordinated teams of providers and trained specialists likely contributes to the problem. In addition, patients in low-income neighborhoods may not be as educated about their health and may have fewer places to buy healthy food or to exercise safely.

As in the state as a whole, the amputation rates in Los Angeles County in 2009 were roughly double in poorer neighborhoods than more affluent ones. In parts of the county, however, the disparities were even greater. For example, there were about 11 amputations per 1,000 diabetics in Compton, compared to 1 per 1,000 patients in Beverly Hills.

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Tuesday, August 5th, 2014

Covered California Rates Up Modest 4.2 Percent

Covered California says health care premiums will go up modestly for most people buying coverage on the state exchange next year by an average of 4.2 percent.

People get information at a Covered California table at Union Station on the health insurance exchange's opening day (Photo by Anna Gorman/KHN).

“We enrolled a lot of people, they’re healthy, and that’s kept rates down,” Covered California Executive Director Peter Lee said at a press conference on Thursday in Sacramento to announce the rates.

About 1.4 million people purchased insurance on the marketplace in California for 2014, the first year Affordable Care Act insurance was available. California is one of the states that created its own exchange, and it is an “active purchaser” under the law, which means it can negotiate with insurers directly on rates.

The low rate hike is an average, Lee noted: “Not everyone is going to see only a very small increase.  Health care is personal. For some, premiums might go up 15 percent, not very many. But for them, they have the ability to shop.”

Lee says the rates were developed over time though rigorous negotiation with insurers. The marketplace barred insurers from changing geographic areas and incorporated children’s dental care in every plan, he said.

Insurers say Covered California’s active role did help keep rates lower. But Charles Bacchi of the California Association of Health Plans says the industry is not expecting medical costs to rise dramatically either.

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Friday, August 1st, 2014

Rx For Clarity: Calif. Considers Bilingual Drug Labels

Every Saturday morning, a steady stream of Chinese and Vietnamese patients line up at the Paul Hom Asian Clinic in Sacramento, Calif. Most of them speak little to no English.

Patient assistance director Danny Tao says people come here to get free medical consultations and drug prescriptions. But, he says that when patients take those prescriptions to be filled, they don’t understand the instructions on the label.

“They go pick them up, and we don’t exactly know if they’re taking it or not — or if they know how to take it,” Tao said.

Tao says drug labels at most pharmacies in California are printed only in English. That puts patients in danger of making any number of errors — taking too much medication or not enough, taking it at the wrong time of day or with the wrong food. Such mistakes can cause serious harm or even death.

Tao says that for the drugs his clinic supplies directly, all have a bilingual label.

“It’s going to be English/Chinese or English/Vietnamese,” he said. “By the time they get home they know exactly how to take the medication, because it’s in their own language.”

This week California’s Board of Pharmacy will discuss new regulations that would require all pharmacies in California to provide translated labels on prescription drug bottles. Statewide, 44 percent of Californians speak a language other than English at home. New York approved a similar rule last year to make it easier for non-English speakers to take their medications properly and avoid costly mistakes.

But the California board’s executive officer Virginia Herold says the move is very controversial. For starters, there is a concern that bilingual labels would mean larger bottles of pills to fit all the text. Patients, she says, don’t like larger bottles.

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Wednesday, July 30th, 2014

Half Of Texas Abortion Clinics Close Due To State Law

This story is part of a partnership that includes Houston Public Media, NPR and Kaiser Health News. It can be republished for free. (details)

In just over the past year, the number of abortion clinics in Texas fell from 41 to 20, and watchdogs say that as few as six may be left by September.

Many of those closed because of the requirement that doctors at those clinics obtain hospital admitting privileges within a certain radius of the clinic, and many doctors couldn’t comply. That requirement began November 1. This week marks the one-year anniversary of the law that started it all.

Bitter fighting over the law last summer propelled state senator Wendy Davis into the national spotlight, and she is now running for Texas governor on the Democratic ticket.

“We’re seeing delays,” said Heather Busby, executive director of  NARAL Pro-Choice Texas. “We’re seeing people being pushed further into pregnancy, having to leave the state, having to drive and sleep in their cars in parking lots because of these barriers to access.”

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Friday, July 18th, 2014

Who Shopped The SHOP Exchanges? Very Few Small Businesses

This story is part of a partnership that includes WNYC, NPR and Kaiser Health News. It can be republished for free. (details)

Monteith Illingworth and Chris Abbate both have small public relations firms in Manhattan. Both offer their employees health coverage through Oxford Health, a division of insurance giant United Healthcare. Both faced double-digit premium hikes last year. And both considered hitting the eject button to buy coverage from the New York State of Health, the new insurance marketplace set up under the Affordable Care Act.

Illingworth didn’t.

“My instincts told me it was too soon,” said Illingworth, president of Monteith & Company, which has four employees. “I didn’t want to take the risk the first year.”

Abbate signed up.

“I was willing to take a chance,” said Abbate, president of Novitá Communications, with 10 employees.

She is in a distinct minority. New York’s new marketplace covered almost a million people, with about 600,000 people getting Medicaid, 400,000 people getting individual plans and just 10,000 getting employer-based small business plans, through the Small Business Health Options Program, or SHOP.

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Wednesday, July 2nd, 2014

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